Incidence, survival and mortality in cervical cancer in Norway, 1956-1990

Long-term trends in incidence, survival and mortality were examined in women with squamous cell carcinoma and adenocarcinoma of the uterine cervix, diagnosed in Norway in the 35-year period 1956-1990. During the 1970s the number of cervical smears increased substantially in Norway, although no organised screening programme was introduced. Special attention was paid to the time period 1971-1990 to evaluate the effect of the extensive spontaneous screening. In addition, the prognostic importance of clinical stage and age was explored. In the squamous cell carcinoma patients the incidence rate peaked in the time period 1971-1975, since when there has been a decrease. In the adenocarcinoma patients the incidence rate rose through the years 1976-1990. Also, the proportion of adenocarcinomas increased in this time period. The mortality rates in both histological types declined modestly through the years 1966-1990. A more favourable stage distribution was noted among the squamous cell carcinomas (P = 0.00), but not among the adenocarcinomas, when comparing the two diagnostic periods 1971-1975 and 1981-1985. The multivariate analysis (GLIM) revealed that stage was the most important prognostic factor in both histological types (P = 0.00). In the squamous cell carcinoma patients the relative rate increased (P = 0.04) in the last period. There was a tendency towards a poorer prognosis in younger women in this group, but age did not prove to be an important prognostic factor (P = 0.08).     

Trends in epidemiologic indicators of lung cancer in the Czech Republic 1970-1990

BACKGROUND: Lung cancer is the malignant tumour with the highest mortality in the Czech Republic as well as in highly developed countries of the world. The objective of the present study in an account on the incidence, diagnosis, treatment and mortality in the Czech Republic, at the Pneumological Clinic and the population in the district. METHODS AND RESULTS: The incidence and mortality rate from lung cancer increased during the past twenty years in men by 12% and declined by 2% resp. In women both indicators are steadily rising by 100 and 76% resp. The highest values of incidence and mortality in men were recorded at the end of the seventies and beginning of the eighties. During the investigation period a reduction of the age of those who died from lung cancer-men and women -was found, the increase in the group of 35-49-year-olds is 51% in men and 159% in women. As to histological types, spinocellular carcinoma is still the most frequent type, gradually the small cell type and adenocarcinoma are increasing in numbers. The authors investigated also differences in the epidemiological situation as regards lung cancer in the southern and northern Czech regions and compared the position in this country with that in other European countries. CONCLUSIONS: Despite some positive signals (decline of the lung cancer incidence in men), lung cancer still remains a serious medical and social problem. An alarming feature is in particular the linear rise of lung cancer incidence in women and the shift of deaths from this disease to younger age groups.     

Malignant melanoma in Europe: changes in mortality rates (1970-90) in European Community countries

We measured metabolic rates (mL O2 h-1, converted to kcal d-1), deep body temperatures (degree C), and skin temperatures (degree C) and calculated whole-animal thermal conductances (mL O2 g-1 h-1 degree C-1) of five 3-yr-old harbor seals (Phoca vitulina concolor) at air temperatures between -20 degrees and 35 degrees C. The mean thermal neutral zone of these seals extended from a lower critical temperature of -12.9 degrees +/- 1.6 degrees C (SD) to an upper critical temperature of 28.6 degrees +/- 1.7 degrees C. Hyperthermia was observed at an ambient air temperature of 35 degrees C. Mean standard metabolic rate was 1,553.6 +/- 168.2 kcal d-1, about 1.2 times the value expected for adult animals of similar body mass (mean mass = 49.2 +/- 7.5 kg). Mean deep body temperature increased from 37.5 degrees +/- 0.30 degrees C at an ambient temperature of 30 degrees C and reached 39.3 degrees +/- 0.33 degrees C at an ambient temperature of 35 degrees C. Skin temperature decreased with decreasing ambient temperature but remained well above ambient temperature. Mean whole-animal thermal conductance decreased from an ambient temperature of 35 degrees C until it reached a minimum value of 0.007 mL O2 g-1 h-1 degree C-1 at -4.0 degrees C; it then increased with a further decrease in ambient temperature. In comparison to the thermal limits of the same seals during their first year of life, the results indicate a broadening of the thermal neutral zone with age: an 11 degrees C decrease in the lower critical temperature and a 3.5 degrees C increase in the upper critical temperature. These findings suggest that warm ambient air temperatures should not pose any particular thermoregulatory problems for larger and older harbor seals, even beyond the limits of their current annual distribution.     

Continuity and longitudinal aspects of care in general practice in four European countries

Mitral regurgitation (MR) is a common, frequently asymptomatic valvulopathy that can ultimately lead to left ventricular failure. With the objective of forestalling MR progression, a prospective, placebo controlled, double-blind study was conducted. It measured the effectiveness of lisinopril, an angiotensin-converting enzyme inhibitor, in reducing the echocardiographic signs of MR severity over a one-year period. Severe coronary disease was excluded by stress echocardiography. Treatment effectiveness was estimated to be proportional to the reduction in MR fraction and cardiac chamber dimensions, compared with baseline, according to intention-to-treat analysis. A final patient population of 23 asymptomatic adults aged 53.3 +/- 2.4 years (mean +/- SEM), with moderate, organic MR and normal left ventricular function was selected from the echocardiographic database. All baseline patient characteristics were comparable in the two treatment groups, including the MR fraction (55 +/- 3%). Twelve patients received lisinopril (18 +/- 1 mg) and 11 received placebo. After one year of treatment, a statistically significant difference in the MR fraction was observed between the two groups. For the lisinopril group the MR fraction dropped by 6.4 +/- 3.5% and for the placebo group it increased by 3.7 +/- 3.2% versus baseline (P < 0.05). No differences in left atrial or ventricular dimensions were observed. The study drug was stopped in four patients after one patient presented with rapid atrial fibrillation and angina while three patients were intolerant to lisinopril. Only one patient receiving placebo was taken off therapy. In conclusion, treatment with lisinopril indicates some reduction in the severity of chronic moderate MR in asymptomatic patients with normal left ventricular function. This approach appears to be safe, but side effects are not uncommon, warranting regular follow-up.     

Socioeconomic differences in 'avoidable' mortality in Sweden 1986-1990

BACKGROUND: 'Avoidable' mortality is commonly studied as an indicator of the outcome of health care. In this study socioeconomic differences in avoidable mortality in Sweden from 1986 to 1990 are analysed and related methodological issues discussed. METHODS: The 1985 Swedish Population and Housing Census was linked to the National Cause of Death Register 1986-1990. Mortality from potentially 'avoidable' causes of death was analysed for the age group 21-64 years. Analyses were performed for different socioeconomic groups, blue-collar workers, white-collar workers and the self-employed as well as for individuals outside the labour market. Standardized Mortality Ratios were calculated using standardization by age and sex. RESULTS: For all indicators studied, the death rates for those not in work were higher than for people at work. The largest differences were found for chronic bronchitis, diabetes, bacterial meningitis, ulcer of the stomach and duodenum, chronic rheumatic heart disease, asthma and hypertensive and cerebrovascular disease. For these causes of death the risk of dying was between 3.1 and 7.5 times greater in the non-working population than in the work-force. The differences in avoidable mortality between blue-collar workers and white-collar workers and the self-employed were, however, much smaller. For most of the indicators no significant differences were found. For ulcers of the stomach and duodenum, however the death rate for blue-collar workers was 2.8 times higher than those for other categories in work. CONCLUSIONS: The small difference in mortality outcome for different socioeconomic groups within the work-force indicates an equal quality of care for these groups. The greatly increased risk among the non-working population, however, is a warning sign. These results may be due to a 'healthy worker' effect. The measurement of socioeconomic differences in mortality may be dependent on the time-period chosen between occupational exposure and mortality outcome.     

Scientific publications from 10 Central European countries in the leading foreign periodicals

The life science publication output of ten mid-size European countries was investigated in the outstanding foreign journals of 37 disciplines. The activities corrected with the populations show differences of order magnitude. The publication activities of the late communist countries in the leading foreign scientific journals are far below the average, especially in the field of clinical medicine.     

Birthweight-specific trends in perinatal mortality by hospital category in South Australia, 1985-1990

OBJECTIVE: To investigate differences by birthweight in risk of perinatal death between level 3 hospitals (which provide care for high risk pregnancies and neonatal intensive care) and other hospitals in South Australia, using perinatal data for the 1985-1990 period. DESIGN: Analysis of birthweight-specific trends in risk of perinatal death by hospital category for singleton births, adjusting for risk factors. SUBJECTS: 114 725 singleton births of at least 400 g birthweight (or at least 20 weeks' gestation) born in hospitals in the 1985-1990 period and notified to the perinatal data collection. MAIN OUTCOME MEASURE: The relative odds of a perinatal death, as opposed to a live birth which survived the neonatal period. RESULTS: Births at level 3 hospitals had a higher crude risk of perinatal death than those at other hospitals, but this was due to the higher frequency of low birthweights at level 3 hospitals. For birthweights under 2000 g, and especially for the very low birth-weights, there was a higher risk at non-level-3 than level 3 hospitals. There was also the unexpected finding that births at level 3 hospitals in the 2500-2999 g range had a comparatively high risk of perinatal death. There was little difference in risk for births of higher birthweight. CONCLUSIONS: The greatly reduced risk of perinatal death in level 3 hospitals for babies with birthweights under 2000 g seems likely to be due to the specialist services in these hospitals. Further investigation is required to determine why babies in the 2500-2999 g range of birthweights had a comparatively high risk of perinatal death at these hospitals. This appears to be due, at least in part, to an excess contribution of deaths from congenital abnormalities. Also, it seems that the higher prevalence of complications in pregnancy in level 3 hospitals, and the transfers for induction of labour after intrauterine fetal death, would have made a contribution. These same factors may also have affected the risk in level 3 hospitals for higher birthweight births.     

Geography of lung cancer incidence among women and men of Upper Silesia in the years 1986-1990

During a five period (1986-1990) in Katowice province (Upper Silesia) there were 6,140 cases of lung cancer in males and 1,039 females recorded. The standardized (according to age structure of the world population) incidence of lung cancer in both groups, in 93 administrative units (45 cities, 48 communities) significantly vary and are geographically unevenly distributed. The incidence in selected areas in males can be compared with values characterizing regions of the world with highest indices (> 95 per 100,000); whereas in females the incidence of lung cancer is much lower. The prognosis for lung cancer incidence in the Upper Silesia, according to the regression analysis is pessimistic.     

Epidemiology of prostate cancer in two European countries: Scotland and Norway

PURPOSE: The authors assess whether adjunctive mitomycin C improves Molteno tube shunt surgery in terms of intraocular pressure (IOP), visual acuity, and complication rates. PATIENTS AND METHODS: Twenty-five eyes of twenty-five consecutive patients undergoing double-plate Molteno implant surgery were randomized to receive either mitomycin C (MMC) 0.4 mg/mL for 2 minutes or a control balanced salt solution in a masked, prospective study. Intraocular pressure, visual acuity, and complications were recorded 1 week and 1, 3, 6, and 12 months after surgery. A repeated measures analysis of variance (ANOVA) model was used to test the overall effect of the drug on IOP and percent change from preoperative IOP. RESULTS: Thirteen eyes received balanced salt solution and 12 eyes received MMC. There was no difference between the groups with respect to age, preoperative IOP, log mean angle of resolution (LogMar) visual acuity, or number of preoperative medications. Except for week 1, there were no differences between the groups at any of the clinic visits with respect to IOP and percent change from baseline IOP. Analysis of the visual acuity (LogMar) showed reduction in vision for both groups. Complications were similar in each group, as were number of postoperative hypotensive agents required. CONCLUSIONS: Adjunct MMC does not demonstrate a significant difference in outcomes compared with placebo in pressure-ridged Molteno implant surgery. Results of this study are limited by a small number of patients in each group and a fixed dose of MMC.     

Trends in United States ovarian cancer mortality, 1979-1995

The authors have compared the results of scalp reductions with extenders with their earlier results of scalp reductions without extenders. The extenders seem to prevent "stretch-back" and provide 30 to 86% more effectiveness when a second reduction is performed 4 weeks later.     

Trends in non-epithelial cancer incidence in Denmark, Finland, and Sweden, 1961-1990

Trends in the incidence of non-epithelial cancers are particularly likely to reflect environmental carcinogens, since these malignancies are not commonly the targets of screening efforts, and have generally not been closely associated with life style factors such as cigarette smoking and diet. We used data from nation-wide cancer registries in Denmark, Finland, and Sweden to examine trends in non-epithelial cancers over the period 1961-1990. Linear regression analysis of age-standardized rates, and age-period-cohort models were fit to assess the temporal patterns within each country. Within each of the 3 countries, there was a similarly increasing incidence of both hematological malignancies and nervous system/bone/soft-tissue neoplasms. The increases were smallest in children and adolescents (ages 0-14), moderate among young and middle aged adults (ages 15-64), and most pronounced among the elderly (ages 65+). Age-period-cohort modeling suggested that the dominant factor in the increases were birth cohort effects. It is not clear what factors underlie this increase in incidence; it seems most likely that increases both in diagnostic efficiency and in exposure to environmental carcinogens play a role.     

Epidemiology of Creutzfeldt-Jakob disease in the United States, 1979-1990: analysis of national mortality data

The trends and current incidence of Creutzfeldt-Jakob disease (CJD) was examined by using a unique and potentially high sensitive source for case ascertainment. We analyzed death certificate information for 1979-1990 from US multiple-cause-of-death mortality data, compiled by the National Center for Health Statistics, Centers for Disease Control and Prevention. We evaluated death certificate data for US residents for whom CJD was listed as one of the multiple causes of death on the death certificate (046.1) from the International Statistical Classification of Diseases, Injuries, and Causes of Death (9th revision). Age-adjusted and age-specific CJD death rates by gender, race, and region were calculated to measure the disease incidence because of the rapidly fatal course of the disease for most patients with CJD. We identified 2,614 deaths with CJD listed on the death certificates. The average annual age-adjusted mortality rate was 0.9 deaths per million persons (range 0.8-1.1). The mean age at death was 67 years. CJD-related deaths were uncommon among persons younger than 50 years of age (4.3% of all deaths). The highest average annual mortality rate was for those persons aged 70-74 years (5.9 deaths per million persons). A slight majority (53.0%) of the deaths was in females, but the age-adjusted mortality rate was 1.2 times higher for males. Most deaths (94.8%) were in whites; the mortality rate for blacks was only 40% of that for whites. The age-adjusted CJD mortality rate in the United States is similar to published estimates of the crude incidence of CJD worldwide.(ABSTRACT TRUNCATED AT 250 WORDS)     

Epidemiology of orofacial clefts in Slovenia, 1973-1993: comparison of the incidence in six European countries

For over 40 years, all children with orofacial clefts in Slovenia have been treated at the Department of Maxillofacial Surgery in Ljubljana, which maintains a register of these anomalies. Since 1987, clefts have also been registered within the framework of the perinatal Information System. An analysis of patients included in each of the two sources showed that an estimated 3.5% of cases were missing from the Cleft Register of the Department of Maxillofacial Surgery and 15% from the Perinatal Registry. The incidence of clefts in the period 1973-1993 was 1.64 per 1000 live births, with an increasing trend of 0.02 per year. Considerable differences were established among different geographic regions of Slovenia. Comparison with the data for Finland, Denmark, Hungary, Poland and Bohemia revealed some synchronicity of fluctuations in the incidence of clefting in these countries. The last two observations suggest that exogenous factors of two types play a part in the aetiology of orofacial clefts: some are limited in their action to a small geographical area, while others exert their influence simultaneously in areas several thousand kilometers apart.     

Social class and male cancer mortality in New Zealand, 1984-7

Social class differences in cancer mortality among New Zealand men aged 15-64 years are examined for the period 1984-7. Age-standardised rates are presented for all cancer deaths, and for 23 specific cancer sites. The strongest social class mortality gradients were found for cancers of the larynx, liver, buccal cavity/pharynx, oesophagus, lung and for soft tissue sarcoma. On the other hand, rectal cancer, malignant melanoma, colon cancer, brain/nervous system cancers, and multiple myeloma showed higher death rates for the more advantaged socioeconomic groups. Lung cancer accounted for 54.1% of the overall social class gradient, and the major smoking related cancers (these include buccal/pharynx, oesophagus, larynx, lung and bladder, although it should be stressed that not all cases of these cancers are caused by smoking) accounted for 77.6% of the overall gradient.     

Cervical cancer mortality in Belgium, 1955-1989. A descriptive study

This study describes trends in cervical cancer mortality among women in Belgium from 1954 to 1989. Data are analysed by means of the standardised mortality rate, age- and cohort-specific mortality rates and standardised cohort mortality ratios. The age-standardised mortality rate decreased progressively from 6.3/100,000 women-years in the first period (1955-1959) to 3.8/100,000 in 1985-1989, indicating a decline of 39.7% over the seven quinquennial periods. A decrease was observed in almost all age groups between 30 and 69 years. In the last 15 years, no further decline, but even a discrete increase, occurred for the age categories younger than 50 years. The successive cohorts born between 1915 and 1939 expressed a continuing lower risk of cervical cancer mortality. This trend was not observed for the most recent generations, for whom even a slight increase of the standardised cohort mortality ratio could be distinguished.     

Comparative analysis of mortality due to violence in developed countries and in a few developing countries during the 1985-1989 period

A comparative analysis of crude death rates and specifically of deaths from violence was conducted for a large number of developed and developing countries which provide data to the World Health Organization's data bank. For these countries, the analysis shows, first of all, that violent deaths rank third among the major causes of death, after diseases of the circulatory system and malignant tumours, in most developed countries and in some developing countries with reliable data. The comparative analysis also reveals substantial variations in the level and structure of death rates, both among the developed and the developing countries. Thus the crude death rate varies by a factor of 2 in both sexes, both in the developed and the developing countries. For violent deaths, the ranges are even wide: the highest death rate is 3 to 4 times greater than the lowest, except for women in developing countries where it is only twice as high. The method reveals in which countries the situation regarding violent deaths is relatively tolerable and in which countries the situation is decidedly bad. Although it is difficult to draw up a clear classification whereby countries can be grouped according to their profile of deaths by cause, it can be seen that a number of countries have a fairly characteristic profile of mortality by cause; these are mainly the developed countries (Western Europe and other regions) and some developing countries (Hong Kong and Israel) with low crude death rates. In these countries certain causes of violent death predominate as a result of the level of development achieved; motor vehicle accidents, falls and suicides. Moreover, in the other developed countries (in Eastern Europe) and in the developing countries (except Hong Kong and Israel) there is a more "traditional" profile of mortality by cause; this profile is characteristic of the less-developed countries where there are generally fewer deaths from suicide and from motor-vehicle accidents and where unintentional factors predominate over intentional factors. This analysis also brings out the very distinctive situation of the countries of Latin America with regard to violent deaths, particularly the large number of deaths from homicide in a number of countries. This is unquestionably a high-risk region for which further studies need to be undertaken, and where preventive measures need to be applied in order to curb the rising tide of violence and its harmful consequences for these societies.(ABSTRACT TRUNCATED AT 400 WORDS)