Cancer surveillance with particular reference to the uses of mortality data

As it is impossible to use alveolar CO as an useful index of the exposure to ambiant CO in smokers, young children between 8 and 11 were used in this study, who had no contact with smoking. In a sample of 306 schoolchildren living in rural or urban areas, it was shown: a) that the technique which is usually employed in adults to get a sample of alvelolar air was applicable to young children, b) that alveolar CO concentrations did reflect very closely in these children ambiant CO concentrations, c) that smoking habits of parents have to be taken into account before assessing the relationship between alveolar CO concentrations and exposure.     

Incidence and prevalence of digestive system tumors in Italy: estimates from mortality data

This work presents estimates and middle-term projections of incidence and prevalence levels in Italy for cancers of the oral cavity and pharynx, of the stomach, and of colon and rectum. The estimation procedure was previously validated using incidence data observed by Italian cancer registries operating in limited geographical areas. Projections up to the year 2000 of mortality, incidence, and prevalence rates and estimated cohort effects are reported for stomach and colorectal cancers only. For both cancer sites, cohort effects, rather than period effects, result to be responsible for mortality and incidence dynamics. Incidence levels show a general decreasing trend for stomach cancer and an increasing one for colorectal cancer. Cumulative risk trend tends, however, to level-off for the youngest cohorts. Moreover, the well known geographical differences between the North and the South of the country seem to be progressively reducing.     

Cancer surveillance in the U.S.: can we have a national system?

Cancer-related services are consuming ever-increasing health resources; along with this trend, health care costs are rising. As health care planners, researchers, and policymakers formulate strategies to meet this challenge, they are looking to cancer registries and the health information system built around them as collectors of the most extensive information regarding cancer treatment in the U.S. Currently, there are multiple programs collecting and reporting data regarding cancer incidence, morbidity, mortality, and survival. This report profiles cancer surveillance efforts in the U.S. and describes the National Coordinating Council for Cancer Surveillance, which was organized in 1995 to facilitate a collaborative approach among the organizations involved.     

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)     

Drowning fatalities of children in Tasmania: differences from national data

All drownings of people under 15 years of age in Tasmania from 1981 to 1993 were identified from the Tasmanian coroner's case files. Age- and sex-specific mortality rates were calculated and found to be similar to Australian drowning mortality rates. An exception was the lower drowning rate for Tasmanian females aged 0 to 4 years. Only 9 per cent of drowning deaths were caused by immersion in a swimming pool, 32 per cent of deaths occurred in dams and ponds and 21 per cent occurred in a river. Most drownings (88 per cent) associated with dams, ponds, swimming pools and baths were in the 0-to-4-year age group. Compared with Australia as a whole, toddlers drowning in swimming pools is uncommon in Tasmania; however, there are relatively more drownings in dams and ponds. Strategies for the prevention of drowning in childhood in Tasmania should consider the hazards associated with rural living.     

Arrested pregnancy syndrome in Haiti: findings from a national survey

This report describes findings from a national survey of pregnant women in Haiti regarding the social epidemiology of pedisyon (perdition), or "arrested pregnancy syndrome," a condition believed to be associated with infertility. Data collected on mortality of respondents' sisters were used to indirectly measure the prevalence of this culture-bound syndrome in the adult female population and to compare its distribution in urban and rural areas. Perdition appears to be a fairly common event that affects a large proportion of Haitian women. Reported cases of pedisyon were significantly higher in urban areas, which also differed from rural areas on respondent education, economic status, use of prenatal care, and fertility. No differences were found on sociodemographic, health, or fertility variables when women reporting perdition deaths were compared with women who reported other sister deaths. The utility and limitations of the proxy respondent method are discussed. Possible explanations for the higher rate of pedisyon among urban Haitian women are discussed, and suggestions are made for future research on arrested pregnancy syndrome.     

Infant mortality in Denmark and Sweden. A comparison based on data in two national registries

Pigmentation in a psychrotrophic M.roseus was found to be increased when the bacteria were grown at 5 degrees C as compared to its pigmentation at 25 degrees C. In addition more polar pigments were synthesised at low temperature. The pigments were identified as bacterioruberins and were demonstrated to bind to synthetic membranes of phosphatidylcholine with almost equal affinity, irrespective of the polarity of the pigments.     

Bronchiolitis obliterans syndrome in heart-lung transplantation: surveillance biopsies

Transbronchial biopsies (TBBs) are useful to diagnose acute rejection and infection in patients with lung transplants. The value of routine surveillance biopsies (S-TBBs) is not known, and such biopsies with a clinical indication are not without risk and are expensive. One hundred twenty-six 6-mo survivors of heart-lung transplantation (HLT) were studied to determine the effect of stopping S-TBBs on the development of bronchiolitis obliterans syndrome (BOS) and subsequent survival. Fifty-one received transplants while S-TBB was part of routine care (group A), and 75 received transplants after this practice was stopped (group B). There was no difference in patient characteristics. Group A had shorter graft ischemia (p < 0.01) and longer postoperative ventilation (p < 0.01). Maintenance immunosuppression was similar, but group A had more steroid pulses in the second 6 mo after HLT (p < 0.01). The number of patients free from any functional deterioration at 49 to 60 mo after HLT declined to 39% in group A and 64% in group B. The risk of developing BOS grade 1 in group A relative to group B was 1.63 (95% confidence intervals: 0.96-2.79, p = 0.07). Patient survival was similar in the two groups. A total of 86 TBBs were taken in the absence of any signs or symptoms and had low diagnostic yield. In summary, there was no increased incidence of BOS after stopping S-TBBs.     

Epidemiology and detection of HIV-1 among pregnant women in the United Kingdom: results from national surveillance 1988-96

OBJECTIVE: To describe the epidemiology of HIV-1 infection in pregnant women in the United Kingdom. DESIGN: Serial unlinked serosurveillance for HIV-1 in neonatal specimens and surveillance through registers of diagnosed maternal and paediatric infections from reporting by obstetricians, paediatricians, and microbiologists. SETTING: United Kingdom, 1988-96. SUBJECTS: Pregnant women proceeding to live births and their children. MAIN OUTCOME MEASURES: Time trends in prevalence of HIV-1 seropositivity in newborn infants (as a proxy for infection in mothers); the proportions of mothers with diagnosed HIV-1 infections, and their characteristics. RESULTS: HIV-1 prevalence among mothers in London rose sixfold between 1988 and 1996 (0.19% of women tested; 1 in 520 in 1996). Apart from in Edinburgh and Dundee, levels remained low in Scotland (0.025%; 1 in 3970) and elsewhere in the United Kingdom (0.016%; 1 in 1930). Over a third of births to infected mothers in 1996 occurred outside London. In London the reported infections were predominantly among black African women, whereas in Scotland most were associated with drug injecting. The contribution of reported infection among African women increased over time as that of drug injecting declined. In Scotland 51% of mothers' infections were diagnosed before the birth. In England, despite a national policy initiative in 1992 to increase the antenatal detection rate of HIV, no improvement in detection was observed, and in 1996 only 15% of previously unrecognised HIV infections were diagnosed during pregnancy. CONCLUSIONS: HIV-1 infection affects mothers throughout the United Kingdom but is most common in London. Levels of diagnosis in pregnant women have not improved. Surveillance data can monitor effectively the impact of initiatives to reduce preventable HIV-1 infections in children.     

Immune system dysfunction during exposure to poult enteritis and mortality syndrome agents

Poult Enteritis and Mortality Syndrome (PEMS) is a condition of yet undefined etiology. Affected flocks may exhibit 100% morbidity with mortality up to 50% or more between 2 to 4 wk of age. The current study reports the immune status of poults experimentally infected with PEMS agent(s) in various trials. When compared with the unchallenged controls, PEMS-infected poults had significant atrophy of the bursa (up to 2-fold), thymus (up to 11-fold), and spleen (up to 2-fold) (P < or = 0.05). When challenged with SRBC, PEMS-infected poults had 1 to 2 log2 lower anti-SRBC antibody titers than the controls (P < or = 0.05). Responsiveness to a mitogenic lectin, phytohemagglutinin-P, was reduced significantly in PEMS poults (P < or = 0.05). These data show that the immune system of the poults is compromised significantly during PEMS infection in terms of lymphoid organ integrity and humoral and cell-mediated immunity. These findings imply, therefore, that immune dysfunction may contribute to the mortality observed during PEMS outbreaks.     

The use of designated drivers by US college students: a national study

A representative national sample of students attending 4-year colleges in the United States reported whether they had served as or had ridden with a designated driver in the past 30 days and how much alcohol they had consumed the last time they used this prevention strategy. Among drinkers (those who had consumed alcohol in the past year), 36% said they had served as a designated driver in the past 30 days; of these, 40% said they usually binged when they drank but had not done so the last time they served as the designated driver, with the vast majority either abstaining or having 1 drink. Among drinkers, 37% reported riding with a designated driver in the past 30 days; of these, 22% said they did not usually binge but did so the last time they had a designated driver because they had had 1 or more extra drinks. Among college students, using designated drivers is now a well-established strategy for avoiding impaired driving.     

Epidemiology of hyaline membrane disease in the United States: analysis of national mortality statistics

National mortality statistics for hyaline membrane disease (HMD) and respiratory distress syndrome (RDS) were examined in this study for the years 1968 to 1973. Detailed data were obtained by computer analysis of magnetic tapes from the National Center for Health Statistics. During the six-year interval, HMD/RDS was determined to be the underlying cause of death in 54,064 infants or 9,010 +/- 560 (mean +/- SD) infants per year. Analysis of individual death certificates for 1968 revealed the disease to a major contributing factor in another 24%. Thus, it may be estimated that HMD was involved in the demise of nearly 12,000 neonates per year over this period. This amounts to approximately 20% of all neonatal deaths. On the basis of mortality rates, a trend toward an increased incidence of fatal HMD/RDS was established from 1968 to 1973. Deaths tend to cluster in the summer months and January-February represent the lowest months of recorded fatalities. Analysis of the age at death, reflecting time course of the disease, revealed idential patterns for 1968 to 1970. The number of deaths was found to decline exponentially between the first and fourth 24-hour periods so that 92% of all deaths occurred by 4 days of age. Boys contributed more prominently to the death totals than girls with ratios from 1.62 to 1.76. Examination of mortality rates by race suggested that black permatures have a lower incidence of fatal HMD/RDS. In addition to nationwide figures, those of individual states were compared for three years. Generally, HMD/RDS mortality rates correlated with overall neonatal mortality statistics. Exceptions were observed, however, such as Illinois where low rates for the former coexist with relatively high neonatal death rates. These data respresent the first national mortality statistics for HMD and may prove useful in planning and providing intensive neonatal care.     

Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults

CONTEXT: A prominent hypothesis regarding social inequalities in mortality is that the elevated risk among the socioeconomically disadvantaged is largely due to the higher prevalence of health risk behaviors among those with lower levels of education and income. OBJECTIVE: To investigate the degree to which 4 behavioral risk factors (cigarette smoking, alcohol drinking, sedentary lifestyle, and relative body weight) explain the observed association between socioeconomic characteristics and all-cause mortality. DESIGN: Longitudinal survey study investigating the impact of education, income, and health behaviors on the risk of dying within the next 7.5 years. PARTICIPANTS: A nationally representative sample of 3617 adult women and men participating in the Americans' Changing Lives survey. MAIN OUTCOME MEASURE: All-cause mortality verified through the National Death Index and death certificate reviews. RESULTS: Educational differences in mortality were explained in full by the strong association between education and income. Controlling for age, sex, race, urbanicity, and education, the hazard rate ratio of mortality was 3.22 (95% confidence interval [CI], 2.01-5.16) for those in the lowest-income group and 2.34 (95% CI, 1.49-3.67) for those in the middle-income group. When health risk behaviors were considered, the risk of dying was still significantly elevated for the lowest-income group (hazard rate ratio, 2.77; 95% CI, 1.74-4.42) and the middle-income group (hazard rate ratio, 2.14; 95% CI, 1.38-3.25). CONCLUSION: Although reducing the prevalence of health risk behaviors in low-income populations is an important public health goal, socioeconomic differences in mortality are due to a wider array of factors and, therefore, would persist even with improved health behaviors among the disadvantaged.     

Gianotti-Crosti syndrome: clinical, serologic, and therapeutic data from nine children

Gianotti-Crosti syndrome (GCS), a self-limiting papulovesicular acrodermatitis often associated with underlying viral infection, is mainly described in children. Nine children with GCS were evaluated with dermatologic examination and serologic tests for viral infections. Therapy was modified according to the subjective symptoms of patients, which included characteristic acrolocated papulovesicles, generalized skin eruption, and mild to severe pruritus. Results of serologic investigations revealed Epstein-Barr virus, Coxsackie A virus, parvovirus B19, and parainfluenza virus 1/2. In three children no underlying viral infection was found. Therapeutic interventions included topical clioquinol lotion 1 percent, topical application of corticosteroids, systemic antihistaminic therapy, and systemic methylprednisolone. Skin lesions resolved after 2 to 4 weeks in treated as well as in nontreated children. Although GCS in children often lacks close association with a causative viral infection, such severe infections as hepatitis B and human immunodeficiency virus must be considered. Whole-body involvement seems to correlate with severe pruritus and additional general symptoms requiring more intensive therapy.