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Burkitt lymphoma, a childhood tumor common in parts of sub-Saharan Africa, has been directly associated with Epstein-Barr virus (EBV) and indirectly with prevalence of malaria. We studied antibodies to both EBV and malaria in children diagnosed with this cancer in Uganda. We performed a case-control study of HIV-seronegative children (

Aim: To examine cancer mortality by occupation among New Zealand women, 1988-1997., Method: Proportional mortality ratios (PMRs) were calculated for the six most common general occupations among women: clerical workers, health professionals, teachers, farmers, cleaners and textile workers. Age groups examined were those aged 20-59 and those > or =20 years. Data on occupation was obtained from death certificates., Results: From 1988-1997, annually 12-54% of women had a codeable occupation on their death certificate, leaving 3079 deaths among women 20-59 years, and 7236 in those > or =20 years for analysis. Leukaemia was significantly increased in health professionals aged > or =20 years (PMR=1.52; 95% CI: 1.08-2.09, n=38). In nurses alone, the PMR for leukaemia was 1.42; 95% CI: 0.96-2.01, n=31)., Conclusion: This study represents the first systematic examination of cancer mortality by occupation among women in New Zealand. These data should be examined routinely as part of regular surveillance of occupational cancer among women. Avenues for further research identified particularly include an analytical study of leukaemia and other cancers among female health professionals.

Both electroweak precision measurements and simple supersymmetric extensions of the standard model prefer a mass of the Higgs boson less than the experimental lower limit (on a standard-model-like Higgs boson) of 114 GeV. We show that supersymmetric models with R parity violation and baryon-number violation have a significant range of parameter space in which the Higgs boson dominantly decays to six jets. These decays are much more weakly constrained by current CERN LEP analyses and would allow for a Higgs boson mass near that of the Z. In general, lighter scalar quark and other superpartner masses are allowed. The Higgs boson would potentially be discovered at hadron colliders via the appearance of new displaced vertices.

Background: To report the experience of health workers who had played key roles in the early stages of implementing the prevention of mother-to-child HIV transmission services (PMTCT) in Uganda., Methods: Interviews were conducted with 15 key informants including counsellors, obstetricians and PMTCT coordinators at the five PMTCT test sites in Uganda to investigate the benefits, challenges and sustainability of the PMTCT programme. Audio-taped interviews were held with each informant between January and June 2003. These were transcribed verbatim and manually analysed using the framework approach., Results: The perceived benefits reported by informants were improvement of general obstetric care, provision of antiretroviral prophylaxis for HIV-positive mothers, staff training and community awareness. The main challenges lay in the reluctance of women to be tested for HIV, incomplete follow-up of participants, non-disclosure of HIV status and difficulties with infant feeding for HIV-positive mothers. Key informants thought that the programme's sustainability depended on maintaining staff morale and numbers, on improving services and providing more resources, particularly antiretroviral therapy for the HIV-positive women and their families., Conclusion: Uganda's experience in piloting the PMTCT programme reflected the many challenges faced by health workers. Potentially resource-sparing strategies such as the 'opt-out' approach to HIV testing required further evaluation.

To study the effect of HIV infection on quality of life (QOL) during pregnancy and puerperium, QOL was measured in a cohort study at St. Francis Hospital Nsambya, Kampala, Uganda. Dartmouth COOP charts were administered to 132 HIV-positive and 399 HIV-negative women at 36 weeks of pregnancy and six weeks post-partum. Responses were coded from 0 = best health-status to 4 = worst health-status and scores of 3-4 defined as poor. Odds ratios (OR) (95% confidence intervals(CI)) for poor scores were calculated and independent predictors of poor QOL examined using logistic regression. In pregnancy, HIV-positive women were more likely to have poor scores in feelings: OR = 3.2(1.9-5.3), daily activities: OR = 2.8(1.4-5.5), pain: OR = 2.1(1.3-3.5), overall health: OR = 1.7(1.1-2.7) and QOL: OR = 7.2(3.6-14.7), all p= 0.2). HIV infection was independently associated with poor QOL: OR = 8.5(3.8-19). Findings in puerperium were similar to those in pregnancy except more HIV-positive women had poor scores in social activities: OR = 2.5(1.4-4.7) and change in health: OR = 5.4(2-14.5) and infant death also predicted poor QOL: OR = 6.7(2.4-18.5). The findings reflect HIV's adverse impact on maternal QOL and the need for interventions to alleviate this infection's social and emotional effects.

Background: There has been a Human Volunteer Programme at the British chemical weapons research facility at Porton Down since the First World War, in which some of the participants were exposed to chemical warfare agents., Aim: To identify any striking specific morbidity patterns in members of the Porton Down Veterans Support Group (PDVSG)., Methods: A self-completed postal questionnaire was prepared including health immediately after the visits to Porton Down, subsequent diagnoses and hospital admissions, symptoms in, and after, the first 5 years after the visits, fatigue symptoms and current quality of life, measured using the SF-36., Results: Responses were received from 289 of 436 (66%). Results reported here relate to 269 male respondents of mean age 66.8 years. Sixty-six per cent reported their first visit to Porton Down in the 1950s. The most common diagnoses or hospital admissions reported were diseases of the circulatory system. In the first 5 years after their visits the most common symptoms were headache, irritability or outbursts of anger and feeling un-refreshed after sleep. In the later period, most common symptoms were fatigue, feeling un-refreshed after sleep and sleeping difficulties. Sixty-five per cent met the definition for a case of 'fatigue'. Current quality of life dimensions were consistently lower than age-specific estimates from general population samples., Conclusions: Members of the PDVSG responding to this survey reported poorer quality of life than the general population. Despite there being no clear pattern of specific morbidities, we cannot rule out ill-health being potentially associated with past experience at Porton Down.

Objective: Changing behaviour is an important method for preventing HIV infection. We examined why a community randomized trial of a behavioural intervention found no significant effect of this on HIV incidence in rural Uganda., Design: An individual-level analysis of a community randomized trial., Methods: All sexually active, initially HIV-seronegative individuals with data on sexual behaviour were included (1558 men and 1836 women). Uptake of the intervention was measured using self-reported attendance at meetings, videos, dramas, and interactions with community educators in the past year. Sexual behaviour was assessed using self-reported condom use and the number of sexual partners in the past year., Results: Overall, 81% of individuals in the intervention communities and 9% in the comparison communities reported attending at least one of the intervention activities in the past year. Attendance was lower in women, in those aged 55 years or older, and in the widowed. There was a lower HIV incidence in those who reported attending at least one intervention activity compared with those who attended none, and in women this effect was statistically significant (in women, adjusted rate ratio 0.41, 95% CI 0.19-0.89, P = 0.024; in men, adjusted rate ratio 0.66, 95% CI 0.25-1.79, P = 0.42). Reported behaviour change did not differ markedly between those who did and did not report attending any intervention activities., Conclusion: Although the intervention had no significant benefit in the communities as a whole, it resulted in a reduced risk of HIV acquisition in women who attended it. The methodological implications for future trials are discussed.

Background and Purpose: Disease of the cardiovascular system is the main cause of long-term complications and mortality in patients with type I (insulin-dependent) and type II (non-insulin-dependent) diabetes. Cerebrovascular mortality rates have been shown to be raised in patients with type II diabetes but have not previously been reported by age and sex in patients with type I diabetes., Methods: A cohort of 23 751 patients with insulin-treated diabetes, diagnosed under the age of 30 years from throughout the United Kingdom, was identified during 1972 to 1993 and followed up for mortality until the end of December 2000. Age- and sex-specific mortality rates and standardized mortality ratios (SMRs) were calculated., Results: There were 1437 deaths during the follow-up, 80 due to cerebrovascular disease. Overall, the cerebrovascular mortality rates in the cohort were higher than the corresponding rates in the general population, and the SMRs were 3.1 (95% CI, 2.2 to 4.3) for men and 4.4 (95% CI, 3.1 to 6.0) for women. When stratified by age, the SMRs were highest in the 20- to 39-year age group. After subdivision of cause of death into hemorrhagic and nonhemorrhagic origins, there remained a significant increase in mortality from stroke of nonhemorrhagic origin., Conclusions: Analyses of mortality from this cohort, essentially one of patients with type I diabetes, has shown for the first time that cerebrovascular mortality is raised at all ages in these patients. Type I diabetes is at least as great a risk factor for cerebrovascular mortality as type II diabetes.

Objective: To describe study design, methods and baseline findings of a behavioural intervention alone and in combination with improved management of sexually transmitted diseases (STDs) aimed at reducing HIV incidence and other STDs., Design: A three-arm community randomized controlled trial (RCT) of 18 rural communities (approximately 96 000 adults) in SW Uganda. A standardized behavioural intervention was implemented in 12 communities (arms A and B) through community-based education, meetings and information leaflets. Six of these communities in addition received improved STD management through government and private health units (arm B). Arm C communities received routine government health services. Impact assessment was through three questionnaire and serological surveys of 750-1000 adults in each community at 18-24-month intervals. The primary outcome measure was HIV incidence and secondary measures were syphilis and herpes simplex virus type 2 incidence, prevalence of Neisseria gonorrhoea and Chlamydia trachomatis and sexual behaviour changes., Results: Approximately 15 000 adults (72% of eligible population) were enrolled at baseline. HIV baseline prevalence rates were 9-10% in all arms and demographic and behavioural characteristics and STD prevalence were also similar. In intervention communities, there were 391 995 attendance at 81 502 activities (6.1 per target adult), 164 063 leaflets distributed (2.6 per person) and 1 586 270 condoms (16.5 condoms per adult). In the STD communities a total of 12 239 STD cases (65% women) were seen over a 5-year period (7.7 per 100 adults/year)., Conclusion: This is the first community RCT of its type with a behavioural component. There is fair baseline comparability between study arms and process data suggest that interventions were adequately implemented.

Objective: To assess whether sexually transmitted infections (STIs) and sexual behavior are independently associated with HIV-1 among adult women, men, and teenagers in rural Uganda., Design: Cross-sectional survey., Methods: All adults (13 years and older) residing in 18 communities were invited to participate. HIV status was determined from serum samples and data collected during confidential interview. Independent effects of risk factors for HIV were estimated using adjusted odds ratios (ORs) with 95% confidence intervals (CIs) from logistic regression., Results: Women reporting genital ulcers in the last 12 months were over twice as likely to be HIV positive after adjustment for sociodemographic factors and number of lifetime sexual partners (OR, 2.5; 95% CI, 1.9-3.4). Equivalent associations were stronger for men (OR, 3.2; 95% CI, 2.2-4.7) but weaker for teenagers (OR, 2.0, 95% CI, 0.5-8.7). Number of lifetime sexual partners was associated ( p <.05) with HIV status for women, men, and teenagers independently of reported genital ulcers. Teenagers reporting casual partners were over four times ( p <.001), and men reporting condom use almost twice ( p <.001), as likely to be HIV positive. Neither history of genital discharge nor other measures of sexual behavior were independently related to HIV status., Conclusion: Reported STIs and sexual behavior are independently associated with HIV in rural Uganda. Community-based interventions to reduce HIV should target both and should include teenagers.

The traditional exploration of large contingency tables leads to multiple comparisons with the inherent generation of chance associations. To allow for this, a simple empirical Bayesian approach is used here to derive estimates of association 'shrunk' towards a global mean. Estimates are displayed on ordered normal plots, to allow visual detection of outliers, with the addition of 'guide rails', derived from simulation, to facilitate their detection. The methods, and the interpretation of results, are illustrated using a large table of occupations for cancer registrations in England and Wales for 1971-90.

Objectives: To find a simple and robust method for adjusting ante-natal clinic data on HIV prevalence to represent prevalence in the general female population in the same age range, allowing for fertility differences by HIV status., Background: HIV prevalence comparisons for pregnant women and women in the general community show that prevalence in the latter is significantly higher than in the former. An adjustment procedure is needed that is specific for the demographic and epidemiological circumstances of a particular population, making maximum use of data that can easily be collected in ante-natal clinics or are widely available from secondary sources., Methods: Birth interval length data are used to allow for subfertility among HIV-positive women. To allow for infertility, relative HIV prevalence ratios for fertile and infertile women obtained in community surveys in populations with similar levels of contraception use are applied to demographic survey data that describe the structure of the population not at risk of child-bearing., Results: For populations with low contraception use, the procedure yields estimates of general female HIV prevalence of 35-65% higher than the observed ante-natal prevalence, depending on population structure. Results were verified using general population prevalence data collected in Kisesa (Tanzania) and Masaka (Uganda). For high contraception use populations, adjusted values range from 15% higher to 5% lower, but only limited verification has been possible so far., Conclusions: The procedure is suitable for estimating general female HIV prevalence in low contraception use populations, but the high contraception variant needs further testing before it can be applied widely.

A competitive type-specific enzyme-linked immunosorbent assay (ELISA) for herpes simplex virus type 2 (HSV-2) antibody was developed using an infected cell antigen and a monoclonal antibody to glycoprotein G-2. This assay has been validated for use for epidemiological studies using a large panel of sera collected in rural Uganda and a panel of 143 sera characterised previously by Western blotting, the 'gold standard' for HSV type-specific serology. This evaluation was found to have a sensitivity of 96% and a specificity of 91% in comparison with Western blot on 143 sera from clinic patients. The ELISA had a sensitivity of 93% and a specificity of 91% in comparison with Western blot on 495 sera collected in Uganda. The assay showed good reproducibility and a low percentage of sera gave equivocal results, indicating its suitability for epidemiological studies.

Objective: To identify risk factors associated with HIV incidence in a rural Ugandan population., Design: Case-control study., Methods: Men and women who seroconverted between 1990 and 1997 (cases) and seronegative subjects (controls) were drawn from a general population cohort of approximately 5000 adults in rural, southwestern Uganda. Information on risk factors was ascertained through a detailed interview and physical examination by clinicians who were blind to the study subjects' HIV status. All patients were interviewed within 2 years of their estimated date of seroconversion., Results: Data were available on 130 men (37 cases, 93 controls) and 133 women (46 cases, 87 controls). There was a significantly higher risk of infection in men (odds ratio [OR], 6.51; 95% confidence interval [CI], 1.06-39.84) and women (OR, 4.75; 95% CI, 1.26-17.9) who were unmarried and in a steady relationship, and in men who were divorced, separated, or widowed (OR, 4.33; 95% CI, 1.32-14.25) compared with those who were married. There was a significantly higher risk of HIV infection in men (OR, 3.78; 95% CI, 1.20-11.93) and women (OR, 20.78; 95% CI, 2.94-141.2) who reported > or =5 lifetime sexual partners compared with those who reported at most 1 partner. For men, there was an increased risk of infection associated with receiving increasing numbers of injections in the 6 months prior to interview (p < .001 for trend). Women reporting sex against their will in the year prior to interview were at higher risk of infection (OR, 7.84; 95% CI, 1.29-47.86; p = .020)., Conclusions: The strongest risk factor for HIV incidence in this rural Ugandan population is lifetime sexual partners. The increased risks found for women reporting coercive sex and men reporting injections require further investigation.

Objective: To assess trends in HIV-1 infection rates and changes in sexual behaviour over 7 years in rural Uganda., Methods: An adult cohort followed through eight medical-serological annual surveys since 1989-1990. All consenting participants gave a blood sample and were interviewed on sexual behaviour., Results: On average, 65% of residents gave a blood sample at each round. Overall HIV-1 prevalence declined from 8.2% at round 1 to 6.9% at round 8 (P = 0.008). Decline was most evident among men aged 20-24 years (11.7 to 3.6%; P < 0.001) and women aged 13-19 (4.4% to 1.4%; P = 0.003) and 20-24 (20.9% to 13.8%; P = 0.003). However, prevalence increased significantly among women aged 25-34 (13.1% to 16.6%; P = 0.04). Although overall incidence declined from 7.7/1000 person-years (PY) in 1990 to 4.6/1000 PY in 1996, neither this nor the age-sex specific rates changed significantly (P > 0.2). Age-standardized death rates for HIV-negative individuals were 6.5/1000 PY in 1990 and 8.2/1000 PY in 1996; corresponding rates for HIV-positive individuals were 129.7 and 102.7/1000 PY, respectively. There were no significant trends in age-adjusted death rates during follow-up for either group. There was evidence of behaviour change towards increase in condom use in males and females, marriage at later age for girls, later sexual debut for boys and a fall in fertility especially among unmarried teenagers., Conclusions: This is the first general population cohort study showing overall long-term significant reduction in HIV prevalence and parallel evidence of sexual behaviour change. There are however no significant reductions in either HIV incidence or mortality.

Objective: Few studies have described levels and determinants of perceived risk of HIV-1 among African adults for whom the sero-status is known. This study describes HIV risk perception obtained from a large rural population in south-west Uganda which also underwent serological testing for HIV., Design: Cross-sectional survey., Methods: Information on risk perception and sexual behaviour was collected by interview. Sera were obtained from all consenting adults (13 years and above) in order to assess HIV-1 prevalence., Results: Of 14,818 adults with a definitive sero-status, 9.7% were HIV-1 positive and 51% considered themselves to be at risk of infection. Risk perception showed similar patterns as age- and sex-specific sero-prevalence and there was correspondence between risk factors for perceived risk and known HIV risk factors. Partner's sexual behaviour was the commonest reason for risk perception in women whereas men cited their own sexual behaviour. Abstinence from sex was much more commonly mentioned as a protective practice than condom use in men and women., Conclusion: Half of the adults we have studied already see infection with HIV as a real possibility in their lives and are aware of HIV risk behaviours. More efforts should be made to implement sustainable control measures rather than simply raising awareness. In addition to recommending abstinence, these include mutual faithfulness, condom use and better treatment for STDs.

Background: HIV-1 infection is associated with lower fertility among women in sub-Saharan Africa and this association is not explained by the frequency of sexual intercourse, illness, knowledge of HIV status or infection with other sexually transmitted diseases. Women with fertility problems are at increased risk of marital instability and, therefore, HIV infection; consequently, pre-existing subfertility among HIV-infected women may contribute to the association., Objective: This study examines the relationship between HIV-1 infection and the incidence of recognised pregnancy and the role of low gravidity prior to seroconversion in rural Uganda., Methods: A group of 176 women (80 HIV infected and 96 uninfected) were enrolled into an HIV-1 natural history cohort and invited to attend 3-monthly clinic appointments. Data from clinic visits were analysed to assess the independent effects of HIV infection and age, lactation, illness, reported frequency of sexual intercourse and sexually transmitted diseases (STD) on the risk of pregnancy in the following 3 months. The number of previous pregnancies was recorded at enrolment, and the effect of gravidity was examined for the subgroup of women who were uninfected at enrolment or who enrolled within 2 years of their estimated seroconversion date., Results: During follow-up, 124 pregnancies were observed in 83 women beginning in the 3 months following 47 (7.0%) of 669 visits made by HIV-infected women and 77 (9.5%) of 812 visits by HIV-negative women (P = 0.12). Adjusting for age, lactation, illness, STD and the reported frequency of sexual intercourse, the estimated reduction in the risk of pregnancy associated with HIV infection was 47% [95% confidence interval (CI) 18-66]. Pre-existing low gravidity was strongly associated with a reduced incidence of pregnancy (odds ratio 0.39; CI 0.19-0.81). Additionally, adjusting for low gravidity reduced the estimate of the effect of HIV infection by almost a half, to 25% (95% CI-57-29)., Conclusion: Low gravidity prior to seroconversion accounts for almost 50% of the observed association between HIV infection and lowered incidence of pregnancy, after adjusting for age, lactation, illness, STD and the frequency of sexual intercourse.

Objective: To assess the efficacy of transmission of HIV-1 within married couples in rural Uganda according to the sero-status of the partners., Design: Estimation of HIV incidence rates for 2200 adults in a population cohort followed for 7 years comparing male-to-female with female-to-male transmission and sero-discordant with concordant sero-negative couples., Methods: Each year, adults (over 12 years of age) resident in the study area were linked to their spouses if also censused as resident. The HIV sero-status was determined annually., Results: At baseline 7% of married adults were in sero-discordant marriages and in half of these the man was HIV-positive. Among those with HIV-positive spouses, the age-adjusted HIV incidence in women was twice that of men (rate ratio (RR) = 2.2 95% confidence interval (CI) 0.9-5.4) whereas, among those with HIV-negative spouses, the incidence in women was less than half that of men (RR = 0.4, 95% CI 0.2-0.8). The age-adjusted incidence among women with HIV-positive spouses was 105.8 times (95% CI 33.6-332.7) that of women with HIV-negative spouses, the equivalent ratio for men being 11.6 (95% CI 5.8-23.4)., Conclusion: Men are twice as likely as women to bring HIV infection into a marriage, presumably through extra-marital sexual behaviour. Within sero-discordant marriages women become infected twice as fast as men, probably because of increased biological susceptibility. Married adults, particularly women, with HIV-positive spouses are at very high risk of HIV infection. Married couples in this population should be encouraged to attend for HIV counselling together so that sero-discordant couples can be identified and advised accordingly.

Objectives: To examine patterns of cause specific mortality in NHS hospital consultants according to their specialty and to assess these in the context of potential occupational exposures., Methods: A historical cohort assembled from Department of Health records with follow up through the NHS Central Register involving 18,358 male and 2168 female NHS hospital consultants employed in England and Wales between 1962 and 1979. Main outcome measures examined were cause specific mortality during 1962-92 in all consultants combined, and separately for 17 specialty groups, with age, sex, and calendar year adjusted standardised mortality ratios (SMRs) for comparison with national rates, and rate ratios (RRs) for comparison with rates in all consultants combined., Results: The 2798 deaths at ages 25 to 74 reported during the 30 year study period were less than half the number expected on the basis of national rates (SMR 48, 95% confidence interval (95% CI) 46 to 49). Low mortality was evident for cardiovascular disease, lung cancer, other diseases related to smoking, and particularly for diabetes (SMR 14, 95% CI 6 to 29). Death rates from accidental poisoning were significantly raised among male consultants (SMR 227, 95% CI 135 to 359), the excess being most apparent in obstetricians and gynaecologists (SMR 934); almost all deaths from accidental poisoning involved prescription drugs. A significantly raised death rate from injury and poisoning among female consultants was due largely to a twofold excess of suicide (SMR 215, 95% CI 93 to 423), the rate for this cause being significantly raised in anaesthetists (SMR 405). Compared with all consultants, significantly raised mortality was found in psychiatrists for all causes combined (RR 1.12), ischaemic heart disease (RR 1.18), and injury and poisoning (RR 1.46); in anaesthetists for cirrhosis (RR 2.22); and in radiologists and radiotherapists for respiratory disease (RR 1.68). There were significant excesses of colon cancer in psychiatrists (RR 1.67, compared with all consultants) and ear, nose, and throat surgeons (RR 2.25); melanoma in anaesthetists (RR 3.33); bladder cancer in general surgeons (RR 2.40); and laryngeal cancer in ophthalmologists (RR 7.63)., Conclusions: Lower rates of smoking will have contributed substantially to the low overall death rates found in consultants, but other beneficial health related behaviours, and better access to health care, may have also played a part. The increased risks of accidental poisoning in male consultants, and of suicide in female consultants are of concern, and better preventive measures are needed. The few significant excesses of specific cancers found in certain specialties have no obvious explanation other than chance. A significant excess mortality from cirrhosis in anaesthetists might reflect an occupational hazard and may warrant further investigation.

We set out to detect a transient increase in risk of breast cancer following childbirth, the existence of which has been postulated, but for which empirical evidence is contradictory. Breast cancers and births occurring among the cohort of Swedish women born after 1939 were linked, yielding 3,439 cases and 25,140 age-matched controls with at least two children. Within three years of their last childbirth, women had an estimated rate of breast cancer of 1.21 (95 percent confidence interval [CI] = 1.02-1.44) times that of women whose last birth was 10 or more years earlier, after adjustment for parity and age at first birth. Further analyses suggested that this effect reflected, in part, a small transient increase in breast cancer risk that lasts for about three years following completed pregnancy. The effect of age at first birth on breast cancer risk appears to be confounded by time since last birth; the parity-adjusted rate ratio for having a first birth at age 35 years or more compared with under 20 years is reduced from 1.72 (CI = 1.14-2.58) to 1.36 (CI = 0.88-2.09) on additional adjustment for time since last birth. A transient increase in breast cancer risk after childbirth appears thus appears to account for part of the effect of age at first birth on breast cancer risk.

One hundred and fifty-two patients in whom a diagnosis of dermatitis herpetiformis was made at St John's Hospital for Diseases of the Skin, London, during 1950-85, were followed from the date of diagnosis to the end of 1989 for mortality, and from 1971, or the date of diagnosis if later, to 1986 for cancer incidence. Thirty-eight deaths occurred under the age of 85, slightly fewer than expected on the basis of national general population rates [standardized mortality ratio (SMR) = 87; 95% confidence interval (CI) 61-119]. All-cause mortality was somewhat lower in patients who had followed a gluten-free diet (SMR = 51; 17-120) than in those who had not (SMR = 97; 66-136), but the difference in SMRs was not significant (P = 0.3). Cancer mortality was non-significantly below expectations from national rates (SMR = 72; 31-142), but cancer incidence was significantly increased [standardized registration ratio (SRR) = 394; 180-749]. No particular cancer site accounted for the cancer incidence excess. One death occurred from cancer of the small intestine (SMR = 4953, P = 0.04), and one lymphoma was incident (SRR = 1555, P = 0.12). Increased risks of these malignancies have previously been found to be associated with coeliac disease (which is present in many patients with dermatitis herpetiformis), and with dermatitis herpetiformis, respectively. Mortality from ischaemic heart disease (IHD) was significantly below national rates (SMR = 37; 95% CI 12-86), and was similar in patients who had followed a gluten-free diet and those who had not.(ABSTRACT TRUNCATED AT 250 WORDS)

Congenital anomalies of the airway are generally uncommon, but a vast array of possibilities exists. Some present life-threatening emergencies at birth, and others go undiagnosed for years. Clinical symptoms are often nonspecific, and radiographic evaluation is frequently requested to localize and characterize the lesion before endoscopy, surgery, or medical management. The most common intrinsic congenital anomalies causing airway compromise in infants include choanal atresia, mandibular hypoplasia, laryngomalacia, vocal cord paralysis, and congenital subglottic stenosis. The radiologist must be on the alert for unsuspected additional anomalies involving the airway, lungs, and esophagus, which occur with relative frequency. Numerous extrinsic congenital masses of the head, neck, and mediastinum may compromise the airway. Hemangiomas, lymphangiomas, and teratomas are more likely to be noted at birth, whereas branchial cleft cysts, thyroglossal duct anomalies, and dermoid cysts frequently present later. Mass location and radiographic characteristics usually allow accurate preoperative diagnosis. Intracranial involvement by nasal or nasopharyngeal masses, intrathoracic involvement by lower neck mass, and intraspinal involvement by posterior neck mass must always be sought for radiographically. Persistence of respiratory symptoms after removal of such masses is not uncommon because tracheal deformity and laxity may take months or years to resolve. Recent advances in cine CT and MR imaging promise to improve imaging of the airway in general and in the pediatric population in particular. Significant limitations in imaging of the pediatric larynx remain. As a result, endoscopy continues to be the primary diagnostic tool for airway anomalies of this region.

Interview data from 434 women (aged greater than or equal to 20 years) in two Wellington suburban areas were used to estimate the prevalence and quality of performance of breast self-examination. Although 98% of women were familiar with breast self-examination, and 73% had performed it at least once, only 39% did so at least monthly. Its practice was significantly more common in the middle years (30-59), among Europeans, and in women with tertiary education. Thoroughness or quality of performance was assessed by comparison with Cancer Society recommendations. Scores for examination technique were generally high (mean = 73%) compared with those assessing timing (mean = 47.5%) and conditions under which breast self-examination was performed (mean = 43.3%). Results from this study were compared with 1975-76 New Zealand survey data which produced lower estimates of the prevalence of monthly breast self-examination. Both studies found that more than a quarter of women have never practiced it. Future research and intervention efforts should be directed toward this group of women.

When human serum must be stored for extended periods before analysis, conditions must be such that samples give results comparable with those for "fresh" (unstored) samples. In a balanced experiment with statistically pre-determined sample size, we assessed, at three-weekly intervals for 18 weeks, the stability of total cholesterol, high-density-lipoprotein cholesterol, and triglycerides in human serum stored at -15 degrees C. No significant changes were observed.

The age-adjusted, sex-specific mortality rates from certain cancers of the digestive system were analysed by type of water source supplied to 238 urban areas in England, Wales and Scotland using weighted multiple regression. Of the types of water source, the per cent supplied from upland rivers best described the pattern in cancer mortality for each cancer site and each sex. After adjustment was made for a number of socioeconomic factors, the regression coefficient for the percentage of upland river supply remained statistically significant only for female stomach cancer and female intestinal cancer. The association with intestinal cancer could equally well be explained by some other factor with a strong north-west/south-east geographical distribution. The association found for female stomach cancer could not be accounted for by a geographical trend, but suggests a small effect, equivalent to a relative risk of only 1.11. This is an unexpected finding and must be considered a hypothesis, to be tested further by studies conducted by other researchers, in different locations, preferably on individuals.

Indices of thyroid function were measured in 229 healthy term neonates at birth and at 5, 10, and 15 days of age. Results were analysed to assess whether maternal diabetes mellitus, toxaemia of pregnancy, intrapartum fetal distress, duration of labour, method of delivery, asphyxia at birth, race, sex, birthweight, birth length, head circumference, or method of feeding influenced any index. Thyroxine, the free thyroxine index, and free thyroxine concentrations at birth correlated with birthweight. Method of delivery influenced mean thyroxine and free thyroxine index values at birth and at age 5 days. Mean values of triiodothyronine, reverse triiodothyronine, thyroxine binding globulin, and thyroid stimulating hormone were not affected by any of the perinatal factors studied. Birthweight and perhaps method of delivery should be taken into account when interpreting neonatal thyroxine parameters but determination of thyroid stimulating hormone as a screen for congenital hypothyroidism in healthy term neonates circumvents these considerations.