Family Mem Research Articles

In Search of Hospice Information: Consumer Information Available on Hospice Compare and Yelp.

Background: The hospice industry has expanded in recent years with limited oversight and few consumer-facing resources to assist consumers in selecting hospice agencies to care for their family members.Objectives: To better understand the availability of consumer-facing hospice information and how hospices are evaluated by these websites, this study examined two websites with national reach—the Centers for Medicare and Medicaid Services' Hospice Compare (HC) website and Yelp.com. We described Yelp hospice ratings and caregiver-reported ratings on HC and compared conceptually related HC ratings to each other.Methods: We collected hospice ratings from Yelp and hospice- and caregiver-reported quality indicators (QIs) from HC for all California hospices. We conducted descriptive statistics for all variables and conducted chi-square to examine differences in proportions for categorical variables. We conducted Pearson's correlation coefficient (r) to test the strength of the association between the hospice-reported pain assessment QI and the caregiver-reported indicators on HC.Results: Among our sample of 1040 California hospices, HC reported QIs for 200 (19.2%) hospices for the caregiver-reported QIs ranging to 448 (43.1%) hospices for the hospice-reported QIs. Just 236 hospices (22.7%) had a Yelp review. Hospice ratings on both Yelp and HC were fairly high. For-profit hospices were less likely to show HC QIs or to be rated on Yelp. Caregiver-reported HC ratings for pain and symptom management were significantly lower than conceptually related HC hospice-reported QIs.Conclusions: More research is needed to understand the lack of hospice representation on HC and investigate the usefulness of hospice-reported HC measures.

Model Pelaksanaan Mediasi Melalui Pranata Tutur Pada Masyarakat Batak Muslim Tapanuli Selatan

This article examines the contribution of local culture or costum ( adat ) in family conflict management among Batak Muslims in Southern Tapanuli. It is very common that marital conflicts ended up in the court. To avoid engaging court to judge a marital conflict within a family, Batak Muslim in Southern Tapanuli utilized Dalihan Na Tolu custom to resolve the problem. Batak Muslims in Southern Tapanuli often mediated the conflicting couples through a process, which is referred to as Tutur . By utilizing anthropological and socio-legal approach, the authors analyze the effectiveness in utilizing Tutur tradition among Batak Muslim family and argue that local costum such as Tutur has still played an effec- tive role in preventing divorce as well as in reconciling conflicting family mem- bers.

Burnout in Music Therapists: Work, Individual, and Social Factors

Music therapists work in range of settings that may evoke higher than normal levels of professional stress. Furthermore, demographic, psychosocial, and environmental factors in these work settings may create levels of stress that actually lead to burnout (Youngshin, 2012). In addition to common experiences of caring for others (e.g., Dewe, 1989), Youngshin (2012) outlined several factors experienced by music therapists that may generate additional workplace stress. These include therapist age, work experience, workload, role conflict/ ambiguity, and personal characteristics. This literature review outlines definitions and descriptions of burnout and compas- sion fatigue, and related work, individual, and social factors contributing to burnout to the profession of music therapy.Burnout and Compassion FatigueBurnoutDefinition. Keidel (2002) defined burnout as a of physical exhaustion including negative self-concept, nega- tive job attitude and loss of concern and feelings'' (p. 200). Maslach, Jackson, and Leiter (1996) describe burnout as syndrome of depersonalization, emotional exhaustion, and sense of low personal accomplishment that leads to decreased effectiveness at work'' (p. 358).Causes of burnout. Keidel (2002) addressed several categories of factors that cause burnout and compassion fatigue among hospice caregivers:1. Personal characteristics of the patient care staff, patient, and primary caregiver. These included culture, race, sex, sexual orientation, age, stage of illness, and education, which challenge caregiver's views of suffering, death, and dying.2. Societal influences. The contrast between the hospice recognizing that comfortable death for terminally ill patient is success, and society's perception of death as medical failure.3. Problems with the healthcare system. Numerous regu- lations, insurance problems, and excessive paper work, all consume staff time and energy, leaving less available for direct patient care.4. Institutional Problems. Short staffing and mandatory overtime.5. Problems with the nursing system. Job related tasks such as working with dying patients and distraught family members are uncomfortable and often stressful tasks that are presented as normal'' by the institution.6. Problems with the hospice system. Administrative stresses such as financial pressure, tensions in staff interactions and lack of support may cause feelings of isolation or lack of control over one's working environment.7. Stresses related to patient's family. Families may have complicating factors such as depression, family mem- bers who do not get along, or may differ on issues such as healthcare decisions. (pp. 201-202)In reviewing these categories, there are number of parallels that apply to music therapists. Undeniably music therapist's ability to provide care and compassion will be affected by these seven factors. Though the literature on burnout is more developed for professions such as nursing, this topic is significant for music therapists as well because professional and/or personal burnout are real possibilities as this paper demonstrates.Niven (2000) examines three categories of burnout factors for their validity, applicability, and generalization to music therapists. The categories include work, individual, and social factors (see Table 1 for detailed description of each category).Stages of burnout. Gorkin (2012) outlined four stages of burnout namely: physical, mental, and emotional exhaus- tion; shame and doubt; cynicism and callousness; and failure, helplessness, and crisis. It is important for music therapists to recognize what stage they may be at in order to prevent themselves from reaching point where conse- quences are critical.Compassion FatigueCompassion fatigue is another type of negative outcome associated with stress, frustration, and dissatisfaction at work. …

Chisel of Remembrance: Poems by Vera Schwarcz

, the poem "Passing On," the broth 1 ers lament their relationship with , their father, for he was "difficult 1 always to satisfyand relax? / how i impossible to talk to, in fact,how 1 expert with silence." The Mower viv i idlydemonstrates Andrew Motion's , illuminating discovery of his own voice and his gift of voice to both , his father's generation and today's, 1 a gift that renders this collection i worthy of perusal. 1 Matilda Saenz i Mountain View College,Dallas i Pedra foguera: Antologia de poe , sia jove dels Paisos Catalans. Enric 1 Casasses, preface. Palma de Mallorca, i Spain. Federaci? Llull /Documenta Bale 1 ar. 2008. 201 pages. 7. isbn978-84 ! 96841-65-9 i "Pedra foguera" in Catalan means , "flint stone"?the actual stone, not 1 the cartoon. This is an anthol , ogy of young poets (under thirty) 1 from the Catalan-speaking lands, i which include not only Catalonia 1 but also Valencia in southeastern i Spain and the Balearic Islands as well (the anthology was published i inMallorca). , Pedra foguera is an anthology 1 of poets more than an anthology i of poems. There are twenty-eight 1 authors included, all of them repre i sented by a picture, a brief statement ' of poetics, an autobiographical note, i and three poems, most of which , were previously unpublished. But it 1 is,above all, an anthology fortheedi , tors: all themembers of the anthol 1 ogy's five-person editorial board are i included in the volume. An elder ' poet-performer, Enric Casasses? i one of themost respected voices of , the Catalan scene?celebrates their 1 appearance in his preface. , Poet Gabriel Ferrater used to 1 say that in a literary world as small as Catalan's, a single author was turned into a literary movement. Do theseyoung poets represent twenty eight literarymovements? By no means. If one were to take their poetics seriously, their definitions ofwhat poetry is range fromadoles cent naivete, such as Ivette Nadal's "Patiment + Filosofia = Poesia" (Suf fering+ philosophy = poetry) to the ironically intriguing, such as Pere Antoni Pons's: "La poesia consisteix a expressar els misteris i les passions de la vida sense fergaire el ridicul" (Poetry is a way to express life's pas sions and mysteries without making a foolof oneself). Some of the poets represent ed here, such as Pere Antoni Pons, Josep Pedrals, Marti Sales, Carles Rebassa, and Jaume C. Pons Alorda, have published several books, and their careers continue to show much promise. Pedrals and Rebassa, as well as others such as Bianca Llum Vidal and Clara Fontanet, often read and perform their work inpublic. On theone hand, ifthisanthol ogy makes anything clear, it is that contemporary Catalan poetry is alive, with plenty of young poets, some of them promising. On the other, for those poets included in Pedra Foguerawho have yet topub lish much of theirpoetry, threeshort poems is far too short a sample to perceive whether or not their flint will lightan enduring fire. Melcion Mateu New YorkUniversity Vera Schwarcz. Chisel of Remem brance: Poems. Simsbury, Connecticut. Antrim. 2009. ix+ 76 pages. $16. isbn 978-0-9817883-2-6 Vera Schwarcz is a Jewishhistorian and poet who has built a formidable reputation on an impressive list of publications, including the prize pedra foguera antologia de poesia jove dels paisos Catalans winning Bridge across Broken Time: Chinese and JewishCultural Memory (1999). Her poetry blends a wom an's sensitivity and imagination, a Jew's religious piety, the erudition of a multilingual scholar, and the deep sense of responsibility in a child ofHolocaust survivors. Chisel ofRemembrance, the titleof her lat est volume of poems, manifests a central theme in all of Schwarcz's work?namely, "the quest for remembrance." Schwarcz incorporates in these poems remembrances of her childhood and her family mem bers, of the sufferingsof the Jewish people in general, of ancient Juda ism, and of other ancient cultures, especially Chinese culture. These remembrances are more often than not intermingled, sometimes in unexpected ways. In "Hands," for instance, the poet addresses her grandfather, whom she never knew. He "died inbed, / a heart attack. / Jews did not just die / in 1944." The second sentence...

The Mower: New and Selected Poems by Andrew Motion

The Mower: New and Selected Poems by Andrew Motion

Some remarks on Talcott Parsons’s family

It is no doubt very well known that Talcott Parsons was of New England ances try. It may be less well known how pure this ancestry was. His father, my grandfa ther Edward Smith Parsons (1863-1943), had a strong interest in genealogy and did quite a bit of work (evidently some of it with the help of other family mem bers)2 tracing his ancestry and that of his wife, Mary Augusta Ingersoll Parsons (1863-1944). He verified that every line of the ancestry of both could be traced back into seventeenth-century New England. Several ancestors apparently came to Massachusetts Bay Colony in its earliest years, and it appears that one came on the Mayflower. Grandfather wrote out handwritten copies of the genealogy for his chil dren. The one he gave to my father is now in my possession, but some years ago we gave a copy of it to the Harvard University Archives, so that some of you may have seen it. In this paper I will say something about the earlier history of the family up to Grandfather's generation, mentioning some individuals who might interest you. Then I will say something about my grandfather's life and his world as I perceive it. The aspects of it that have struck me most forcefully have not only vanished; they were beginning to vanish in the last years of his life, and I will mention some intra-family events that were part of that process. What I find most striking about my grandfather is the strength of his New England identification, even though neither he nor his wife was born or reared there. This seems to have been shared by others in his milieu and by other family members in the nineteenth and early twen tieth centuries. There was evidently for a long time a self-conscious New England diaspora to which Edward and Mary Augusta Parsons belonged. Although the phe nomenon seems to be recognized by historians, it has not been systematically stud ied, and my own efforts to obtain relevant readings have been largely frustrated, in spite of helpful responses to inquiries with Harvard historians.3

Wide complex rhythm and cardiac arrest

m h p b w e e ( s t r. Peter Pang: Today’s case is that of a 54-year-old oman who presented to the Emergency Department ED) in respiratory distress. Paramedics were called for hortness of breath and weakness. At the scene the paient complained of worsening shortness of breath hroughout the day, increasing significantly over the past our, and generalized weakness over the past week. ccording to the paramedics, the patient denied chest, ack, or abdominal pain. There were no fevers, chills, ausea, vomiting or diarrhea. The past medical history ncluded depression and a pulmonary embolism (PE). ital signs in the field were: blood pressure 104/60 mm g, heart rate 70 beats per minute (bpm), and respiratory ate 24 breaths per minute. During transport, the patient ecame increasingly short of breath and lethargic. Upon rrival in the ED, the patient deteriorated rapidly. She ad clear lungs, a slow regular heart rate, soft abdomen, nd bilateral lower extremity edema. The patient was ethargic, minimally responsive to verbal stimuli, and oving all four extremities. During transport from the aramedics’ gurney to the hospital stretcher, the patient’s espiratory effort ceased, and no pulses were palpable. Dr. Eric Nadel: Are there any questions about the nitial presentation? Dr. Emily Senecal: You mentioned the past medical istory included pulmonary embolism and depression. as the patient taking any medications? Were any pill ottles found in the house? Was there any family mem-

Criminal Procedure Reform in the People's Republic of China: The Dilemma of Crime Control and Regime Legitimacy

CRIMINAL PROCEDURE REFORM IN THE PEOPLE'S REPUBLIC OF CHINA: THE DILEMMA OF CRIME CONTROL AND REGIME LEGITIMACY Mike P. H. Chut I. INTRODUCTION During the era of reforms in China and the resulting rapid social changes, criminal law and proceedings have primarily been used as an instrument to combat the upsurge in crime and cor- ruption, and to punish individuals that have had the temerity to challenge Party rule. In effect, criminal institutions have been widely regarded as an important discretionary instrument of the Communist Party to institute social and political order.' It is only through recent developments in China's criminal procedure that the Party has recognized and elevated the rights of criminal suspects against the interests of the state. Changes in China's criminal procedure constitute a critical component of the whole legal reform package and reflect how the regime will respect its commitment to the protection of human rights and the develop- ment of the rule of law. This study approaches the question of human rights and the rule of law in China by examining aspects of due process, equal- t Ph.D. candidate, Department of Political Science at the University of Chi- cago. B.A. 1994, University of California at Berkeley. M.A. 1995, Stanford Univer- sity. The author would like to express his thanks to those who organized the interviews in China and to the interviewees who took time to reveal aspects of legal change in China. The author is also grateful to Professor Dali Yang, Yuan Bai, and Fubing Su for their constructive comments on earlier drafts, and to his family mem- bers for their support. 1. See generally Donald C. Clarke & James V. Feinerman, Antagonistic Con- tradictions: Criminal Law and Human Rights in China, 141 CHINA Q. 135, 152-3 (1995). See also LAWYERS COMM. HUMAN RIGHTS, CRIMINAL JUSTICE WITH CHI- NESE CHARACTERISTICS: CHINA'S CRIMINAL PROCESS AND VIOLATIONS OF HUMAN 1, 2 (1993); Xu Youjun, Zhongguo Xingshi Susong yu Renquan [China's Criminal Procedure and Human Rights], 2 ZHONGWAI FAXUE [Peking University RIGHTS Law Journal] 38, 38-43 (1992); No ONE AMNESTY INT'L, CHINA, REPRESSION AND ABUSE OF POWER IN THE 1990S 9 IS SAFE: POLITICAL

Dilemmas of Cosmopolitanism: Karl Popper, Jewish Identity, and “Central European Culture”

“There was and there always will be something called the ‘Republic of Scholars,’” art historian Ernst Gombrich said recently. “We scientists or scholars, res publica litterarum, stick together and our home is our work. I do not feel myself an Englishman. I feel myself to be exactly what I am: a Central European who works in England.” Like other Central European emigres, Gombrich thought himself a member of a cosmopolitan scholarly community. But his self-identification as both a “Central European” (not an Austrian or Viennese) and a citizen of a timeless and contextless Republic of Letters seems strange. Neither interwar nor postwar Central Europe represented a unified entity, political or cultural, likely to draw the allegiance of an assimilated Jewish exile. Ethnonational tensions in the successor states to the Habsburg Empire, the Holocaust, the expulsions in the aftermath of World War II, and the Iron Curtain shattered whatever semblance of cultural unity Central Europe may have had. Gombrich recognized early on that Austria had no place for him. He emigrated to England in 1936 and tried desperately to convince family mem-

Youth Unemployment: Does the Family Matter?

Conventional models of the incidence of unemployment in the youth labour market are augmented by variables describing the unemployment status of family mem bers. These variables are typically highly significant, and associated with unemploy ment effects greater in magnitude than those associated with personal characteristics such as educational attainment. Application of a within-family estimator reinforces the conclusion that family and regional circumstances are more important in determining unemployment outcomes than personal characteristics. This suggests that regional employment initiatives might be a more appropriate focus for policy than policies such as job training aimed simply at improving the employability of individuals.

Syndromes of Thrombosis and Hypercoagulability: Congenital and Acquired Thrombophilias

This article stresses the common hereditary and acquired blood protein defects associated with thrombosis. The most common of the hereditary defects apear to be APC-R, SPS, antithrombin, protein C, and protein S deficiency, and the most common acquired defects are anticardiolipin antibodies and the lupus anticoagulant (antiphospholipid antibodies). Therefore, these are the defects that should first be looked for in an individual with unexplained thrombosis. If these more common defects are not found, then the rarer defects including HC II, plasminogen or TPA deficiency, dysfibrinogenemia, el evated PAI-1 and hyperhomocysteinemia should be sought. The importance of finding these defects has significant impli cations for therapy of the individual patient and for institutions of family studies to identify, inform, and possibly treat others at risk. It is expected that as knowledge of hemostasis expands, more hereditary and acquired defects, such as elevated lipopro tein (a) or defects of extrinsic (tissue factor) pathway inhibitor (EPI, TFPI), may be associated with enhanced risks of throm bosis. Finally, it must be recalled that a diagnosis of thrombo sis, like that of anemia, is only a generic and partial diagnosis; just as in the anemic patient, the etiology must be clearly de fined. Only in this manner can cost-effective and appropriate therapy for both primary treatment and secondary prevention be designed. In addition, the demonstration of a hereditary defect will allow primary prevention in afflicted family mem bers by allowing the choice of appropriate therapy.

Familial Thrombophilia: A Review Analysis

The correct approach to the management of the asymptomatic carrier with a recognized inherited thrombophilic disorder is uncertain because reliable in formation of the risk of spontaneous (unprovoked) throm bosis in these disorders is not available. To determine the best available estimate of the annual incidence of spon taneous thrombosis in asymptomatic carriers of disorders that have been linked to familial thrombophilia, we per formed a literature review. Using Medline search from 1965 to 1992, supplemented by manual searches, we re trieved all articles that presented data on antithrombin III, protein C, protein S, dysfibrinogenemia, plasmino gen, histidine-rich glycoprotein, heparin cofactor II, and fibrinolysis in relation to thrombosis. Publications were included in the analysis if they (1) reported one or more probands with thrombotic disease and a heterozygous biochemical abnormality of the hemostatic system, (2) assessed the presence of this abnormality in family mem bers independent of the presence or absence of a history of thrombotic disease, and (3) assessed the presence of a history of thrombotic disease in all available family mem bers. The biochemical status and clinical details of all family members reported were extracted from each eligi ble article. For each abnormality the odds ratio for throm bosis was compared in family members with and without the biochemical abnormality. If applicable, thrombosis- free survival and age-specific incidences of thrombosis were calculated. The thrombotic episodes were classified as spontaneous or secondary to a recognized risk factor, and the proportion of spontaneous episodes was calcu lated. The influence of diagnostic suspicion bias in symp tomatic patients with a family history of thrombosis was reduced by recalculating the absolute incidence of throm bosis from the odds ratio after adjusting the incidence of venous thrombosis in nonaffected family members to that observed in the general population. Statistically signifi cant associations between the presence of a biochemical abnormality and a history of venous thrombosis were found for antithrombin III deficiency types 1 and 2a and 2b, protein C deficiency type 1, and protein S deficiency type I. Dysfibronogenemia was statistically significantly associated with venous as well as arterial thrombosis. Thirty-five to 67% of the events were classified as being provoked, as they occurred following exposure to a rec ognized risk factor for thrombosis. The recalculated an nual incidence of spontaneous thrombosis was 0.6 to 1.6%/year. It is concluded that this relatively low inci dence does not warrant life-long continuous use of anti coagulant prophylaxis since the reported risk of major and fatal bleeding associated with the use of oral antico agulants is 2-3 and 0.4%/year, respectively.

Normal Sialophorine (CD43) Expression in a Thrombocytopenic and Immunodeficient Woman Carrier of Wiskott—Aldrich Syndrome

We report on a 24-year-old thrombocytopenic woman with a history of recurrent infections, skin and mucosal bleeding, and a member of a family with the Wiskott—Aldrich syndrome. Hemorrhagic complications occurred at age 20, when mild peripheral thrombocyto penia (38-52 g/L) was confirmed. Four male family mem bers died of infectious complications at ages ranging from 6 months to 3 years. At the time of the study, she was free of infection. Physical examination exhibited ecchymoses of skin of the legs only, and her laboratory investigations demonstrated a lack of secondary waves of platelet ag gregation with adenosine diphosphate (ADP) and prolon gation of the lag phase after collagen stimulation. Inten sities of aggregation induced by ADP, collagen, and thrombin were decreased. Patient's plasma aggregating activity was diminished. Abnormal intraplatelet malo nylodialdehyde formation was also found. Assessment of the platelet volume distribution demonstrated the pres ence of normal-size population. Examination of isolated platelets by electron microscope showed a reduced num ber of dense bodies. The content of mepacrine-labeled platelet bodies in the fluorescent microscopy study was also diminished. Immunological investigations revealed a slight decrease in immunoglobulin G (IgG) serum concen tration and a low isohemagglutinin titer. Additionally, di minished percentages of T activated and total B cells were detected. Moreover, a slight increase of natural killer cells was revealed. Lymphocyte surface sialophorin (CD43) expression was normal. Polymorphonuclear cell (PMN) phagocytosis, chemotaxis, spontaneous migra tion, intravascular polymorphonuclear granulocyte aggre gate number, and Fc IgG receptor expression study all showed no abnormalities. However, a reduced bacteri cidal capacity of the PMN, reduced adhesion to albumin- covered plastic surfaces, and diminished resting super oxide/hydrogen peroxide production were found. Key Words: Wiskott-Aldrich syndrome carrier—Thrombo cytopenia—Immunodeficiency.

Midlife Women With Disabilities: Another Challenge for Social Workers

The paucity of information about midlife women with disabilities led to a qualitative study of 25 such women. The study found that these are competent, independent women who provide care for family mem bers and friends and participate in the community. However, the women need services to maintain the control necessary to function. Social workers can help them by locating role models and mentors and by working with policymakers to develop beneficial programs and policies.

Social Class and Agrarian Political Ideology: A Note on Determinants of Political Attitudes Among Full- and Part-Time Farmers

Farmers in the U.S. have had an uneven, elusive political history. On the one hand, farmers have historically been the bulwark of support for largely leftist movements such as Populism and the Southern Farmers' Alliance. However, farmers have traditionally been members and supporters of conservative organizations such as the American Farm Bureau Federation and are often regarded as the center of gravity of traditional rural conservatism. Finally, observers such as Angus Campbell and his Michigan Survey Research Center colleagues have painted a picture of farmer politics as being alternatively apathetic and volatile. The highly influential Campbell et al. account of agrarian politics depicted agrarian political behavior as shortterm and transient-prone to evaporate on solution of immediate grievances. The focus of this paper is on extending the debate over the proper categoric designation (e.g., conservative vs. liberal, stable vs. volatile) of agrarian political behavior by exploring the factors that shape politicalideological differences among farmers. While there have been a number of important changes in U.S. agriculture during the post-World War II period, two structural changes appear to be of particular relevance to this inquiry into agrarian political ideology. First, there has been a growing degree of differentiation among farmers as some farms have grown in size and scale while others have remained relatively small. Related to this trend toward differentiation is the growing prominence of part-time farming in which one or more farm family mem-

Managing the Man with the Gun

Since most homicides, we now know, occur among family mem bers and most involve firearms, there is probably no type of call more frightening to the police officer than one concerning a man with a gun. With such a call, a policeman knows very well he runs a risk of becoming one of those homicide victims. By learning how to approach disturbed people who threaten him and others with fire arms, the officer enhances his chances of survival.

DISEASES OF HYPERSENSITIVITY AND CHILDHOOD LEUKEMIA.

STUDIES have suggested that certain states of hypersensitivity may be causally related to leukemia and lymphoma.1-5 This report is an epidemiologic evaluation of allergic and conditions appearing in a relatively large collection of histories of leukemic children and their close relatives. Data were obtained by a review of records from the National Cooperative Leukemia Survey, in which 12 medical centers participated. The Survey was conducted by interviewing the parents of 498 leukemic children under 16 years of age and the parents of neighborhood controls matched by age, birth order, family size, and race. The diagnoses of leukemia were made between 1958 and 1961 by well-qualified hematologists at the participating centers. The present study is based on replies to questions regarding the presence of allergic and conditions in each family member and on pertinent information concerning hospitalizations and x-ray examinations. The conditions recorded were restricted to those occurring before the onset of leukemia in the propositus. A comparison of allergic conditions in the leukemia and control series is presented in the Table. None of the ob¬ served differences were statistically significant by the Yatescorrected chi square test (significance defined as P < 0.05). In addition, significant case-control differences were not found in the frequency of specific types of allergy (asthma, hay fever, eczema, hives) for each family member, or in the coincidence of allergy among various pairs (mother and propositus, mother and father, etc). Comparison of the and arthritic diseases also revealed no conclusive case-control differences. Articular manifestations of leukemia were excluded, so that among propositi only those with conditions clearly ante¬ dating the stated onset of leukemia were tabulated. Four leukemic children, as compared with no controls, had his¬ tories of disease ( rheumatic fever in three, rheumatoid arthritis in one). While these disorders may have been entities distinct from the ensuing leukemia, ab¬ sence of diagnostic confirmation raises the possibility that the manifestations represented an early and un¬ recognized phase of leukemia. Similarly inconclusive was the paradoxical finding that more mothers of leukemic children ( ten cases, four controls ) reported heart disease, while more control mothers ( 12 cases, 24 controls ) gave a history of fever. For other family mem¬ bers, no case-control variations in the frequency of rheu¬ matic disease were found. This study was stimulated by evidence that hypersensi¬ tivity states are familial, and that abnormal immune re¬ sponses may be leukemogenic.1 In addition, a number of reports have suggested associations between specific dis¬ eases of hypersensitivity and leukemia. An epidemiologic survey of 223 cases of childhood cancer by Manning and Carroll ' revealed a statistically significant excess of allergies