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Observes that a major risk factor for developing malignant melanoma is severe exposure to the sun in childhood and adolescence. Summarises the epidemiology of skin cancers, including the alarming rate of increase in new cases of malignant melanoma. Describes the Government target of halting the rise each year in newly diagnosed cases of skin cancers by 2005. Given the dearth of suitable resources available to assist health educators in teaching young people about the harmful effects of the sun, describes the development of a user‐friendly teaching pack suitable for Key Stage 2 children (7 to 11 years), which aims to promote positive behaviours. Suggests that educating children at this crucial stage may lead to a decrease in new cases of skin cancer in future years. Shows that early evaluation of the teaching course has so far been encouraging.

Trends in HIV seroprevalence, AIDS and prevention policy among intravenous drug users and men who have sex with men, before and after 1990 in Austria.

This study reports for the first time on secular trends in human immunodeficiency virus (HIV) infection and AIDS, and possible associations with prevention policy in Austria. We analysed HIV seroprevalence and AIDS cases among intravenous drug users (IDU) and men who have sex with men (MSM). In this study we found a diminished rate of increase in new cases of AIDS and a decline in HIV seroprevalence among IDU but not among MSM. Among clients visiting HIV counselling and testing centres in Austria between 1987 and 1990, seroprevalence among IDU was estimated at 27.9% as compared to 19.6% between 1990 and 1992 (odds ratio (OR): 0.62; 0.45-0.85). Among MSM corresponding prevalence for these two periods was 12.1% and 10.9%, respectively, which was not a significant decline. In the period 1990 to 1994, the increase in AIDS cases per half-year levelled off for IDU (incidence rate ratio (IRR) :1.00; 0.99-1.01) but to a lesser extent among MSM (IRR: 1.01; 1.01-1.02). The most effective prevention policy intervention was considered to be the national Methadone Maintenance Program (MMTP), started in 1987, and the provision of sterile injection equipment. We observed that in the recent period there was a decline in the frequency of attendance among young (less than 28 years of age) MSM at counselling centres (OR: 1.27; 95 % CI: 1.08-1.49), accompanied by the observation that the rate of seroprevalence among this group did not decline. This is in contrast to young IDU where attendance did not decline but seroprevalence did. Although inference is limited from cross sectional studies, we argue for a reoriented and effectively monitored HIV prevention policy focused on young MSM.

Human hydatidosis in Dalmatia, Croatia.

Human echinococcosis remains a very serious public health problem worldwide, although a decline in incidence has been observed in some endemic areas during the last decades. However, in some non-endemic areas an increase in new cases and new foci of animal echinococcosis were registered during the same time. In Dalmatia, a well known endemic area of hydatidosis in the most Mediterranean part of Croatia, from the mid-1950s until present a decrease of incidence of over 70% has been registered. Age, sex and occupational category specific incidence as well as lethality rate have remained the same as before. Migrations from rural to urban regions seem to be the most important parameter in the changing epidemiology of human hydatidosis in Dalmatia.

Tuberculosis in pregnancy

Tuberculosis has re-emerged as a serious health problem throughout the world. In the United States, the human immunodeficiency virus epidemic, increased numbers of foreigners from areas where tuberculosis is endemic, and lack of an adequate infrastructure to deal with the large increase of new cases have led to tuberculosis being a serious problem. Because of the long treatment time required, there is a significant risk of developing drug resistance in partially treated patients. Directly observed therapy is a cornerstone of treatment in both pregnant and nonpregnant patients. We need to think about those at risk for tuberculosis in pregnancy and screen the high-risk population. With the advent of satisfactory drugs to treat tuberculosis, the effects on pregnancy are not as serious as before. However, particularly in low socioeconomic populations, tuberculosis probably increases the prematurity and abortion rate.

Chronische Granulomatöse Chorioretinitis bei Tuberkulose

Though the incidence of tuberculosis decreased substantially during the second half of the century, a steady increase of new cases has been observed within the last decade. Among other reasons, the growing number of immunodeficient patients (e.g. HIV, therapy with immunosuppressive agents) and migration from underdeveloped to industrial countries contribute to this finding. A 57-year-old male patient presented with a history of chronic bilateral chorioretinitis of unknown origin. During the last months a marked decrease in visual acuity of the left eye was noted. Prior diagnostic attempts had not led to a specific diagnosis. Notable was the history of long-term systemic corticosteroid therapy for chronic obstructive lung disease. Funduscopy of the right eye revealed a choroidal granuloma with adjacent serous retinal detachment. Both eyes showed multiple dot-like lesions in the retinal pigment epithelium of the posterior pole. Finally the diagnosis could be made by isolating Mycobacterium tuberculosis from sputum samples and gastric aspirate. Within a few weeks after starting tuberculostatic therapy the ocular symptoms regressed and the visual acuity improved significantly. Securing the diagnosis of tuberculous uveitis is often difficult. The differential diagnosis includes other granulomatous ocular inflammations. The detection of Mycobacterium tuberculosis and the clinical course make the diagnosis most likely. Tuberculosis should always be included in the differential diagnosis as a possible etiology for uveitis, particularly in those cases taking a chronic course. Despite the recent emergence of drug-resistant strains in most cases tuberculosis is a well curable disease.

The epidemiology of tuberculosis in Gran Canaria, Canary Islands, 1988-92: Effectiveness of control measures

Setting: Since there is no national programme for tuberculosis control in Spain and the epidemiological situation in this country is unknown, a programme against tuberculosis in Gran Canaria (Canary Islands) was started in 1987. Objective: To analyze the impact of this control programme, particularly the trend of new cases of tuberculosis by age groups and risk factors for 1988-92. Design: A detailed search of all new cases of tuberculosis was carried out by examining the files of all public and private hospitals and outpatient clinics of the island, the records of the Services of Clinical Microbiology and Pathology of the public hospitals, and the registers of patients with AIDS. Results: The annual rates of new cases of tuberculosis per 100 000 were 32.2 in 1988 (214 cases), 26.2 in 1990 (174 cases), and 29.4 in 1992 (196 cases), and the rates of sputum-positive cases 13.3 (89 cases), 12 (80 cases) and 15 (100 cases), respectively. The distribution of tuberculosis cases by age peaked in the age groups 40–49 and 30–39 years. Between 1988 and 1992, statistically significant differences were found in the percentage of cured patients (21% [ 45 214 ] vs 85.7% [ 168 196 ]), patients with a delay in diagnosis > 3 months (40.2% [ 86 214 ] vs 21.9% [ 43 196 ]), and contacts evaluated (45.3% [ 97 214 ] vs 90.3% [ 177 196 ]). However, an upward trend in the incidence of tuberculosis for 1990-92 was found in association with an increase of new cases among the homeless, immigrants, and HIV-infected people. When these three population groups were excluded from the analysis, the annual rate for the total population showed a progressive decline from 1988-92. Conclusions: The data studied here show that successful priority control measures (cure rate, early diagnosis, study of contacts) have been achieved in this island. It is necessary, however, to develop strategies for combating the tuberculosis problem in specific high risk populations.

Incidence of eating disorders in psychiatric hospitals and wards in Denmark, 1970-1993.

Two previous studies in Denmark found diverging results in analyzing trends in new cases of eating disorders in the psychiatric in- and day-patient services, although the same data source, the nationwide Danish Psychiatric Case Register, was used. The present study--also using information from the nationwide Danish Psychiatric Case Register, but correcting for several register biases--confirms a highly significant increase in new cases of eating disorders in psychiatric hospitals and wards. The increase is seen exclusively in younger females. The diverging results in the previously mentioned studies in Denmark may be ascribed to methodological issues.

Surveillance of AIDS in the United Kingdom.

The surveillance of cases of the acquired immune deficiency syndrome (AIDS) in the United Kingdom is described and a preliminary analysis made of the 1012 cases that were reported to the end of August 1987. Homosexuals were the largest risk group. For the first time it is possible to present cases by the date of diagnosis and by the regional health authority of residence. The rate of increase of new cases shows no sign of slowing down. One third of patients with AIDS lived in a different regional health authority from that in which their disease had been diagnosed. The geographical distribution varied with the risk group. The commonest presenting clinical feature at diagnosis was Pneumocystis carinii pneumonia. Kaposi's sarcoma was considerably more common among homosexuals than among people in other groups at risk.

Survey of patients presenting to the government chest service in Hong Kong and the effects of active tuberculosis case-finding by publicity campaigns

A previous survey showed that many of the patients diagnosed in a Government chest clinic as new cases of active pulmonary tuberculosis had already attended one or more private practitioners, and that this often resulted in a considerable delay before first attending the Government clinic. Furthermore, outside the Government clinics the standards of investigation, diagnosis and treatment were found to be very variable and patients were, in general, ill informed about the Government chest clinics and the free service they offered. Active case-finding campaigns using television, radio, posters, and leaflets were therefore conducted in 1979 and 1981 and the effects of the campaigns monitored. The aim was to encourage people with a cough which had lasted for a month or more to attend a Government chest clinic for free advice and, if necessary, treatment. In the event, during and immediately after the campaigns there were only minor increases in the numbers of new clinic attenders and of patients with cough, and there were no detectable increases in new cases of tuberculosis. The campaigns failed, in particular, to persuade middle-aged and elderly men with cough and sputum to attend a clinic, although there is evidence that in this group there is a high incidence of tuberculosis requiring treatment.

Genetic characteristics of hemophilia A in Chile.

A genetic and demographic study of 40 kindreds (113 cases) with hemophilia A, representing one quarter of all Chilean cases is reported. Only 10 sporadic cases were found. Segregation analysis of progeny from matings Aa X AY showed p = 0.2206 +/- 0.043. Fertility of 59 obligatory carriers was 3.88 children per mother with a mean age of 49.9 years, a figure higher than the mean of a control population, 3.36. The fertility of hemophiliacs was found to be 2.3 compared with their normal sibs with 3.15 children per couple. Life expectancy at birth in hemophiliacs was 22.4 years, compared with 28.1 for their normal brothers, 34.4 for their sisters and 58.5 and 64.6 for males and females in the general population. Mean relative fitness was calculated as 0.45 and the prevalence of hemophilia A in Chile as 1 case among 13,500 males. A preliminary estimate of the mutation rate was 1.35 X 10-5, within expected ranges. During the last 10 years, family planning and modern treatment with cryoprecipitates have increased the mean age of living hemophiliacs from 12.7 up to 22.7 years, and life expectancy from 15.6 to 22.4 years. Probably relaxation of natural selection will account for a possible increase of new cases of hemophilia A in the near future.

Course and prognosis of Crohn's disease.

During the period 1938-70 there were 303 patients at the Radcliffe Infirmary, Oxford, diagnosed as suffering from Crohn's disease. Of these, 82 have been excluded, leaving 221 with a firm diagnosis. These patients have been divided into 'new cases', in which the disease was diagnosed at the Radcliffe Infirmary, and 'referred cases' in which the diagnosis was already made at the time of referral. In this series, there were three main sites of involvement: small intestinal, large intestinal, and both small and large intestinal. Ileocolitis was the commonest anatomical distribution. The disease showed progression to new, sites in a considerable number of the patients during the period under study. There was a fivefold increase of new cases between the first and third decades covered by the study and this applied equally to patients presenting as an acute abdomen, which supports the idea that the disease is truly increasing. Survival curves have been plotted and compared with expected survival curves. In terms of mortality, Crohn's disease emerges as a disease which becomes progressively more dangerous as the years go by, which is in sharp contrast with the findings in ulcerative colitis in which the main risk of dying is in the early years.

大阪大学微生物病研究所癩部門における最近の癩外来患者と,本学の過去63年間の癩患者についての統計的観察

There has been a marked decrease in new cases of leprosy from 1903 to today. If the ratio of new cases of leprosy to the total number of patients visiting the Dermatology Department in 1938 taken as 100, the ratio in 1963 is 14. This sharp decrease may be attributed to improvement in hygienic environment, isolation of patients and the widespread practice of giving BCG vaccinations. It is not clear, however, which of these factors has played the major role.Of the 183 patients treated in the out-patients clinic of the Institute in the past one year, 129 (70%) are home therapy cases and 53 (30%) have been treated in a leprosarium at one time or another. Though 70% of the out-patients are being treated at home without hospitalization, there has been no special increase in new cases of leprosy in the Osaka- Kobe area because of this.In the Meiji (1903-1911), Taisho (1912-1925) and early Showa (1926-1938) eras, the peak in the age range of new cases of leprosy was at 20-30 years but recently (1950-1963), two peaks, one at 20-30 years (mostly the L-form) and another at 50-60 years (almost all T-form) have become apparent. New cases in the 50-60 year range have, of course, occur- red previously but the number of cases was small compared to the cases in the 20-30 year range and did not form a peak. The extension of the life span with an increase in the number of old aged has also contributed to this. The reason for infection in the aged is not clear but it can be assumed that, similar to childhood, there is a decline in resistance to the leprosy bacillus.The ratio of new cases of T-form to L-form, which was 7.1: 1 in the Meiji era (1903- 1908) has gradually declined and is 1: 0.9 today. In Japan, the T-form was previously predominant similar to India and Southeast Asia but today, there has been a marked decrease in the T-form but the decrease in the L-form has not been so pronounced.This increase in new cases in the aged and the reversal in the ratio of T-form to L-form are extremely interesting from the epidemiological viewpoint.This report was prepared in commemoration of the 35th anniversary of the founding of the Osaka Dermatological Institute.

EFFECT OF COINCIDENTAL PENICILLIN ADMINISTRATION ON THE SPREAD OF SYPHILIS: AN ATTEMPT AT QUANTITATION.

For a variety of reasons, many early syphilitics go undiagnosed. They may: remain untreated; be treated on epidemiologic grounds as recent sex contacts of patients with infectious syphilis; or be treated coincidentally (by happenstance) with penicillin given for another disease. Penicillin in ordinary dosage is effective against coexistent early syphilis. The broad spectrum antibiotics, in usual dosage, are not. In this presentation an attempt has been made to show the effect of penicillin, administered for other diseases, on the spread of syphilis. That an expected 3.4% increase in new cases per generation of syphilis is converted to an 8.4% decrease by inclusion of the happenstance factor is demonstrated via diagrams. Its cumulation effect over several generations is readily apparent. Happenstance penicillin treatment is considered to have been a major factor in the dramatic decline in the incidence of syphilis in the early fifties. Less widespread use of penicillin for nonsyphilitic ailments is believed to be a major factor in the recent resurgence of syphilis. The effectiveness of happenstance penicillin therapy in limiting the spread of syphilis lies primarily in: Its ability to abbreviate the duration of infectiousness, often reaching (and curing) the early syphilitic before he has had any chance to disseminate his treponemes; Its ability to reach (and cure) the unidentified syphilitic who escapes, and will continue to escape, the epidemiologic dragnet. Because it is unlikely that penicillin will ever again be used as widely as it was ten to fifteen years ago, other methods must be sought to bring treponemicidal agents in curative dosage, early in his infectious period, to the unidentified syphilitic.

THE EPIDEMIC RECEDING.

The situation in New Orleans continues to improve, while in the remainder of Louisiana there are some seriously infected points, but there is no longer a general increase of new cases and foci. The storm center of news for the past week has rested in Mississippi, with a lively subsidiary center at Memphis. Another town conspicuous for its boasted "air-tight" shotgun quarantine—Vicksburg—has been compelled to admit the presence of infection. In the case of several towns, infection has been discovered, or admitted, only after a person recently from the town has fallen ill with the disease elsewhere, thus leading to a tracing back of the infection. A notable and welcome feature of the week's news has been the<i>volte</i>face of Governor Vardaman. His views on quarantine and on methods of fighting the epidemic have come quite into accord with those of the best posted medical men, and for this