Effect of hysterectomy on pain in women with endometriosis: a population-based registry study

OBJECTIVE

To assess pain symptoms before and after hysterectomy in women with endometriosis.

DESIGN

A population-based registry study.

SETTING

Sweden.

POPULATION

Women aged 18-45 years who underwent hysterectomy for endometriosis between 2010 and 2015.

METHODS

Pain symptoms before hysterectomy and 12 months after surgery were collected from the Swedish National Quality Register for Gynaecological Surgery (GynOp). Pain symptoms were also assessed by follow-up surveys after a median follow-up period of 63 months.

MAIN OUTCOME MEASURES

Pelvic or lower abdominal pain after hysterectomy.

RESULTS

The study included 137 women. The proportion of women experiencing pain of any severity decreased by 28% after hysterectomy (P < 0.001). The proportion of women with severe pain symptoms decreased by 76% after hysterectomy (P < 0.001). The majority of women (84%) were satisfied with the surgical result. Presence of severe pain symptoms after the hysterectomy was associated with less satisfaction (P < 0.001). Pain symptoms after surgery, patient satisfaction and the patient's perceived improvement were not significantly different between women whose ovarian tissue was preserved and women who underwent bilateral oophorectomy.

CONCLUSIONS

We observed a significant, long-lasting reduction in pain symptoms after hysterectomy among women with endometriosis. Hysterectomy, with the possibility of ovarian preservation, may be a valuable option for women with endometriosis who suffer from severe pain symptoms.

TWEETABLE ABSTRACT

Hysterectomy is a valuable option for women with endometriosis and severe pain symptoms.

Altered cerebral pain processing of noxious stimuli from inflamed joints in rheumatoid arthritis: An event-related fMRI study

OBJECTIVE

To our knowledge, this is the first study assessing brain activation in response to painful stimulation over disease-relevant (finger joint) vs. neutral area (thumb nail) in patients suffering from rheumatoid arthritis (RA) compared to healthy controls (HC).

METHOD

Thirty-one RA patients and 23 HC underwent functional magnetic resonance imaging (fMRI) while stimulated with subjectively calibrated painful pressures corresponding to a pain sensation of 50 mm on a 100 mm VAS scale (P50) at disease-affected finger joint and thumbnail (left hand), and corresponding sites in HC.

RESULTS

Compared to controls, RA patients had significantly increased pain sensitivity (lower P50) at the inflamed joints but not at the thumbnail. RA patients exhibited significantly less activation in regions related to pain- and somatosensory processing (S1, M1, anterior insula, S2, SMG and MCC) during painful joint stimulation, compared to HC. No group difference in cerebral pain processing was found for the non-affected thumbnail. Within RA patients, significantly less brain activation was found in response to painful stimulation over disease-affected joint compared to non-affected thumbnail in bilateral S1, bilateral S2, and anterior insula. Further, RA patients exhibited a right-sided dlPFC deactivation, psycho-physiologically interacting (PPI) with the left dlPFC in response to painful stimulation at disease-affected joints.

CONCLUSION

The results indicate normal pain sensitivity and cerebral pain processing in RA for non-affected sites, while the increased sensitivity at inflamed joints indicate peripheral/spinal sensitization. Brain imaging data suggest that disease-relevant pain processing in RA is marked by aberrations and a failed initiation of cortical top-down regulation.

Durations of second stage of labor and pushing, and adverse neonatal outcomes: a population-based cohort study

OBJECTIVE

The associations between duration of second stage of labor, pushing time and risk of adverse neonatal outcomes are not fully established. Therefore, we aimed to examine such relationships.

STUDY DESIGN

A population-based cohort study including 42 539 nulliparous women with singleton infants born in cephalic presentation at ⩾37 gestational weeks, using the Stockholm-Gotland Obstetric Cohort, Sweden, and the Swedish Neonatal Quality Register, 2008 to 2013. Poisson regression was used to analyze estimated adjusted relative risks (RRs), with 95% confidence intervals (CIs). Outcome measures were umbilical artery acidosis (pH <7.05 and base excess <-12), birth asphyxia-related complications (including any of the following conditions: hypoxic ischemic encephalopathy, hypothermia treatment, neonatal seizures, meconium aspiration syndrome or advanced resuscitation after birth) and admission to neonatal intensive care unit (NICU).

RESULTS

Overall rates of umbilical artery acidosis, birth asphyxia-related complications and admission to NICU were 1.08, 0.63 and 6.42%, respectively. Rate of birth asphyxia-related complications gradually increased with duration of second stage: from 0.42% at <1 h to 1.29% at ≥4 h (adjusted RR 2.46 (95% CI 1.66 to 3.66)). For admission to NICU, corresponding rates were 4.97 and 9.45%, and adjusted RR (95% CI) was 1.80 (95% CI 1.58 to 2.04). Compared with duration of pushing <15 min, a duration of pushing ⩾60 min increased rates of acidosis from 0.57 to 1.69% (adjusted RR 2.55 (95% CI 1.51 to 4.30)).

CONCLUSION

Prolonged durations of second stage of labor and pushing are associated with increased RRs of adverse neonatal outcomes. Clinical assessment of fetal well-being is essential when durations of second stage and pushing increases.

The Swedish CArdioPulmonary BioImage Study: objectives and design

Cardiopulmonary diseases are major causes of death worldwide, but currently recommended strategies for diagnosis and prevention may be outdated because of recent changes in risk factor patterns. The Swedish CArdioPulmonarybioImage Study (SCAPIS) combines the use of new imaging technologies, advances in large-scale 'omics' and epidemiological analyses to extensively characterize a Swedish cohort of 30 000 men and women aged between 50 and 64 years. The information obtained will be used to improve risk prediction of cardiopulmonary diseases and optimize the ability to study disease mechanisms. A comprehensive pilot study in 1111 individuals, which was completed in 2012, demonstrated the feasibility and financial and ethical consequences of SCAPIS. Recruitment to the national, multicentre study has recently started.

Small constrained SP1-7 analogs bind to a unique site and promote anti-allodynic effects following systemic injection in mice

Previous results have shown that the substance P (SP) N-terminal fragment SP1-7 may attenuate hyperalgesia and produce anti-allodynia in animals using various experimental models for neuropathic pain. The heptapeptide was found to induce its effects through binding to and activating specific sites apart from any known neurokinin or opioid receptor. Furthermore, we have applied a medicinal chemistry program to develop lead compounds mimicking the effect of SP1-7. The present study was designed to evaluate the pharmacological effect of these compounds using the mouse spared nerve injury (SNI) model of chronic neuropathic pain. Also, as no comprehensive screen with the aim to identify the SP1-7 target has yet been performed we screened our lead compound H-Phe-Phe-NH2 toward a panel of drug targets. The extensive target screen, including 111 targets, did not reveal any hit for the binding site among a number of known receptors or enzymes involved in pain modulation. Our animal studies confirmed that SP1-7, but also synthetic analogs thereof, possesses anti-allodynic effects in the mouse SNI model of neuropathic pain. One of the lead compounds, a constrained H-Phe-Phe-NH2 analog, was shown to exhibit a significant anti-allodynic effect.

Prolonged second stage of labour, maternal infectious disease, urinary retention and other complications in the early postpartum period

Objective

To study the association between duration of second stage of labour and risks of maternal complications (infection, urinary retention, haematoma or ruptured sutures) in the early postpartum period.

Design

Population‐based cohort study.

Setting and sample

We included 72 593 mothers with singleton vaginal deliveries at ≥37 weeks of gestation in cephalic presentation, using the obstetric database from the Stockholm‐Gotland region in Sweden, 2008–12.

Methods

Logistic regression analysis. Odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated and adjustments were made for maternal age, body mass index, height, smoking, cohabitation, gestational age, labour induction, epidural analgesia and oxytocin augmentation.

Results

Rates of any complication varied by parity from 7.3% in parous women with previous caesarean section, 4.8% in primiparas and 1.7% in parous women with no previous caesarean section. Compared with a second stage <1 hour, the adjusted ORs for any complication (95% CI) in primiparas were for 1 to <2 hours 1.28 (1.11–1.47); 2 to <3 hours 1.54 (1.32–1.79), 3 to <4 hours 1.63 (1.38–1.93) and ≥4 hours 2.08 (1.74–2.49). The corresponding adjusted ORs for parous women without previous caesarean were 2.27 (1.78–2.90), 2.97 (2.09–4.22), 3.65 (2.25–5.94) and 3.16 (1.44–6.94), respectively. The adjusted ORs for women with previous caesarean were for 1 to <2 hours 1.62 (1.13–2.32); 2 to <3 hours 1.56 (1.00–2.43), 3 to <4 hours 2.42 (1.52–3.87), and ≥4 hours 2.31 (1.25–4.24).

Conclusions

Risks of maternal complications in the postpartum period increase with duration of second stage of labour also after accounting for maternal, pregnancy and delivery characteristics. Special attention has to be given to parous women with previous caesarean deliveries.

Prospects for cleaning ash in the acidic effluent from bioleaching of sulfidic concentrates

Leaching of ashes in sulfuric acid (pH 1.0, liquid-to-solid (L/S) ratio 10:1, 25 degrees C) has been characterized with respect to the neutralizing capacity and the dissolution of dominant ions and trace elements. The conditions mimic the oxidation stage of a biohydrometallurgical process for base metal production from sulfidic mineral concentrates. Direct acid leaching of ash, integrated with this metallurgical process, offers a feasible route to the sustainable handling of metal-rich ashes. The treated ash will be deposited together with the inert mineral residue. Cd, Co, Cu, Ni and Zn are effectively leached and can be recovered utilizing existing hydrometallurgical technology, but the recovery of other readily dissolved metals, notably Mn, U and V, requires that additional steps are implemented. We make two recommendations for industrial processes. The first is to replace limestone with ash from biofuels, except peat, for pH control in biohydrometallurgical processing. This requires a modest increase of fresh alkali compared with limestone. The second is to implement sulfuric acid leaching of fly ash from the combustion of solid waste and other metal-rich fuels (used wood, tires), thereby avoiding costly ash-deposits. There is a significant economic incentive for these changes, since no costly ash-deposits and less limestone will be needed.

Survival among motherless children in rural and urban areas in Guinea-Bissau

AIM

With the increasing incidence of HIV and TB, motherless children are becoming a rapidly growing problem in Africa. However, few studies describe the survival patterns of these children. The aim of this study was to investigate the mortality of motherless children in urban and rural areas of Guinea-Bissau.

METHODS

A historical cohort study was set up in urban and rural areas in Guinea-Bissau. Motherless children were selected from two study cohorts under demographic surveillance since 1990. The relatives of 128 motherless children from the rural cohort and 192 from the urban area, as well as a total of 807 controls, were examined and interviewed.

RESULTS

Controlling for significant background factors revealed that motherless children had a markedly higher mortality than that of controls in both urban (mortality rate ratio (MR) 2.32 (95% confidence interval 1.11-4.84)) and rural areas (MR = 4.16 (2.79-6.22)). Virtually all the excess mortality occurred among children under 2 y of age when their mother died. Few motherless children had been provided with surrogate breastfeeding.

CONCLUSIONS

Since nearly all children in Guinea are breastfed until 2 y of age, premature weaning may be one of the major causes of the higher mortality rates observed among motherless children.

Factors associated with maternal mortality in rural Guinea-Bissau. A longitudinal population-based study

OBJECTIVE

To assess demographic and obstetric risk factors for pregnancy-related death in a multiethnic rural population in a developing country.

DESIGN

A prospective survey of women in the fertile age-range.

SETTING

Rural Guinea-Bissau.

POPULATION

More than 15,000 women living in 100 clusters were visited at six-monthly intervals over a period of more than six years. A total of 10,931 pregnancies were registered prospectively; 85 of these pregnancies resulted in maternal or late maternal death.

MAIN OUTCOME MEASURE

Maternal mortality ratio.

METHOD

In the rural areas of Guinea-Bissau, we conducted a prospective survey of women in the fertile age range. More than 15,000 women living in 100 clusters were visited at 6-monthly intervals over a period of more than six years. An analysis of demographic, environmental and obstetric risk factors for maternal death was performed based on 10,931 prospectively registered pregnancies; 85 of these pregnancies resulted in maternal or late maternal death.

RESULTS

In the adjusted model maternal mortality ratio increased with increasing distance from the regional hospital (OR>25 km = 7.4 [95% CI: 1.6-132]). Multiple pregnancy was found to increase the risk of maternal death (OR = 3.4 [95% CI: 1.3-7.5]). The risk of subsequent maternal death was increased if the fetus was stillborn (OR = 5.3 [95% CI: 2.8-9.4]). Women living in the region of Gabu had higher mortality than those living in Biombo (OR = 2.5 [95% CI: 1.3-5.1]). No category of age or parity were associated with an increased risk of maternal mortality. Predictive values did not exceed 3% for any of the significant risk factors.

CONCLUSIONS

For the purpose of reducing maternal mortality, the screening approach of antenatal care is of limited value. Age and parity should not be used routinely as selection criteria for transfer of otherwise healthy pregnant women to higher-level health institutions. Twin pregnancy seems to be the only operational risk factor identified in this study. Stillbirth is associated with an increased risk of maternal death. Regional differences must be studied further. The distance to emergency obstetric care (EOC) may determine the outcome of a complicated delivery.

Tacrine and rate of progression in Alzheimer's disease--relation to ApoE allele genotype

Today, cognitive impairment can be successfully treated with acetylcholine esterase inhibitors (AChE-I) in many, but not all, patients with Alzheimer's disease (AD). To investigate the relation between tacrine treatment, inheritance of ApoE epsilon4 alleles, and rate of progression, the differences in MMSE and CIBIC scores (efficacy parameters) after 6 and 12 months of tacrine (an AChE-I) treatment were investigated in 145 AD patients. Of these, 84 were ApoE epsilon4-positive (ApoE4) and 61 were ApoE epsilon4-negative (ApoE2-3). No differences were found after 6 months of treatment, but after 12 months the CIBIC scores revealed that the ApoE4 patients had declined more than the ApoE2-3 patients (p < 0.05). No differences were found for the last 6 months of treatment. The results primarily suggest a faster rate of decline in the ApoE4 AD compared to the ApoE2-3, but may also reflect that ApoE epsilon4 genotype inheritance is a negative predictor of treatment effect of tacrine in AD patients.

NMR structure of oxidized glutaredoxin 3 from Escherichia coli

A high precision NMR structure of oxidized glutaredoxin 3 [C65Y] from Escherichia coli has been determined. The conformation of the active site including the disulphide bridge is highly similar to those in glutaredoxins from pig liver and T4 phage. A comparison with the previously determined structure of glutaredoxin 3 [C14S, C65Y] in a complex with glutathione reveals conformational changes between the free and substrate-bound form which includes the sidechain of the conserved, active site tyrosine residue. In the oxidized form this tyrosine is solvent exposed, while it adopts a less exposed conformation, stabilized by hydrogen bonds, in the mixed disulfide with glutathione. The structures further suggest that the formation of a covalent linkage between glutathione and glutaredoxin 3 is necessary in order to induce these structural changes upon binding of the glutathione peptide. This could explain the observed low affinity of glutaredoxins for S-blocked glutathione analogues, in spite of the fact that glutaredoxins are highly specific reductants of glutathione mixed disulfides.

Prevalences of HTLV-1 infection and associated risk determinants in an urban population in Guinea-Bissau, West Africa

OBJECTIVE

To assess the prevalence and modes of transmission of HTLV-1 infection in an adult population in Bissau, and to evaluate possible interactions between the pattern of spread of HTLV-1 and HIV-1/HIV-2.

DESIGN AND METHODS

Univariate and multivariate analyses were used to evaluate gender-and age-specific HTLV-1 prevalences as well as associated risk determinants in an adult population based on a serosurvey comprising 2127 individuals from 304 randomly selected houses in Bissau.

RESULTS

Using stringent Western blot criteria, the overall seroprevalence of HTLV-1 was 3.6%, 2.2% among men and 4.7% among women, respectively. One individual was seropositive to HTLV-2. The prevalence of HTLV-1, which increased with age in both genders, however more markedly among women, was >4 times higher (9.4%) among older individuals (>44 years of age) than among younger individuals (2.4%). Blood transfusion and HIV-2 seropositivity were independently associated with HTLV-1 seropositivity in men. Among women, both HIV-2 seropositivity and HIV-1 seropositivity were significant risk determinants. Having had sexual partners was associated with a fivefold increased risk among women but did not reach significance.

CONCLUSION

The adult population of Guinea-Bissau has a higher prevalence of HTLV-1 than reported from most other countries in West Africa. The gender-and age-specific pattern of spread of HTLV-1 closely resembles that observed for HIV-2, another retrovirus prevalent to the region. The close correlation between HTLV-1 and HIV-2 most likely reflects the shared risk factors related to sexual behavior. The implication of the high percentage of double infections in this population needs to be determined.

Class 1 integron-borne, multiple-antibiotic resistance encoded by a 150-kilobase conjugative plasmid in epidemic vibrio cholerae O1 strains isolated in Guinea-Bissau

In the 1996-1997 cholera epidemic in Guinea-Bissau, surveillance for antimicrobial resistance showed the emergence of a multidrug-resistant strain of Vibrio cholerae O1 during the course of the epidemic. The strain was resistant to ampicillin, erythromycin, tetracycline, furazolidone, aminoglycosides, trimethoprim, and sulfamethoxazole. Concomitant with the emergence of this strain, we observed a resurgence in the number of registered cholera cases as well as an increase in the case fatality rate from 1.0% before the emergence of the multiple-drug-resistant strain to 5.3% after the emergence of the strain. Our study shows that the strain contained a 150-kb conjugative multiple-antibiotic resistance plasmid with class 1 integron-borne gene cassettes encoding resistance to trimethoprim (dhfrXII) and aminoglycosides [ant(3")-1a]). The finding of transferable resistance to almost all of the antibiotics commonly used to treat cholera is of great public health concern. Studies should be carried out to determine to what extent the strain or its resistance genes have been spread to other areas where cholera is endemic.

Protection from cholera by adding lime juice to food - results from community and laboratory studies in Guinea-Bissau, West Africa

Epidemiological studies have shown that food plays an important role in the transmission of Vibrio cholerae, and different foods have been incriminated in many epidemic outbreaks of cholera. Storing contaminated meals at ambient temperatures allows growth of V. cholerae. Some ingredients such as lime juice may inhibit the survival of V. cholerae in foods. During an epidemic caused by V. cholerae O1 in Guinea-Bissau in 1996, a case control study was conducted in the capital Bissau, the main affected region with an attack rate of 7.4%. Cases were hospitalized patients and controls were matched for area, gender and age. Lime juice in the sauce eaten with rice gave a strong protective effect (odds ratio [OR] = 0.31, 95% confidence interval [CI] = 0.17-0.56), and tomato sauce was also protective (OR = 0.36, 95% CI = 0.24-0.54). On the other hand, use of a bucket for storage of water in the house was associated with increased risk (OR = 4.4, CI = 2.21-8.74). Laboratory experiments to elucidate the inhibitory effect of different concentrations of lime juice on survival of V. cholerae in meals showed that V. cholerae thrives in rice with peanut sauce, but lime juice inhibited its growth. Since lime juice is a common ingredient of sauces, its use should be further encouraged to prevent foodborne transmission in the household during cholera outbreaks.

A 3-year follow-up study of preformed beta-quartz glass-ceramic insert restorations

OBJECTIVE

The purpose of this study was to evaluate the clinical performance of preformed beta-quartz glass-ceramic insert restorations.

METHODS AND MATERIALS

Nine Class I and 30 Class II beta-quartz glass-ceramic insert restorations were placed in 16 patients who were seen regularly by personnel at Umeå University Dental School. The California Dental Association criteria were used to evaluate the restorations at baseline, 6 months, and 1, 2, and 3 years after luting. The occurrence of postoperative sensitivity, the time taken to manufacture each restoration, and certain periodontal conditions were also evaluated.

RESULTS

Sixty-nine percent of the restorations were rated satisfactory at the 3-year examination. During the follow-up period, 4 became loose and 7 were fractured or had flaking surfaces. Caries was registered in connection with 1 restoration. Excellent ratings were obtained for marginal integrity, anatomic form, surface, and color in 62%, 84%, 32%, and 44% of the restorations, respectively. There was no statistically significant difference in the occurrence of plaque and bleeding on probing in comparison with the controls. The mean overall time for placement was 38 minutes. The estimated survival rate (Kaplan-Meier) was 59% after 3.5 years.

CONCLUSION

The quality of the beta-quartz glass-ceramic restorations in the present study was inferior to that presented in most earlier studies of ceramic or resin composite posterior restorations placed in patients treated at university clinics. Both the technique and the beta-quartz glass-ceramic inserts have to be evaluated in more long-term studies to assess the possibility of their serving as an alternative restorative technique.

Low-dose quinine for treatment of Plasmodium falciparum malaria in Guinea-Bissau

The recommended dose of 10 mg quinine/kg bodyweight 3 times a day for 7 days for treatment of malaria is so high that many patients experience cinchonism. We have earlier obtained good results with 7 days' treatment with 20 mg Quinimax/kg bodyweight divided into 2 daily doses. In order to identify the lowest effective dose, children with symptomatic malaria were treated with quinine twice a day for 7 days. They were assigned to 1 of 3 groups treated daily with 10 mg/kg, 15 mg/kg, or 20 mg/kg bodyweight, respectively; 42, 46, and 34 children, respectively, received treatment and completed 5 weeks of follow-up. The cumulative percentages of all children with parasitaemia during follow-up on day 28 or before were 33%, 13% and 12%, respectively. Treatment with 10 mg quinine salt/kg daily for 7 days gave a significantly higher rate of recrudescence than did treatment with 15 or 20 mg/kg daily. Thus at least 15 mg of quinine salt/kg bodyweight daily should be recommended for treatment of symptomatic Plasmodium falciparum malaria in Guinea-Bissau.

Prevalence of HIV infection among hospital patients in north west Tanzania

In order to estimate hospital HIV prevalence, the economic impact of AIDS on health care and to assess the implications of HIV testing on clinical suspicion of AIDS this hospital based study was done at the government regional hospital of Kagera, Tanzania. Consecutive admissions were recruited into the study, and those consenting had a blood specimen taken, one portion of which was used to aid clinical diagnosis, while the other was tested anonymously for HIV antibodies using two ELISA systems. A short questionnaire was used to specify demographic characteristics, hospital ward of admission and diagnosis of each study subject. The overall age adjusted HIV-1 prevalence was 32.8% (N = 1422) and there was no significant difference in the age adjusted sex specific prevalence. The highest prevalence (53.3%) was found in the 25-34 years age group as well as in the gynaecological and medical wards (41.2% and 40.4%, respectively). The diagnostic category of clinical AIDS had a sensitivity of 11.3% and a specificity of 99.3%, indicating that only 11.3% of the HIV seropositives would have been HIV tested on clinical suspicion of AIDS. Similarly, the HIV-1 antibody sensitivity and specificity for tuberculosis were 5.9% and 97.9%, respectively. Patients who were HIV-1 infected were more likely to have a history of previous hospital admissions, RR = 1.34 (95% CI = 1.16-1.56), and were at an increased risk of developing tuberculosis, RR = 2.02 (95% CI = 1.50-2.70). The diagnostic categories with the highest HIV-1 infection prevalence were clinical AIDS (88.5%), herpes zoster and other HIV-1 skin manifestations combined (85.7%) and pulmonary tuberculosis (58.3%). In conclusion, the prevalence of HIV-1 infection was high among hospitalized patients in Bukoba hospital indicating that the major cause of illness leading to admission to the hospital may have been underlying HIV-1 infection. The findings also indicate that in a high HIV-1 prevalence area, testing for HIV infection on the basis of clinical suspicion of AIDS alone is not sufficient to provide rational care to the majority of HIV infected patients.

The solution conformation of a carbocyclic analog of the Dickerson-Drew dodecamer: comparison with its own X-ray structure and that of the NMR structure of the native counterpart

The NMR conformation of a carbocyclic analog of the Dickerson-Drew dodecamer [d(CGC-GAAT*T*CGCG)]2 containing 6'-alpha-Me carbocyclic thymidines (T*) has been determined and compared with that of its X-ray structure. The solution structure of the 6'-alpha-Me carbocyclic thymidine modified duplex has also been compared with the solution structure of the corresponding unmodified Dickerson-Drew duplex solved by us under the same experimental conditions. The NMR structures have been based on 24 experimental distance and torsion constraints per residue for [d(CGCGAAT*T*CGCG)]2 (1) and on 21 constraints per residue for the natural counterpart. In general, both final NMR structures are more close to the B-type DNA. The cyclopentane moieties of the carbocyclic thymidine residues adopt C1'-exo B-DNA type puckers (the phase angles P = 136-139 degrees and the puckering amplitudes psi = 36-37 degrees) that are close to their previously published crystal C1'-exo or C2'-endo puckers. The main differences between the two NMR structures are for beta(T*8) and epsilon, xi(T*7) backbone torsions (27-50 degrees ), for basepair twist for the 7-8 and 8-9 basepair steps (5-6 degrees), tilt for the 8-9 step (7 degrees), roll for the 7-8 step (7 degrees), shift for the 7-8 step (0.9A) and slide for the 9-10 step (0.6A). The relatively small deviations of helical structure parameters lead to structural isomorphism of these duplexes in aqueous solutions (atomic RMSD = 1.0A). The difference of the minor groove widths (less than 0.7A) in the core part of the modified duplex in comparison with the native one is much smaller than the difference between the X-ray structures of these duplexes. A detailed comparison of NMR and X-ray structure parameters showed significant monotonic differences (0.9-2.5A) for all basepair slides in both duplexes. Deviations between NMR and X-ray structure parameters for the modified duplex were also found for basepair tilt of the 4-5 step (13 degrees), rolls for the 8-9 and 10-11 steps (16 and 19 degrees), twist of the 3-4 step (8 degrees) and shift of the 9-10 step (0.9A).

Declining HIV-2 prevalence and incidence among men in a community study from Guinea-Bissau

OBJECTIVE

To assess the present level of HIV-2 infection in an adult population in Bissau and to evaluate sex and age-specific changes in HIV-2 prevalence and incidence between 1987 and 1996.

DESIGN AND METHODS

Sex and age-specific changes in HIV-2 prevalence were evaluated comparing a survey from 1987 in a sample of 100 houses with a survey performed in 1996 in an independent sample of 212 houses from the same study area. HIV-2 incidence rates were examined in an adult population (age > or = 15 years) from 100 randomly selected houses followed with four consecutive HIV serosurveys from 1987 to 1996.

RESULTS

The HIV-2 prevalence in 1996 was 6.8% (men, 4.7%; women, 8.4%). Compared with the 1987 survey there was a significant decrease in prevalence among men [age-adjusted relative risk (RR), 0.50; 95% confidence interval (CI), 0.31-0.83], whereas it remained unchanged in women (RR, 1.00; 95% CI, 0.67-1.48). The male-to-female RR decreased from 0.99 (95% CI, 0.61-1.61) in 1987 to 0.51 (95% CI, 0.34-0.76) in 1996. The overall annual incidence rate was 0.54 per 100 person-years of observation (PYO), being higher in women (0.72 per 100 PYO) than in men (0.31 per 100 PYO). With the observation time divided into an early and a late period, there was a decrease in incidence with time among men (0.66 to 0.00 per 100 PYO), but no major change among women (0.59 to 0.85 per 100 PYO). The two trends differed significantly (P = 0.03). We observed a higher annual incidence rate amongst older women aged > 44 years (1.77 per 100 PYO) than among younger women (0.55 per 100 PYO; P = 0.05).

CONCLUSION

There are no signs of an epidemic spread of HIV-2 in Bissau even though the HIV-1 prevalence is increasing rapidly. A significant reduction in the male HIV-2 prevalence and incidence rates has resulted in a major shift in the pattern of spread of HIV-2, from being equally distributed to being predominantly a female infection. Currently, older women in particular seem to have a high risk of getting infected.

Acceptability of voluntary HIV testing with counselling in a rural village in Kagera, Tanzania

A pilot study on acceptability of voluntary HIV testing with counselling was performed in a rural village in Kagera, Tanzania as a potential intervention against HIV transmission. Village residents were prepared by their leaders and subsequently invited to health education group meetings to volunteer for the test. Consenting individuals were interviewed to determine awareness and acceptance of the offer followed by pre-test counselling and taking of a blood sample for subsequent HIV testing. Two months later, the results of the test were returned with post-test counselling coupled with a short interview of a random sample of adults in the village. Of the 245 adults responding to the call, 137 (55.9%) subsequently volunteered. The main reason for volunteering was to know the HIV status (96%). Among those who were aware of the offer, the main reason for not volunteering was that they felt unlikely to catch AIDS, implying that they had a false perception of being at low risk. In this study a significant proportion were willing to volunteer for the HIV test and to receive the results, indicating a moderate level of acceptability. The results also indicate the need for developing innovative ways of enhancing acceptability of voluntary HIV testing with counselling. However, the relationship between knowledge of HIV status and behavioural change is complex and therefore several potential mechanisms may exist by which HIV testing in combination with counselling can influence behaviour. For this reason, people should be given the choice of knowing their HIV status since it may constitute a potential mechanism for influencing behaviour towards reduction of HIV transmission.

The NMR structure of estrone (Es)-tethered tandem DNA duplex: [d(5'pCAGCp3')-Es] + [Es-d(5'pTCCA3')]: d(5'pTGGAGCTG3')

The solution structure of an estrone (Es)-tethered tandem DNA duplex consisting of two Es-tethered tetranucleotides and a target octameric DNA sequence is reported. The structure of this Es-tethered tandem duplex has been compared with a corresponding natural tandem duplex without estrones. The Tm of the 3'-Es-tethered tetranucleotide part of the tandem duplex increases by 5 degrees C, whereas the Tm of the 5'-Es-tethered tetranucleotide part increases by 7 degrees C, compared with the corresponding natural counterpart. The NMR structures of both the Es-tethered tandem duplex and the natural counterpart have been based on 24 experimental NMR constraints per residue. Despite the fact that there is considerable distortion at the junction of two Es-tethered tetranucleotides in the major groove of the Es-tethered DNA duplex compared to the natural counterpart, both duplexes do take up B-type DNA structures. It is likely that the spatial proximity of two Es residues, and the resulting hydrophobic interaction between them might be responsible for the increase of the thermal stability of the Es-tethered tandem duplex in comparison with the natural counterpart.

Communicating with the people about HIV infection risk as a basis for planning interventions: lessons from the Kagera Region of Tanzania

In order to deepen the understanding of risk factors associated with HIV infection in the Kagera region of Tanzania and to investigate the potentials of communicating with the people in planning for interventions, two studies were performed in the districts of Bukoba Urban, Bukoba Rural and Muleba in 1989. The HIV prevalence of these areas ranged between 4.5% and 24.2% according to the prevalence study performed earlier in 1987. The studies involved the community in ward meetings on the one hand, and previously studied individuals on the other hand. The studies aimed both at conveying to the people the results of a previously performed study and at collecting new data using a combination of quantitative and qualitative methods in order to better understand the associated risk factors, perceived or real, and what suggestions the community could offer for reducing HIV transmission in the region. From the initial study, awareness about AIDS was found to be universal. Change of sexual partners and infection with syphilis were found to be the major risk factors for HIV-I infection. From the ward meetings people suggested a variety of solutions for interventions which we have categorized as either "hard" or "soft". The "hard" solutions involved suggestions such as isolation, imprisonment, castration and killing of AIDS victims, while the "soft" solutions involved sympathetic handling of the sick and educating the people about the modes of transmission and how best to prevent infection. There was a greater tendency for the low HIV prevalence rural communities to suggest the "hard" solutions than the high HIV prevalence urban ones which tended to suggest the "soft" solutions. However, with the changing dynamics of HIV infection in the region towards higher HIV prevalence in rural areas, it is likely that the "soft" solutions will gain acceptance and become adopted for interventions throughout the region. The information obtained from these studies has provided lessons that can be used for rational counselling as well as for guiding the implementation of IEC activities geared at interventions. It is also suggested that there should be further research into new strategies or their combinations which could be crucial in prevention such as those of community participation, empowerment of women and solidarity in AIDS intervention work.

A one-year community study of under-fives in rural Ethiopia: health and behavioural determinants of morbidity

Based on a one-year weekly home surveillance study, morbidity patterns of 1,304 children under five years of age in a rural Ethiopian community were measured, together with nutritional and health behavioural determinants. Using Poisson regression models, the study showed that nutritional and health care factors make a significant impact on under-five morbidity. Gastroenteritis was particularly associated with child care factors, while acute respiratory infections were particularly associated with nutritional factors. Lack of immunization, low birthweight and pre-term delivery (more than one month early) were not found to have any independent effect on morbidity. Breast feeding was universal, but the introduction of supplementary foods was found to protect from excess morbidity. The study concludes by discussing possible applications of the results in intervention programmes.

The NMR structure of 31mer RNA domain of Escherichia coli RNase P RNA using its non-uniformly deuterium labelled counterpart [the 'NMR-window' concept]

The NMR structure of a 31mer RNA constituting a functionally important domain of the catalytic RNase P RNA from Escherichia coli is reported. Severe spectral overlaps of the proton resonances in the natural 31mer RNA (1) were successfully tackled by unique spectral simplifications found in the partially-deuterated 31 mer RNA analogue (2) incorporating deuterated cytidines [C5 (>95 atom % 2H), C2' (>97 atom % 2H), C3' (>97 atom % 2H), C4' (>65 atom % 2H) and C5' (>97 atom % 2H)] [for the 'NMR-window' concept see: Földesi,A. et al. (1992) Tetrahedron, 48, 9033; Foldesi,A. et al. (1993) J. Biochem. Biophys. Methods, 26, 1; Yamakage,S.-I. et al. (1993) Nucleic Acids Res., 21, 5005; Agback,P. et al. (1994) Nucleic Acids Res., 22, 1404; Földesi,A. et al. (1995) Tetrahedron, 51, 10065; Földesi,A. et al. (1996) Nucleic Acids Res., 24, 1187-1194]. 175 resonances have been assigned out of total of 235 non-exchangeable proton resonances in (1) in an unprecedented manner in the absence of 13C and 15N labelling. 41 out of 175 assigned resonances could be accomplished with the help of the deuterated analogue (2). The two stems in 31mer RNA adopt an A-type RNA conformation and the base-stacking continues from stem I into the beginning of the loop I. Long distance cross-strand NOEs showed a structured conformation at the junction between stem I and loop I. The loop I-stem II junction is less ordered and shows structural perturbation at and around the G11 -C22 base pair.

Cancer incidence for children born in a smelting community

The Rönnskär smelter in Skellefteå, Sweden, produces significant environmental pollutants, such as lead, arsenic, copper, cadmium and sulphur dioxide. The purpose of the present study was to determine whether children born to women living near the smelter during pregnancy had an increased risk of childhood cancer. The study group consisted of children born between 1961 and 1990 in the municipality of Skellefteå and parish of Holmsund. Through linkage to the Swedish Cancer Registry cancer diagnoses in the study group were obtained and compared with the expected ones based on the national incidence rates. Thirteen cases of childhood cancer were identified among children born in the vicinity of the smelter against 6.7 expected (SIR 195, 95%CI 88-300). Among distant born the observed number of cases (n = 42) was similar to that expected (n = 41.8).

Lung cancer, smoking and smelter work in a occupational cohort

BACKGROUND

A cohort of employees at a smelter in Northern Sweden has been updated with the addition of information regarding smoking habits to evaluate the role of smoking in the occurrence of lung cancer in various job categories and employment cohorts. An updated analysis of earlier studies of the interaction between roaster work and smoking is also reported. The cohort members first employed during the period 1928-1979 have been followed up to 1 January 1988. Information regarding smoking habits for 69% of the cohort was gathered in a questionnaire study.

RESULTS

The prevalence of daily smoking decreased during the study period and was lower for salaried employees. The figures were, however, comparable with national figures for similar social and occupational strata. Adjustment for smoking did not alter the lung cancer gradient between employment cohorts or between job categories.

CONCLUSIONS

The interaction between smoking and roaster work was confirmed and the benefits from ceasing to smoke shown to be greater among the roaster workers.

A one-year community study of under-fives in rural Ethiopia: patterns of morbidity and public health risk factors

A prospective weekly home surveillance study was undertaken to determine morbidity patterns within the Butajira Rural Health project in central Ethiopia. Overall prevalence of illness was 5.8% in 1216 person-years observed among rural Ethiopian children aged under 5 years. Acute respiratory infections (ARI) (prevalence 2.8%) and acute diarrhoea (2.4%) were the commonest conditions. Episodes of illness were distributed unequally among children, with a mean of 2.34 episodes per child. These included an average of 1.13 episodes of ARI (of which 0.16 had lower respiratory symptoms [ALRI]) and 1.17 episodes of acute diarrhoea. Sanitation factors were the principal risks for gastroenteritis, while living in rural areas predisposed children to ARI. Parental factors such as illiteracy were also linked to morbidity.

The solution structure of a 3'-phenazinium (Pzn) tethered DNA-RNA duplex with a dangling adenosine: r(5'G-AUUGAA3'):d(5'TCAATC3'-Pzn)

The 3'-Pzn group tethered to an oligo-DNA stabilizes a DNA-RNA hybrid duplex structure by 13 degrees C compared to the natural counterpart. This report constitutes the first full study of the conformational features of a hybrid DNA-RNA duplex, which has been possible because of the unique stabilization of this rather small duplex by the tethered 3'-Pzn moiety (Tm approximately 40 degrees C from NMR). In this study, a total of 252 inter- and intra-strand torsional and distance constraints along with the full NOE relaxation matrix, taking into account the exchange process of imino and amino protons with water, have been used. The 3'-Pzn-promoted stabilization of the DNA-RNA hybrid duplex results in detailed local conformational characteristics such as the torsion angles of the backbone and sugar moieties that are close to the features of the other natural DNA-RNA hybrids (i.e. sugars of the RNA strand are 3'-endo, but the sugars of the DNA strand are intermediate between A- and B-forms of DNA, 72 degrees < P < 180 degrees; note however, that the sugars of our DNA strand have a C1-exo conformation: 131 degrees < P < 154 degrees). This study suggests that 3'-Pzn-tethered smaller oligo-DNA should serve the same purpose as a larger oligo-DNA as a antisense inhibitor of the viral mRNA. Additionally, these types of tethered oligos have been found to be relatively more resistant to the cellular nuclease. Moreover, they are taken up quite readily through the cellular membrane (14) compared to the natural counterparts.

Prevalence and incidence of syphilis and its association with HIV-1 infection in a population-based study in the Kagera region of Tanzania

Population-based prevalence and incidence studies on HIV-1 infection were started in the Kagera region of Tanzania in 1987. The prevalence and incidence of infection with Treponema pallidum was studied to enable development of better strategies for STD control. Serological diagnosis of a past or treated infection with Troponema pallidum was made by seropositivity only to TPHA testing while active syphilis was diagnosed by seropositivity to both VDRL and TPHA tests. Seroconversion was measured in 1989 by finding TPHA serologically positive individuals during the follow-up period among the initially seronegative study population of 1987. The overall prevalence of active syphilis in the total sample of adults in the region was found to be 5.9% while that of past syphilis was 13.5%. The association between the prevalence of HIV-1 infection and syphilis of both types was found to be highly significant. However, the association between one pre-existing infection and seroconversion in the other was present but not statistically significant. The overall incidence of syphilis based on seroconversion in a cohort of adults in the region was found to be 11.6 per 1000 person-years at risk. In view of these findings, syphilis is a significant health problem in the region with a high level of transmission and efforts should be made to control it. Intervention studies should use these base-line data and monitor changes in syphilis incidence which may indicate changes in sexual behaviour. Such indicators could also be useful for evaluating the impact of interventions directed at reducing the transmission of HIV, syphilis and other STDs in the region.

Maternal mortality in Sweden, 1980-1988

OBJECTIVE

To assess recent maternal mortality in Sweden according to the different definitions of the eighth, ninth, and tenth editions of the International Classification of Diseases (ICD).

METHODS

All maternal deaths in Sweden during 1980-1988 were sought in the Medical Birth Registry and in the Registers of Births and Deaths. Hospital records and autopsy reports were requisitioned.

RESULTS

According to ICD-9, the maternal mortality ratio in Sweden for 1980-1988 was 7.4 per 100,000 live births. Of the 58 deaths, 36 were direct maternal deaths. Embolism, hemorrhage, preeclampsia, and infection were the predominant causes in the direct cases. Advanced age was the most pronounced risk factor. Suboptimal standard of care was a contributing cause in almost one-third of the direct maternal deaths. Accidental or incidental deaths, including suicide, accidents, and pregnancy-related deaths, added six cases. There were 76 late maternal deaths, occurring 43-365 days postpartum. Malignancy, stroke, and heart disease were the predominant causes. After malignant disease, suicide constituted the leading cause of pregnancy-related deaths within 1 year of delivery.

CONCLUSIONS

Regular reviews of maternal mortality are still important in a country with a low rate of maternal deaths. The new classification of maternal deaths allows a better international comparison of mortality risks. Continuous surveillance of maternal deaths and pregnancy-related deaths requires record linkage of birth and death registrations.

The Butajira Rural Health Project in Ethiopia: a nested case-referent (control) study of under-5 mortality and its health and behavioural determinants

The associations between under-5 mortality and its health and behavioural determinants were investigated in a rural district of Ethiopia, by means of a concurrent case-referent technique nested within a study-base population established in 1987. Three-hundred and six infant and child deaths registered over a period of 1 year, were contrasted with 612 controls, matched for age, sex and study area. Data were collected by trained non-medical workers using a structured questionnaire. Breastfeeding and supplementary feeding came out as strongly protective against under-5 mortality, even when controlling for parental and environmental determinants. Early termination of breastfeeding was demonstrated to have a substantial impact on mortality, particularly on that caused by diarrhoea. Late introduction of supplementary feeding, particularly of protein origin, was also associated with increased under-5 mortality. When the relative impacts of parental, environmental and behavioural determinants are compared, the greater impact of parental factors can be demonstrated, especially among infants.

Socio-geographical patterns of HIV-1 transmission in Kagera Region, Tanzania

A population-based study on the prevalence of HIV-1 infection in the Kagera region was performed in 1987. The study was based on a multistage cluster sampling technique covering the age-group 15-54 years. The study showed considerable variation of prevalence of HIV-1 infection in the areas studied. A total of 2475 adults were studied and the overall prevalence of HIV-1 infection in the region was 9.6% with a higher prevalence in the urban area (24.2%) compared to that in the rural areas (4.9%). In the present analysis, information on individuals collected during the prevalence study has been used to characterize smaller geographical areas of several villages (wards) and to form the basis for an aggregated analysis of geographical and social patterns relevant to HIV-1 transmission in the studied areas of the region. Kagera region is a heterogeneous society with respect to, for example, religion, ethnic groups and family patterns. There was a moderately strong positive correlation between HIV-1 prevalence and frequent change of sexual partners on the ward level. In Bukoba town the prevalence varied remarkably among the wards, with the lowest prevalence in the ward having the highest social status. In the rural areas, however, the prevalence in the wards decreased considerably with increasing distance from Bukoba town. This aggregated analysis of socio-geographical patterns of HIV-1 transmission characteristics has provided us with information for prioritizing areas of HIV/AIDS intervention in the Kagera community.

Solution structure of lariat RNA by 500 MHz NMR spectroscopy and molecular dynamics studies in water

A 500 MHz NMR study of the lariat RNA tetramer 1 and pentamer 2 mimicking the naturally occurring lariat RNA is reported. The conformational properties of 1 and 2 were compared with those of a linear branched RNA tetramer 3, which show that the conformational features of the two lariat RNAs, 1 and 2, are quite constrained and significantly different from those observed for the linear branched RNA tetramer 3. The conformation of all sugar residues forming the lariat ring in 1 and 2 are locked in a rigid South-type conformation. All residues in both lariat RNAs have a high population of gamma+ (67-85%) and beta t (95-100%) rotamers except guanosine where the gamma+ population is low. The conformation around the glycosidic bond is anti for all residues except for guanosine where NOE data indicates an equilibrium of syn<-->anti. In both lariat RNAs, 1 and 2, the temperature dependent 1H and 31P chemical shifts as well as the oligomerization shifts, with respect to adenosine 2',3',5'-triethyl-phosphate (Sund et al., 1992, Tetrahedron 48, 695) suggests that the 3'-->5' linked U4 or C4 residue is stacked on guanosine. Subsequently, 1H-1H, 1H-31P and 13C-31P coupling constants derived torsional constraints were used for molecular dynamics study in water with counter sodium ions for a total of 226 ps. The MD simulations were first carried out with harmonic torsional constraints which were derived from J couplings (0-86 ps) and then completely without constraints (96-226 ps). The lack of any major changes in the conformation of the two lariat-RNA structures upon releasing the NMR constraints indicate that the conformers generated in the MD simulation in water agree well with the structural features suggested by experimental observables. This means that the ensemble of conformers generated during the MD trajectory of 226 ps are not artificially held in these conformations due to the NMR constraints, suggesting that these conformers can be considered to be good representatives of the actual NMR observed solution structures.

AIDS epidemic in Kagera region, Tanzania--the experiences of local people

This study is part of a collaborative study of HIV infection and AIDS which was launched in 1987 in the Kagera region, Tanzania. This region is characterized as one of the areas most affected by the AIDS epidemic. In order to describe and analyse the epidemiology of HIV infection in the area and also to contribute to the intervention process, a long-term population-based project was initiated. The study was launched in January 1989 as an in-depth behavioural study to describe the experiences of the local people of the AIDS epidemic in the region. The specific objectives were to determine the people's attitudes, perceptions, responses and norms relevant to AIDS-related problems. The data were collected through tape recorded interviews, focus group discussions and direct observations of risk behaviour. The interviews were conducted in 10 villages, in urban and rural Bukoba as well as in Muleba districts. In each village five households were selected and visited once a week for about 6 months. The focus group discussions were held mainly with young males, females, married women and married men, elders and religious leaders, government and party leaders, and other key informants. Perceptions, attitudes and patterns of behaviour among the local people are described in the context of the HIV transmission in the area. The descriptions give answers to questions like: How do people perceive and interpret AIDS? How do they react to AIDS? How do they judge causes and risks? What are the attitudes to people with AIDS and those suspected to have AIDS? What are the implications of these values in affected communities?

Structural studies of the 5'-phenazinium-tethered matched and G-A-mismatched DNA duplexes by NMR spectroscopy

The mechanism through which modified oligo-DNA analogues act as antisense repressors at the transcriptional and translational level of gene expression is based on the information content in the nucleotide sequence which is determined by the specific base pairing. The efficiency of such action is largely determined by the stability of the duplex formed between the oligonucleotide reagent and the target sequence and also by the mismatched base pairing, such as G-A, that occurs during replication or recombination. We herein report that the phenazinium (Pzn)-tethered matched duplex p(d(TGTTTGGC)):(Pzn)-p(d(CCAAACA)) (III) (Tm = 50 degrees C) has a much larger stability than the parent matched duplex p(d(TGTTTGGC)):p(d(CCAAACA)) (I) (Tm = 30 degrees C). On the other hand, the Pzn-tethered G-A-mismatched duplex p(d(TGTTTGGC)):(Pzn)-p(d(ACAAACA)) (IV) (Tm = 34 degrees C) is only slightly more stable than its parent mismatched duplex p(d(TGTTTGGC)):p(d(ACAAACA)) (Tm = 25 degrees C). A detailed 500 MHz NMR study and constrained MD refinements of NMR-derived structures have been undertaken for the DNA duplexes (I), (II), (III) and (IV) in order to understand the structural basis of stabilization of Pzn-tethered matched DNA duplex (delta Tm = 20 degrees C) compared to mismatched duplex (delta Tm = 9 degrees C). Assignment of the 1H-NMR (500 MHz) spectra of the duplexes has been carried out by 2D NOESY, HOHAHA and DQF-COSY experiments. The torsion angles have been extracted from the J-coupling constants obtained by simulation of most of the DQF-COSY cross-peaks using program SMART. The solution structure of the duplexes were assessed by an iterative hybride relaxation matrix method (MORASS) combined with NOESY distances and torsion angles restrained molecular dynamics (MD) using program Amber 4.0. The standard Amber 4.0 force-field parameters were used for the oligonucleotide in conjunction with the new parameters for Pzn residue which was obtained by full geometry optimization using ab initio program (3-21G basis set). It has been shown that mismatched G-A bases are in the anti-anti conformation. The mismatched 7G-1A form stable base pairs through inter-strand hydrogen bonds (N7(A)...HN2(G) (1.92 A) with a subtended angle of 176 degrees and N3(G)...HN6(A) (2.01 A) with a subtended angle of 153 degrees (the 'amino-type' hydrogen bond)) and a propeller twist of 36 degrees for 7G-1A residues.(ABSTRACT TRUNCATED AT 400 WORDS)

The Butajira project in Ethiopia: a nested case-referent study of under-five mortality and its public health determinants

During one year of follow-up, 306 deaths of children under the age of 5 years were included in a concurrent case-referent study that was based on a population estimated at 28,780 in 1987. A total of 612 live referents, matched for age, sex and study area, were also selected from the study population through density sampling. Data were collected by lay reporters by verbal autopsy. For the study period the estimated cumulative under-five mortality rate was 293 and the infant (0-11 months old) mortality rate was 136 per 1000. Major probable causes of death were diarrhoeal disease or acute respiratory infections (ARI). The relative importance of parental and environmental characteristics was assessed using conditional multiple logistic regression analysis. Under-five mortality was associated with paternal illiteracy, maternal ethnicity, and not being in the committee of people's organizations. Parental factors affected the infants relatively more than they did the children, especially with regard to ARI mortality. This was also noted with "absence of window", a proxy measure for evaluating the type of housing. In terms of etiological fractions a greater number of under-five deaths could be ascribed to parental than environmental conditions, with relatively more infants being affected than children.

Cancer incidence among male salaried employees at a smeltery in northern Sweden

This study focuses on mortality and cancer incidence among the male salaried employees at a copper smeltery in northern Sweden, where previously an increased lung cancer risk had been demonstrated among blue-collar workers, with all likelihood due to arsenic exposure. During the period 1928-1979 there has been 1,255 male salaried employees and 6,334 male blue-collar workers. Three cohorts were formed; those who had worked only as salaried employees, those who had worked only as blue-collar workers and those had worked in both job categories. The mortality among the entire group of salaried employees was comparatively lower than that of Sweden as a whole. The incidence of lung cancer was highest among those who had worked in both job categories, most of them former blue-collar workers. The trends in lung cancer incidence among the blue-collar workers along and among those who had had both types of jobs showed the same pattern, with a peak in the 1970s. The decrease in this trend started earlier among the salaried employees. When job category and employment cohort were analyzed together the highest risk was confirmed for those having been employed in both job categories.

The Butajira rural health project in Ethiopia: epidemiological surveillance for research and intervention in primary health care

Ten study populations sampled from a total of 86 communities in a rural Ethiopian area, have been registered and followed for a period of four years. A baseline census revealed a median age of 15 years, a literacy rate of 24%, poor housing and environmental conditions, and low utilization of the existing health care facilities. A surveillance system was established which made it possible to estimate the occurrence of vital events. This showed a crude birth rate of 40.3/1000, a crude death rate of 16.4/1000, a life-expectancy at birth of 48 years, an infant mortality rate of 114/1000, a yearly child (1-4 years) mortality rate of 36/1000, and an under-five mortality rate of 210/1000. The implications of these data in terms of the planning and operations of research and health services are discussed, and on-going and projected studies are outlined emphasizing the methodological potentials of this epidemiological study base.

Reproductive patterns among Swedish women born 1936-1960

An analysis was made of a cross-sectional survey of 4,299 women born in Sweden in the period 1936-1960, regarding their reproductive performance. Fecundability was only 12% lower for women in the 30-39 year age interval than for women up to 29 years of age. Cumulative pregnancy rates for individual years fell in the range 93-96%. No difference in fecundability could be discerned between women born in 1936-45 vis-à-vis 1946-60. Primary and secondary infertility were noted for 6.6% and 11.0% respectively of the entire population surveyed. Primary infertility, more prevalent among those born in 1946-60, was found to be related to a higher level of education, an urban life style and low age at first coitus. The risk of suffering a spontaneous abortion increased with advancing maternal age.

The Butajira rural health project in Ethiopia: mortality pattern of the under fives

A total of 492 deaths of children below 5 years of age were registered during a 2-year period of demographic surveillance in a rural population of Ethiopia, where an epidemiologic study base population of 28,780 individuals was established in 1987. Data were collected by lay-reporters using a verbal autopsy method. The under-five cumulative mortality rate was 209 per 1000 children. When sub-divided into infants and children 1-4 years, the respective yearly mortality rates were 101 and 32.3 per 1000. There were considerable variations within the district by Peasants' Associations. Rural Lowlands experienced the highest mortality rates, especially for children 1-4 years. Mortality trends over a 2-year period indicate a significant increase for the child population, but not for infants. Similar trends were observed for boys and girls although the rates for boys were generally higher especially during infancy. More deaths occurred in the months of April, June, and July, and October and November indicating two peak seasons in both years. More deaths occurred in Peasant's Associations that were furthest from the health centre. Major probable causes of death were acute respiratory infections, measles, and diarrhoea. It is concluded that even in rural areas of a developing country it is possible to collect from mothers the much needed and valid fertility and mortality data through epidemiological surveillance by using lay-reporters.

Electronic energy transfer and fluorescence quenching in the active sites of mercuric reductase

The FAD-containing enzyme mercuric reductase has been studied by means of steady-state and time-resolved fluorescence spectroscopy. The fluorescence relaxation of the excited state of the isoalloxazine ring of FAD can be described by a sum of two exponential functions. The two lifetimes are not due to a different lifetime of each of the two FAD molecules of mercuric reductase. The FAD molecules are quenched dynamically by a quencher that is not sensitive to the solvent viscosity. In vitro activation induces a dynamic quenching of fluorescence, while upon binding of NADP+ the FAD molecules are both statically and dynamically quenched. Time-resolved fluorescence anisotropy experiments of mercuric reductase in water show that the isoalloxazine ring probably undergoes a rapid and restricted vibrational motion of small amplitude. Electronic energy transfer occurs between the two FAD molecules at a rate of about 3.4 x 10(7) s-1. The angle between the emission transition dipole of the donor and the absorption transition dipole of the acceptor is 137 +/- 2 degrees (or 43 +/- 2 degrees). From previous X-ray data of glutathione reductase we find that the corresponding angle is 160 degrees. This suggests that the isoalloxazine rings of mercuric reductase and glutathione reductase are mutually tilted in slightly different ways.