Well-being: A philosophical basis for health services

This paper develops and defends the claim that the promotion of human well-being is a philosophical basis or rationale for health services. It first sketches a case for this thesis, then defends it against various objections arising from the contrary position, here dubbed The Sceptical View. Later sections of the paper elaborate on the meaning of well-being, the nature of well-being, and the scope of appropriate health service concern with well-being. In particular, distinctions are made between thick and thin well-being, and between well-being and its various measures. These discussions generate further defences of the philosophical centrality of human well-being to health services.     

The Po River Delta epidemiological survey: Reference values of total serum IgE levels in a normal population sample of North Italy (8–78 yrs)

The aim of this paper was to define, for the first time in Italy, normal levels of total serum IgE in a general population sample of North Italy. Total serum IgE in 1905 subjects, living in Po Delta area (near Venice), were measured by PRIST method. Normal values were derived from 558 subjects without asthma and/or asthmatic/rhinitic symptoms, noncurrent smokers, skin prick-test negatives (normals). Cut-off values to differentiate normals from the remaining part of the sample (others), from asthmatic, and from rhinitic subjects, were established with the IgE value midway between the upper limit of the 95% confidence intervals (CI) of the geometric mean for normals and the lower limit for others, asthmatics, and rhinitics, respectively. Geometric mean of normal children–adolescents was 45 kU/L (SD: 2.6; 95% CI: 38–63). In normal adults geometric mean was 29 kU/L (SD: 3.3; 95% CI: 25–40) in males and 19 kU/L (SD: 3.8; 95% CI: 16–22) in females. The diagnostic sensitivity of IgE test was low, while the specificity was very high. A good positive predictive value in discriminating normals from others was found, on the contrary, we found a good negative predictive value in discriminating normals from asthmatics or from rhinitics. In conclusion, our results confirm that it is necessary to provide separate total serum IgE reference values for what concerns age in children–adolescents and in adults, and gender, in adults. Low level of total serum IgE are helpful to exclude allergic asthma or rhinitis.     

Education,motivation for learning,and social competence of 6-year-olds in kindergarten in Denmark and the United States

On the basis of ethnological research methods, the everyday life of one Danish and one American kindergarten class in school is described. In the American kindergarten class teaching of the three Rs (reading, writing and arithmetic) is predominant, whereas play constitutes the life in the Danish classroom. The study shows that the American teacher-controlled academic practice and the children's concrete cultural background contribute to the development of motivation for learning at the age of 6 years. On the other hand, the American children are very egocentric and have difficulties in participating in group activities. In contrast, the more child-controlled practice in the Danish kindergarten develops social competence but neglects the development of motivation for learning. With comprehensive development as the educational aim, neither the American teacher-controlled academic practice nor the Danish child-controlled play approach is quite adequate, which calls for a new paradigm in early childhood education.     

Going off the dole: A prudential and ethical critique of the healthfare state

The present healthfare state in the United States in neither practically nor morally justified. The nation currently fails to provide adequate access to health care for tens of millions of uninsured citizens. To suggest that the United States' half-million physicians should provide their care as charity is an inadequate solution. The transfer of assets from the haves to the have-nots through taxation in a healthfare state undermines human compassion, and fails to respect minimal moral requirements. However, alternative strategies are possible. During the next 20 years health care could come to be financed on the basis of sound quasi-libertarian moral and prudential principles. In the interim deliberate political action is required to achieve novel health policy, available and affordable job and career training, and universal employment. It is possible to achieve universal access to adequate health care while sustaining individual choice, and at the same time to reduce or virtually eliminate taxpayersubsidised health care. This approach would, in time, eliminate the healthfare state and eventually encourage and even require citizens to go off the healthfare dole.     

Rethinking Our Understanding of the Resident Group in Group Care

The author of this article lived in two residential homes in order to understand, and create a model of, the residents' social group. By understanding the way in which the group grants power to its members and the beliefs and actions which it values, residential staff have the opportunity to identify and support positive individual and group behaviours. It is a model which starts from the group rather than imposing our adult notions of how young people should behave. The way in which the everyday activities of young people, for example their use of humour, serves to maintain group expectations, organisations and relationships, should not be overlooked but rather identified, understood and encouraged.     

Making sense of illness: late-in-life migration as point of departure for elderly Iranian immigrants' explanatory models of illness

This article is based on data gathered through 60 qualitative interviews conducted within the realm of three research projects that have used culture-appropriate lenses to study the postmigration situation of late-in-life Iranian immigrants to Sweden. The findings gathered through these studies were interpreted against the backdrop that culturally appropriate nursing theories provide. This meant that it was, at times, these elders backgrounds as cultural others that were implicitly used to make sense of the various issues that were brought to the fore by these studies. The particular issue with which this article is concerned is the unusualness of these elders explanatory models of illness. Inspired by the concept definition of situation in the symbolic interactionist perspective and by the feeling that this perspective might bring about a different interpretation of the original findings regarding their understandings of illness and disease, we set out to conduct a secondary analysis of these elders explanatory models of illness. The findings presented in this article will show how the elderly Iranian immigrants interviewed in these three studies utilize the process of late in life migration as a point of reference for their understandings of what has caused the illnesses from which they suffered. Hereby we will suggest that the unusualness of their explanatory models of illness might be best understood if we focus on what they shared as immigrants (i.e., the fact that the process of late-in-life migration has made their culture obsolete) as opposed to what they shared as Iranians (i.e., their culture of origin).     

‘U’ technique and standard technique of Norplant removal

Objectives To compare the side effects and time required for Norplant removal between the U technique (using the no-scalpel vas deferens holding forceps) and the standard technique.Materials and methods A randomized controlled clinical trial was carried out of acceptors in family planning clinics in Dr Kariadi Hospital, Semarang, who wanted to have Norplant removal. The Norplant was removed by experienced doctors who had been trained for both the U technique and the standard technique. Removal time, capsule condition and complications were examined.Results From 41 clients in the U technique group and 41 clients in the standard technique group, the removal times were 2.75±1.28 and 6.57±2.93 minutes, respectively (p<0.01). One week after Norplant removal, complications were found in 5 clients, 1 from the U technique group (2.44%) and 4 from the standard technique group (9.76%). Two weeks after Norplant removal no complications were found.Conclusion The U technique was quicker and less complicated compared with the standard technique.

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ResumenObjectivos Comparar los efectos secundarios y el tiempo requerido para el retiro de Norplant con la técnica U y la técnica estándar.Materiales y métodos Un ensayo clínico controlado aleatorizado de aceptadoras en la clínica de planificación familiar Dr. Kariadi Hospital Semarang que deseaban que se retirase el Norplant. El Norplant fue retirado por médicos experimentados que habían sido adiestrados tanto en la técnica U como en la estándar. Se examinaron el tiempo de retiro, el estado de las cápsulas y las complicaciones.Resultados En 41 clientas en la técnica U y 41 clientas en la técnica estándar, el tiempo de retiro fue 2,75±1,28 y 6,57±2,93 minutos (p<0,01) respectivamente. Se detectaron complicationes después de una semana del retiro de Norplant en 5 clientas, 1 caso (2,44%) en la técnica U y 4 (9,76%) en la técnica estándar. Dos semanas después no se detectaron complicaciones.Conclusión La técnica U fue más rápida y señaló menos complicaciones que la técnica estándar.

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ResumèObjectifs Comparer les effets secondaires et le temps nécessaire pour le retrait du Norplant, entre la technique en U et la technique standard.Matériels et méthodes Un essai clinique randomisé a été effectué sous contrôle à la clinique de planning familial de l'hôpital Dr. Kariadi de Semarang sur des patientes sollicitant le retrait du Norplant. Celui-ci a été retiré par des médecins expérimentés qui avaient, été formés à la technique de retrait dite en U et à la technique standard. On a relevé les temps de retrait, l'état des implants et les complications survenues.Résultats Pour 41 patientes soumises à la technique en U et 41 patientes à la technique standard, les temps de retrait ont été respectivement de 2,75±1,28 et 6,57±2,93 minutes (p<0,01). Des complications ont été observées une semaine après le retrait de Norplant chez 5 femmes, soit 1 cas (2,44%) pour la technique en U et 4(9,76%) pour la technique standard. Deux semaines plus tard, aucune complication n'a été constatée.Conclusion La technique en U est plus rapide et entraîne moins de complications que la technique standard.

     

Quality of life of caregivers in Parkinson’s disease

Objective: To assess the impact of PD on informal caregivers of patients and identify the main factors related to caregiver strain. Patients and methods: Pairs of PD patients and their caregivers. Evaluation by neurologists included the Hoehn and Yahr, Schwab and England, UPDRS (parts 1–3), ISAPD, and Pfeiffers SPMSQ rating scales. Patients completed the Euro-QoL 5D, PDQ-8, and Hospital Anxiety and Depression Scale. The SQLC was used to assess caregivers quality of life (QoL), with caregivers, in turn, applying the Euro-QoL and PDQ-8 to assess patients health-related quality of life (HRQoL). Multiple linear regression models were fitted to ascertain factors linked to the SQLC. Results: Significant correlations were in evidence between the following scores: SQLC and clinical rating scales and SQLC and patients HRQoL. Based on multiple regression analysis, patients functional state (ADL) proved to be the main predictor of caregivers QoL. Self- and caregiver-assessed patients HRQoL also proved to be a relevant factor. Conclusions: (1) Patients functional state was significantly related to caregivers psychosocial burden; (2) patients HRQoL proved to be an additional factor linked to caregiver QoL; (3) improvement of patient disability and HRQoL might alleviate caregiver strain.     

Frequency of consumption of selected indicator foods and serum cholesterol

The relationship between frequency of consumption of eleven indicator foods (milk, meat, liver, carrots, green vegetables, fruit, eggs, ham, fish, cheese and alcohol) and serum cholesterol was investigated in the comparison group of a case-control study of acute myocardial infarction conducted in Italy. Data were collected on 792 subjects from various Italian regions, admitted to hospital for acute conditions unrelated to any known or potential risk factor for myocardial infarction or to long-term modifications in diet. No statistically or epidemio-logically meaningful relationship emerged between serum cholesterol level and frequency of consumption of any of these foods. Cholesterol levels rose according to increasing consumption tertiles for most of the indicator foods considered. Higher values for the higher tertile of consumption were observed for meat, ham and eggs, but also for fruit, carrots and green vegetables. However, correlation coefficients between frequency of consumption of various food items and serum cholesterol level were uniformly low for all food items considered, ranging between –0.09 (for milk) and 0.19 (for ham). Although a more comprehensive diet history may lead to different indications, the present data are not suggestive of any major influence of long-term frequency of consumption of a few selected indicator foods on serum cholesterol levels.GISSI-EFRIM (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto — Epidemiologia dei Fattori di Rischio dell'Infarto Miocardico). Scientific Advisory Board: G.A. Feruglio, M.G. Franzosi, C. La Vecchia, A.P. Maggioni, A. Maseri, G. Tognoni. Participating Clinical Centers: Alba (S. Boscarino); Asti (M. Alciati); Avellino (G. Amoroso); Bari Di Venere (N. D'Amato); Barletta (M.A. Messina); Belluno (A. Darold, A. De Biasi); Biella (A. Pagliarini); Bolzano (C. Romeo); Bozzolo (E. Franzi); Brindisi (C. Andriulo); Broni (B. Albonico); Cagliari (M. Sias); Casale Monferrato (M. Pezzana); Casarano (S. Ciricugno); Caserta (R. Di Sarno); Castel San Giovanni (D. Bozzarelli); Castellammare di Stabia (R. Longobardi); Cento (L. Orselli); Chiari (C. Gentilini); Colleferro (E. Venturini); Copertino (A. Calcagnile); Crotone (R. Lumare); Desio (G. Iacuitti); Fidenza (S. Callegari); Foligno (A. Mattioli); Gallarate (G. Filippini); Genova Galliera (G. Scarsi); Grosseto (A. Cresti); Guastalla (V. Manicardi); Legnago (P. Todesco); Leno (A. Lanzini); Lodi (C. Pezzi); Lugo (T. Tognoli, M. Gobbi); Magenta (G. Ventura, R. Turato); Mantova (A. Izzo, G.P. Guerra); Matera (A. Rizzi); Menaggio (S. Silvani); Messina Policlinico (G. Di Tano); Mestre (G. Gasparini); Milano Niguarda II° divisione (C. Corsini); Milano Policlinico (M. Marconi); Mirano (A. Zanocco); Monza (F. Achilli); Napoli Cardarelli ' (F. Piantadosi, R. Giuliano, G. Sepe, S. Pezzella); Novi Ligure (L. Fasciolo); Nuoro (G. Tupponi); Palermo Cervello (A. Ledda); Palermo Benfratelli (R.G. La Malfa); Palermo Villa Sofia (A. Pizzuto); Perugia (S. Brando); Pescia (L. Iacopetti); Piombino (S. Bechi); Pisa (U. Conti); Pistoia (F. Fantoni); Putignano (A. Marco); Riccione (F. Brighi, A. Benati); Rieti (S. Orazi); Rimini (F. Bologna, D. Santoro); Roma Nuova ITOR (M. Rocchi); Roma S. Pietro (P. Giuliani); Roma Policlinico (P. De Paolis); Saluzzo (P. Allemanno, S. Reinaud); San Donà di Piave (P. Delia Valentina); Sassuolo (G. Fontana, P. Orlandi); Savigliano (V. Cravero); Savona (A. Gandolfo); Sciacca (C. Catalano); Sondrio (M. Marieni); Termoli (M. Esposito); Torino Maria Vittoria (L. Faccio, L. Mussano); Trapani (G.B. Biondo); Treviso (F. Perissinotto); Udine (C. Fresco); Vasto (E. Bottari); Voghera (G. Ferrari).     

Towards a Theory of the Everyday: The Ordinary and the Special in Daily Living in Residential Care

This paper begins with a debate about the relative place of ordinary and special approaches to everyday living with young people in residential care and treatment. It argues for a considered approach to this distinction between the ordinary and the special, based on assessments of children's needs and stages of development, and on the purpose of their residential placement. From this beginning it enters into a broader proposal about the need for a comprehensive theory of the everyday in residential work. The argument focuses on the need for an underpinning framework for the planning and analysis of daily group care practice with young people. Finally, it explores how different assumptions and theoretical frameworks may operate in support of a programme for everyday practice which is differentiated according to the needs of the children and the task of the organisation.     

Changes in plasma,liver, and ovary vitellogenin in landlocked atlantic salmon following exposure to sublethal cyanide

Female landlocked Atlantic salmon (Salmo salar Ouananiche) were exposed to 0.005 mg/L hydrogen cyanide (HCN) for 12 days at 7±1°C during late vitellogenesis (October). Plasma vitellogenin and liver and gonad vitellogenin levels were measured by homologous radioimmunoassay (RIA) specifically developed for this species. Results indicated that plasma vitellogenin levels increased in cyanide exposed fish. Vitellogenin levels in the liver did not change relative to control fish suggesting that the increased levels of plasma vitellogenin did not result from a change in synthesis in the liver. Vitellogenin levels declined in the gonad relative to the controls by day 12. Elevated plasma vitellogenin levels along with decreased vitellogenin in the gonads suggest that exposure of female salmon to sublethal HCN during late vitellogenesis inhibits the uptake of vitellogenin at the ovarian level.Marine Sciences Research Laboratory Contribution No. 675.     

Insecticidal and neuroexcitant actions of DDT analogs on the cockroach,Periplaneta americana

The American cockroach (Periplaneta americana) was used to test 14 DDT analogs for their ability to cause a) death and b) repetitive firing in the abdominal nerve cord. P,p-DDT, p,p-DDD, p,p-methoxychlor, and o,p-DDT were all found to induce repetitive firing in the nerve cord after a twice threshold stimulus, but only p,p-DDT, p,p-DDD, and p,p-methoxychlor produced mortality within 4 days from injection of the pesticides. Also, cockroaches exposed to sublethal doses of p,p-DDT and p,p-methoxychlor were found to exhibit repetitive firing in the abdominal nerve cord three weeks after injection of the pesticide. The cause and effect relationship between neuroexcitation and lethality is therefore questioned, at least in the case of cockroaches.     

Health behaviours and socio-economic status in Ontario, Canada

Data from the 1990 Ontario Health Survey were used to investigate the association of socio-economic status with the likelihood of meeting current recommendations for four health behaviours (smoking, fat intake, alcohol consumption, and physical activity level) in adults living in Ontario (Canada). Health behaviours were categorised as unhealthy if they did not meet current recommendations in Ontario (smoking, fat intake < 30% of dietary energy, alcohol intake < 14 units per week, low level of leisure-time physical activity). Two summary variables based on the number ofÔ unhealthyÕ behaviours were also examined: the crude number of unhealthy behaviours reported and the likelihood of reporting 3 or 4 unhealthy behaviours. Four measures of socio-economic status were used: educational achievement, household income status, source of household income, and occupational prestige. Multiple logistic and linear regression analyses were performed to explore the association of each unhealthy behaviour and of the summary variables with socio-economic status indicators (taken independently or simultaneously), controlling for demographic characteristics. Except for the positive relationship between income status and high alcohol intake, measures of unhealthy behaviours were inversely associated with the socio-economic indices, suggesting that individuals in lower socio-economic groups are at an increased risk for health problems.     

Measurement of quality of life in women with breast cancer. Development of a Life Satisfaction Questionnaire (LSQ-32) and a comparison with the EORTC QLQ-C30

The purpose was to develop and validate a new instrument suitable for measuring perceived quality of life in women with breast cancer. The instrument is to be used within conventional cancer therapy as well as in complementary care, and is called the LSQ-32 (Life Satisfaction Questionnaire). The subjects were 362 women with breast cancer in all cancer stages. Cronbach's reliability coefficient of the LSQ was 0.89. The construct validity was estimated by a principal component analysis. Six orthogonal factors were identified: (1) Quality of family relation, (2) Physical symptoms, (3) Socioeconomic situation, (4) Quality of daily activities, (5) Sickness impact and (6) Quality of close friend relation. The criterion-related validity was estimated by comparing the LSQ-32 and the EORTC QLQ-C30. The scales/items of the EORTC QLQ-C30 were represented in the LSQ-32, but the factors Quality of family relation and Quality of close friend relation were not found in the EORTC QLQ-C30. It was concluded that the LSQ-32 as well as the EORTC QLQ-C30 are valuable tools in the measurement of quality of life in women with breast cancer. The LSQ-32, however, also contains an existential factor.The study was approved on 1992 04 08 by the Research Ethical Committee, Faculty of Health Sciences, University of Linköping.     

An application of structural equation modeling to detect response shifts and true change in quality of life data from cancer patients undergoing invasive surgery

The objective is to show how structural equation modeling can be used to detect reconceptualization, reprioritization, and recalibration response shifts in quality of life data from cancer patients undergoing invasive surgery. A consecutive series of 170 newly diagnosed cancer patients, heterogeneous to cancer site, were included. Patients were administered the SF-36 and a short version of the multidimensional fatigue inventory prior to surgery, and 3 months following surgery. Indications of response shift effects were found for five SF-36 scales: reconceptualization of general health, reprioritization of social functioning, and recalibration of role-physical, bodily pain, and vitality. Accounting for these response shifts, we found deteriorated physical health, deteriorated general fitness, and improved mental health. The sizes of the response shift effects on observed change were only small. Yet, accounting for the recalibration response shifts did change the estimate of true change in physical health from medium to large. The structural equation modeling approach was found to be useful in detecting response shift effects. The extent to which the procedure is guided by subjective decisions is discussed.     

Socioeconomic status, overweight and obesity in prepuberal children: A study in an area of Northern Italy

The aim of this study was to determine whether socio-economical status (SES) is associated with overweight and obesity in prepuberal children. In an area of North-Western Italy a sample of 1420 children, aged 10–11 years, had his/her height and weight recorded, (overweight and obesity were defined, respectively, as relative body weight 120% and 140%), and parents were requested to compile a questionnaire exploring some demographic and social conditions. 23% of the sample resulted overweight or obese. Prevalence rate ratios (PRR) of overweight and obesity (together) were calculated, adjusting for parents' age, parents' area of birth, and school district. PRR for mother's lowest educational level compared to the highest was 1.59 (95% CI: 1.19–2.13), while for father's education was 1.21 (0.90–1.63). PRRs for unemployed or manual mother compared to upper non manual were respectively 1.83 (1.20–2.79) and 2.20 (1.31–3.68), while for unemployed or manual father were 2.63 (1.97–2.63), and 1.63 (1.27–2.09). The cultural resources of the mother, and the economical resources of the family seem to influence the prevalence of weight gain in prepuberal children. This should be taken into account when planning programs for the prevention or reduction of obesity in children.     

Embryotoxic and teratogenic effects in unhatched fertile eggs from hens fed polychlorinated biphenyls (PCBs)

Summary The PCBs tested with caged White Leghorn hens were Aroclors 1221, 1232, 1242, 1248, 1254, 1268, 5442 and BP-6, fed at the 20 ppm level. In addition, 1242, 1248 and 1254 were also fed at the 2 ppm level. Feeding 20 ppm Aroclors 1232, 1242, 1248 and 1254 reduced hatchability and caused teratogenic effects in the embryos. The most common abnormalities found in the unhatched embryos were edema and unabsorbed yolk. Since Aroclors 1221 and 1268 did not adversely affect embryonic development, adverse effects of the PCBs were not directly related to the degree of chlorination of the biphenyls, or to the amount of total residue.     

Definitions of healthy eating in Spain as compared to other European Member States

Study objective: To assess what healthy eating means for the European population and whether this concept differs between Spain and other European Countries. Design: A Pan-European survey was developed between October 1995 and February 1996 by the Institute of European Food Studies (Dublin). Each subject was asked to describe in his or her own words what he/she understood by healthy eating. Comparisons were made among four groups of European countries (Northern, Central, Spain, and other Mediterranean countries). Setting: The survey included participants from the 15 member states of the European Union, selecting quota-controlled samples to make them nationally representative. Subjects: The questionnaire was completed by 14,331 persons, approximately 1000 from each country. Results: The responses were grouped into 89 broad categories of similar answers concerning nutritional value and afterwards these responses were collapsed to simplify the presentation. The definition of healthy eating such as more fiber and less fat was more prevalent in other States, members of the European Union than in Mediterranean Countries, although the definition of balanced diet was more frequently mentioned in Spain than in the rest of the European Union. Conclusions: Our results show that the concept of balance and variety is more prevalent in Spaniards than in other traditional Mediterranean countries. Differences in the definitions of healthy eating among European countries could be explained, at least partially by differences in consumption patterns and in the nutrition education.     

Pesticide residues in human colostrum: Seasonal variations,Yugoslavia

Levels of HCH, HCH, HCH,o,pDDE,p,pDDE andp,pDDT were measured in 59 samples of colostrum collected in the autumn 1982 and the spring 1983 from healthy nursing mothers on the third day after delivery. Pesticide residues were identified and quantitated on a gas chromatograph. Concentrations of HCH were significantly higher in the autumn (mean, 1.71g/L) than in the spring (0.67g/L), while concentrations of HCH were significantly lower in the autumn (0.49g/L) than in the spring (1.50g/L). The differences between the two seasons were not statistically significant for HCH (0.95 g/L vs 0.88g/L),o,pDDE (0.73g/L vs 1.34g/L),p,pDDE (68.63g/L vs 53.72g/L) andp,pDDT (20.00 (g/L vs 14.29 (g/L).Calculated average daily HCH (Lindane) intake of 0.04g/kg body wt (b.w.) and total DDT intake of 4.16 (/kg b.w. in a 3.5 kg newborn, ingesting 60 ml/kg b.w. of colostrum on the third day of life was below the upper limit of FAO/WHO Acceptable Daily Intake (ADI) (0.01 mg/kg b.w. for Lindane and 0.005 mg/kg b.w. for DDT) in the spring. In the autumn, Lindane intake of 1.10k/kg b.w. was below the FAO/WHO ADI and total DDT intake of 5.36 g/kg b.w. was slightly above the FAO/WHO ADI.     

Prospective follow-up of genital HPV infections: Survival analysis of the HPV typing data

A series of 532 women with genital HPV infections has been prospectively followed-up without treatment since 1981 for a mean of 50 (+/-21) months. The patients were examined at six month intervals by colposcopy, PAP smears and/or biopsy. HPV typing of all biopsies was completed using in situ, Southern blot and/or sandwich hybridization with DNA probes for types 6, 11, 16, 18, 31 and 33. Survival data analysis was applied to analyse the clinical course (i.e. spontaneous regression and progression) of the HPV lesions stratified by their HPV type, currently available for 458 women. Clinical progression was significantly related to the HPV type present in the lesions. The progression rate was 11.1% (6/54) for HPV 6 lesions, 14.3% (8/ 56) for HPV 11, 35.2% (32/91) for HPV 16,12.5% (4/32) for HPV 18,18.8% (6/32) for HPV 31,19.4% (6/31) for HPV 33 and 28.6% (4/14) for doubly infected lesions. The lowest progression rate, 6.1% (9/ 148), was found in lesions which remained constantly HPV DNA-negative. In the survival analysis the probability of progression varied significantly between the six HPV types (p=0.0005, overall). After grouping the viral types as HPV 6/11 (low risk), HPV 16/18 (high risk) and HPV 31/33 (intermediate risk) the overall probability of progression remained significantly different (p=0.0035, overall). In clinical regression, however, the HPV type was not an equally good predictor (p=0.1952, overall). Within groups HPV 6/11, 16/18 and 31/33 the differences were even less significant (p= 0.4759, overall). In the pairwise comparison significant differences in progression occurred when HPV type 16 was compared to HPV 6, HPV 11 or HPV DNA-negative lesions. In regression similar differences existed in comparison of HPV DNA-negative to HPV 6 or HPV 18 lesions.These data confirm the previous finding of HPV type 16 as a high risk type in cervical infections. Types 31 and 33 belong to intermediate category. Although, previously included in the high risk category, type 18 did not markedly differ from the clinical course of the low risk (HPV 6, 11) types in the study.Corresponding author.