Applications of computerized adaptive testing (CAT) to the assessment of headache impact

Objective: To evaluate the feasibility of computerized adaptive testing (CAT) and the reliability and validity of CAT-based estimates of headache impact scores in comparison with static surveys. Methods: Responses to the 54-item Headache Impact Test (HIT) were re-analyzed for recent headache sufferers (n = 1016) who completed telephone interviews during the National Survey of Headache Impact (NSHI). Item response theory (IRT) calibrations and the computerized dynamic health assessment (DYNHA^®) software were used to simulate CAT assessments by selecting the most informative items for each person and estimating impact scores according to pre-set precision standards (CAT-HIT). Results were compared with IRT estimates based on all items (total-HIT), computerized 6-item dynamic estimates (CAT-HIT-6), and a developmental version of a static 6-item form (HIT-6-D). Analyses focused on: respondent burden (survey length and administration time), score distributions (ceiling and floor effects), reliability and standard errors, and clinical validity (diagnosis, level of severity). A random sample (n = 245) was re-assessed to test responsiveness. A second study (n = 1103) compared actual CAT surveys and an improved static HIT-6 among current headache sufferers sampled on the Internet. Respondents completed measures from the first study and the generic SF-8 Health Survey; some (n = 540) were re-tested on the Internet after 2 weeks. Results: In the first study, simulated CAT-HIT and total-HIT scores were highly correlated (r = 0.92) without ceiling or floor effects and with a substantial reduction (90.8%) in respondent burden. Six of the 54 items accounted for the great majority of item administrations (3603/5028, 77.6%). CAT-HIT reliability estimates were very high (0.975–0.992) in the range where 95% of respondents scored, and relative validity (RV) coefficients were high for diagnosis (RV = 0.87) and severity (RV = 0.89); patient-level classifications were accurate 91.3% for a diagnosis of migraine. For all three criteria of change, CAT-HIT scores were more responsive than all other measures. In the second study, estimates of respondent burden, item usage, reliability and clinical validity were replicated. The test–retest reliability of CAT-HIT was 0.79 and alternate forms coefficients ranged from 0.85 to 0.91. All correlations with the generic SF-8 were negative. Conclusions: CAT-based administrations of headache impact items achieved very large reductions in respondent burden without compromising validity for purposes of patient screening or monitoring changes in headache impact over time. IRT models and CAT-based dynamic health assessments warrant testing among patients with other conditions.     

Moral strangers and the health care market

In order to reflect on the morality of the health care market this paper critiques some of H. T. Engelhardt's presuppositions. Engelhardt has created the vivid term moral stranger and suggested that there can be a morality of moral strangers. However his position relies either on certain necessary presuppositions which he leaves unmentioned or on presuppositions that are—in a strict sense—not moral ones. Engelhardt advocates the market economy as the guiding principle of health care, and claims that the market needs no moral presuppositions. But when the preconditions of a functioning market are examined it turns out that a functioning market requires property and ownership, and that property and ownership are moral institutions. Therefore the application of the idea of the market to health care undoubtedly has morally serious consequences: most important, the difference between commodities and human beings is obscured.     

The SEIQoL-DW is a valid method for measuring individual quality of life in stroke survivors attending a secondary prevention clinic

Objectives: This paper examines the applicability and construct validity of the Schedule for the Evaluation of Individual Quality of Life-Direct Weight (SEIQoL-DW) for measuring quality of life in stroke survivors living at home that attend a secondary prevention clinic. Participants and methods: Forty-six individuals attending a secondary prevention clinic following a stroke or transient ischaemic attack participated in a semi-structured interview to complete a range of outcome measures. Assessments of cognitive impairment, disability, and handicap were conducted using the Mini mental State Examination (MMSE), Barthel Index (BI), and Rankin Scale (RS). Measures to assess quality of life included perceived health status (PHS), Visual Analogue Mood Scale (VAMS), the Hospital Anxiety and Depression Scale (HADS), and the SEIQoL-DW. The construct validity of the SEIQoL-DW was assessed by correlation with the other measures. Results: According to the cues elicited from the SEIQoL-DW, participants nominated relationships with family and friends as the most important life domain, followed by social and leisure activities, and health. Spearmans rho correlation coefficients demonstrated significant relationships between the SEIQoL-DW index scores, PHS (r=0.35, p=0.016), VAMS (r=0.419, p=0.004), and the HADS anxiety (r=–0.546, p < 0.0001) and depression (r=–0.701, p < 0.0001) subscale scores. Conclusions: The SEIQoL-DW demonstrated reasonable construct validity for use in assessing individual quality of life in a group of individuals following stroke or TIA that attend a secondary prevention clinic.     

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.     

The relationship between lipodystrophy-associated body changes and measures of quality of life and mental health for HIV-positive adults

Objectives:To investigate the relationship between lipodystrophy-specific symptom severity and wellbeing. Methods:HIV-positive adult patients with body fat redistribution (lipodystrophy syndrome) associated with antiretroviral therapy reported their total non-lipodystrophy symptoms and side effects and completed measures assessing body fat changes (yielding Atrophy, Hypertrophy and Total Lipodystrophy scores), mental health and quality of life. Effects of total symptom complex and lipodystrophy severity on quality of life and mental health were analyzed using Spearmans rho correlations. Logistic regression analyses were utilized to determine the relative-odds of depression produced by overall symptom count and lipodystrophy score increments. Results:Mean ratings for Hypertrophy and Atrophy corresponded to very mild and mild degrees of severity, respectively. The total symptom complex was associated with ratings for most of the mental health and quality of life measures. Patient-perceived body image scores were the sole study variable responsive to lipodystrophy severity ratings. In comparison to reference norms, a pronounced degree of body image impairment was evident. Conclusion: Although responsive to the total symptom profile, psychosocial measures typically utilized for evaluating quality of life and mental health status in HIV disease lacked sensitivity and specificity for measuring the consequences of lipodystrophy-associated fat distribution changes alone. Lipodystrophy severity did impact negatively on body image.     

Measuring change over time: a comparison of results from a global single item of health status and the multi-dimensional SF-36 health status survey questionnaire in patients presenting with menorrhagia

This paper compares the sensitivity to change of a multi-item, multi-dimensional health status measure with a single global health status question, in the assessment of treatment for menorrhagia. A cohort study of patients recruited by general practitioners, was carried out, with a follow up at eighteen months. Questionnaires were administered postally at baseline and follow up. General practices in Berkshire, Buckinghamshire, Northamptonshire and Oxford-shire supplied three hundred and nine women who reported heavy menstrual bleeding, and received either drug treatment alone or both drug and surgical treatment (endometrial resection or hysterectomy) during the eighteen months between the two admini-strations of the questionnaires. A single global question was given to patients asking them to rate their overall health status as excellent, very good, good, fair or poor. The eight dimensions of the SF-36 health survey questionnaire were also given to patients to complete. The dimensions of the SF-36 indicated only small levels of improvement for patients who received drug treatment. However, on many dimensions of the SF-36, a moderate to large improvement was detected for the surgical group. However, small changes were reported in overall health status, as indicated by the single global question, for both groups. Single item measures of health status may not provide a sufficiently accurate indication of health status to be appropriate for use in longitudinal studies.     

Reliability of Birth Certificate Data: A Multi-Hospital Comparison to Medical Records Information

Objective: To examine the reliability of birth certificate data and determine if reliability differs between teaching and nonteaching hospitals. Methods: We compared information from birth certificates and medical records in 33,616 women admitted for labor and delivery in 1993–95 to 20 hospitals in Northeast Ohio. Analyses determined the agreement for 36 common data elements, and the sensitivity, specificity, and positive and negative predictive values of birth certificate data, using medical record data as a gold standard. Results: Sensitivity and positive predictive value varied widely (9–100% and 2–100%, respectively), as did agreement, which was almost perfect for measures of prior obstetrical history, delivery type, and infant Apgar score ( = 0.854–0.969) and substantial for several other variables (e.g., tobacco use ( = 0.766), gestational age ( = 0.726), prenatal care ( = 0.671)). However, agreement was only slight to moderate for most maternal risk factors and comorbidities ( = 0.085–0.545) and for several complications of pregnancy and/or labor and delivery ( = 0.285–0.734). Overall agreement was similar in teaching (mean = 0.51) and nonteaching ( = 0.52) hospitals. Although agreement in teaching and nonteaching hospitals varied for some variables, no systematic differences were seen across types of variables. Conclusions: Our findings indicate that the reliability of birth certificate data vary for specific elements. Researchers and health policymakers need to be cognizant of the potential limitations of specific data elements.     

Use of the internet for health care information: results from a national telephone survey

Summary. Use of the internet for health care information results from a national telephone surveyObjectives: The Internet has attracted considerable attention as a means to improve health and health care delivery, but it is not clear how prevalent internet use for health care really is. Available estimates for Germany dont exist. Without accurate estimates of use, it is difficult to focus policy discussions or design appropriate policy activities.Methods: 2026 individuals aged 16 years or older were interviewed in Germany using computer-assisted telephone interview (CATI) in 2001. The sampling frame based on a modified RLD-Design.Results: Approximately 50% of respondents with Internet access reported using the internet to look for advice or information about health or health care. The internet is differently used by the population for the health care information. There is a higher use rate of men, of younger people, of people with high socio-economic status and of the healthy ones. After controlling in multivariate analysis for the user, merely an significant age effect exists.Conclusions: The use of the internet for health care information in Germany is quite different. Questions about consequences remain unanswered. Do the differences increase or do they decrease? And which role does play the health politics? This and other questions could be answered by further studies.

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Verbreitung und Sozialprofil der gesundheitsthemenbezogenen Internetnutzung: Ergebnisse einer bundesweiten Telefonumfrage

Zusammenfassung. Fragestellung: Bereits jeder zweite Bundesbürger nutzt das Internet. Weniger klar ist die Nutzung des Internets speziell zur Beschaffung von Gesundheitsinformationen. Angaben darüber gibt es für Deutschland gegenwärtig nicht. Um eine gezielte Sozial- und Gesundheitspolitik betreiben zu können, sind Bevölkerungsangaben jedoch unerlässlich.Methoden: 2026 Personen im Alter von 16 Jahren und älter wurden mittels einer computergestützten Telefonumfrage (CATI) im Frühjahr 2001 befragt. Grundlage der Stichprobe bildet eine Zufallsauswahl nach einem modifizierten RLD-Design.Ergebnisse: Von den Bürgern, die das Internet schon einmal genutzt haben, gaben ca. 50% der Befragten an, sich schon einmal im Internet über Gesundheitsthemen informiert zu haben. Das Internet wird zur Beschaffung von Gesundheitsinformationen von der Bevölkerung unterschiedlich genutzt, es sind die Männer, die Jüngeren, die besser Gebildeten, Personen aus Haushalten mit einem höheren Haushaltsnettoeinkommen und die Gesünderen, die sich auf diesem Wege eher informieren. Sind die Bürger jedoch einmal Online, so die Ergebnisse der multivariaten Analyse, bleibt lediglich ein signifikanter Alterseffekt bestehen.Schlussfolgerungen: Ob die dargestellten Unterschiede der gesundheitsthemenbezogenen Nutzung des Internets in Zu-kunft zu-oder abnehmen, hängt nicht zuletzt auch von den politischen Rahmenbedingungen ab. Diese und weitere Fragen, wird man erst durch weitere Studien klären können.

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Résumé. Internet et santé une enquête téléphonique nationaleObjectifs: Linternet est devenu une source importante permettant dobtenir des informations médicales. II existe toutefois peu de recherches sur lutilisation de ces informations en Allemagne. Des recherches apparaissent donc nécessaires afin de pouvoir adopter des politiques sociales sensées.Méthode: 2026 individus âgés de 16 ans ou plus ont été interviewés en 2001 en Allemagne au moyen dinterviews assistées par ordinateur (ITAO). Léchantillonnage a été constitué par une sélection aléatoire sur la base dune méthode RLD modifiée.Résultats: Environ 50% des répondants ayant un accès internet ont rapporté utiliser linternet comme source dinformations médicales. Cet usage de linternet varie toutefois au sein de la population. Il y a un taux plus élevé dutilisation parmi les hommes, les personnes plus jeunes, les personnes avec un statut socioéconomique élevé et parmi les individus en bonne santé. Les résultats des analyses multivariées montrent que parmi les gens ayant un accés à Internet, seul lâge demeure significativement relié à lutilisation de linternet à des fins dinformation médicale.Conclusions: Lutilisation de linternet comme source dinformations médicales en Allemagne varie au sein de la population. Les questions concernant les conséquences demeurent sans réponse. Est-ce que les différences augmentent ou diminuent? Quel est le rôle des politiques de santé? Cette question et dautres pourraient être répondues à laide dautres enquêtes.

     

Managing (In)differently: The management and delivery of Australian nursing care under the economic rationalists

Conclusion Economic (mis)management in Australia has understandably been influenced by the experiences of countries such as the UK and the USA with which Australia has traditionally had a close relationship. However, the uncritical acceptance of economic rationalism is an indication of our nation's seduction by the possibility of a quick fix for a struggling economy. In accepting economic rationalism there has been a dismissal, or at least a failure to take account of, both past Australian experiences and the overseas experience—including the recent experience of a close neighbour, New Zealand, whose health system is under severe strain.The introduction of economic rationalist programmes into the Australian health sector was an attempt to contain expenditure and at the same time reduce dependence on the public system. This has failed to happen on both counts. Its only real achievement has been to produce yet more evidence of the practical inadequacies of economic rationalism in general.     

Comprehensive pediatric primary care vs traditional care in an israeli population: Their influence on pediatric emergency room use and hospitalization

Emergency room (ER) utilization and hospitalization were studied as indicators of the impact of improvements in pediatric primary care services in an Israeli development town, Ofakim, population 12,000. One of the two pediatric services was upgraded in 1976 through the introduction of pediatric faculty, integration of preventive and curative services and conversion of the medical records to a problem-oriented format ( experimental clinic B ). The primary care system remained unchanged in the second clinic ( traditional clinic A ). During 1980, ER utilization by the B clinic population was 9.3/100 compared with 17.6/100 for the A clinic population. Fifty two percent of the B clinic population patients reaching the ER were hospitalized compared with 25% of A clinic patients.The lower ER utilization rate represents a significant saving for the health services, and educational interventions are suggested from the study. Analysis of ER utilization data seems to offer useful information for overall planning and monitoring of ambulatory services for a community.Corresponding author.     

Polychlorobiphenyls, ΣDDT,and hexachlorocyclohexane isomers in the western North Pacific ecosystem

Polychlorobiphenyls (PCBs), DDT (p,p-DDT,p,p-DDD, andp,p-DDE and HCH isomers (hexachlorocyclohexanes including , , and isomers) were determined in a marine food chain, including seawater, zooplankton, myctophid, squid and striped dolphin collected from the western North Pacific waters. The concentrations of these pollutants increased in higher trophic levels, where the highest bioconcentration factors (concentration ratio in organisms to water), as much as 10⁷, were obtained from both PCBs and DDT in striped dolphin. The proportions of highly chlorinated biphenyls,p,p-DDE and -HCH increased in higher-ranking predators. These observations suggest that the bioaccumulation mechanisms in lower trophic levels depend primarily on the physicochemical properties of pollutants, whereas those in higher trophic levels are affected by the biodegradability of the pollutants and the metabolic capacity and life-span of the organisms.     

The association of respiratory problems in a community sample with self-reported chemical intolerance

This epidemiological study evaluated respiratory histories in those individuals reporting chemical intolerance (CI) in a community population sample. The subsample of 181 completed standard Respiratory Health Questionnaires. CI was determined from self-ratings of feeling moderately to severly ill from exposure to at least three of five common chemicals (paint, pesticides, car exhaust, new carpet, and perfume); the prevalence rate was 22.7%. The comparison group (CN) (31.5% of the sample) were selected from their reports of never feeling ill from the same chemicals. The prevalence rate of CI in females was over twice that in males (28% vs 12.9%), a significant difference. There were no significant differences in smoking, age, or education between CI and CN. Prevalence rates for symptoms and Relative Risk Ratios (RR) indicated that the CI were significantly more likely to report chronic cough, phlegm, wheeze, chest tightness, exertional dyspnea, acute respiratory illnesses, hay fever, child respiratory trouble, and physician confirmed asthma. Several of these respiratory symptoms were significantly, though differentially, related to current asthma and hay fever reports. Results suggest a potential vulnerability to and greater interference from respiratory illness for the CI, which have implications for women's health and quality of life.     

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.     

The significance of age and duration of effect in social evaluation of health care

To give priority to the young over the elderly has been labelled ageism. People who express ageist preferences may feel that, all else equal, an individual has greater right to enjoy additional life years the fewer life years he or she has already had. We shall refer to this asegalitarian ageism. They may also emphasise the greater expected duration of health benefits in young people that derives from their greater life expectancy. We may call thisutilitarian ageism. Both these forms of ageism were observed in an empirical study of social preferences in Australia. The study lends some support to the assumptions in the QALY approach that duration of benefits, and hence old age, should count in prioritising at the budget level in health care.     

Immunological and detoxication interaction in p,p-DDT fed rabbits

Summary Thirty-one rabbits were immunized against Salmonella or SRBC. These rabbits had an impaired immunological response when they received 200 ppm p,p-DDT in their drinking water during a period of 38 days. The total gamma globulins as reflected by the 7 S fraction were significantly decreased in the p,p-DDT-Salmonella receiving rabbits when compared with the rabbits receiving only Salmonella. This decrease was not statistically significant in the p,p-DDT-SRBC receiving rabbits when compared with the rabbits receiving only SRBC.The antibody titer against Salmonella was significantly decreased in p,p-DDT-Salmonella receiving rabbits when compared with the rabbits receiving only Salmonella. The decrease of the SRBC antibody titer in the p,p-DDT-SRBC receiving rabbits was not statistically significant.The plasma total DDT level differed significantly in the two groups receiving p,p-DDT (p,p-DDT-Salmonella and p,p-DDT-SRBC receiving rabbits). This finding may explain the different degree of impairment of the immunological response, the higher plasma DDT level having a more marked effect. These differences in total DDT plasma level in the two groups of rabbits which received the same amount of p,p-DDT in their drinking water may be considered as a consequence of the concomitant presence of a different kind of foreign antigen in the internal milieu.The bi-directional relationship between a detoxication process and an immunological response is emphasized.This investigation was supported by a grant from the World Health Organization, International Agency for Research on Cancer, Lyon.     

DDT,DDD, and DDE contamination of sediment in the Newark Bay estuary,New Jersey

Two hundred and forty-six surface and buried sediment samples from Newark Bay, New Jersey, and its major tributaries (Passaic River, Hackensack River, Newark Bay, Arthur Kill, Elizabeth River, and Kill Van Kull) were assayed for p,p-dichlorodiphenyltrichloroethane (p,p-DDT), p,p-dichlorodiphenyldichloroethane (p,p-DDD), and p,p-dichlorodiphenylchloroethylene (p,p-DDE) between February 1990 and March 1993. Chronological profiles in sediments from pre-1940 to the present were determined by radioisotope activities of ²¹⁰Pb and ¹³⁷Cs. The concentrations of these chemicals were compared to National Oceanic and Atmospheric Administration (NOAA) benchmark sediment values (Long and Morgan 1991). The objectives were to (a) determine the spatial and temporal distributions of DDT compounds in sediments, (b) identify possible sources, and (c) assess the potential for sediment toxicity within the estuary. Mean concentrations in surface sediments in individual waterways ranged from 5 to 473 g/kg for p,p-DDT, 18 to 429 g/kg for p,p-DDD, and 5 to 111 g/kg for p,p-DDE. A regional background mean concentration of approximately 100–300 g/kg p,p-DDT (sum of p,p-DDT, p,p-DDD, and p,p-DDE) was measured in surface sediments throughout the estuary, with the exception of the Arthur Kill, where mean concentrations exceeded 700 g/kg. The elevated concentrations found in recently deposited surface sediments in the Arthur Kill may be due to the presence of ongoing sources. The highest concentrations in buried sediments occurred in the lower Passaic River at depths corresponding to historical deposits from 1940 to 1970, the peak time period for production and usage of DDT in the United States. Comparisons to NOAA benchmark sediment toxicity values indicate that p,p-DDT, p,p-DDD, and p,p-DDE concentrations in surface sediments may pose a potential hazard to fish, shellfish, and other benthic and demersal organisms in some portions of the estuary, particularly in the upper and lower Arthur Kill.     

Translocation,distribution, and environmental degradation of hexachlorophene in tomatoes

The translocation, distribution, metabolism and environmental degradation of hexachlorophene were investigated in tomato plants (Lycopersicon esculentum Mill cv. beefsteak). All plants were grown under standardized conditions and treated with leaf-applied¹⁴C-ring-labeled hexachlorophene (HCP). Treatment time ranged from 0 to 70 days. Autoradiographic analyses were performed on all plants. Selected plant tissues were extracted and chromatographed, using thin layer (TLC) and gas liquid chromatography (GLC).Hexachlorophene was not translocated from the plant leaves. No metabolites of hexachlorophene were found. A slight, but statistically nonsignificant, amount of HCP was lost from the leaves and the inert controls.At the end of the 70-day treatment, based on TLC and regression analysis of thin layer chromatographic plates, averages of 89.5% and 75.9% of the applied HPC remained unaltered on the treated plants and controls, respectively. This indicated that 10.5% and 24.1%, respectively, of the original HCP had been altered. Differences between the treatments and controls were statistically significant after 28 days of exposure. Further analyses of the above data, using gas chromatographic methods, showed that as many as 14 peaks were found in the treated samples and the controls, including the parent material.Ultraviolet photolysis seemed to be the mechanism responsible for alteration of the hexachlorophene. Three extracted chlorinated compounds have been identified by GC-mass spectral (MS) analysis including 2,2-dihydroxy-3,5, 6,6-tetrachlorodiphenylmethane, 2,2-dihydroxy-3,5,5,6,6-pentachlorodiphenylmethane, and 2,2-dihydroxy-3,3,5,5,6,6-hexachlorodiphenylmethane (parent HCP). Eleven other electrophylic compounds have been found in various treated plant or control extracts. Further analyses will be necessary to verify the identification of the other degradation products.     

Public health, prevention and federalism: insights from the implementation of the federal law on health insurance

Summary Public health, prevention and federalism: insights from the implementation of the federal law on health insuranceObjetives:In 1996, the new Swiss law on health care insurance (KVG) introduced the coverage of certain preventive measures. This provided an opportunity to include research-based public health issues in federal health policy. The present article examines the problems with which the realization of those goals in a federalist health care system with strong cantonal autonomy as it is found in Switzerland was confronted.Method:Comparative qualitative case studies design (vaccination of school age children and screening-mammography).Results:Switzerlands federalist health care system strongly hinders the realisation of the Confederations public health goals. Prevention falls into the cantons autonomy and the federal KVG (Krankenversicherungsgesetz; Health insurance law) only regulates the coverage of the services provided, but does not contain any instruments to assure implementation in consistency with the policy goals. Under those circumstances, conflicts of interest between the implementing actors, varying cantonal preferences, and scarce resources block the implementation of public health goals.Conclusions:The results imply stronger leadership of the Confederation in prevention policy and an improved consideration of implementation aspects in approving new measures to obligatory insurance coverage.

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Public Health, Prävention und Föderalismus: Erkenntnisse aus der Umsetzung des Bundesgesetzes über die Krankenversicherung

     

Association study of proposed candidate genes/regions in a population of Spanish asthmatics

A number of genes/regions have recently been reported to be linked to asthma or its related phenotypes (i.e. atopy and bronchial hyperresponsiveness), by genetic linkage and allele-sharing methods. We have performed a case–control study comparing the allelic distribution of nine microsatellite markers and two genetic variants in a group of patients attended at emergency room departments because of an acute attack of asthma with respect to an external healthy population of controls. A total of 146 asthmatic subjects and 50 population controls from Barcelona, Spain, were genotyped for nine microsatellite markers from some asthma/atopy candidate genes/regions: the -subunit of the high-affinity IgE receptor (FcRI-) located on chromosome 11; the 5q31–32 candidate region; the T-cell receptor genes, TCR- on chromosome 14 and TCR- on chromosome 7. Two genetic variants of the -subunit of the high-affinity IgE receptor (FcRI-) gene were also analyzed. None of the asthmatic or control individuals carried the Ile181Leu variant. There were no significant differences between asthmatic and control subjects neither for the polymorphic markers nor for the other variant of the -subunit of the high-affinity IgE receptor (FcRI-) gene. No association could be observed in this sample of Spanish asthmatics with the genes/regions studied.     

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.