Rising incidence of type 1 diabetes in Scottish children, 1984-93. The Scottish Study Group for the Care of Young Diabetics

OBJECTIVES: To calculate the incidence of type 1 diabetes in Scottish children aged less than 15 years between 1984 and 1993; to examine changes in incidence; and to calculate the prevalence of diabetes at the end of this period. DESIGN: Three data sources were used to construct the Scottish Study Group for the Care of Young Diabetics register: active reporting of all new cases; reports from the Scottish Morbidity Register 1; and local registers. SUBJECTS: All children resident in Scotland diagnosed with primary insulin dependent diabetes mellitus when less than 15 years of age between 1984 and 1993. MAIN OUTCOME MEASURES: Annual incidence and prevalence rate for Scotland; time trend in incidence over the 10 years; differences in incidence between the three different age groups; and completeness of the register. RESULTS: The average annual incidence for Scotland was 23.9/100,000 children. The prevalence rate was 1.5/1000 in 1993. A total of 2326 cases was identified from the three sources. Capture-recapture analysis suggests a case ascertainment of 98.6%. The annual incidence rates increased at a rate of 2% each year (rate ratio = 1.02, 95% confidence interval (CI) 1.01 to 1.03). The incidence was higher in boys than girls (rate ratio = 1.08, 95% CI 1.00 to 1.18), and the incidence rates increased with age: 15.3/100,000/year for age 0-4 years, 24.4/ 100,000/year for age 5-9 years, and 31.9/ 100,000/year for age 10-14 years. CONCLUSIONS: The incidence of type 1 diabetes in Scotland is increasing and the prevalence is relatively high. These findings have important implications for health service resource allocation. The Scottish Study Group for the Care of Young Diabetics' register provides a base for monitoring and research.     

Psychosocial and behavioral characteristics in chronic headache patients: support for a continuum and dual-diagnostic approach

The present study attempted to identify psychological differences among different headache diagnoses defined by IHS criteria as well as psychological differences by headache intensity and frequency. Differences between diagnostic categories reflected characteristics used to assign diagnoses, namely the constancy of pain and distracting behaviors of significant others due to isolating behavior from photophobia and phonophobia. A rating of headache intensity and frequency was a more powerful predictor of psychological ratings than diagnosis. Diagnosis was related to headache frequency but not intensity. The results suggest that a continuum diagnosis based on severity can be useful in conceptualizing headaches, and a dual-diagnostic system integrating headache characteristics with perceptions and coping ability would be helpful in determining treatment options.     

Familial Burkitt's lymphoma in Papua New Guinea.

A study of Burkitt''s lymphoma (BL) in Papua New Guinea for the years 1958-87 revealed four instances of familial BL. Incident cases occurred within 1 year of each other in the four families. Personal follow-up was possible for three of these families whose pedigrees showed that two or more siblings were affected. There was no significant variation of the incidence of BL by year of diagnosis or month of onset. There was significant variation in annual average incidence of BL between the three provinces studied, with the highest incidence in the Nuku and Lumi census districts (of the West Sepik Province). This is the first report of familial BL outside Africa.     

Women worried about their familial breast cancer risk--a study on genetic advice in general practice

AIMS: To ascertain whether women who consulted their GP because they perceived themselves as at increased risk of familial breast cancer were indeed at increased risk, and to evaluate potential strategies for assessing genetic risk of breast cancer in general practice. METHODS: Sixty-seven out of 81 women who had consulted their GP for advice about their possible increased risk of developing breast cancer due to breast cancer in the family were interviewed. Familial breast cancer risk was assessed by a clinical geneticist. This assessment was compared with two recent guidelines for referral for genetic counselling. RESULTS: More than half (52%; n = 35) the women had a relative risk of two and over for developing breast cancer, while another half of these 35 (25%; n = 17) had a relative risk of three and over. All the women (n = 17) with a relative risk of three and over were identified by means of the two current guidelines for referral for genetic counselling, while more than half of the women (61%; n = 11) with a relative risk between two and three were identified. CONCLUSIONS: More than half the women concerned about their familial risk of breast cancer are indeed at increased risk of breast cancer. Current guidelines correctly identify women at high risk. However, doubts about the health gain and feasibility of referral warrant caution, and need further investigation.      

Lung lesions: correlation between viewing time and detection

The influence of viewing time on the detectability of subtle and obvious lung cancers was studied. Frontal chest radiographs of 40 patients with subtle cancers, 40 patients with obvious cancers, and 40 healthy control subjects were shown to four observers for four different viewing times (0.25 second, 1 second, 4 seconds, and unlimited time). Receiver operating characteristic analysis was used to compare the detectability of lesions. Performance was degraded as viewing time decreased. The true-positive fractions for subtle and obvious cancers were 30% and 70% at 0.25 second and 74% and 98% at unlimited viewing time, respectively, for a given false-positive fraction of 20%. Thus, even with unlimited viewing time, the false-negative fraction for subtle cancers was 26%. The difference in detectability between subtle and obvious lung cancers was exaggerated at 1.0 second compared with 4 seconds and unlimited viewing time. The following conclusions were reached: (a) a substantial proportion of subtle lung lesions are missed, even with unlimited viewing time; (b) a large proportion of obvious lung cancers are detected with flash viewing; (c) the detectability of lesions decreases considerably as viewing time becomes less than 4 seconds; and (d) differences in detectability are exaggerated by short viewing times.