Fetal growth and autoimmune thyroid disease

To determine whether fetal and infant growth could influencesusceptibility to autoimmune disease in adults, the occurrenceof thyroid autoantibodies and autoimmune thyroiditis was studiedin 305 women, aged 60–71, born in Hertfordshire and forwhom details of birth weight, infant growth, and feeding wereroutinely recorded. Thyroglobulin autoantibody was detectedin 37% of the women, thyroid peroxidase autoantibody in 41%,and autoimmune thyroiditis, defined as biochemical or clinicalhypothyroidism in association with thyroid autoantibodies, in5.6%. The proportion of women with thyroglobulin and thyroidperoxidase auto antibodies fell with increasing birth weightbut was not related to weight at 1 year of age or the methodof infant feeding. The prevalence of both autoantibodies rosewith increasing adult body mass index but fell as the waistto hip ratio increased. These results demonstrate the importance of early environmentin determining the susceptibility to autoimmune thyroid disease.The contrasting effects of adult body mass index and waist tohip ratio on antibody prevalence could be explained by theirassociations with different hormonal environments.     

Variation in Mortality from Ischaemic Heart Disease between England and Scotland

A Comparison of mortality from ischaemic heart disease underthe age of 60 for 1980 to 1981 between the Grampian Health Boardand the North Staffordshire Health Authority has been made.A total of 993 deaths was notified by death certificate fromthe two areas of similar population of which 434 were from Grampianand 559 from North Staffordshire. After examination of generalpractitioner and hospital case notes, autopsy reports and deathcertificates, nearly all (532) of the North Staffordshire deathswere accepted as being due to ischaemic heart disease but onlythree-fifths (263) of the Grampian deaths could be begin besubstantiated as there was inadequate information for the remainder.Deaths from ischaemic heart disease seem apparently to be twofoldgreater in North Staffordshire than Grampian but much of thisdiscrepancy could be attributed to a widely different autopsyrate and to unavailability of case notes. Experience of thissurvey suggests that the results of other epidemiological investigationsmay be equally or even more unreliable.     

Ten principles for geriatric health promotion

The concept of health promotion for elderly people holds promisefor countries faced with limited resources and the unprecedentedgrowth of their elderly populations. This article draws on thework of David Werner and on research in health education, communitydevelopment, health promotion and gerontological health to discussten principles underlying the concept of geriatric health promotion.By stressing empowerment, the strengths and not merely the needsof aged people, community participation and the role of publicpolicy, geriatric health promotion is seen as embracing theWorld Health Organization approach to health promotion as abroad, enabling process. Similarly, in its attention to functionalhealth status, the needs of informal caregivers and the socialas well as the health needs of elderly people, it complementsand draws upon recent trends in the fields of geriatrics andgerontological health. The need for further development of the conceptual base of geriatrichealth promotion is stressed, as is the importance of surveyingexisting efforts in this area. Finally, the article underscoresthe need for developing a theoretical basis for action thatwould take account of the diversity of settings and conditionsin which the model might be applied.     

CERVICAL MYELOPATHY COMPLICATING MULTIPLE JOINT REPLACEMENT IN RHEUMATOID DISEASE

The incidence of cervical myelopathy and subluxation was investigatedin 48 patients with rheumatoid disease who had three or moremajor lower limb joint replacements. Eight (17%) developed cervicalmyelopathy requiring cervical fusion. This was the subsequentcause of death in two. Four further patients demonstrated clinicalfeatures of myelopathy. Cervical subluxation was present in29 of 44 (66%) in whom adequate radiographs were available.The development of cervical symptoms and signs could not havebeen predicted from the sex, age of onset, duration of diseaseor steriod therapy. Radiographic changes in the cervical spinewere independent of major lower limb joint destruction and wereoften not present when planning a programme of joint replacement.Fifty-one control patients were studied. Cervical myelopathyoccurred in 2 (4%) and subluxation in 24 (47%). The developmentof rheumatoid changes in the cervical spine was unrelated toinvolvement of the hip or knee joints in the control group. There was a significant (p<0.05) increase in the incidenceof cervical myelopathy in patients with multiple lower limbjoint replacements compared with the control population. KEY WORDS: Rheumatoid arthritis, Cervical myelopathy, Cervical subluxation, Arthroplasty     

HIV risk of transmission behaviour amongst HIV-infected prisoners and its correlates

Thirty-eight from a total of 42 known HIV-positive prisoners in the Irish prison system voluntarily cooperated in a survey of psychological attitudes, knowledge of risk behaviour, intentions with respect to future risk behaviour, and actual past risk behaviour Of this group, 65% reported that they had put others at risk of HIV, since they became aware of their own HIV + status. Only 16% stated that they would definitely not share their drug-taking equipment in the future and 32% that they would always use a condom in sexual intercourse. In general, psychological and biographical variables were not strongly related to whether or not the respondents had put others at risk of HIV. Nor were there any significant differences in knowledge of at risk behaviour between those who had and those who had not put others at risk. However, there was some evidence for considerable independence between risk-taking behaviour in the sexual and in the drug-taking domains, in that risk-taking in one area was not highly predictive of risk-taking in the other.     

Interferon Alfa-2b or Not 2b? Significant Differences Exist in the Decision-Making Process between Melanoma Patients Who Accept or Decline High-Dose Adjuvant Interferon Alfa-2b Treatment

BACKGROUND: Patients with thick (Breslow>4 mm) primary melanoma and/or regional nodal metastasis have a high risk of tumor recurrence. High-dose adjuvant interferon (IFN) alfa-2b offers/=50% risk of recurrence/disease-related mortality and offered IFN. Telephone surveys delineated reasons behind patients' decisions to accept IFN. RESULTS: Acceptors, 60 of 135 (45%), decided to take IFN alfa-2b whereas 75 of 135 (55%) declined. Being female (OR, 2.4; 95% CI, 1.17-5.03; p=.017) and positive SLN status (OR, 2.2; 95% CI, 1.01-4.97; p=.048) were strongly associated with patients who chose IFN. Acceptors of IFN were younger, more influenced by physicians, and less affected by depression and side effect profile (p<.05 for all). Decliners were more concerned by strained relationships with family and social life (p<.05). CONCLUSIONS: Gender and positive SLN were predictive of high-risk melanoma patients' acceptance of IFN treatment. Physician insight into melanoma patients' therapeutic decision-making process can guide patients through this difficult disease.