Objectives: To examine changes of risk behaviour and its determinants as well as risk factors for HIV infection in intravenous drug users (IVDU) with particular attention to imprisonment and its risk patterns. Setting: In 1993 a multisite cross-sectional study was carried out by standardized questionnaires and blood/saliva samples in which 612 IVDU from Berlin were enrolled. Results: Multifactorial analysis revealed that the most important risk factor for HIV infection was needle-sharing in prison. In total, 353 IVDU (58%) reported reduced risk behaviour; changes related more to injection behaviour than sexual practices (91 versus 68%). Important determinants for needle-sharing during the last 6 months were intravenous drug use in prison, duration of drug-taking history, and knowledge of a negative HIV test. The most frequently reported reasons for current needle-sharing were having shared needles with only one regular partner (45%) and imprisonment (26%). Conclusion: Information campaigns and other prevention measures appear to have produced risk awareness in IVDU, and as a consequence, a reduction in risk behaviour. The situation in prisons (no sterile injecting equipment, no effective disinfectants), however, is counteractive to prevention measures implemented outside prisons. An important task for future strategies should be to enable IVDU to avoid HIV transmission while in prisons.
In a clinical study, 702 Nigerian children aged 1–6 years were examined for malaria. Comparison of morbidity rates and parasitemia of patients with different glucose-6-phosphate dehydrogenase (G6PD) status provided evidence that in heterozygous females the gene for G6PD deficiency (GdA-/GdB) confers an advantage against malaria.
Abstract. Using Littmann's method for correcting the magnification of central fiindus photographs, we determined the absolute size of 35 unselected optic discs with pseudopapilledema. The optic disc area (1.95 ± 0.33 mm 2 (mean and SD)) was significantly ( P < 0.001. Student's t ‐test) smaller than standard values of normal unselected optic nerve heads (2.73 ± 0.76 mm 2 ). There was no cupping in the discs with pseudopapilledema. Cocfficients of variation for intraobserver re‐evaluation were 0.045, and for interobserver re‐evaluation 0.08. The markedly reduced optic disc size coincident with an abnormally small optic nerve scleral canal may inhibit the intraaxoplasmatic flow with secondary swelling of the juxtapapillary optic nerve fibers. This may lead to prominence and indistinct borders of the optic disc. Pseudopapilledema might be related to optic nerve head drusen, which are also associated with abnormally small optic discs.
Background. Anatomic location has been identified by several investigators as a significant prognostic factor for patients with primary cutaneous melanoma (CM). However, the best determination of higher and lower risk sites is still controversial, and the biologic significance of tumor site in the course of primary CM is unknown. The aim of the present study was to identify higher and lower risk sites based on multivariate analysis. Methods. A series of 5093 patients with invasive primary cutaneous melanoma followed from 1970 to 1988 at four university centers in Germany was investigated using the multivariate Cox proportional hazard model to analyze the importance of anatomic location for survival probability. Results. The anatomic location was found to be a highly significant prognostic factor for patients with primary melanoma by multivariate analysis (P < 0.0001). An optimized classification into sites of higher and lower risk with respect to survival was evaluated by multivariate analysis controlling for the possible confounding effects of the other significant prognostic factors. Relative to the lower leg as the prognostically favorable baseline, the following locations were associated with a significantly higher risk of death caused by primary cutaneous melanoma: back and breast (thorax), upper arm, neck, and scalp (TANS regions). The lower trunk, thigh, lower leg, foot, lower arms, hands, and face were identified as lower risk sites. Conclusions. Anatomic location was confirmed as an independent prognostic factor for patients with primary cutaneous melanoma. The TANS regions were identified as high risk sites, and the lower trunk, thigh, lower leg, foot, lower arms, hands, and face were identified as intermediate sites.
Recently published case-control studies on third versus second generation oral contraceptives showed a slightly increased risk for venous thromboembolism (VTE) and led to a discussion about biases or confounders external to the study such as, preferential prescribing of third generation pills to women at higher risk and differential diagnostic behaviour.An interview survey with 102 physicians was performed in 2 weeks of December 1995 in Germany and 1209 of their patients were included in a retrospective cohort analysis of drug utilization and risk markers.German physicians previously preferred to prescribe third generation pills whenever an increased risk was perceived, i.e. risk for VTE and for arterial thrombosis (risk factors, personal or family history of cardiovascular diseases). Almost all predefined risk scenarios were associated with an increased attention to non-specific venous symptoms and patients were more frequently sent for intensive diagnostic search for venous thromboses. The behaviour was not directly dependent on the type of OC; however the third generation pills were indirectly associated with higher risk in the pill-taking women. The physicians' view was confirmed by the analysis of the cohorts of patients: preferential prescribing was also found in this data set, although it was not as impressive as in the physicians responses.The possibility cannot be excluded that preferential prescribing and differential diagnostic behaviour alone could have explained the roughly two-fold increased odds ratios from case-control studies recently published, had this information been available among the study variables.
To investigate the factors influencing the malignant potential of adenomas, a logit analysis was carried out. The malignancy rate (frequency of malignant areas infiltrating into submucosa) in adenomas is influenced by
Summary Background Atopic family history and cord blood IgE have been used as predictors of atopic disease in newborns for about 20 years, but at least for cord blood IgE the sensitivity has been shown to be very low. The objective of this paper was to evaluate whether parental history and cord blood‐IgE were more accurate predictors for the appropriate atopic phenotypes in the infants rather than for any atopy. Methods A total of 1314 newborn infants was recruited in six German obstetric departments in 1990 and followed‐up for 2 years. Four hundred and ninty‐ninc (38%) were at high risk for atopy with at least two first degree atopic family members and/or elevated cord‐blood IgE concentrations. Results The cumulative incidence of atopic dermatitis over the first 2 years of life (AD24) amounted to 20. 1%, and there was a significant association with AD history of the mother (OR 2.5, 95%‐Cl 1.46–4.26) and of the father (OR 3.53, 95%cC1 1.90–6.54). The cumulative incidence of recurrent wheezing in the first 2 years of life (RW24) amounted to 16.1%, and was positively associated with asthma history (OR 2.11, 95%CI 1.33–3.60) and sensitization history (OR 1.64, 95%C1 1.34–2.36) of the mother, but with neither for the father. RW24 was less prevalent in girls than in boys (OR 0.64. 95%Cl 0.47–0.89). Thirty‐one per cent of infants were sensitized (CAP test value > 0.35 kU/L) against at least one of nine food or inhalative allergens (S24) and this was signilicantly associatcd with cord blood‐IgE value (OR 2.43, 95%C1 1.69–3.49). and sensitization history of the mother (OR 1.64, 95%CI 1.18–2.41). Using multiple logistic regression analysis, the prediction of AD24 by AD of parents, of RW24 by asthma of parents, and of sensitization by cord blood IgE was of low accuracy. Conclusion The predictive capacity of parental history and cord blood IgE is not high enough to recommend them as screening instruments for primary prevention. The majority of atopic manifestations and of sensitization occur in infants with no demonstrable risk at birth.
