Thyroid cancer in children in Belarus: ascertainment bias?
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Adolescent↗
Biomedical subjects
T Abelin
Publications and source records attributed to T Abelin.
Fallout from Chernobyl. Belarus increase was probably caused by Chernobyl.
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Child↗
Thyroid cancer in Belarus post-Chernobyl: improved detection or increased incidence?
There is debate on whether the reported increase in the number of cases of childhood thyroid cancer in Belarus is real and attributable to radiation released following the Chernobyl nuclear accident, or rather an artefact due to incorrect histological diagnosis, more complete case reporting and mass screening of children after the accident. We have scrutinised the histological slides of 120 (75%) of the 160 cases reported among children aged up to 15 years to the Belarus tumour registry from 1986 to 1992 and examined time trends and geographical patterns in incidence and tumour characteristics. Incidence based on reported cases increased from 0.041 per 100,000 in 1986 to 2.548 in 1992. Carcinoma was confirmed in 94% of reviewed tumours. Except for one medullary carcinoma all histologies were of the papillary type. Most of the tumours had spread beyond the organ capsule and measured over 10 mm in diameter. There was a weak and statistically non-significant trend (p = 0.19) towards smaller tumours in the later years. The proportion of cases with lymphnode or distant metastasis remained unchanged. Incidence based on histologically confirmed cases was highest adjacent and to the west and north of Chernobyl, matching best estimates of iodine-131 contamination. Our data thus strongly suggest that the observed increase is real but more data are needed in order to assess the impact of mass screening and to clarify the possible association with radiation released at Chernobyl in 1986.
Adolescent↗
[Rubella epidemiology in military recruit schools].
In 1986, at the start of their training, 6877 male recruits were screened for the presence of anti-rubella IgG antibodies. 595 (9%) were seronegative. Of the latter group, 475 (80%) were retested in the week prior to discharge. During their four months of training, 113 (24%) exhibited seroconversion which proved acquisition of a rubella virus infection during the period of service. A clinical diagnosis of rubella was established in 15 (13%) of the persons with seroconversion. Catarrhal symptoms were present in half of those infected, whereas 41 (36%) did not report sick, suggesting a subclinical course of infection. Rubella is hardly a problem for the military in Switzerland. However, outbreaks such as the ones reported may have implications for the epidemiology of rubella in the general population, and hence should be taken into account in the planning of programs attempting to eliminate rubella virus infections.
Adult↗
[Therapy for smoking: consensus in German-speaking countries].
The german speaking countries (Austria, Germany, Switzerland) are not the most advanced in the world when it comes to the control of tobacco related diseases. The medical system in these countries has yet to be convinced that smoking cessation is not only necessary but feasible. In order to provide a basic document for further activities, a consensus development process was initiated. The consensus development process forms part of the activities performed by the UICC (International Union Against Cancer) Project Smoking Cessation, which is a project within the framework of the UICC Tobacco and Cancer Programme. The 1988 Report of the US Surgeon General states very clearly, that the use of tobacco products is not a matter of free choice, but is the result of an addiction as scientifically valid as the addiction to heroin and other narcotics. The scientific literature provides informations on many methods and techniques for a smoking cessation, both pharmacological and non-pharmacological. Many pharmacological approaches have been tried to treat nicotine dependence in man. According to scientific standards and many controlled studies, nicotine has been the only drug found to be effective in treating nicotine dependence. Many techniques, ranging from self help to sophisticated combined therapeutic approaches including pharmacological interventions, are now available to deal with the nicotine addiction. Smoking cessation treatment uses time, effort and other resources and the question of reimbursement for these services has to be considered. As with any other form of treatment, costs needed to be paid either by the individual patient/client and/or by other sources including private and national health insurance systems.(ABSTRACT TRUNCATED AT 250 WORDS)
Acupuncture Therapy↗
Pathomorphological findings in thyroid cancers of children from the Republic of Belarus: a study of 86 cases occurring between 1986 ('post-Chernobyl') and 1991.
Recently, an impressive increase in malignant thyroid tumours has been observed among children less than 15 years of age living in the Republic of Belarus at the time of the nuclear accident of Chernobyl in 1986. More than half of these patients lived in the region of Gomel, nearest to Chernobyl. Because of the very short time interval between the accident and the tumour occurrence an independent review of the available histopathological material was done. Out of 101 cases diagnosed as thyroid cancers, we reviewed slides of 93 cases and agreed the diagnosis of malignancy in 92.5%. Of these tumours 96.5% were papillary carcinomas, 61.5% were moderately or poorly differentiated. Extrathyroidal extension was observed in 60.5%, regional lymph node metastases in 74% and distant metastases in 7%. One of the patients died from lung metastases. Our results confirm that the neoplasms increasingly diagnosed between 1986 and 1991 among children of this region are thyroid carcinomas. In addition, we correlate several histopathological findings with sex and age of the patients and other parameters, and compare the results with data from other studies.
Accidents↗
[Is iodination of cooking salt still necessary? Current studies on iodine supply in Switzerland].
Salt with 3.75 mg iodide per kg was introduced in Switzerland stepwise in the individual cantons between 1922 and 1952. The iodide content was raised to 7.5 mg in 1962 and to 15 mg per kg in 1980. 92% of retail salt and 78% of all salt for human consumption (including salt used in industrial food processing) was iodized in 1989. Under this measure, prevalence of grade 1b or larger goiter dropped continuously to a present value of 1.3% in school-children and 0.3% in male army recruits. Endemic cretinism has disappeared completely. Urinary iodine has reached the desired range of 150 +/- 77 (SD) micrograms per g creatinine. The following facts prove that iodization of salt (and not other changes of food habits) have corrected the iodine deficiency in Switzerland: 1. Urinary iodine is highly correlated with urinary sodium. Backward extrapolation yields a theoretical urinary iodine of 30 micrograms per g creatinine in the absence of iodized salt, a value typical of severe deficiency. 2. Goiter prevalence declined later in those cantons which introduced iodized salt last. 3. Surrounding countries without iodized salt (France, Italy, Federal Republic of Germany, Spain) suffer from considerable iodine deficiency with areas of high goiter prevalence and even endemic cretinism. The new data underscore the absolute and continued need for iodized salt in Switzerland.
Adolescent↗
[Smoking and smoking cessation in the context of preventive cardiology].
Knowledge about the effects of smoking on the development of cardiovascular disease is constantly growing. As an example, we know today that myocardial infarction is more frequent among smokers, also among monozygous twins, and that the relative risk of women who smoke is comparable to that of male smokers. The mechanisms of action are in atherogenesis, in the stimulation of the adrenergic system and in an increase of plasma fibrinogen. In order to best support his patients to give up smoking, the practicing physician has to be aware of the factors influencing the smoking habit. The parallel development of psychological dependence and physical addiction to nicotine is described, and it is shown how nicotine substitution therapy can help to stagger psychological and physical withdrawal. The introduction of transdermal nicotine substitution opens new possibilities in this context.
Adult↗
The use of transdermal nicotine in smoking cessation.
The transdermal administration of nicotine by means of a transdermal nicotine system (TNS) affords a novel way of nicotine replacement to alleviate smoking cessation. The plasma levels of nicotine maintained with the TNS are in the range of the footpoint concentrations observed in smokers. The efficacy of the TNS was investigated in two placebo-controlled double-blind smoking cessation programs with minimal contact and minimal psychological support. A total of 311 smokers were treated for 3 months or 9 weeks. The abstinence rates at the end of the treatment and weaning periods were almost doubled in the TNS groups (36% and 39%) as compared to the placebo groups (23% and 20%) with a significant difference for both studies (p less than 0.05). These data suggest that the TNS can also improve the smoking cessation rates under the conditions of general medical advice, making it suitable for use outside of specialized smoking cessation centers.
Administration, Cutaneous↗
[Epidemiology of alcohol and its sequelae in Switzerland].
5 to 7% of adults in Switzerland are consumers of health damaging quantities of alcohol, and some 10% are drinkers at elevated risk of becoming alcoholics. The 7% of the adults who are the heaviest drinkers account for about half of the total alcohol consumed in Switzerland. Among middle-aged men and women, alcohol-related diseases are among the leading causes of hospitalisation in medical departments. About 100 deaths per year are due to causes related to alcoholism. Alcohol consumption at all levels is markedly elevated in the French- and Italian-speaking parts of Switzerland. These observations lead to a preventive strategy, in which preventive support of at-risk drinkers at the worksite and by the personal physician plays an important role; special efforts are indicated in the western and the southern part of the country.
Alcoholism↗
[The development in smoking habits in Canton Bern 1977 to 1987. Survey of smoking habits through regular x-ray screening in industry].
The smoking habits of workers were registered on occasion of chest-x-ray screening over the eleven years period from 1977 to 1987 in Berne, Switzerland. In 1977 about 52% of the males were smoking. During the eleven years a decrease in prevalence of smoking can be observed in the male population. The decrease is more pronounced among older than among younger males. Young women smoke more frequently than older women. The prevalence has remained stable at about 28% in the female population between 1977 and 1987. These findings are in accordance with other Swiss studies and show that in Switzerland the preventive radiodiagnostic institutions are important vehicles for community oriented prevention and prevention research.
Adult↗
[Current trends in the epidemiology of smoking, passive smoking and lung cancer].
In this review of new developments in the field of "smoking and health", three questions are more closely analyzed. The first concerns the health consequences of passive smoking. Based on the example of bronchial carcinoma, evidence is shown on which independent expert committees have come to the conclusion that a causal relationship has to be accepted as probable. A graph is presented showing that among more than a dozen epidemiologic studies, most point clearly to a dose response relationship. In addition it has been shown that passive smoking involves mainly inhalation of sidestream smoke containing significant amounts of carcinogens. The second question concerns the trend of smoking habits in Switzerland. Among men, the proportion of smokers has dropped from at least 60 to 70% in the nineteen fifties to 40% today, and among women, a downward trend has also been observed in recent years. Finally, lung cancer rates have started to decline in several countries and levelled off among men in Switzerland. A decline of the proportion of smokers and a reduction of the tar content of cigarettes by the tobacco industry are seen as principal factors in this development.
Adolescent↗
Controlled trial of transdermal nicotine patch in tobacco withdrawal.
A transdermal nicotine patch, which delivers 0.7 mg/cm2 per 24 h and is available in sizes of 10, 20, and 30 cm2 was tested in subjects from 21 general medical practices in a 3-month, placebo-controlled randomised double-blind study. The nicotine group (n = 100) and the placebo group (n = 99) were similar at entry. Participants who smoked more than 20 cigarettes a day were treated with the 30 cm2 patch and the others with the 20 cm2 patch. When abstinence, defined as smoking 0-3 cigarettes per week and verified by CO measurement, was achieved, the next smallest patch was applied. After 1, 2, and 3 months of treatment 41, 36, and 36%, respectively, in the nicotine group were abstinent. The corresponding figures in the placebo group were 19, 20, and 23%. The differences were significant for all 3 months. Body weight did not increase in the nicotine group, but in the placebo group the mean increase was 4.4 kg. Craving and withdrawal symptoms decreased more with nicotine substitution for cigarettes. The patches were generally well tolerated, although 25% of subjects in the nicotine group and 13% in the placebo group had transient local erythema after application of the patch; 5 members of the nicotine group withdrew because of poor cutaneous tolerance.
Administration, Cutaneous↗
The family and the help needs of disabled elderly in two Swiss cities.
The purpose of the present article is to describe the situation in which informal help is no longer sufficient, and thus to contribute to the understanding needed for the planning of organized services. Interviews were conducted with a stratified random sample of 480 over 65-year-olds in two urban areas of Switzerland representing a 80.4% response rate. The married elderly receive most of their daily help from their spouse; daily nursing assistance to the widowed elderly comes from a family member (60-70%) or from organized services, whereas neighbours may provide occasional help in household activities. Unmarried old people in need of daily help live almost always in stationary institutions. Under the conditions examined, domiciliary services for the disabled elderly serve to complement informal help rather than to replace it. Supporting and motivating informal caregivers would seem to be a promising strategy toward more efficient domiciliary services.
Activities of Daily Living↗
Effectiveness of a transdermal nicotine system in smoking cessation studies.
To investigate the effectiveness and tolerability of a transdermal nicotine system (TNS) as an aid towards easing smoking cessation, two double-blind placebo-controlled randomized field studies were performed. The TNS was available in sizes of 10, 20 and 30 cm2, delivering 7, 14 and 21 mg of nicotine per 24 h. A first study was undertaken in general medical practice by a group of 21 doctors (Practitioner Study). This study involved 199 nicotine-dependent cigarette smokers of whom 100 were allocated to the nicotine group and 99 to the placebo group. The second trial was performed in 112 young people, 56 in each treatment group, at the Universities of Basle and Zurich (University Study). The placebo and the nicotine groups were comparable in both studies. Participants smoking more than 20 cigarettes a day were treated with the 30-cm2 system and the others with the 20-cm2 system. When abstinence, as verified by CO measurements, was achieved, the next smaller system was applied. In the Practitioner Study, the double-blind treatment phase lasted for 12 weeks with consultations every month and in the University Study the consultations during the 9-weeks' treatment period took place every 3 weeks. Abstainers in both studies will be followed up until 12 months after treatment was begun. After 1, 2 and 3 months of treatment 41%, 36% and 36% of the participants in the nicotine group of the Practitioner Study were abstinent. The corresponding figures in the placebo group were 19.4%, 20.4% and 22.5%. The differences were statistically significant for all three months (p = 0.001; p = 0.018 and p = 0.043). Body weight did not increase in the TNS group, but did in the placebo group (+ 4.4 kg). The craving for cigarettes and withdrawal symptoms decreased more under nicotine substitution. Abstinence rates in the University Study were initially higher with 51.8% in the nicotine group and 28.6% in the placebo group after 3 weeks of treatment, but then declined to 42.9% after 6 weeks and 39.3% after 9 weeks in the nicotine group and to 25% and 19.6%, respectively, in the placebo group. The differences between the groups were statistically significant on all 3 occasions, with p = 0.012, p = 0.046 and p = 0.023.(ABSTRACT TRUNCATED AT 250 WORDS)
Administration, Cutaneous↗
[The Swiss Society of Social and Preventive Medicine--what should the future be? An invitation to discussion].
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Forecasting↗
Smoking, alcohol consumption, and endurance capacity: an analysis of 6,500 19-year-old conscripts and 4,100 joggers.
Using data from two Swiss studies, a 20% random sample (n = 6,592) of all 19-year-old army conscripts and all male participants in a 16-km popular race (n = 4,358), we studied the relationships among smoking, alcohol consumption, and endurance capacity using univariate and multivariate analyses. Alcohol was significantly correlated with endurance capacity among joggers in univariate analysis, but lost its significance in multivariate analysis. Among army conscripts, the distance covered in a 12-min endurance run was inversely related to daily cigarette consumption and years of smoking (P less than 0.001). This association was apparent even among light smokers who had been smoking for less than 2 years when they were compared with nonsmokers. Among joggers, even when the lower training activity of the smokers was controlled for, smoking retained a negative, independent association with endurance capacity, as measured by 16-km race time. In multiple regression analysis of endurance capacity, the standardized regression coefficient for smoking was -0.14 for distance covered in the 12-min run and 0.10 for 16-km running time, the latter despite the low prevalence (6.9%) of regular cigarette smokers among the joggers. Seventy percent of the 16-km race participants who smoked around the time they took up jogging quit smoking as joggers. Within the limits of this cross-sectional study design, these results suggest that smoking exerts a direct, biologically mediated, deleterious effect on endurance capacity. The lower levels of exercise of the smokers did not entirely explain the difference in endurance between smokers and nonsmokers. This observation of a short-term negative association between even light smoking and endurance capacity may have implications for health education and promotion efforts.
Adult↗
Relationship of training and life-style to 16-km running time of 4000 joggers. The '84 Berne "Grand-Prix" Study.
To investigate running activity, life-style, and endurance capacity of joggers, all competitors of a popular 16-km race were surveyed by questionnaire. The response rate was 83.6%, yielding a study population of 4358 male runners over age 16. In univariate analysis, there were significant associations between 16-km running time and weekly training distance (average of 1 year), weekly training frequency, body mass index (BMI), age, cigarette smoking, years of regular running, and frequency of alcohol cosumption. A multiple regression analysis provided six significant, independent predictors of 16-km time, explaining 47% of its variance: weekly training distance (standardized regression coefficient = -0.46), age (0.37), BMI (0.23), years of regular running (-0.19), weekly training frequency (-0.11), and cigarette smoking (0.10). Based on laboratory treadmill testing of a subsample of runners, 16-km running times were transformed into maximum aerobic capacities (VO2 max equivalents) for all competitors. In comparison with the general population, even the slowest 5% of the runners showed a higher endurance capacity than the age-specific population mean. Application of the multivariate regression model for an estimation of the overall impact of training and life-style on endurance capacity showed that the great difference in mean endurance levels between joggers and the general population could entirely be attributed to differences in running activity, BMI, and smoking. We conclude that the joggers investigated were, on average, not selected concerning biological predisposition and genetic endowment since their behavior alone explained their high average endurance capacity.
Adolescent↗