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PubMed2005

Differential respirable dust related lung function effects between current and former South African coal miners.

Dust-related dose-response decrements in lung function among coal miners have been reported in several studies, with varying magnitudes across populations. Few studies have compared differences between current and former coal miners. No studies on dose response relationships with lung function have been conducted in South African coal mines, one of the top three producers of coal internationally. The objectives of this study were (1) to describe the relationship between respirable dust exposure and lung function among current and former South African coal miners and to determine whether differential dust related effects were present between these employment categories; (2) to examine dust related dose response relationships, controlling for potential confounding by smoking and a history of tuberculosis (TB). Six hundred and eighty-four current and 188 ex-miners from three bituminous coal mines in Mpumalanga Province were studied. Interviews assessing work histories, smoking profiles and other risk factors were conducted. Work histories were also obtained from company records. Standardised spirometry was performed by trained technicians. Cumulative respirable dust exposure (CDE) estimates were constructed from company-collected sampling and measurements conducted by the researchers. Regression models examined the associations of CDE with per cent predicted FEV(1) and FVC, controlling for smoking, past history of TB and employment status. A statistically significant decline in FEV(1) of 1.1 and 2.2 ml/mg-year/m(3) was found in representative 40-year-old, 1.7-m tall current and former miners, respectively. Significant differences were found between the highest and medium exposure categories. Ex-miners had a lower mean per cent predicted lung function than current miners for each cumulative exposure category, suggesting a "healthy worker" effect. Past history of TB contributed to 21 and 14% declines in per cent predicted FEV(1) and FVC, respectively. Thus, in this cohort, a dose-related decline in lung function was associated with respirable dust exposure, with a magnitude of effect similar to that seen in other studies and important differences between current and former employees. A "healthy worker" effect may have attenuated the magnitude of this relationship. TB was a significant contributor to lung function loss.

Adult↗

PubMed1999

Vitamin C and other compounds in vitamin C rich food in relation to risk of tuberculosis in male smokers.

To examine whether vitamin C rich food consumption and related vitamin C intake are associated with the risk of tuberculosis, the authors analyzed 167 incident cases of tuberculosis during a median follow-up time of 6.7 years in a clinical trial cohort of 26,975 Finnish men for whom they had baseline dietary data. A highly statistically significant inverse association between calculated vitamin C intake and the incidence of tuberculosis was found, but adjustment for non-dietary factors weakened the association to nonsignificant. Furthermore, the risk of tuberculosis decreased with increasing intake of fruits, vegetables, and berries independent of vitamin C intake. Subjects who had dietary vitamin C intake >90 mg/day and who consumed more than the average amount of fruits, vegetables, and berries had a significantly lower risk of tuberculosis (adjusted relative risk = 0.40; 95% confidence interval 0.24, 0.69). Associations between dietary vitamin C intake and occurrence of various diseases without proper control of confounding have often been interpreted as causal. These findings show that such associations can be confounded even by some other dietary components. Lower tuberculosis incidence in subjects who consumed more fruits, vegetables, and berries poor in vitamin C suggests that other compounds in such a diet may reduce the risk of tuberculosis.

Aged↗

PubMed1976

[Use of nekal BX for pretreatment of clinical material before culture to diagnose tuberculosis (author's transl)].

Recently, also detergents have been proposed for use in the pretreatment of clinical material for cultural demonstration of Mycobacterium tuberculosis. One of such substances is the anionic detergent. Neckal BX (diisobutyl naphthaline sulphonate) which in combination with 0.5% sodium hydroxide, is capable of homogenization and decontamination of the material within 16-18 h of action. At the same time, the mycobacteria are accumulated in the sediment by precipitation in the presence of barium, calcium, and phosphate ions. The results obtained by the new method were compared with those obtained by the sulphuric acid method, in a paralles study of samples of sputum, gastric juice, and faeces and a second one of sputum samples only. By using two different formulas for reagents (Table 1), the mycobacterial isolation rate was shown to be dependent upon the concentration of the precipitant. By the following criteria, the Nekal method was superior over pretreatment with sulphuric acid: 1. The reduction of the number of contaminated was obvious in the cases of sputum and gastric juice samples and significant for sputum samples. (Tables 2-7). 2. Using Nekal BX, 31 out of 616 sputum samples were found to be positive; using sulphuric acid, their number was only 22. This difference was found to be statistically significant. The additional yield came primarily from material containing only few mycobacteria and samples which could not be assessed because of contamination present after pretreatment with sulphuric acid (Table 8). The average period which passed until reading of the cultures was approximately the same: 4.2 weeks for sulphuric acid and 4.4 weeks for Nekal (Table 9). When applying the new method, the material admits of mechanical shaking and need not be centrifuged. No strict control of the period of action is required. Taking into account these operational advantages, the Nekal method is considered particulary suitable for laboratories receiving high numbers of samples.

Decontamination↗

PubMedDate not supplied

Tuberculosis in aboriginal Canadians.

Endemic tuberculosis (TB) was almost certainly present in Canadian aboriginal people (aboriginal Canadians denotes status Indians, Inuit, nonstatus Indians and metis as reported by Statistics Canada) before the Old World traders arrived. However, the social changes that resulted from contact with these traders created the conditions that converted endemic TB into epidemic TB. The incidence of TB varied inversely with the time interval from this cultural collision, which began on the east coast in the 16th century and ended in the Northern Territories in the 20th century. This relatively recent epidemic explains why the disease is more frequent in aboriginal children than in Canadian-born nonaboriginal people. Treatment plans must account for the socioeconomic conditions and cultural characteristics of the aboriginal people, especially healing models and language. Prevention includes bacillus Calmette-Guerin vaccination and chemoprophylaxis, and must account for community conditions, such as rates of suicide, which have exceeded the rate of TB. The control of TB requires a centralized program with specifically directed funding. It must include a program that works in partnership with aboriginal communities.

Antitubercular Agents↗

PubMed2001

Occurrence of matrix metalloproteinases and tissue inhibitors of metalloproteinases in tuberculous pleuritis.

OBJECTIVE: Matrix metalloproteinases (MMP) and tissue inhibitors of metalloproteinases (TIMP) have been found in high concentrations in pleural effusions. Because MMP and TIMP may play a part in the causation of the fibrosis seen in tuberculous (TB) pleuritis their occurrence was examined. DESIGN: Pleural effusion fluid and plasma concentrations of MMP-1, MMP-2, MMP-3, MMP-8, MMP-9, TIMP-1 and TIMP-2 were determined by ELISA in 21 patients with TB pleuritis. To adjust for the total protein content, respective ratios were calculated. Activities of MMP-2 and MMP-9 were measured by gelatine zymography and the MMP-9/MMP-2 ratios calculated. Pleural effusions and plasma of 15 patients with congestive heat failure (CHF) and plasma of 15 healthy persons (CON) served as controls. RESULTS: Immunoreactive pleural fluid concentrations of MMP-1, MMP-2, MMP-8, and MMP-9 were higher in TB compared to CHF, but plasma concentrations were not different between the groups. TB pleural fluid concentrations of MMP-1, MMP-2, TIMP-1, and TIMP-2 were higher compared to TB plasma. MMP-3 was found in trace amounts only. The MMP-9/total protein ratios in pleural fluid were higher in TB compared to CHF (0.4492+/-0.1633 vs 0.0364+/-0.0145, P<0.005) but the TIMP-1 ratios were lower (139.0+/-28.7 vs 517.8+/-183.7, P<0.0005). In TB pleural fluid vs TB plasma, the respective MMP-1, MMP-2, TIMP-1, and TIMP-2 ratios were increased (0.46+/-0.10 vs 0.17+/-0.02; 25.2+/-2.8 vs 4.2+/-0.9; 139.0+/-28.7 vs 27.8+/-8.2; 0.67+/-0.13 vs 0.18+/-0.04, P<0.0005 each). Gelatine zymography demonstrated MMP-2 and MMP-9 bands of different brightness in TB effusions but in CHF effusions the MMP-9 band was barely visible. The MMP-9/MMP-2 effusion ratios were therefore higher in TB compared to CHF (0.46+/-0.15 vs 0.05+/-0.04, P<0.0005). CONCLUSION: Compartmentalized MMP-1, MMP-2, TIMP-1, and TIMP-2 and, compared to CHF, a surplus of MMP-1, MMP-2, MMP-8, and MMP-9 in the pleural space obviously contribute to the fibrotic reactions in TB pleuritis.

Adult↗

PubMed2004

Feasibility of "directly observed home-based twice-daily iron therapy" (DOHBIT) for management of anemia in rural patients: a pilot study.

BACKGROUND: Iron deficiency anemia (IDA) is a significant public health challenge in resource-poor settings, despite strong evidence for efficacy of iron supplementation. We hypothesized, modeled on the successful initiatives in disorders like tuberculosis or HIV, that directly observed therapy is an effective and practical strategy for control of IDA in such settings. OBJECTIVE: To overcome practical constraints and optimize compliance and effectiveness of iron supplementation by "Directly Observed Home-Based twice daily Iron Therapy" (DOHBIT) through village youth volunteers. DESIGN: Prospective longitudinal evaluation of DOHBIT. SETTING: A remote rural hilly hamlet with 25 families. METHODS AND MATERIAL: 100 mg elemental iron was administered twice daily under direct supervision to 33 anemic patients at home for 90 days. Outcome measures included hemoglobin rise, weight gain and side-effects. STATISTICS: Pre- and post-intervention weight and hemoglobin values were compared using paired t-test. RESULTS: 29 patients completed 3-months twice-daily iron therapy without interruption (compliance 87%). There was significant increase in mean weight (43.3 +/- 6.8 kg vs. 45.1+/- 6.9 kg; P < 0.0001) as well mean hemoglobin concentration (9.5 +/- 0.9 gm% vs. 11.7 +/- 0.7 gm%; P < 0.0001) and prevalence of anemia decreased by 40% from recruitment through the 3-months therapy. In terms of side effects, occasional constipation was stated by 3 patients, transient heartburn by two and diarrhea by none. Vomiting prompted withdrawal of iron therapy in one patient. CONCLUSIONS: Providing iron supplementation as directly observed home based therapy is feasible and successful in decreasing the prevalence of anemia in resource-poor settings.

Adolescent↗

PubMed2001

Use of purified protein derivative to assess the risk of infection in children in close contact with adults with tuberculosis in a population with high Calmette-Guérin bacillus coverage.

SETTING: Household contacts <15 years of age of adults with tuberculosis (TB) attending a reference center in Aracaju, Sergipe, Northeast Brazil. OBJECTIVE: To assess the use of purified protein derivative (PPD) and frequency of infection in children with high Calmette-Guérin bacillus (BCG) coverage who were recently exposed to TB. DESIGN: Cross-sectional study of 141 exposed household contacts <15 years of age and 506 nonexposed neighborhood controls. Children were examined and assessed for degree of exposure to index cases, BCG vaccination and scar and were tested with PPD. RESULTS: Exposed children were younger and less up to date in their vaccination schedule than controls (P < 0.05). BCG had been given to 95.6% of exposed children and 97.4% of controls, but only 80.9% of exposed vs. 88.5% of controls had a scar (P < 0.05). Scar sizes of exposed children were smaller (medians, 4.5 and 7 mm, respectively; P < 0.05). Children had lower weight for age z scores and height than the National Center for Health Statistics standards. Exposed children had lower weight for age z scores than controls (P < 0.05). Sixty-seven (47.5%) exposed children and 18 (3.6%) controls had PPD readings of >10 mm. Positivity and induration sizes increased with age, although this was significant only in the controls. The presence of a BCG scar was not associated with having a positive PPD. The degree of exposure was an important factor for PPD positivity; 66 (60.6%) of the 109 children with close exposure were positive compared with 1 (3.1%) of 32 with less intimate exposure. PPD indurations among close contacts were also larger than those with restricted exposure and controls (16.3, 11 and 9.4 mm, respectively; P < 0.05). PPD positivity was associated with the quantification of acid-fast bacilli in the adult; 38.5% of contacts with adults with sputum with (+) were positive, compared with 42.3% of those with (++) and 58.4% with (+++) (P < 0.05). CONCLUSION: PPD is a useful test to identify children infected with TB independently of whether they had received BCG or not. Children exposed to adults with TB are at high risk of infection. The risk of infection is associated with the intimacy of contact and the number of bacilli expectorated in sputum.

Adolescent↗

PubMed1981

[Newer aspects of the electrophoretic mobility test after stimulation of human lymphocytes with PPD].

The Electrophoresis-Mobility-Test is a modified Macrophage-Electrophoretic-Mobility-Test by using sheep erythrocytes, tanned and stabilized by sulfosalicyl acid. The test is used to demonstrate specific sensibilised T-lymphocytes in cell culture after having them isolated from human venous blood and after stimulation with antigen. 34 tests were done by stimulation with antigen PPD, the lymphocytes having been taken from patients with positive Tuberculin-Tine-Test. All tests were bacteriologically and cytologically controlled and only 9 could be used finally as a base for statistical control by using x2- und t-tests and histogram. A special attention was payed to the aggregation of monocytes and their morphological changes in cell culture. Every single test is not statistically significant, but the results of the whole lot give an attest of the concept of the EM-Test, which can be reproduced with a probability of about 60%.

Humans↗

PubMed2003

Characteristics and treatment outcomes of leprosy patients detected during a leprosy elimination campaign in Mozambique compared with routinely detected patients.

The objective of this study is to assess whether the case-finding method is a determinant for diagnostic characteristics and treatment outcome of newly diagnosed leprosy patients in Northern Mozambique. This is a retrospective cohort study of 3202 patients on the differences between entrance characteristics and treatment outcome in self-reporting patients and patients detected during a leprosy elimination campaign (LEC) in 1999 in Northern Mozambique. As a consequence of LEC activities, 3 times more patients were found compared with the same period 1 year earlier. After the LEC, case detection remained higher in the years 2000-2002 compared with the years preceding the LEC. More young (<15 years) paucibacillary (PB) cases were diagnosed during LEC activities with, surprisingly, equal percentage of disability grades. No gender imbalance was found in diagnosed LEC patients contrary to self-reporting patient groups. Comparing patients detected during a LEC in 1999 with the passive group of 1998 and 1999 showed a slight but statistically significant better treatment result for the passive group. The classification of leprosy (in favour of PB) and age (in favour of older age groups) were also determinants for favourable treatment outcomes. Volunteers had a significantly better result of treatment compared with trained nurses and regardless of detection method. LEC proved to be a useful addition to the National Leprosy and Tuberculosis Programme in Northern Mozambique. As a result, many new cases were diagnosed and put on treatment and their treatment results were very satisfactory. LEC had a lasting impact on case finding. Volunteers make a valuable contribution to leprosy control in Mozambique because they have consistently better treatment results compared with nurses.

Adolescent↗

PubMed1991

Investigations on etiology of Crohn's disease. Humoral immune response to stress (heat shock) proteins.

Many investigators have tried to prove a relationship between Crohn's disease and Mycobacteria. Recent evidence suggests that some autoimmune diseases may be initiated through "molecular mimicry" between mycobacterial stress protein antigens and their human homologs. We investigated whether antibody to stress proteins was more frequent in patients with Crohn's disease than controls. We used ATP binding to separate stress proteins (heat-shock-induced, de novo-synthesized, and constitutively expressed ATP-binding proteins) from crude extracts obtained from Mycobacteria and from an SV40-transformed human epithelial cell line that expresses a heat-shock protein, hsp73, as a complex with SV40 T antigen. We used immunoblots to compare sera from 34 patients with Crohn's disease, 14 with ulcerative colitis, and 14 with duodenal or gastric ulcers (noninflammatory bowel disease control patients). We found no statistically significant pattern or frequency of antibodies against single proteins or a combination of mycobacterial or human stress proteins. These observations do not support the hypothesis that a humoral immune response to stress proteins of Mycobacteria is important in the pathogenesis of Crohn's disease.

Antibody Formation↗

PubMedDate not supplied

HIV sero-prevalence among newly diagnosed adult pulmonary tuberculosis patients in Sagamu.

BACKGROUND: [corrected] The association between Tuberculosis (TB) and Human immunodeficiency virus (HIV) has been described in several studies. TB was well represented in the first description of AIDS in Africa. In 1999, 25% of TB cases were attributable to the spread of HIV/AIDS. Frequencies of between 54-79% were recorded in medical in-patients in our hospital. The objective of the study is to assess the frequency of HIV in TB outpatients attending the tuberculosis and leprosy control centre in Sagamu. METHODS: A cross-sectional study of adult tuberculosis patients admitted into the DOTS programme of the TB and leprosy control centre, Olabisi Onabanjo University Teaching Hospital, Sagamu between January 2001 and December 2002 was undertaken. Free anti tuberculosis drugs were provided by the German leprosy Relief Association. Data was collected using interviewer-administered questionnaire. HIV screening, packed cell volume and sputum microscopy for acid fast bacilli were carried out on all patients. RESULTS: A total of 269 cases of pulmonary T.B were registered at the clinic of which 40 (14.9%) were HIV sero-positive. The peak age prevalence was in the 3d decade accounting for 42.5% of cases, followed by 32.5% in the 2rd decade. There was a statistically significant difference in the bacillary count and packed cell volume between HIV positive and negative TB patients. The mean weight at presentation, sputum positivity rate and sputum conversion rate at the end of two months of therapy was similar in both HIV positive and negative TB patients. CONCLUSION: This study has demonstrated a frequency of 14.9% of HIV sero-prevalence amongst our TB population. Efforts should be intensified to ensure adherence to INH prophylaxis among HIV infected individuals in TB endemic areas as well as strengthening preventive measures.

AIDS-Related Opportunistic Infections↗

PubMed1980

The incidence of cancer among participants in controlled, randomized isoniazid preventive therapy trial.

Cancer morbidity and mortality were examined among 11,894 Puerto Rican participants in a US Public Health Service preventive therapy trial begun in 1957. The mean duration of follow-up was 18 years (range 16-19 years). No statistically significant difference in overall cancer rates was observed between the participants in the trial assigned isoniazid and those assigned placebo. There were also no significant differences between the groups when rates for specific types of cancer and age-specific cancer rates were compared. No trend toward an increasing cancer rate in the isoniazid group was observed with the passage of time. The mortality rate due to cancer was similar in the two groups. These data coupled with other information reported in the literature provide substantial evidence that isoniazid, when given in the usual therapeutic doses, is not carcinogenic in humans.

Adolescent↗

PubMed2001

Factors contributing to poor compliance with anti-TB treatment among tuberculosis patients.

Tuberculosis (TB) has made a comeback. It has become a resurgent public health problem in developing countries in the tropics and is the leading cause of death from any single infectious agent. Non-compliance to anti-tuberculosis treatment is the most serious problem in TB control. A cross-sectional study was conducted to investigate the determinants of poor compliance with anti-tuberculosis treatment among tuberculosis patients in Kota Bharu, Kelantan, Malaysia in 1999. A total of 390 patients were included in the study of which 130 were tuberculosis patients who defaulted treatment and 260 were those compliant to treatment. Data collection was done by interviewing the patients and collecting clinical and laboratory data from their medical records. Using multiple logistic regression analysis, patients who were not on direct observed therapy (DOT) lived distant to the health facility, were non-intravenous drug users (IVDU) and were HIV positive had statistically significant higher odds of being non-compliant. Patients should be given treatment under direct supervision with special attention to IVDU and HIV positive groups. Anti-TB treatment should be accessible to patients at the nearest health center from their residence. Interventions with health education programs emphasizing the benefits of treatment compliance should be implemented by further large-scale multicentered studies.

Adult↗

PubMed2001

[Prospective follow-up of a HIV infected population with and without access to antiretroviral therapy: impact of survival and complications].

BACKGROUND: Three-drug antiretroviral therapy (ART-3) has reduced complications and improved survival in HIV+ patients. The Chilean Public Health System began dual therapy (ART-2) in 1997, covering approximately 40% of patients in need. AIM: To report the results of a follow-up of patients with and without access to ART in a Chilean public hospital. PATIENT AND METHODS: Prospective follow-up of patients with ART-2 and 3 (cases) and patients with no access to ART (controls). All patients needed ART but it was available to a minority of them. Selection for ART was at random. Follow-up was between 6-24 months (11/96 to 3/99). Basal and periodic clinical and laboratory parameters were determined. Mortality and occurrence of new AIDS-defining events (ADE) were compared statistically using chi square. RESULTS: One hundred and fifty cases (106 ART2, 28 ART3 and 16 ART2 expanded to ART3) and 166 controls were studied. Basal parameters were similar except prior ART (32.7 and 18.7% in cases and controls respectively). Close to 1/3 patients had AIDS. Cases had a mean follow up of 527 days; controls, 478. Six cases (4%) (5 in ART-2) and 17 controls (10%) died. Mortality x 100/pts/yr was 2.7 in cases and 7.7 in controls, p < 0.05. ADE per 100/pts/yr was 21 in cases (24.4 in ART2, 15.1 in TAR3) and 54.5 in controls, p < 0.05. Cases had a reduction of: esophageal candidiasis (84%), tuberculosis (75%), cryptococcosis and toxoplasmosis (66%), P carinii pneumonia (55%) and bacterial pneumonia (46%) and they had fewer hospitalizations (73%). Late assessment: 70 of 101 ART-2 patients had changed to ART-3 (1 death); 22 of 101 kept original ART-2 (12 dead, 10 alive), 39 of 43 ART-3 patients were alive and 1 died. CONCLUSIONS: Short-term ART-2 and 3 significantly reduced mortality (60% and 73%) ADE (65% and 76% respectively) and hospitalizations. Benefits of ART-2 were short lived. Resource-constrained countries cannot depend on weaker than standard ART for proper care of people with HIV disease.

Adult↗

PubMed2006

Dynamic changes in pro- and anti-inflammatory cytokine profiles and gamma interferon receptor signaling integrity correlate with tuberculosis disease activity and response to curative treatment.

Pro- and anti-inflammatory cytokines and their signaling pathways play key roles in protection from and pathogenesis of mycobacterial infection, and their balance and dynamic changes may control or predict clinical outcome. Peripheral blood cells' capacity to produce proinflammatory (tumor necrosis factor alpha [TNF-alpha], interleukin-12/23p40 [IL-12/23p40], and gamma interferon [IFN-gamma]) and anti-inflammatory (IL-10) cytokines in response to Mycobacterium tuberculosis or unrelated stimuli (lipopolysaccharide, phytohemagglutinin) was studied in 93 pulmonary tuberculosis (TB) patients and 127 healthy controls from Indonesia. Their cells' ability to respond to IFN-gamma was examined to investigate whether M. tuberculosis infection can also inhibit IFN-gamma receptor (IFN-gammaR) signaling. Although there was interindividual variability in the observed responses, the overall results revealed that M. tuberculosis-induced TNF-alpha and IFN-gamma levels showed opposite trends. Whereas TNF-alpha production was higher in active-TB patients than in controls, IFN-gamma production was strongly depressed during active TB, correlated inversely with TB disease severity, and increased during therapy. By contrast, mitogen-induced IFN-gamma production, although lower in patients than in controls, did not change during treatment, suggesting an M. tuberculosis-specific and reversible component in the depression of IFN-gamma. Depressed IFN-gamma production was not due to decreased IL-12/IL-23 production. Importantly, IFN-gamma-inducible responses were also significantly depressed during active TB and normalized during treatment, revealing disease activity-related and reversible impairment in IFN-gammaR signaling in TB. Finally, IFN-gamma/IL-10 ratios significantly correlated with TB cure. Taken together, these results show that M. tuberculosis-specific stimulation of IFN-gamma (but not TNF-alpha) production and IFN-gammaR signaling are significantly depressed in active TB, correlate with TB disease severity and activity, and normalize during microbiological TB cure. The depression of both IFN-gamma production and IFN-gammaR signaling may synergize in contributing to defective host control in active TB.

Adolescent↗

PubMed2001

Cohort mortality study of North American industrial sand workers. I. Mortality from lung cancer, silicosis and other causes.

BACKGROUND: In 1997 a Working Group of the International Agency for Research on Cancer changed an earlier classification of crystalline silica as a human carcinogen from Group 2A to Group 1, though commenting that the carcinogenicity might vary with industrial circumstances and depend on additional factors affecting biological activity, including the distribution of its polymorphs. OBJECTIVE: We aimed to determine whether pure quartz exposure uncomplicated by the presence of other contaminating carcinogens, as experienced by workers in the production of high-grade industrial sand, was causally related to an increased risk of lung cancer. METHODS: A cohort of 2670 men employed before 1980 for 3 years or more in one of nine North American sand-producing plants and a large associated office complex was selected for study. Of the cohort, 2644 (99%) were traced through 1994, and certificated cause of death ascertained for 1025 (99%) of the 1039 men known to have died. Standardised mortality ratios (SMRs) were calculated for the main causes of death, using both US and state or provincial male mortality rates for reference. FINDINGS: The main analyses of deaths, 20 or more years after first employment against regional rates, gave the following SMRs: all causes 109, lung cancer 139, other malignancies 98, non-malignant respiratory disease 161, and nephritis/nephrosis 244. There were, in total, 37 deaths from silicosis or silico-tuberculosis, with one or more death at least in all nine production plants. Analyses failed to show any relation between lung cancer risk and duration of employment. The increased SMR for lung cancer was wholly due to high rates in four plants in two states, whereas no increase was found in the remainder of the cohort. CONCLUSION: In the absence of information on smoking histories and risk in relation to estimated exposure, the increased SMR for lung cancer (139), although statistically significant, cannot be attributed confidently to crystalline silica. An answer to the question of attributability must await the findings of the nested case-control study, in which level of exposure and smoking habits were ascertained for cases and matched controls. The strong indication in this cohort of excess mortality from non-malignant renal disease deserves further investigation.

Adult↗

PubMed2003

HIV-1-positive female migrants in Northrhine-Westphalia--relevant, but unfocussed problem?

Data of 204 HIV-1-positive female migrants from Sub-Saharan Africa, Asia and European countries other than Germany were analysed and compared to those of 282 German female virus carriers. Because not much is known about this subpopulation, the first step was to get an overview about the existing data and to describe them statistically in order to design prospective studies. A first result was that female migrants generally are tested for HIV-1 at a younger age than the control subjects. Predominant infection mode in the migrant population was heterosexual intercourse, whereas in the controls there were significantly more i.v. drug users. Distribution to the CDC-stages, CD4+-cell count and plasma viral load did not differ in both groups except for a higher percentage of AIDS-defined individuals among the controls. Surprisingly, significantly more migrants were treated with antiretroviral drugs than in the control group. However, both groups showed the same pattern of AIDS-defining diseases, only tuberculosis occurs more often in migrants. The data show that migrants are a vulnerable subpopulation which can be once being integrated in the health system of the host country effectively treated. - Results are discussed with respect to the international literature. The urgent need for adequate preventive strategies is underlined.

Adult↗

PubMed1997

Dietary factors associated with a low risk of colon cancer in coloured west coast fishermen.

OBJECTIVE: To examine the relative roles of dietary fibre, anti-oxidant vitamins and fish oils in the relatively low incidence of colon cancer in coloured West Coast fishermen. DESIGN: Dietary intake survey, based on food frequency questionnaire and household surveys. Blood sampling for vitamin and fatty acid concentrations. SETTING: Isolated West Coast fishing villages (sample population) and urban Cape Town inhabitants (controls). PARTICIPANTS: 101 male and female West Coast fishermen over the age of 40 years, and 99 age- and sex-matched urban whites. OUTCOME MEASURES: Dietary analysis by 'Foodfinder' technique, and nutrient blood levels. Statistical analysis using SASR program version 6. RESULTS: An analysis of the number of recorded cases of colorectal cancer over a period of 5 years leading up to the study confirmed a lower rate of colorectal cancer in the West Coast fishermen than in the Cape Town population: fishermen 6 cases/120000, urban whites 677/2 million. A significantly higher proportion of fishermen were smokers, had hypertension and gave a history of previous tuberculosis infections. Vitamin supplementation was noted in one-third of whites but in no fishermen. The results of the dietary analysis (mean (SD)) demonstrated that fishermen consumed less fibre (9.9 (4.7) g/d v. 17.4 (7.2) g/d; P < 0.01) and less fruit and vegetables (190 g/d v. 365 g/d; P < 0.001), with a lower intake of vitamin C, thiamin, riboflavin, vitamin B6 and folate. Sodium intake was higher in fishermen, whereas intakes of potassium, magnesium, calcium, iron, zinc and copper were lower. In addition, the daily intake of omega-3 fatty acids (fish oils), docosahexaenoic acid (C22:6) and eicosapentaenoic acid (C20:5) in the West Coast population was considerably higher (0.71 (0.51) g/d v. 0.14 (0.09) g/d; P < 0.0001 and 0.37 (0.3) g/d v. 0.05 (0.05) g/d; P < 0.0001, respectively) than in the urban population owing to their higher intake of fish (110 g v. 30 g/d; P < 0.001). Plasma fatty acids correlated positively with these dietary intake figures, showing fishermen to have higher levels of circulating omega-3 fatty acids, C20:5 (3.9 (1.8)% v. 0.66 (0.29)%; P < 0.001) and C22:6 (5.6 (1.8) v. 2.9 (0.08)%; P < 0.001) and lower levels of omega-6 fatty acids, C18:2 and C20:3 (29.7 (4.7)% v. 33.5 (5.6)%; P < 0.05 and 0.85 (0.48)% v. 1.5 (0.47)%; P < 0.001, respectively) compared with the urban group. CONCLUSION: The low incidence of colorectal carcinoma in West Coast fishermen might be explained by the protective effects of fish (omega-3) oils, but not by other "protective' dietary items such as fibre, anti-oxidant vitamins or calcium. The high incidence of hypertension may be related to a higher sodium intake, accompanying high consumption of salted fish, or to the higher prevalence of tobacco smoking.

Adult↗