Last month saw the end of the first year of operation of the Abortion Act in Britian, and statistics are now available for the first 10 months, from April 1968, to February 1969. In that time, legal, notified abortions totalled 28,849, of which 20,746 were on the grounds of risk of injury to the physical or mental health of the women. A further 1350 were carried out because of risk to the life of the woman, 1137 because of risk to the physical or mental health of existing children, 965 because of the risk of the woman bearing a physically or mentally handicapped child, and 52 as emergencies to save the life of the woman or prevent grace injury to her health. Another 4599 abortions were carried out for more than 1 of these reasons. An earlier set of statistics, covering the period up to December 1968, showed that 22,256 abortions legally carried out up to then, 13,609 were in National Health Service hospitals and 8601 in other approved hospitals. It is likely that the total number of legal abortions in Britain for the first full year of the Act will be about 34,000. In the years leading up to the introduction of the Abortion Act, the number of abortions carried out in Britain for reasons then legal had been growing steadily, and had reached 7600 in National Health Service hospitals in 1967. An unknown further number of legal abortions had been done in private nursing homes - these cannot be computed because they were not notifiable before the Abortion Act came into force. There are 4 legal abortions for every 100 live births in Britain; this is about 1/2 the figure for Denmark and one tenth that of Czechoslovakia.
High rates of tuberculosis, including multidrug-resistant tuberculosis (MDR-TB), have been reported from the former Soviet Union. Our laboratory has supported operational studies in jails in Baku, Azerbaijan, and Mariinsk, Siberia. Combining the results from these two penal systems, the rates of MDR-TB among 'newly enrolled' and 'non-responding' cases were 24.6% and 92.1%, respectively. Restriction fragment length polymorphism (RFLP) studies strongly suggest transmission of MDR-TB between prisoners. In Mariinsk, the high rates of MDR-TB have been associated with failure rates of 23%-50% among smear-positive cases receiving fully-supervised standard short-course treatment. There are no coherent guidelines for TB control programmes confronted by high pre-existing levels of MDR-TB but who have only limited laboratory, clinical, pharmaceutical and financial resources. A 'DOTS plus' strategy has been advocated in which an established TB control programme is complemented by facilities to treat MDR-TB patients. However, the exact format of these programmes remains unresolved. Further research is required to describe the natural history of MDR-TB infection, to determine the failure rate of (and the additional resistance induced by) standard short-course treatment when MDR-TB is prevalent, to decide whether standardised or individualised second-line regimens can be employed, and to define the laboratory facilities required by a 'DOTS plus' programme.
Nasopharyngeal carcinoma is a disease with a remarkable racial and geographical distribution. In most parts of the world it is a rare condition and in only a handful of places does this low risk profile alter. These include the Southern Chinese, Eskimos and other Arctic natives, inhabitants of South-East Asia and also the populations of North Africa and Kuwait.
OBJECTIVE: To facilitate the quantitative comparison of AIDS incidence statistics between countries and with other diseases using statistics based on age-standardized incidence rates instead of absolute number of cases. DESIGN: AIDS incidence rates for 19 countries belonging to the World Health Organization (WHO) European region, and for comparative purposes, the United States. METHODS: Incidence rates were standardized using the world standard population for all ages, from 1985 to 1992. The data were derived from the WHO European Non-Aggregate AIDS Dataset and the Centers for Disease Control and Prevention (CDC) AIDS Public Information Dataset, adjusted for reporting delays in each country. RESULTS: The AIDS incidence rate for men (81 in 1,000,000) in the United States was fourfold higher than the highest rate in a European country (Switzerland) in 1985; incidence rates in all other European countries, except France and Denmark, were below 10 in 1,000,000. Subsequently, AIDS incidence has increased more rapidly in southern Europe than in the rest of the continent. The estimated incidence rate for men in Spain (243 in 1,000,000) approached that in the United States (304 in 1,000,000) in 1992, and three additional countries (France, Switzerland and Italy) showed rates above 100 per million. The spread of the AIDS epidemic among women in some southern European countries was faster than in the United States. In Switzerland and Spain the standardized incidence rates in women were higher than in the United States by 1988 and 1992, respectively. CONCLUSIONS: Analysis trends in incidence rates avoids some weaknesses of AIDS statistics based on absolute numbers, and should become one of the standard tools for AIDS surveillance.
OBJECTIVE: Frequency of heavy alcohol use among adolescents is examined by family structure and propensity toward heavy alcohol use on the individual level, and by alcohol availability and drinking patterns among adolescents on the societal level. The analysis includes direct effects and moderating effects of societal-level indicators on individual-level associations between family structure and frequency of heavy alcohol use. METHOD: The study drew upon self-reports from 34,001 students in Cyprus, France, Hungary, Iceland, Ireland, Lithuania, Malta, the Slovak Republic, Slovenia, Sweden and the United Kingdom participating in the 1999 European School Survey Project on Alcohol and Other Drugs study. Distinctions were drawn between adolescents living with both parents, a single mother, a single father, a mother and stepfather, a father and stepmother, and neither biological parent. The multilevel analysis estimated the effects of societal-level factors on the intercepts and slopes of individual-level regression models. RESULTS: Adolescents living with both biological parents engaged less frequently in heavy alcohol use than those living in any other arrangements. Living with a single mother was associated with less heavy drinking than living with a single father or with neither biological parent. National beer sales figures and societal patterns of heavy adolescent alcohol use predicted more frequent heavy drinking and greater effects of living in nonintact families. CONCLUSIONS: Adolescent heavy drinking is more common in all types of nonintact families. The adverse effect of living in nonintact families is greater in societies where alcohol availability is greater and where adolescents drink more heavily.
OBJECTIVE: The aim of this study was to quantify the global burden of osteoporotic fracture worldwide. METHODS: The incidence of hip fractures was identified by systematic review and the incidence of osteoporotic fractures was imputed from the incidence of hip fractures in different regions of the world. Excess mortality and disability weights used age- and sex-specific data from Sweden to calculate the Disability Adjusted Life Years (DALYs) lost due to osteoporotic fracture. RESULTS: In the year 2000 there were an estimated 9.0 million osteoporotic fractures of which 1.6 million were at the hip, 1.7 million at the forearm and 1.4 million were clinical vertebral fractures. The greatest number of osteoporotic fractures occurred in Europe (34.8%). The total DALYs lost was 5.8 million of which 51% were accounted for by fractures that occurred in Europe and the Americas. World-wide, osteoporotic fractures accounted for 0.83% of the global burden of non-communicable disease and was 1.75% of the global burden in Europe. In Europe, osteoporotic fractures accounted for more DALYs lost than common cancers with the exception of lung cancer. For chronic musculo-skeletal disorders the DALYs lost in Europe due to osteoporosis (2.0 million) were less than for osteoarthrosis (3.1 million) but greater than for rheumatoid arthritis (1.0 million). CONCLUSION: We conclude that osteoporotic fractures are a significant cause of morbidity and mortality, particularly in the developed countries.
Among 424 HLA identical siblings undergoing stem cell transplantation, 364 were Scandinavians and 60 represented other ethnic groups. The cumulative probabilities of acute graft-versus-host disease grades II-IV were similar in both groups, 17% in Scandinavians and 12% in the others, p = 0.4. In a multivariate analysis, less effective immune suppression with cyclosporine or methotrexate alone (p = 0.001), recipient seropositive for three to four herpes viruses (p = 0.004), CMV-seropositive recipient (p = 0.05) and early engraftment (before day 15) (p = 0.05) were independent risk-factors for acute GVHD grades II-IV. The cumulative probabilities of chronic GVHD were 47% and 68% in the two ethnic populations, respectively (p = 0.004). In multivariate analysis, higher patient age (p
The comparison of the first and second waves of the pandemic influenza A(H1N1)pdm09 in the world and Russia was performed on the basis of weekly reports of Regional offices for Europe and on the data of the Federal Center for Influenza on a weekly incidence of influenza and acute respiratory viral infections, hospitalization, and mortality from the influenza in the age groups of population in 49 cities of the Russian Federation. The first wave of the pandemic, which continued in the countries of the world all summer, was of mixed etiology and, in spite of the availability of imported cases, has not caused a steep increase in Russia. The second wave of the pandemic in the countries of the Southern hemisphere was less intense. In the countries of the Northern hemisphere (in autumn 2009), on the contrary, it was more intensive, which was associated with different seasonality of influenza in these hemispheres. In Russia, the second wave (2011) was of a lesser intensity as compared to the first with respect to the duration in the country and in urban areas, the incidence in the entire population, including schoolchildren and adults, the rate of hospitalization and case fatality rate reduction of laboratory-confirmed influenza infection. The duration of the last pandemic of 2009 was the same as in 1957 and 1968, and longer than in 1977. The morbidity was one-half less than in the pandemic of 1957 and 1968, and was approaching the pandemic 1977. At the same time, the incidence in children 3-6 and 7-14 years was higher than in previous pandemics.