Health effects of passive smoking in adolescent children.

OBJECTIVE AND DESIGN: To study the effects of passive smoking on health in adolescent schoolchildren by questionnaire, spirometry and laboratory investigations. SETTING: Two schools in the Vanderbijlpark area. PARTICIPANTS: Seven hundred and twenty-six high-school children of average age 16 years. OUTCOME MEASURES: Lung function, serological abnormality or historical (i.e. questionnaire) evidence of ill health. RESULTS: The prevalence of respiratory illness before and after 2 years, respiratory symptoms, earache over the past year, low birth weight and learning difficulties were found to be significantly increased in the children exposed to parenteral smoke in the home, especially those exposed to maternal smoking. Spirometric and laboratory parameters, however, were not affected by passive smoking.

The value of radiotherapy or chemotherapy after intubation for advanced esophageal carcinoma--a prospective randomized trial.

After intubation for advanced, inoperable squamous carcinoma of the oesophagus, a prospectively controlled randomized trial was done to investigate the effect of radiotherapy (41 patients) or mono-chemotherapy (40 patients) or no further treatment (46 patients). Treatment had no significant effect on either palliation or survival (p < or = 0.7) and did not alter the natural history of the disease.

Exposure to air pollution from transitional household fuels in a South African population.

Exposure to high levels of particulate matter is one of the risks associated with a household utilizing low quality coal as primary household energy source. In South Africa more than 20 million people rely on traditional (wood) and transitional (coal and paraffin) fuels to fulfil their basic energy needs--cooking and space heating. Personal exposures to TSP in a coal burning Township in the Vaal Triangle (central South Africa) were determined during the winter and summer of 1991 and 1992. Personal monitoring of TSP were conducted over a 12 hour period. Forty five children, age 8-12, participated. Exposures varied from 294 to 2304 micrograms/m3. The average 12 hour exposure during a summer day (8:30 a.m.-8:30 p.m.) was 662 micrograms/m3 (N = 15) compared to 1333 micrograms/m3 for a winter school day (N = 13). The difference was highly significant (P < 0.0002). The study identified the following risk factors associated with exposure: season (winter higher than summer), gender (boys higher than girls), and day of the week (school days higher: schools are situated in the centre of completely unelectrified areas). Statistical significant difference between personal exposures to TSP were documented between electrified vs unelectrified (utilize coal only) areas. The study confirmed other reports of extremely high exposures to air pollution documented in developing communities across the globe.

Preliminary results of exposure measurements and health effects of the Vaal Triangle Air Pollution Health Study.

The aim of the Vaal Triangle Air Pollution Health Study is to assess the adequacy of South Africa's air pollution control programme to protect human health. It is a longitudinal study of children aged 8-12 years which will evaluate exposure and effects of outdoor and indoor air pollution levels on the health of more than 10,000 white and black children living in Vanderbijlpark, Sasolburg, Vereeniging, Meyerton, Randvaal, and the Sebokeng/Sharpeville areas (Lekoa), Transvaal, RSA. Extensive data on outdoor and indoor levels of air pollution as well as personal exposures to total suspended particulate matter were collected. Preliminary results indicate that the levels of particulate matter exceed the USA health standards. A health questionnaire administered to 10,187 white children indicated that during the past year 65.9% had suffered from upper respiratory tract illnesses (URI) such as sinusitis, rhinitis and hay fever and 28.9% from lower respiratory tract illnesses (LRI) such as bronchitis, chronic cough and chronic chest illnesses. Parents who perceived that the air pollution in the region is serious had a higher reporting rate of URI/LRI for their children than parents who considered the air pollution not to be serious (77.4% v. 56.8% respectively for URI and 24.1% v. 16.3% respectively for LRI). The effect of this recall bias will be evaluated in later analyses. A statistically significant higher prevalence of LRI was reported in children exposed to parental smoking (25.7% for households where both parents smoked v. 20.8% in households without parental smoking) (odds ratio (OR) 1.32 (1.2-1.5)).(ABSTRACT TRUNCATED AT 250 WORDS)

Relationship between self-reported activity levels and actual heart rates in teenagers.

A study was designed to explore the relationship between self-reported activity levels and actual heart rate (HR) as measured by a portable heart rate monitor (Sport Tester PE3000). Twenty-two teenagers (8 boys, 14 girls, median age of 16) from Watertown High School, Massachusetts participated in this pilot study which involved continuous monitoring of HR during normal daily activities and simultaneous completion of a time/activity diary. There were 31 successful monitoring sessions ranging from 1.9 to 17 hours with a median monitoring time of 12.6 hours. Four unsuccessful monitoring sessions were experienced due to equipment failure. Apart from participant cooperation, the single most important factor affecting the feasibility of continuous heart rate monitoring was found to be equipment design. The overall average heart rate observed was 88.4 bpm (SD = 24.3). An individual's correlation coefficient for perceived activity level (documented in half-hour intervals) and heart rate (averaged over the half-hour intervals) varied from 0.24 to 0.89. More than half of the correlation coefficients were below 0.40. There was a significant difference (P less than .0001) between average heart rate for time spent indoors (90 bpm) versus outdoors (103 bpm) even after correcting for sleeping time. It is concluded that continuous HR monitoring with simultaneous completion of a time/activity diary is feasible and is a promising source of information for studies on exposure to air pollutants.

Self-reported exertion levels on time/activity diaries: application to exposure assessment.

Recent developments in air pollution analysis have focused on methods for collecting data on contaminant levels in the locations actually frequented by people, especially personal monitoring. While there is still much to understand about human exposures, the next advancements will be in the area of dose assessment. This paper discusses the results of a study designed to provide data for linking exposure to dose. Specifically, we used time/activity diaries to collect information on the exertion levels associated with the reported activities. As part of a community health study, 91 children between the ages of 9 and 11 kept diaries over a two-week summer-time period (July 1989) and during a two-week school-time period (September 1989). The diary was also administered for two days to 42 teenagers between the ages of 15 and 17. This paper describes our concerns about interpreting self-reported exertion levels, particularly with respect to the disparity between participant and researcher perception and coding. We then present the distribution of exertion levels associated with children's activities, highlighting seasonal, day-of-week, and age-group differences.

The prognostic significance of age in patients with advanced Hodgkin's disease.

One hundred and forty-eight patients with Stage III and IV Hodgkin's disease, treated at a single institution, were studied to investigate the importance of age as a prognostic pre-study factor. The median age of the patients was 30 (2-81). All patients received combination chemotherapy. The overall response rate was 85%. The median survival is not reached with a median follow-up time of 9.6 years. Age was found to be the dominant prognostic discriminant with younger patients having a better survival. Factors which were significant in a univariate analysis were performance status (PS), stage, weight loss, histology and liver involvement. In a stepwise logistic regression model, however, only age and PS remained independent significant prognostic discriminants. It is concluded that even in the absence of serious concomitant disease, such as heart disease, age is the single most important prognostic variable.

Trimetrexate in advanced carcinoma of the esophagus.

Twenty-four patients with advanced epidermoid carcinoma of the esophagus were treated with trimetrexate (TMTX), a lipid soluble non-classical antifol. Patients were given TMTX 8 mg/m2 intravenously day 1-5 every 28 days. In nine of these patients the dose was escalated to 12 mg/m2 day 1-5 every 28 days. Three patients had a partial response (95% confidence limit 3-32%) with a median response duration of 14 weeks. No hematologic toxicity was documented. Two patients developed moderate stomatitis and only 3 patients experienced any nausea or vomiting. The median survival of all patients is 12 weeks. It is concluded that a higher dose of TMTX should be studied in patients with esophageal cancer in order to assess the true therapeutic value of the agent at a dose closer to the median tolerated dose. A phase II ECOG study using TMTX 12 mg/m2 intravenously day 1-5 every 21 days is currently being conducted.

Cyclophosphamide, mitoxantrone, vincristine and prednisone in the treatment of non-Hodgkin's lymphoma.

Twenty-two patients with histologically confirmed non-Hodgkin's lymphoma received treatment with a chemotherapy combination containing cyclophosphamide, mitoxantrone, vincristine and prednisone. Leukopenia, nausea and vomiting were the most common side effects. A response rate of 77% (17 of 22 patients) was documented. These results indicate that the four-drug combination including mitoxantrone has good therapeutic activity in the treatment of non-Hodgkin's lymphoma.

Mitoxantrone in the treatment of acute leukemia.

Forty-six patients with acute leukemia were treated with mitoxantrone as a single agent. Twenty-nine patients had relapsed and/or refractory acute leukemia. Seventeen patients with acute non-lymphatic leukemia had received no prior treatment. Twelve mg/m2 of mitoxantrone was given intravenous on five consecutive days. Treatment related side effects included bone marrow suppression, mucositis, alopecia, nausea, vomiting and infection. Cardiotoxicity was documented in 7 patients. This study reconfirms that mitoxantrone is an active agent in acute leukemia with complete response documented in 10 of 29 patients with relapsed and/or refractory acute leukemia (34% response rate, 95% confidence limits 18-53%) and complete response documented in 11 of 17 patients (65% response rate, 95% confidence limits 38-87%) with previously untreated acute nonlymphatic leukemia.

Aspergillus brain abscess. A case report.

The history and findings in a patient with erythroleukaemia who developed a fungal brain abscess during the agranulocytic phase of induction treatment is reported. The radiological features of fungal infection are reported, with emphasis on the importance of clinical judgement in making the diagnosis. The autopsy findings further illustrate the increasing importance of this previously very rare condition.

Prognostic factors in patients with small-cell carcinoma of the lung.

Fifty-two patients with histologically confirmed small-cell carcinoma of the lung, 15 with disease localized to one hemithorax and 37 with extensive metastases, were studied. Only patients whose general condition was considered good enough to tolerate intensive combination chemotherapy were included in this study. The median survival time of these patients was 33 weeks (range 7-192 weeks) with a mean survival time of 43 weeks. Patients who responded with objective tumour improvement within 6 weeks had a median survival time of 39 weeks. Those showing disease stabilization at 6 weeks had a median survival time of 35 weeks while those having disease progression at this time had a median survival of 22 weeks. Patients without liver involvement and a normal serum albumin level at the start of treatment had statistically superior survival times.

Oral idarubicin in combination with cytosine-arabinoside in previously untreated patients with acute non-lymphocytic leukemia.

Twenty-six previously untreated patients with acute non-lymphocytic leukemia (ANLL) were treated with oral idarubicin and cytosine-arabinoside (Ara-C). The median age of the patients was 44 years (range, 11-72). In 23 of the 26 patients a hypoplastic marrow, with a peripheral white cell count of less than 1,000/mm3 after treatment, was documented. Treatment was well tolerated with minimal symptoms of nausea and vomiting. Diarrhea was observed in three patients and stomatitis in nine patients. Alopecia was documented in only six patients. A complete remission (CR) was obtained in 12 patients (median duration 25 weeks). The median time to CR was 3.4 weeks (range, 1.4-5). Ten of the 26 patients were alive 6 months after the start of induction treatment, while a further four patients who were in the study for less than 6 months are alive and in remission at 5, 4, 3, and 3 months, respectively. Eight of 12 patients in whom bone marrow aplasia was documented achieved a CR; perhaps the drug dosages used in this study were suboptimal.

Value of steroid hormone receptor analysis in predicting time to treatment failure in operable breast cancer.

An analysis of prognostic factors for predicting time to treatment failure (TTF) was performed on 246 patients who were referred for adjuvant chemotherapy after mastectomy. Oestrogen receptor (ER) and progesterone receptor (PgR) analyses were carried out on 172 and 102 patients respectively. Prognostic factors predicting for TTF were, in decreasing order of significance: nodal status, tumour size, ER status and age of the patient. Comparison of TTF for ER+ and ER- (without categories of other prognostic factors) showed that ER status is prognostic irrespective of nodal status. ER is prognostically significant within both categories of PgR. PgR predicted significantly for TTF only in patients without nodal involvement.

[Prognostic parameters in patients with advanced non-Hodgkin's lymphoma]. / Prognostiese parameters by pasiënte met gevorderde nie-Hodgkinse limfoom.

Ninety-five patients with advanced non-Hodgkin's lymphoma (NHL) were studied to evaluate parameters affecting their survival. The median survival time was 52 months (range 3-107 months). The log-rank test was used to analyse the data. Favourable parameters that significantly influenced actuarial survival were nodular histology (P = 0.01), age less than 50 years (P = 0.002), good performance status (P = 0.006), and normal serum lactate dehydrogenase, SGOT and alkaline phosphatase levels. The absence of systemic symptoms, namely weight loss in excess of 10%, fever or night sweats, had less prognostic implication. Sex and stage (III or IV) did not significantly affect survival.