Payback time? Influence of having children on mortality in old age.

BACKGROUND: It is known that parents have lower mortality than childless individuals. Support from adult children to ageing parents may be of importance for parental health and longevity. The aim of this study was to estimate the association between having a child and the risk of death, and to examine whether the association increased at older ages when health starts to deteriorate and the need of support from a family member increases. METHODS: In this nationwide study, all men and women (born between 1911 and 1925 and residing in Sweden), as well as their children, were identified in population registers and followed over time. Age-specific death risks were calculated for each calendar year for individuals having at least one child and for individuals without children. Adjusted risk differences and risk ratios were estimated. RESULTS: Men and women having at least one child experienced lower death risks than childless men and women. At 60 years of age, the difference in life expectancy was 2 years for men and 1.5 years for women. The absolute differences in death risks increased with parents' age and were somewhat larger for men than for women. The association persisted when the potential confounding effect of having a partner was taken into account. The gender of the child did not matter for the association between parenthood and mortality. CONCLUSIONS: Having children is associated with increased longevity, particularly in an absolute sense in old age. That the association increased with parents' age and was somewhat stronger for the non-married may suggest that social support is a possible explanation.

Marital partner and mortality: the effects of the social positions of both spouses.

BACKGROUND: Dimensions of the individual socioeconomic position-education, social class, social status and income-are associated with mortality. Inequalities in death also related to the social position of the household. It is, however, less clear how the socioeconomic position of one marital/cohabiting partner influences the mortality of the other partner. We examine the independent effect on mortality of own and partner's positions regarding these four socioeconomic factors. METHODS: Register data on education, social class, social status and income of both marital/cohabiting partners were collected from the 1990 Census of the employed Swedish population aged 30-59 (N = 1,502,148). Data on all-cause mortality and deaths from cancer and circulatory disease for the subsequent period 1991-2003 were collected from the Cause of Death Register. Relative mortality risks for different socioeconomic groups were estimated by Cox regression. RESULTS: All-cause mortality of both men and women differs by women's education and status and by men's social class and income. For men, the wife's education is more important for the mortality risk than his own education when the man's social class is included in the model. For women, the husband's social class yields larger mortality differences than own occupational measures. Women's education and men's social class and income are particularly important for women's deaths from circulatory diseases. CONCLUSION: The partner's social position has a clear independent association with individual mortality, and women's education and men's social class seem to be particularly important. Suggested explanations of health inequality are not always compatible with the observed relationship between partners' social and economic resources and mortality.

Increased prevalence of oral Candida albicans serotype B in homosexual men: a comparative and longitudinal study in HIV-infected and HIV-negative patients.

Several investigators have shown a comparatively high prevalence of Candida albicans serotype B among HIV-infected individuals. We serotyped oral C. albicans strains from 50 HIV-infected homosexual men, 39 HIV-seronegative homosexual men and 40 clinical oral isolates of a control group. The prevalence of serotype B was significantly higher in homosexual men, regardless of HIV serostatus, than in the control subjects. We suggest that the reported high prevalence of serotype B among AIDS patients in Europe and the USA simply reflects the high proportion of homosexual men among HIV-infected patients. In 22 subjects, oral C. albicans isolates were obtained at two or more time points, up to 8 years apart. No change in serotype was observed over time. The serotype prevalences in HIV-infected patients with oral thrush or AIDS-defining illness were similar to the group of homosexual men as a whole, indicating that there is no serotype-related variation in pathogenicity.

Oral Candida albicans isolates with reduced susceptibility to fluconazole in Swedish HIV-infected patients.

A total of 62 patients with HIV-related conditions were examined for clinical and mycological oral findings. Cultures from 51 patients were positive for yeasts and included 49 Candida albicans and 8 non-albicans isolates. Of patients with positive culture, 35% had pseudomembranous thrush. In vitro susceptibility testing of 49 C. albicans isolates revealed that the minimal inhibitory concentration for 50% of the strains (MIC50) was 2.0 mg/l for fluconazole, and the MIC50 was < or = 0.125 mg/l for both ketoconazole and itraconazole. Fluconazole resistance (MIC > or = 32.0 mg/l) was found for 14% of the C. albicans isolates tested. Two C. albicans isolates showed cross-resistance to ketoconazole and itraconazole. Associations between reduced susceptibility to fluconazole and low CD4+ cell counts, the length of time since the first AIDS-defining illness and the interval from the first fluconazole treatment, indirectly reflecting the total fluconazole exposure, were observed.

Long-term remission of Kaposi's sarcoma following foscarnet treatment in HIV-infected patients.

Five patients with HIV-associated Kaposi's sarcoma (epidemic KS) were treated with foscarnet 180 mg/kg/day i.v. for 10 days. Four of them suffered from severe immunodeficiency with CD4 cell counts below 30 x 10(6)/l. Three of the patients went into long-term remission of KS. One patient was free of relapse for 12 months and 2 patients are still in remission after an observation period of 13 and 20 months respectively. The results suggest a possible role of foscarnet in the treatment of epidemic KS.

Recurrent transient hyperphosphatasemia of infancy in an adult.

We report a case of recurrent transient hyperphosphatasemia in a 29-year-old man with immune deficiency. He had serum alkaline phosphatase (ALP; EC 3.1.3.1) activity 16.9- and 4.8-fold greater than the upper reference limit on two occasions; the activity returned to normal within 2 months on the first and within 1 month on the second. On both occasions we observed the typical electrophoretic pattern for ALP isoenzymes seen in transient hyperphosphatasemia of infancy. We noted no evidence of liver or bone disease. Recognition of the occurrence of transient hyperphosphatasemia of infancy in adults, although rare (it is the fifth case reported), seems as important as in children so that unnecessary extensive investigations are avoided.

The exanthema of acute (primary) HIV infection. Identification of a characteristic histopathological picture?

A male homosexual presented with a skin rash, pharyngitis, fever and lymphadenopathy. The clinical symptoms were suggestive of an acute primary HIV infection. The diagnosis was confirmed serologically. We describe here the clinical and histopathological picture of the exanthema. Biopsy from a papular skin lesion revealed a possibly characteristic pattern.

Dermatophytosis and HIV infection. A study in homosexual men.

Mycological and clinical investigations were carried out in 193 homosexual men, 83 of whom had HIV antibodies, and 117 heterosexual men. Dermatophytes were recovered from the feet in 37.3% of HIV seropositive homosexual men, 31.8% of seronegative homosexual men and 8.6% of heterosexual men. Tinea pedis in homosexual men was significantly more common with increasing age. There was an increased number of sexual partners in the group of homosexual men with tinea pedis. Two dermatophytes were recovered from single samples in 14.5% of homosexual men with dermatophytosis. Dermatophytes were occasionally isolated from clinically normal toe clefts. Present results point to the importance of dermatophytes in nail dystrophy affecting patients with advanced HIV infection. Dermatophytosis in homosexual men was not associated with any changes in counts of blood T lymphocyte subsets or skin reactivity to tuberculin.

Purified trichophytin: lymphocyte reactivity in vitro and trichophytin-induced suppression.

Three trichophytin preparations from different strains of Trichophyton mentagrophytes were produced according to the ethylene glycol method and assessed for their lymphocyte stimulation activity in vitro (LST). These trichophytin preparations showed significant variations in their effects on cord lymphocytes reactivity. The preparations also varied in their stimulation of lymphocytes from patients with dermatophytosis. Conclusions could be drawn about the immunological specificity, sensitivity and lymphocyte toxicity, which is important for the standardization of antigens. Furthermore, it was demonstrated that trichophytin-preincubated lymphocytes mediated a suppression of lymphocyte reactivity to this antigen.

Oral candida albicans in HIV infection.

The prevalence of oral colonization with Candida albicans was studied in 225 homosexual men, 99 of whom had HIV antibodies and in 175 heterosexual men. Oral candidal carriage was most prevalent among HIV seropositive homosexual men (77.8%). Rich growth of C. albicans in culture and findings of pseudomycelial elements in oral mucosal smear also correlated with HIV seropositivity. Pseudomycelial forms of C. albicans were demonstrated in mucosal smear from all patients with oral mucosal lesions suspected for candidiasis. However, 26/53 patients (49.1%) with positive smear had no clinical signs of oral candidiasis. The oral yeast flora was sampled twice in 85 homosexual men at an interval of 12-18 months. 71/85 patients (83.5%) were grouped into the same category of candidal colonization; carrier or noncarrier state, on both occasions. No statistically significant differences in numbers of CD 4 cells or CD 8 cells were observed between patients with respect to candidal colonization, when HIV seropositive and seronegative homosexual men were considered separately.

Extensive hemangiomatosis of the extremities with the same histopathological pattern as the early lesion of Kaposi's sarcoma.

For 13 years a 28-year-old man had on his hands and feet bluish red patches, which had slowly progressed in size. Biopsy specimens exhibited an abnormal vascular pattern similar to that seen in early lesions of Kaposi's sarcoma. Skeletal radiographs of the hands and feet showed lesions indicating hemangiomatosis.

Persistent generalized lymphadenopathy: immunological and mycological investigations.

Immunological and mycological investigations were carried out in 21 Swedish homosexual males. One of them had AIDS, one pre-AIDS and 19 lymphadenopathy of whom 18 fulfilled the criteria of persistent generalized lymphadenopathy (PGL) as defined by the Centers for Disease Control, Atlanta, (CDC). The patients were investigated immunologically with respect to their in vitro lymphocyte reactivity to various mitogens. The patients with AIDS and pre-AIDS belonged to the group of 8 patients with low response to mitogens. Blood helper T cell percentages and serum beta 2-microglobulin concentrations correlated with the PHA reactivity. Three patients, with the diagnoses AIDS, pre-AIDS and PGL respectively, had clinical signs of oral candidiasis with rich growth of Candida albicans in culture. These were all low responders to mitogen stimulation. Six cases of tinea pedis were diagnosed and seemed to be distributed among the patients irrespectively of the severity of their immunological disorders.

Dermatophytid--a misdiagnosed entity?

A mycological and immunological survey was performed in 26 patients with clinical signs of dermatophytid. Only 10 patients fulfilled the main criteria of dermatophytid reactions, i.e. positive delayed skin test to trichophytin and dermatophyte isolated by culture. Trichophyton mentagrophytes--especially the zoophilic variant--was found in 9 patients of 10. In the majority of cases, inflammatory tinea pedis caused the dermatophytid reaction which appeared as vesicles localized to the palms. Relying on clinical appearance only implies an obvious risk of erroneously including pyoderma and various eczemas, e.g. pompholyx and contact dermatitis, as dermatophytids. Mycological culture and skin test with a reliable trichophytin antigen preparation ought to be applied in order to avoid misdiagnosis.