Medical social workers as mediators between patients, physicians, and the court: the case of former ringworm patients.

Facilitating benefit and resource acquisition to assist clients is a major responsibility of medical social workers, requiring them to have a thorough knowledge of community resources, legislation, and regulations. The aim of the current study was to examine knowledge of the Law for Compensation of Scalp Ringworm Victims and ringworm-related irradiation damage among 101 social workers employed in diverse healthcare settings in Israel. We found that 65.3% of the social workers were aware of the law, but only 40.6% were aware of the health effects of scalp ringworm irradiation. Media coverage and clients who underwent scalp ringworm irradiation were social workers' major sources of knowledge. Working with former ringworm patients had the strongest association with knowledge of the law and of ringworm-related irradiation damage. Results highlight the important contribution of exposure to clients' experiences and knowledge to expand social workers' knowledge of health issues.

[THE TRUTH ABOUT THE RINGWORM AFFAIR].

INTRODUCTION: Ringworm of the scalp (Tinea Capitis), a fungal skin ailment that appears on the scalp, was treated until the early sixties by radiation therapy. It was discovered during the seventies that radiation treatment for ringworm may be associated with a higher risk of cancerous and benign tumors in the head and neck area for patients undergoing treatment. In 1995, Israel enacted a law to compensate ringworm irradiation patients which provided monetary compensation for those who were treated between 1946 and 1960. "The Ringworm Affair" focuses on the issue of radiation treatment for ringworm and the social perceptions surrounding the ethnic identity of the patients. Common opinion in Israel holds that the target population for these treatments was limited to the children of North African immigrants, and that the treatment was intentionally administered despite knowledge of its health hazards. Furthermore, according to these beliefs, over 100,000 children of immigrants were treated. This paper examines these common arguments in light of historical and research-based data regarding the ethnic background and total number of patients treated. Moreover, this paper will examine the argument that a mass operation took place to cure those children only in Israel between 1946 and 1960. As evidence will show, these arguments are unfounded. Notably, radiation therapy was used worldwide; other populations in Israel as well as other Jewish communities in Europe and North Africa were exposed to the same treatment since the 20's. The total number of patients in Israel is less than 100,000.

A case of tinea incognito.

Tinea incognito is a dermatophyte infection of the skin that presents atypically because it has previously been treated with imunnosuppresive medication. Herein we present a case of a middle-aged man who was initially clinically diagnosed to have plaque-type psoriasis on his arms. Over the course of two months of topical hydrocortisone and calciptriol treatment as well as phototherapy, the rash worsened. At the time of presentation to hospital the patient had a pruritic, widespread, sloughing, erythematous rash with areas of eschar. A punch biopsy skin confirmed dermatophyte fungal infection of the skin. Fungal culture was positive for Trichophyton Rubrum and the eruption resolved with systemic anti-fungal therapy. Patient specific risk factors for atypical presentation included poor hygiene and hepatatic disease.

[The amazing treatment of ringworm in a Nantes hospital at the beginning of the 20th century]. / Le surprenant traitement de la teigne dans un hôpital nantais au début du XXème siècle.

In 1900, in Nantes, the ringworm was a real plague. Despite the very painful cares recovery could not be hoped before two years while the poor boys were roaming around far from school. At the Home St Jacques, a district for children suffering from ringworm and a department of electro-radiology were open where Doctor Gustave Bureau began to use X Rays to cure the ill hair and create a long lasting alopecia. The result was spectacular and patches disappeared in a few days. Besides three cases of radio dermatitis, there was no noticeable incident in spite of irradiation for twenty to twenty five minutes. The treatment has been used for about fifty years as it changed the life of the children till an effective drug. Then some studies showed the harmful long-term effects of such expositions to X rays.

[The forgotten ringworm campaign of OZE-TOZ in Poland].

In 1921, the JOINT-JDC [the American Jewish WeLfare Organization) together with the Jewish health organizations of Eastern Europe (OZE, TOZ) initiated a campaign to eradicate ringworm of the scalp, which was one of the major medical causes that prevented Jews from immigrating to the West. This campaign continued until 1938. During the years 1921-1938, 27,760 children were irradiated (x-rayed) as part of the treatment. This study, based on archival sources in Israel and abroad, presents the story of this unique campaign to eradicate ringworm in the Eastern European Jewish communities, the ideology behind this initiative, the health and medical factors that played a role and its outcomes. This research was conducted at The Gertner Institute for Epidemiology and Health Policy Research and The School of Public Health at Tel Aviv University.

Public health, racial tensions, and body politic: mass ringworm irradiation in Israel, 1949-1960.

In this essay, we analyze the case study of mass ringworm irradiation conducted in Israel during its first years of existence and its consequences. We analyzed the case study of ringworm irradiation in the framework of racial construction of illness and its treatment, showing the elasticity of race and ethnicity as medical and social categories.

Tumors and other diseases following childhood x-ray treatment for ringworm of the scalp (Tinea capitis).

The objective of the study is to characterize the risk of tumors from radiation exposure to the head and neck. A cohort of 2,224 children given x-ray treatment and 1,380 given only topical medications for ringworm of the scalp (tinea capitis) during 1940-1959 have been followed up for a median of 39 y to determine tumor incidence. Follow-ups were by mail/telephone questionnaire, with 84-88% of the original cohort followed and with medical verification of diseases of interest. Sixteen intracranial tumors [7 brain cancers, 4 meningiomas, and 5 acoustic neuromas (vestibular schwannomas)] occurred in the x-irradiated group following an average brain dose of about 1.4 Gy, compared to 1 acoustic neuroma in the control group. The standardized incidence ratio (SIR) for brain cancer was 3.0 [95% confidence interval (CI): 1.3, 5.9]. Even though the dose to the thyroid gland was only about 60 mGy, 2 thyroid cancers were found in the irradiated group vs. none among controls, and 11 vs. 1 thyroid adenomas were found in the respective groups. Following an average dose of about 4 Gy to cranial marrow, 8 cases of leukemia (SIR = 3.2, CI: 1.5, 6.1) were observed in the irradiated group and 1 in the control group. There was also a suggestive excess of blood dyscrasias. There was no difference between the groups in the frequency of other cancers of the head and neck (excluding nonmelanoma skin cancer) or in total mortality.

Photodynamic inactivation of the dermatophyte Trichophyton rubrum.

Dermatophytes are fungi that can cause infections (known as tinea) of the skin, hair and nails because of their ability to use keratin. Superficial mycoses are probably the most prevalent of infectious diseases worldwide. One of the most distinct limitations of the current therapeutic options is the recurrence of the infection and duration of treatment. The present study shows that Trichophyton rubrum in suspension culture is susceptible to photodynamic treatment (PDT), a completely new application in this area. T. rubrum could be effectively killed with the use of the light-activated porphyrins deuteroporphyrin monomethylester (DP mme) and 5,10,15-tris(4-methylpyridinium)-20-phenyl-[21H,23H]-porphine trichloride (Sylsens B). The photodynamic efficacy was compared with that of some other photosensitizers that are well known in the field of PDT: the porphyrins deuteroporphyrin and hematoporphyrin, the drug Photofrin and several phthalocyanines. It was demonstrated that with the use of broadband white light, the phthalocyanines and Photofrin displayed a fungistatic effect for about 1 week, whereas all the porphyrins caused photodynamic killing of the dermatophyte. Sylsens B was the most effective sensitizer and showed no dark toxicity; therefore, in an appropriate formulation, it could be a promising candidate for the treatment of various forms of tinea. For Sylsens B and DP mme, which displayed the best results, a concentration-dependent uptake by T. rubrum was established.

Skin cancer after X-ray treatment for scalp ringworm.

Some 2,224 children given X-ray therapy for tinea capitis (ringworm of the scalp) have been followed for up to 50 years to determine cancer incidence, along with a control group of 1,380 tinea capitis patients given only topical medications. The study found a relative risk (RR) of 3.6 (95% confidence interval, 2.3-5.9) for basal cell skin cancer (BCC) of the head and neck among irradiated Caucasians (124 irradiated cases and 21 control cases), in response to a scalp dose of about 4.8 Gy. No melanomas of the head and neck have been seen, and only a few squamous cell carcinomas. About 40% of irradiated cases have had multiple BCCs, for a total of 328 BCCs. Although 25% of both the irradiated and control groups are African-American, only 3 skin cancers have been seen among them, all in the irradiated group, indicating the importance of susceptibility to UV radiation as a cofactor. Light complexion, severe sunburning and North European ancestry were predictive of BCC risk in the irradiated group, but chronic sun exposure was not. Children irradiated at young ages had the highest BCC risk. The RR for BCC risk is approximately constant with time since exposure, suggesting that risk will probably last for a lifetime.

[An autopsy case of epithelioid sarcoma--a review of the cases reported in Japan].

A 48-year-old Japanese woman died of a general metastasis of epithelioid sarcoma originating in the right palm, which had been irradiated for trichophytia therapy 30 years earlier and where a contraction of the fingers and recurrent ulceration for seven years despite several surgical treatments had occurred. Although the tumor cells in the biopsy materials consisted of both large ovoid and polygonal cells with deeply eosinophilic cytoplasm and spindle-shaped cells, no particular appearances for definite diagnosis were obtained. The epithelioid appearance of tumor cells was first recognized in the metastatic foci of the lungs and kidneys at autopsy. In addition, 20 cases of epithelioid sarcoma reported in Japan are reviewed.

Garland Lecture. On the question of cancer induction by small X-ray doses.

There is no proven body of fact that establishes an increase in human cancer after low doses of x or gamma radiation such as those received environmentally, occupationally, or from medical diagnostic procedures; that is, radiation levels below about 10 rad (0.1 Gy). This paper reviews the principal low dose epidemiologic studies that have investigated possible cancer increases. The results of these studies are negative, equivocal, or, when positive, invalidated by methodologic defects or by inconsistency with the feasible carcinogenic effect of background radiation. Despite the lack of direct evidence however, it will never be possible to exclude a very small cancer risk from even the lowest radiation levels, primarily because of statistical limitations in the design of epidemiologic studies. Estimates of cancer risk from low levels of x or gamma ray exposure are therefore based on assumptions regarding the relation between cancer increases and radiation dose. The statistical uncertainties of the meager human data at low doses do not permit unique relations to be established. Nevertheless recent radiobiologic investigations of dose/effect relations for neoplasms in animal populations, for chromosomal damage in human cells, and for malignant transformation in cultured mammalian cell lines suggest that a linear-quadratic relation, when fitted to the human data, provides a reasonable and conservative basis for risk estimation.

[Effect of 8-methoxypsoralen and blacklight on microorganisms in vitro and in experimental trichophytosis in guinea pigs]. / Zur Wirkung von 8-Methoxypsoralen (8-MOP) und Blacklight auf Mikroorganismen in vitro und den Ablauf der experimentellen Meerschweinchen-Trichophytie

The lack of experimental test models causes problems in comparative evaluation of photodynamic effects of 8-MOP and its possible derivatives after irradiation with blacklight or other irradiation sources. In our experiments in vitro, tests with various microorganisms and the in vivo model of experimental dermatophytosis in guinea pigs by Trichophyton mentagrophytes appeared to be suitable. In vivo, 8-MOP was applicated orally and topically in two formulations.