Cancer in south Louisiana. Part 1: Tobacco-related cancers.

Tobacco-related cancers comprise about one third of the newly-diagnosed cancer in South Louisiana. These cancers are three times more common in men than in women. For cancers originating from anatomic sites where there is a direct contact with tobacco, ie, lung, larynx, oral cavity and pharynx, and esophagus, incidence rates for blacks are either higher than or similar to the rates for whites. For cancers of the bladder and the kidney, sites which have no direct contact with tobacco products, incidence rates are higher in whites than blacks. In general, white men in South Louisiana tend to have risks significantly higher than national for tobacco-related cancers, in particular, cancers of the lung (31% higher) and the larynx (42% higher). A similar pattern is observed for white females but is less pronounced. Black men in South Louisiana, on the other hand, have significantly lower rates than the SEER averages for cancers of the esophagus, oral cavity, and pharynx. Risks for other tobacco-related cancers are very comparable. There are very small differences in rates for black women between South Louisiana and SEER areas. Tobacco-related cancers are most preventable. Any effective cancer program in Louisiana must emphasize prevention and cessation of tobacco use.

Cancer in south Louisiana. Part II: Gastrointestinal tract cancers.

Incidence rates for the most common cancers of the gastrointestinal tract are presented for the 5 geographic regions in South Louisiana for the period 1983-1986. The risk of colorectal cancer, the most frequent GI cancer in males and females, is uniformly lower in these regions of South Louisiana than in other areas of the United States. Gastric cancer rates are significantly high in black males, as are pancreatic cancer rates in whites of both sexes compared to national rates.

Cancer in south Louisiana. Part III: Cancers of the breast and the reproductive system.

Cancers of the breast and reproductive system are less common in South Louisiana than other parts of the nation. The only exception is invasive cervical cancer. Incidence rates for breast cancer in South Louisiana women are 20% lower than the SEER combined rates, and rates for cancer of the uterine corpus and the ovary among white women are 43% and 32% lower respectively than the SEER averages. South Louisiana men also have risks 14% (whites) and 30% (blacks) less than the national of developing prostatic cancer. These significantly low rates are observed for all regions in South Louisiana. The reasons for the low rates are not clearly understood. Possible explanations include: less frequent use of cancer screening tests, high prevalence of hysterectomy, lower risk exposures, and host/genetic factors. The low incidence rates for these cancers are not accompanied by more favorable mortality outcomes, suggesting a poorer survival among Louisiana cancer patients partially due to late stage disease at the time of diagnosis and treatment. Programs to increase the accessibility of cancer screening tests and improve early detection are greatly needed.

Costs and outcomes in a regional neonatal intensive care unit.

At the Birmingham Maternity Hospital the mean cost of caring for surviving infants who require neonatal intensive care ranges from approximately pounds 2500 (for infants above 1500 g birthweight), to pounds 5500 (for infants 1000 to 1499 g birthweight), to pounds 10 000 (for infants less than 1000 g birthweight). The mean cost of caring for non-survivors is pounds 1000 or less, with little difference between the birthweight groups. These figures are based on the lengths of stay in three treatment regimens-intensive care, high dependency care, and special care-the average daily costs of which are estimated to be pounds 235, pounds 122, and pounds 43 respectively. The survival of very low birthweight infants (less than 1500 g) at this hospital has improved from 42% to 73% since the introduction of regional funding for neonatal intensive care. This increase in survival has been brought about without undue disability in the survivors.

Erythrocyte and dietary zinc in adolescent females.

Erythrocyte zinc has been suggested as an index of zinc status. This study was undertaken to investigate the possible relationships of erythrocyte zinc concentration to age, physical maturity, and zinc intake of teenage girls of two races. Dietary zinc was calculated from two 1-day food recalls, and erythrocyte zinc was determined for over three hundred 12-, 14- and 16-yr-old girls in Oklahoma and Virginia. Erythrocyte zinc concentration increased and the intake of zinc from the diet decreased after attainment of menarche. Among girls of the same menarcheal state, age was not related to zinc intake, but concentration of zinc in erythrocytes increased with each 2-yr age increment in those that were past menarche. Results did not show a direct relationship of erythrocyte zinc values to calculated intakes of zinc by adolescent females. Black and white races did not differ in either zinc intake or red cell zinc content.

Are breast-fed babies still getting a raw deal in hospital?

After preliminary validation of test weighing under ward conditions the fluid intake and weight gain of 39 breast-fed and 25 artificially fed infants were compared. All were fed every four hours for six feeds a day, and the breast-fed infants received dextrose supplements only. The average intake and weight gain of the breast-fed group was significantly less than that of the group fed artificially.When cows'-milk supplements are withheld from breast-fed infants a four-hourly regimen provides insufficient stimulus to lactation for their needs in the first week of life. If more than lip service is to be paid to the mother who desires to breast-feed in hospital, early and more frequent feeding should be practised.

Factors affecting neonatal jaundice.

Plasma bilirubin was estimated on 690 term infants on about the 6th day of life. Perinatal factors were recorded and the results analysed. Hyperbilirubinaemia was defined as a level greater than 205 micromol/1 (12 mg/100 ml) and this was present in 20% of cases. Three factors--epidural analgesia, breast feeding, and poor weight recovery--showed highly significant associations with jaundice. The relative importance of these is discussed and compared with recent reports. Induction of labour, for reasons other than postmaturity, and a gestational age less than 39 weeks showed a slightly increased incidence of jaundice. There was no correlation with other factors tested including oxytocic drug administration. Despite the high incidence (20%) of hyperbilirubinaemia, only 2.5% infants needed treatment and none required exchange transfusion. Radical changes in obstetric management or infant feeding are not indicated.

Sequelae of neonatal jaundice.

A total of 371 newborn infants falling into 3 groups, non-haemolytic jaundice, haemolytic jaundice, and non-jaundiced controls, have been reassessed in the 6th year of life as regards neurological, audiological, and psychological function. Neurological handicap was concentrated among the infants of low birth weight and was not related to jaundice, apart from one case of athetoid cerebral palsy with deafness. No other cases of perceptive deafness were discovered. Intelligence testing on the Stanford Binet scale showed no relation between depth of jaundice and I.Q.These findings support the majority of reports in the literature that reduction in intelligence does not occur in non-haemolytic jaundiced babies with serum bilirubin below about 20 mg./100 ml. In haemolytic jaundice slight doubt remains. There is no indication for changing present standards for exchange transfusion.