Continued surveillance of cancer incidence among Swedish smelter workers.

A cohort study of workers at a smeltery in northern Sweden showed an excess mortality, mostly due to deaths in cancer (especially in the respiratory organs) and circulatory diseases. Further follow-up of the cohort showed a decreasing trend in lung cancer incidence and mortality. The cohort studied has now been expanded and comprises 6,334 blue-collar workers first employed 1928-1979. They were followed in the cancer register up to 1987-01-01 and in the cause-of-death register up to 1988-01-01. The decreasing trend in lung cancer incidence and mortality continued but there was still an elevated lung cancer incidence among the workers when compared with Swedish males. The cumulative occurrence of lung cancer since time of first employment was analyzed by different employment cohorts and a higher occurrence of lung cancer was found among those earlier employed.

Epidemiology in developing countries--some experiences from collaboration across disciplines and cultures.

Epidemiology has been increasingly recognized as a public health strategy for health research, intervention and health policy making. In this communication I will focus on strategies and methods for epidemiology within the context of working together across disciplines and cultures. That problems are local but methods global is one of the immediate lesions from these collaborations as well as the obvious awareness that no one can be an expert on others. Our experience from collaborative research and research in Sweden is also that of a mutual benefit between Swedish and development research. This also applies to research training and capability strengthening where a close connection between field research and training is needed.

Dietary factors and the risk of developing insulin dependent diabetes in childhood.

OBJECTIVE: To study different nutrients and food additives as risk factors for insulin dependent diabetes mellitus in childhood. DESIGN: Prospective case-control study. Parents of the children being studied were asked to fill in a questionnaire regarding the children's frequency of consumption of various foods. Parents of children with diabetes were asked about the period before onset of the disease. SETTING: Population based study throughout Sweden. SUBJECTS: 339 Children aged 0-14 who had recently developed insulin dependent diabetes mellitus and 528 control children matched for age, sex, and county of residence who were traced through the official Swedish population register. MAIN OUTCOME MEASURES: Foods were classified according to their content of protein, fat, carbohydrates, monosaccharides or disaccharides, nitrosamines, nitrates or nitrites, vitamin C, and fibres. The frequency of intake was categorised as high, medium, and low and the relative risk for developing insulin dependent diabetes was estimated for the three frequencies of intake and calculated as odds ratios. RESULTS: Significant linear trends for dose response in odds ratios by frequency of intake were shown for solid foods containing high amounts of protein (odds ratio for low frequency of intake 1.0; medium 2.3; and high 5.5), and nitrosamines (1.0; 1.7; 2.6) and significant but non-linear trends were found for carbohydrates (1.0; 1.3; 4.4) and nitrates or nitrites (1.0; 0.8; 2.4). The significant trends were not affected when the results were standardised for possible confounders. No significant increases in odds ratios were found for protein, monosaccharides and disaccharides, vitamin C, and fibres. CONCLUSION: Nutrients and food additives such as protein, carbohydrate, and nitrosamine compounds may influence the risk of developing insulin dependent diabetes in childhood and significant trends in odds ratios indicate a causal relation.

Cancer incidence and mortality among Swedish smelter workers.

Cancer incidence was analysed in a retrospective cohort of 3710 male Swedish smelter workers between 1958 and 1982 using a record linkage with the Swedish Cancer Register. During this period 467 cancers were registered in the cohort. An excess incidence of total cancer of about 30% was shown relative to general and local populations mainly due to 120 respiratory cancers. Excess SMRs for all cancer and respiratory cancer were highly significant. Trends in the incidence of cancer were studied using moving five year calendar periods. A decreasing rate of lung cancer was found during 1976-80 for both mortality and incidence. Incidence figures for two more years show a continued decreasing trend. This is validated by an analysis of different employment cohorts, taking latency into account, showing that the later the date of first employment the lower the incidence of cancer, especially for lung cancer.

Report of tuberculous hepatitis presenting as metastatic disease.

This is a case report of macronodular TB of the liver, without other known organ involvement, which presented with defects on RN scan and hypoechoic areas by ultrasound, suggesting metastatic disease. The demonstration on liver scan is quite rare and ultrasound visualization has not been reported. Although confirmation could not be obtained with AFB stain or positive culture, the clinical and liver scan response with a highly suggestive histologic picture are sufficient to make the diagnosis.