[Participation of the immigrant population in breast cancer screening in Tarragona, Spain]. / Participación de la población inmigrante en el cribado de cáncer de mama de Tarragona, España.

OBJECTIVE: To evaluate the differences between autochthonous and allochthonous women's participation in a breast cancer screening programme. METHOD: Retrospective study based on data from the Breast Cancer Screening Programme of the province of Tarragona (2008-2015). The sample is the target population of the programme with known country of origin. RESULTS: Cohort of 40,824 women. Allochthonous women participate less than autochthonous women (41.8% vs. 72.3%) although they have a similar global detection rate to the latter but with differences according to the human development index of their country of origin. Both groups present similar tumour stages on detection (p=.59). CONCLUSIONS: Strategies specifically aimed at the immigrant population are required to improve their participation in breast cancer screening.

Caracterización clínica de la tuberculosis en el municipio de Matanzas. Año 2010-2014 / Clinical characterization of tuberculosis in the municipality of Matanzas. 2010-2014 years

Introducción: la tuberculosis es la más antigua de las pandemias y causa alrededor de 1,7 millones de muertes y 9 millones de casos nuevos cada año constituyendo una enfermedad remergente en cuba por lo cual se realizó un estudio observacional descriptivo retrospectivo en el municipio de Matanzas en el período comprendido entre enero 2010 a diciembre del 2014. Objetivo: determinar el comportamiento clínico de la tuberculosis. Materiales y métodos: el universo del estudio fue el total de 41 pacientes con diagnóstico de tuberculosis en el municipio de Matanzas en el periodo estudiado y los datos fueron obtenidos del departamento de estadística del Centro Municipal de Higiene y Epidemiología. Resultados: predominó el sexo masculino con el 87,8% de los pacientes y el grupo de edades de 60 y más años con el 34,15 %. El grupo vulnerable más frecuente fue el de los alcohólicos 50,09% seguidos de los pacientes con 60 o más años con el 34,14%. Predominó el diagnóstico mediante el pesquisaje pasivo con el 65,85% de los pacientes. El síntoma más frecuente fue la tos en 85,35% de los pacientes seguido por la expectoración y la disnea con 68,29% y 65,85% respectivamente. La tasa de defunción por tuberculosis en quinquenio estudiado fue 0,36 x 100000 habitantes. Conclusiones: el diagnóstico de tuberculosis fue más frecuente en el sexo masculino, en el grupo etario de 60 años y más y en alcohólicos. Los síntomas más frecuentes fueron tos, expectoración y disnea. Predominó el pesquisaje pasivo en el diagnóstico (AU).

Introduction: tuberculosis is the oldest of the pandemics and causes around 1.7 million of death and 9 million of cases every year, being a reemerging disease in Cuba. That is why a retrospective, descriptive, observational study was carried out in the municipality of Matanzas in the period between January 2010 and December 2014. Objective: to determine the clinical behavior of tuberculosis. Materials and methods: the universe of study was the total of 41 patients diagnosed with tuberculosis in the municipality of Matanzas in the studied period. Data were obtained from the Department of Statistics of the Municipal Center of Hygiene and Epidemiology. Results: male sex predominated with 87.8 % of the patients in the age group of 60 years and more (34.15 %). The most vulnerable group was the one of the alcoholics with 50.09 %, followed by the patients aged 60 years or more, with 34.14 %. The predominating diagnosis was the one obtained through passive screening, for 65.85 % of the patients. The most frequent symptom was cough in 85.35 of the patients, followed by expectoration and dyspnea, with 68.29 % and 65.85 respectively. The death rate for tuberculosis in the studied five-year period was 0.36 x 100 000 inhabitants. Conclusions: Tuberculosis diagnosis was more frequent in male sex, in the age group of 60 years-old and more and in alcoholics. The most frequent symptoms were cough, expectoration and dyspnea. Passive screening predominated in the diagnosis (AU).

El impacto epidemiológico de la invasión europea en América / Epidemiological impact of the European invasión on America

Los aniversarios estimulan la tentación de hacer balances, y esta tentación se vuelve máxima ante el próximo 500 aniversario de la invasión europea de América. Es posible que este balance, que se está llevando a cabo en todo el mundo, arroje conclusiones diferentes al que se hizo hace 100 años. Hasta no hace mucho, las evaluaciones hegemónicas de la invasión eran positivas. Los vencidos no elevaban su voz, y polémicas del tipo de la "leyenda negra" con la que cierta historiografía, principalmente anglosajona, impugnaba la acción de los españoles -los primeros invasores- parecía no ser más que una reyerta entre vencedores. Para ventaja de los que estamos reflexionando sobre el 5o Centenario, en las últimas décadas han aparecido muchos trabajos de investigación que han permitido resignificar la información atesorada por los cronistas, y han podido obtener mucha información nueva. Historiadores, arqueólogos, demógrafos, ecólogos, agrónomos y epidemiólogos modernos han podido generar materiales sobre los que se han abalanzado analizadores críticos de toda índole; porque esta información nueva resalta la tragedia que representó para América (y secundariamente para África) la colisión con Europa, que comenzó con el arribo a Guanahaní de una nao y dos carabelas en 1492. En lo que sigue, nos limitaremos a hacer una reseña del impacto epidemiológico...(AU)

Mutations in desmoglein 1 cause diverse inherited palmoplantar keratoderma phenotypes: implications for genetic screening.

The inherited palmoplantar keratodermas (PPKs) are a heterogeneous group of genodermatoses, characterized by thickening of the epidermis of the palms and soles. No classification system satisfactorily unites clinical presentation, pathology and molecular pathogenesis. There are four patterns of hyperkeratosis - striate, focal, diffuse and punctate. Mutations in the desmoglein 1 gene (DSG1), a transmembrane glycoprotein, have been reported primarily in striate, but also in focal and diffuse PPKs. We report seven unrelated pedigrees with dominantly inherited PPK owing to mutations in the DSG1 gene, with marked phenotypic variation. Genomic DNA from each family was isolated, and individual exons amplified by polymerase chain reaction. Sanger sequencing was employed to identify mutations. Mutation analysis identified novel mutations in five families (p.Tyr126Hisfs*2, p.Ser521Tyrfs*2, p.Trp3*, p.Asp591Phefs*9 and p.Met249Ilefs*6) with striate palmar involvement and varying focal or diffuse plantar disease, and the recurrent mutation c.76C>T, p.Arg26*, in two families with variable PPK patterns. We report one recurrent and five novel DSG1 mutations, causing varying patterns of PPK, highlighting the clinical heterogeneity arising from mutations in this gene.

Systematic review of risk factors for suicide and suicide attempt among psychiatric patients in Latin America and Caribbean / Revisión sistemática de los factores de riesgo de suicidio e intento de suicidio entre los pacientes psiquiátricos de América Latina y el Caribe

OBJECTIVE: To analyze published evidence from the Latin America and Caribbean (LAC) region pertaining to risk factors for completed suicide and suicide attempts among psychiatric populations. METHODS: Potential studies were identified through systematic electronic searches in MEDLINE and LILACS. Included studies were cohort, case-control, and cross-sectional designed investigations of psychiatric samples in which suicide or a suicide attempt was reported as an outcome and evaluated with some measure of impact (odds ratio, risk ratio, or hazard ratio). Methodological quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations. RESULTS: Of the 2 987 identified studies, a total of 17 studies were reviewed to determine potential suicidal risk factors. Eleven studies used a case-control design, five used a cross-sectional design, and only one study used a prospective-cohort design. The main risk factors for suicide attempts in LAC included major depressive disorder (MDD), family dysfunction, and prior suicide attempt, while the main risk factors for completed suicide were male gender and MDD. The methodological quality of most of the studies was low. CONCLUSIONS: This review provides evidence that the majority of relevant risk factors for suicide and suicide attempts in the LAC region are similar to those observed in Western societies but different from those reported in Eastern societies. Studies of higher methodological quality from the region are needed to support these results.

OBJETIVO: Analizar los datos probatorios publicados de la región de América Latina y el Caribe (ALC) que fueran pertinentes a los factores de riesgo de suicidio consumado e intentos de suicidio entre las poblaciones psiquiátricas. MÉTODOS: Se seleccionaron los posibles estudios mediante búsquedas electrónicas sistemáticas en MEDLINE y LILACS. Se incluyeron estudios cuyos diseños de investigación fueran de cohortes, de casos y controles, o transversales de muestras psiquiátricas, y en los que el suicidio o un intento de suicidio se notificaran como un resultado, y se evaluaran mediante alguna medida de la repercusión (razón de posibilidades, razón de riesgos o razón de riesgos instantáneos). Se evaluó la calidad metodológica mediante el uso de las recomendaciones de la iniciativa de Fortalecimiento de la Notificación de los Estudios Observacionales en Epidemiología (STROBE, por sus siglas en inglés). RESULTADOS: Se analizaron 17 de los 2 987 estudios seleccionados con objeto de determinar los posibles factores de riesgo de suicidio. Once estudios usaron un diseño de casos y controles, cinco usaron un diseño transversal, y un único estudio usó un diseño de cohortes prospectivo. Los principales factores de riesgo de intento de suicidio en ALC fueron el trastorno depresivo mayor (TDM), la disfunción familiar y el intento de suicidio previo, mientras que los principales factores de riesgo de suicidio consumado fueron el sexo masculino y el TDM. La mayor parte de los estudios mostraron una mala calidad metodológica. CONCLUSIONES: Esta revisión aporta datos probatorios de que la mayor parte de los factores de riesgo pertinentes al suicidio y los intentos de suicidio en la región de ALC son similares a los observados en las sociedades occidentales pero diferentes a los notificados en las sociedades orientales. Se necesitan estudios regionales de mayor calidad metodológica para apoyar estos resultados.

Insights from paleomicrobiology into the indigenous peoples of pre-colonial America - a review.

This review investigates ancient infectious diseases in the Americas dated to the pre-colonial period and considers what these findings can tell us about the history of the indigenous peoples of the Americas. It gives an overview, but focuses on four microbial pathogens from this period: Helicobacter pylori, Mycobacterium tuberculosis, Trypanosoma cruzi and Coccidioides immitis, which cause stomach ulceration and gastric cancer, tuberculosis, Chagas disease and valley fever, respectively. These pathogens were selected as H. pylori can give insight into ancient human migrations into the Americas, M. tuberculosis is associated with population density and urban development, T. cruzi can elucidate human living conditions and C. immitis can indicate agricultural development. A range of methods are used to diagnose infectious disease in ancient human remains, with DNA analysis by polymerase chain reaction one of the most reliable, provided strict precautions are taken against cross contamination. The review concludes with a brief summary of the changes that took place after European exploration and colonisation.

Insights from paleomicrobiology into the indigenous peoples of pre-colonial America - A Review

This review investigates ancient infectious diseases in the Americas dated to the pre-colonial period and considers what these findings can tell us about the history of the indigenous peoples of the Americas. It gives an overview, but focuses on four microbial pathogens from this period: Helicobacter pylori, Mycobacterium tuberculosis, Trypanosoma cruzi and Coccidioides immitis, which cause stomach ulceration and gastric cancer, tuberculosis, Chagas disease and valley fever, respectively. These pathogens were selected as H. pylori can give insight into ancient human migrations into the Americas, M. tuberculosis is associated with population density and urban development, T. cruzi can elucidate human living conditions and C. immitis can indicate agricultural development. A range of methods are used to diagnose infectious disease in ancient human remains, with DNA analysis by polymerase chain reaction one of the most reliable, provided strict precautions are taken against cross contamination. The review concludes with a brief summary of the changes that took place after European exploration and colonisation.

[Characteristics of patients with chronic hepatitis B virus infection. analysis of a series of 474 patients]. / Características de los pacientes con infección crónica por el virus de la hepatitis B. Análisis de una serie de 474 pacientes.

OBJECTIVE: To determine the clinical, laboratory, serological and histologic characteristics of chronic hepatitis B virus carriers in our environment. MATERIAL AND METHODS: A retrospective cohort study was performed that included chronic AgHBs carriers aged more than 13 years attending our service since January 2000. RESULTS: A total of 474 patients were included. At diagnosis, 55.49% were men, with a mean age of 41.05±13.93 years. Alanine aminotransferase (ALT) levels were within the normal range in 57.17% of the patients, and 87.76% were AgHBe(-). Hepatitis C and D virus coinfection was found in 3.62% and 1.86%, respectively. Liver biopsy was performed in 31.22%; varying grades of inflammation-fibrosis were found in 63.51% and cirrhosis was found in 12.84%. Compared with AgHBe(-) patients, those who were AgHBe(+) were younger and had greater disease activity. This difference was statistically significant. Patients in the immunotolerant phase were the least numerous (5.26%), while AgHBe(-) patients with chronic HBV infection were the most numerous (48.32%). Patients in the immunoreactive phase showed greater histological involvement (16.67% cirrhosis). A familial history of chronic HBV was found in 21.52%. The percentage of non-Spanish patients increased in the last few years and accounted for 18.78%. CONCLUSION: Chronic HBV infection in our environment occurs mainly in middle-aged persons. GPT values are normal in more than 50%, most are AgHBe(-), and approximately half are inactive carriers. The incidence of chronic infection has increased in the non-Spanish population in recent years.

Disaggregating Canadian immigrant smoking behaviour by country of birth.

As of the 2006 census, nearly one fifth of Canada's population was foreign-born. With such a sizeable and fast-growing immigrant population, research in immigrant health in Canada is increasingly important, including research on the smoking behaviours of Canada's immigrants. Research has shown that immigrants are significantly less likely to smoke than non-immigrants, yet differences by immigrant origins have yet to be fully explored. This paper explores smoking prevalence and cessation amongst immigrants in Canada disaggregated by country of birth. Additionally, it examines the impact of neighbourhood level effects on smoking cessation to determine if residential location has an impact on the likelihood of quitting. Results reveal important heterogeneities previously unseen in studies employing aggregate data. While immigrants in general were less likely to smoke than non-immigrants, and are also more likely to quit than non-immigrants, considerable variation exists between immigrant groups defined by origin region or country. Asian immigrants were the least likely to smoke but exhibited the greatest variation between countries of origin. Vietnamese men were found to be the most likely immigrant group to smoke and among the least likely to quit. While neighbourhood disadvantage was negatively associated with quitting smoking, it is not as important as individual socioeconomic characteristics in explaining variations in smoking cessation. The research illustrates the need for disaggregated data to account for the diversity of Canada's immigrant population.

[Mortality in immigrants in Tuscany]. / La mortalità nella popolazione straniera in Toscana.

OBJECTIVE: Aim of the paper is to examine the characteristics and the trend of mortality in immigrants in Tuscany in the last decade, and to compare it with that observed in Italians resident in the same region. DESIGN: it is a descriptive study using the data 1997- 2008 of the Regional Mortality Registry of Tuscany. SETTING AND PARTICIPANTS: Immigrants have been defined those who are resident in Tuscany with non Italian citizenship.They have been classified in immigrants from countries at high migration rates (PFPM) and immigrants from developed countries (PSA). MAIN OUTCOME MEASURES: Proportional mortality for the period 1997-2008 and trends of standardized (standard: European population) mortality truncated rates (20-64 years) per 100 000 in the period 2002-2008 by citizenship (PFPM, PSA and Italians), gender, age-class and causes of death. RESULTS: In the period 1997-2008, in Tuscany, 4 755 deaths have been registered in immigrants: 3 055 residents (1 782 from PFPM and 1 273 from PSA) and 1 700 not residents. Trends for all and the main causes of death show an increasing gap in mortality between immigrants from PFPM and Italians, with higher rates for Italians.On the contrary infant mortality is higher in children from PFPM and the gap is increasing in the last years. Also the mortality for accidents (1° and 3° cause of death respectively in male and female PFPM) and the mortality for infectious diseases are higher in PFPM immigrants. CONCLUSION: Mortality study on immigrants in Tuscany highlighted specific health problems of this population deriving from living conditions in the home country as well in the host country. It will be necessary to continue to monitor the mortality trend and characteristics of this population because it represents a good indirect tool to evaluate his socioeconomic integration (considering also his use of our health system), and because this population is still expected to raise in the next decades.

Cancer risk diversity in non-western migrants to Europe: An overview of the literature.

BACKGROUND: Cancer risk varies geographically and across ethnic groups that can be monitored in cancer control to respond to observed trends as well as ensure appropriate health care. The study of cancer risk in immigrant populations has great potential to contribute new insights into aetiology, diagnosis and treatment of cancer. Disparities in cancer risk patterns between immigrant and autochthonous populations have been reported many times, but up to now studies have been heterogeneous and may be discordant in their findings. The aim of this overview was to compile and compare studies on cancer occurrence in migrant populations from non-western countries residing in Western Europe in order to reflect current knowledge in this field and to appeal for further research and culturally sensitive prevention strategies. METHODS: We included 37 studies published in the English language between 1990 and April 2010 focussing on cancer in adult migrants from non-western countries, living in the industrialised countries of the European Union. Migrants were defined based on their country of birth, ethnicity and name-based approaches. We conducted a between-country comparison of age-adjusted cancer incidence and mortality in immigrant populations with those in autochthonous populations. FINDINGS: Across the board migrants from non-western countries showed a more favourable all-cancer morbidity and mortality compared with native populations of European host countries, but with considerable site-specific risk diversity: Migrants from non-western countries were more prone to cancers that are related to infections experienced in early life, such as liver, cervical and stomach cancer. In contrast, migrants of non-western origin were less likely to suffer from cancers related to a western lifestyle, e.g. colorectal, breast and prostate cancer. DISCUSSION: Confirming the great cancer risk diversity in non-western migrants in and between different European countries, this overview reaffirms the importance of exposures experienced during life course (before, during and after migration) for carcinogenesis. Culturally sensitive cancer prevention programmes should focus on individual risk patterns and specific health care needs. Therefore, continuously changing environments and subsequently changing risks in both migrant and autochthonous populations need to be observed carefully in the future.

La Salud de los Pueblos Indígenas de las Américas: Conceptos, Estrategias, Prácticas y Desafíos / The Health of Indigenous Peoples of the Americas: concepts, strategies, practices, and challenges

La implementación de la Iniciativa Salud de los Pueblos Indígenas de las Américas en el ámbito regional, subregional y en los países ha sido posible por el rol desempeñado por los Ministerios de Salud y otras instancias gubernamentales, organizaciones no gubernamentales, instituciones académicas, otras agencias del Sistema de las Naciones Unidas y de cooperación internacional, las organizaciones indígenas, Áreas y Unidades Técnicas de la Sede y las Representaciones de la OPS/OMS en los países. Todos estos esfuerzos deben ser reconocidos ya que han contribuido a la generación de marcos conceptuales, estrategias e instrumentos que han facilitado la formulación de políticas, planes, programas, proyectos y redes de cooperación en bien de los pueblos indígenas de la Región. Este documento aborda la salud de los pueblos indígenas desde su concepción holística, los factores del contexto actual que influyen en su bienestar y las experiencias en marcha desde los países de la Región de las Américas en el enfoque intercultural de la salud de estos pueblos.

Ethnicity and its significance in the pathobiology of prostatic carcinoma in Southern Israel.

BACKGROUND: Several studies have noted ethnic differences in the natural history of prostatic carcinoma. Southern Israel has been regarded as a melting pot and, perhaps more than the rest of the country, has encouraged the ingathering of immigrants from several countries, as well as a large Bedouin community. OBJECTIVES: In an attempt to determine any differences that may exist in population groups in Israel, we have examined clinical and biologic markers in patients diagnosed with prostatic cancer in Southern Israel in 1996-2000. We wanted to demonstrate differences in the incidence and features of prostate carcinoma among the population groups in Southern Israel, and to evaluate their possible biologic significance. METHODS: Clinical parameter features, including the ethnicity origin of patients with prostatic adenocarcinoma, were reviewed in a cohort of 189 patients seen between 1996 and 2000. Tissue sections from specimens in a subset of 40 of these patients who had undergone prostatectomy were studied by immunohistochemistry for TP53, Bcl-2, and chromogranin A using the ABC peroxidase method. These markers were chosen because of their suggested impact on the biology of this tumor. Clinical correlations were examined. RESULTS: We confirm the presence of ethnic differences in the features of prostatic adenocarcinoma in our geographic area. Notably, patients of North African origin were treated surgically at a younger age than immigrants from East Europe. Higher total prostate-specific antigen levels and more robust tumor cell Bcl-2 expression were detected in the East European patients. The number of Bedouin subjects in our cohort of patients with prostatic cancer was much more limited than expected. No immigrants from Ethiopia were included in our study diagnosed with prostate carcinoma during this period. CONCLUSIONS: The proportion of patients of European, especially East European, origin was relatively high among the cohort of 189. Their older age and the lower proportion of subjects that underwent surgery, together with the tendency toward higher total prostate-specific antigen levels and higher Bcl-2 expression, suggest that this ethnic group may not differ significantly from the African-American group in the United States. The low representation of Bedouin and absence of Ethiopian immigrants among our patients with prostate cancer may point to a genuinely low incidence or it may be related to inadequate medical supervision in these population groups.

[Education level and origin as predictors of hospitalization among Jewish adults in Israel: a population-based study].

BACKGROUND: Age, sex, origin and level of education are recognized as predictors of healthcare utilization. However, the joint effects of these variables on the risk of hospitalization have yet to be described for specific diagnostic categories, such as diseases of the circulatory, respiratory, genitourinary, digestive and nervous systems, infectious and parasitic diseases, malignant neoplasms, injury and poisoning. OBJECTIVES: To evaluate the association between origin, education, sex, age and the risk of hospitalization due to major diagnostic categories. METHODS: Cross-sectional study linking population-based databases, including Israeli census and hospitalization records. RESULTS: The study encompassed 35,413 hospitalized subjects and 386,317 non-hospitalized subjects. Origin other than Israel was a risk factor for hospitalization, with an odds ratio of 1.31 (95% CI 1.25-1.36) for Asia, 1.43 (1.37-1.50) for Africa, and 1.24 (1.20-1.29) for Europe-America (P for all origins <0.0001). Compared to subjects with post-high school educations, those with high school educations were 1.18 times more likely to be hospitalized (1.14-1.21), while those with elementary school educations experienced a risk of 1.32 (1.28-1.37) (P < 0.0001). Origin was a marked risk factor for hospitalization due to malignancy, with an odds ratio of 2.19 (1.71-2.79) for European-American origin relative to Israeli origin (P < 0.0001). The inverse association between education level and risk of hospitalization was constant across all diagnostic categories other than malignancy. CONCLUSIONS: Lower education was found to be a significant risk factor for hospitalization in most diagnostic categories. Origin was associated with increased risk for hospitalization due to malignant neoplasms and diseases of the respiratory, nervous, genitourinary and circulatory systems.

Factors affecting the compliance of the antenatal hepatitis B screening programme in Italy.

The effectiveness in the prevention of perinatally transmitted HBV infection was assessed in 11858 pregnant women consecutively recruited in public and private hospitals in six Italian regions during a 2 months period in 2001. Of them 10881 (91.8%) attended HBsAg antenatal screening. The overall HBsAg prevalence was 1.7% (CI 95%: 1.4-1.9); it was 1.4% (CI 95%: 1.2-1.7) in pregnant women born in Italy but 5.9% (CI 95%: 4.1-8.1) in those born in Asia, Africa, central and south America, and eastern Europe. Results of multiple logistic regression analysis indicate that birth in foreign countries (OR 2.0; CI 95%: 1.3-3.0), family size with more than 4 members in the household (OR 3.5; CI 95%:2.7-4.6), and birth in a private hospital (OR 1.9; CI 95%: 1.3-2.8) were all independent predictors of lack of adherence to HBsAg screening. Out of the 182 new-borns of HBsAg positive mothers 172 (95.0%) were given active plus passive immunisation; this figure was 100% in new-borns of foreign mothers. These findings evidence a good effectiveness in the prevention of perinatally transmitted HBV in Italy. More efforts should be addressed to improve the effectiveness of the programme among foreign pregnant women who have high rate of HBsAg and more likely escape HBsAg screening than Italian pregnant women.

Seroprevalence of Kaposi's sarcoma-associated herpesvirus in healthy adults in Israel.

To determine if Kaposi's sarcoma-associated herpesvirus (KSHV) prevalence is correlated with the 9-fold difference in the incidence of classic Kaposi's sarcoma observed among Israeli Jewish populations, we conducted a cross-sectional KSHV seroprevalence survey in a population of 166 HIV-seronegative healthy subjects from the general population (26 women, 140 men). Eight individuals (4.8%) (all men) were seropositive for KSHV; differences between men and women were not statistically significant. If we consider the sensitivity and specificity of the assays, the corrected prevalence would be 6.1% (95% confidence interval 2.0-10.1). We noticed a non-statistically 5.5-fold difference between individuals above and below 40 years of age, but did not find an association with the incidence of classic KS among the Israeli Jewish sub-population, according to their origin. This suggests that KSHV is only necessary, albeit not sufficient, cause of classic Kaposi's sarcoma.

Tuberculosis screening in adults who have received bacille Calmette-Guérin vaccine.

The incidence of tuberculosis among immigrants to the United States is 12 times that in the native-born population. Screening immigrants for tuberculosis is complicated by the widespread use of bacille Calmette-Guérin (BCG) vaccination. To determine the utility of tuberculin testing in adults who have been vaccinated with BCG vaccine, we studied the tuberculin reactions of 80 adults who came to us for naturalization physical examinations. No adverse effects were reported from tuberculin testing. Subjects from regions with a low prevalence of tuberculosis who had received BCG vaccine were significantly more likely to have a positive reaction than subjects who had not received BCG vaccine. However, among subjects from regions with a high prevalence of tuberculosis, there was no difference in the prevalence of positive reactions between those who reported having BCG vaccinations and those who said they had not. Interpretation of tuberculin reactions in immigrants who receive BCG vaccinations depends on the prevalence of tuberculosis in the country of origin. Adults receiving BCG vaccination who have a positive reaction and no evidence of active tuberculosis should receive prophylactic therapy or be observed carefully.

Mutations in the SLC3A1 transporter gene in cystinuria.

Cystinuria is an autosomal recessive disease characterized by the development of kidney stones. Guided by the identification of the SLC3A1 amino acid-transport gene on chromosome 2, we recently established genetic linkage of cystinuria to chromosome 2p in 17 families, without evidence for locus heterogeneity. Other authors have independently identified missense mutations in SLC3A1 in cystinuria patients. In this report we describe four additional cystinuria-associated mutations in this gene: a frameshift, a deletion, a transversion inducing a critical amino acid change, and a nonsense mutation. The latter stop codon was found in all of eight Ashkenazi Jewish carrier chromosomes examined. This report brings the number of disease-associated mutations in this gene to 10. We also assess the frequency of these mutations in our 17 cystinuria families.

Variantes estructurales de la hemoglobina en Iberoamérica / Structural variations of the hemoglobin in Iberoamerica

Structural hemoglobin variants are reviewed for Iberoamerica; specially in Latin America, they reflect racial composition and geographic origin. Latin American genetic composition is a function of ethnic composition in each country (mainly Africans and Spaniards, and the "indians" or native peoples). For this reason the distribution of hemoglobin variants has been greathy affected by the individual and population movements, specially as a result of the 18th and 19th century African slave trade. Scientific, sanitary, social and cultural factors explain (at least for Latin America and Portugal), a quantitative and qualitative subestimation of the structural variants of hemoglobin. In Spain, which has extensive research on the subject, the Caucasian variant number is known to be high, compared with Latin America and Portugal. Concerning origin and prevalence of hemoglobin polimorphism, the only established positive selection force is malaria falciparum. In Iberoamerica, the Hb S, as the major polimorphism and the HbC. have the greatest clinical and anthropological importance. Nevertheless, most variants are rare (found in an individual person or a particular family). Other minor Iberoamerica polimorphisms are the Hb E and D-Punjab, from Asia; and the Hb Korle-Bu, G-Philadelphia and A'2 from Africa.