Associations between plasma levels of vitamins and cataract in the Italian-American Clinical Trial of Nutritional Supplements and Age-Related Cataract (CTNS): CTNS Report #2.

PURPOSE: To investigate the association at baseline between plasma levels of selected vitamins and the presence and type of cataract in the participants in The Italian-American Trial of Nutritional Supplements and Age-related Cataract. METHODS: At baseline, the participants (1020, 710 with "early cataract" and 310 with "no cataract," 55-75 years of age) received an ocular examination, photographic lens grading, and measurement of plasma levels of vitamins A, C, E, beta-carotene, and of red blood cell glutathione reductase activity. RESULTS: In multiple logistic models adjusted for potential confounders, high vitamin C levels were associated with a protective effect on nuclear (N) [OR: 0.54; 95% CI: 0.30, 0.97] and posterior subcapsular (PSC) cataract (OR: 0.37; 95% CI: 0.15, 0.93). High vitamin E levels were associated with increased prevalence of cortical cataract (C) (OR: 1.99; 95% CI: 1.02-3.90), PSC (OR: 3.27; 95% CI: 1.34, 7.96) and of any cataract (OR: 1.86; 95% CI: 1.08, 3.18). CONCLUSIONS: In agreement with some earlier studies, we found higher plasma levels of vitamin C to be associated with reduced prevalence of N and PSC cataracts. The finding of an increased prevalence of some types of cataract with higher levels of vitamin E was unexpected, has not been previously reported, and could be due to unadjusted confounding.

Allergy, asthma and markers of infections among Albanian migrants to Southern Italy.

BACKGROUND: Studies of immigrants represent an useful tool to determine the relative relevance of environmental vs genetic factors in causing the reported rapid increase of the prevalence of sensitization and allergic diseases. METHODS: A total of 152 Albanian migrants to Southern Italy responded to a questionnaire based on the European Community Respiratory Health Survey (ECRHS) and 139 of them underwent skin prick test, and 61 serological assays for total IgE and IgG antibodies against Toxoplasma gondii (TG), herpes simplex virus 1 (HSV-1), hepatitis A virus (HAV) and Helicobacter pylori (HP). RESULTS: Reported asthma was rare (2/152; 1.3%) and reported nasal allergies rather frequent (24/152; 15.8%). Sensitization to common inhalant allergens occurred in 27/139 (19.4%) subjects. The frequency of skin sensitization to pollen (P = 0.003) and that of hay fever (P = 0.004) increased with the time spent in Apulia. All the 61 sera had antibodies against HAV, 59/61 (96.7%) against HSV-1, 48/61 (78.7%) against HP and 34/61 (55.7%) against TG. The prevalence of skin sensitization and hay fever symptoms were correlated to the duration of residence in Southern Italy. CONCLUSIONS: Data presented indicate that Albanian migrants to Italy, in spite of the low prevalence of allergic diseases and sensitization in their country of origin, manifest with time an increasing prevalence of sensitization to local allergens and nasal symptoms after immigration to Italy. This would suggest a permanent role of allergen exposure and lifestyle factors in influencing the appearance of sensitization and symptoms of allergic diseases.

Exposure to foodborne and orofecal microbes versus airborne viruses in relation to atopy and allergic asthma: epidemiological study.

OBJECTIVE: To investigate if markers of exposure to foodborne and orofecal microbes versus airborne viruses are associated with atopy and respiratory allergies. DESIGN: Retrospective case-control study. PARTICIPANTS: 240 atopic cases and 240 non-atopic controls from a population sample of 1659 participants, all Italian male cadets aged 17-24. SETTING: Air force school in Caserta, Italy. MAIN OUTCOME MEASURES: Serology for Toxoplasma gondii, Helicobacter pylori, hepatitis A virus, measles, mumps, rubella, chickenpox, cytomegalovirus, and herpes simplex virus type 1; skin sensitisation and IgE antibodies to relevant airborne allergens; total IgE concentration; and diagnosis of allergic asthma or rhinitis. RESULTS: Compared with controls there was a lower prevalence of T gondii (26% v 18%, P=0.027), hepatitis A virus (30% v 16%, P=0.004), and H pylori (18% v 15%, P=0.325) in atopic participants. Adjusted odds ratios of atopy decreased with a gradient of exposure to H pylori, T gondii, and hepatitis A virus (none, odds ratio 1; one, 0. 70; two or three, 0.37; P for trend=0.000045) but not with cumulative exposure to the other viruses. Conversely, total IgE concentration was not independently associated with any infection. Allergic asthma was rare (1/245, 0.4%) and allergic rhinitis infrequent (16/245, 7%) among the participants (245/1659) exposed to at least two orofecal and foodborne infections (H pylori, T gondii, hepatitis A virus). CONCLUSION: Respiratory allergy is less frequent in people heavily exposed to orofecal and foodborne microbes. Hygiene and a westernised, semisterile diet may facilitate atopy by influencing the overall pattern of commensals and pathogens that stimulate the gut associated lymphoid tissue thus contributing to the epidemic of allergic asthma and rhinitis in developed countries.

Influence of cataract surgery on progression of lens opacities in the fellow eye.

OBJECTIVE: To evaluate whether, in the Italian-American natural history study, cataract surgery in one eye influences the incidence/progression rate of lens opacities in the fellow eye. DESIGN: Follow-up study of age-related cataract. PARTICIPANTS: A total of 1399 participants with age-related cataracts were regularly followed for 5 years and cataract status evaluated by the Lens Opacities Classification System II on slit-lamp and retroillumination lens photographs. A total of 228 participants had cataract surgery in 1 eye during the study period, and 192 had sufficient follow-up visits to be included in the analysis. MAIN OUTCOME MEASURE: The incidence/progression of cataract was defined as two or more consecutive visits with a severity grade greater than the baseline grade. RESULTS: When entered into a Cox model, incidence/progression of specific cataract types was not associated with cataract surgery on the fellow eye and was not significantly different from that observed in participants who had no cataract surgery. CONCLUSIONS: Cataract extraction does not influence incidence/progression rate of specific lens opacities in the fellow eye.

[A survey on epidemiologic ethics and research]. / Un'indagine su etica e ricerca epidemiologica.

In April 1997, 126 of 163 employees (77%) in the Laboratory of Epidemiology and Biostatistics of the Istituto Superiore di Sanità answered 11 questions of an ethical nature, regarding the relationship between scientist and human subject of experimental research. The possible answers were: "yes", "no", "maybe", "depends", "don't know". The unexpected variability of the answers provided by a rather homogeneous group showed how different interpretations and personal points of view may highlight different aspects of an ethical problem.

Sibship size, birth order, and atopy in 11,371 Italian young men.

BACKGROUND: Having a low number of siblings and a low birth order has been reported to be a relevant risk factor for development of atopic diseases and skin sensitization to common inhalants. Although the inverse association of atopy with sibship size has been confirmed repeatedly, the association with birth order has provided conflicting results. This possibly is due to the relatively small size of the population sample examined. OBJECTIVE: The objective of this study was to investigate the relation between sibship size, birth order, and atopy in a very large population sample, highly homogeneous for age and sex. METHODS: This was a retrospective survey of 11,371 Italian young men, 18 to 24 years old, all candidates for enrollment in the Italian Air Force. Demographic data had been collected by a standard questionnaire. Specific IgE for locally relevant airborne allergens had been tested by a multi-RAST assay (CAP-Phadiatop). RESULTS: The prevalence of atopy (defined as a high level of specific IgE against inhalants [cut-point >1.2 log RU]) was inversely related to the total number of siblings (25% in those with no siblings and 9% in those with five or more siblings), with a mean of a 3% decrease in prevalence for each added sibling. This relation persisted after adjustment for relevant variables such as father's education and rural and southern residence. An independent association between birth order and atopy was also observed because the decrease in atopy prevalence with increasing numbers of older siblings was significantly steeper than that found with the number of younger siblings (chi2 = 179, df = 1, p < 0.0001). CONCLUSIONS: In a very large and homogeneous population sample of a Mediterranean country, not only sibship size but also birth order was significantly associated with atopy. This observation further highlights the role of family structure in the development of atopy and supports the hypothesis that cross-infections acquired early in infancy or in later childhood might prevent development of atopy later in life.

Prevalence of Helicobacter pylori infection in a cohort of Italian military students.

In 1990, to study regional prevalences and risk factors of Helicobacter pylori infection in healthy young adult males, sera were collected from a nationwide sample of 1659 males (mean age 20.7 years) at introduction into the Air Force School for military students in Caserta, Italy. An enzyme-linked immunosorbent assay was used to detect H. pylori specific immunoglobulin G antibodies. The observed overall seropositivity rate was 17.5% (95% CI 15.7-19.4). Prevalence was higher in southern Italy and in the Italian islands as compared with northern Italy and central Italy (21.3% vs. 9.5%). Multiple logistic regression analysis showed that residence in southern areas and islands was the strongest predictor of the likelihood of H. pylori seropositivity; number of siblings in the household was marginally associated; years of father's schooling was not a significant predictor. H. pylori positive subjects were more likely positive for antibodies to hepatitis A virus infection (anti-HAV) than those H. pylori negative (35.4% vs. 24.9%; Odds Ratio 1.7, 95% CI 1.3-2.2). Adjustment for the confounding effect of sociodemographic variables weakened this association (OR 1.3, 95% CI 1.0-1.7). These findings suggest that differences in environmental conditions rather than in socioeconomic status may have played the major role in the different spread of H. pylori infection across the country.

An independent evaluation of the Age-Related Eye Disease Study (AREDS) cataract grading system.

PURPOSE: To assess intra- and interobserver reproducibility of the Age-Related Eye Disease Study (AREDS) system for grading lens opacities and to provide data on its capacity to reliably detect changes in lens status. METHODS: Independent and replicate grading of 40 sets of lens photographs (one slit-lamp and two retroillumination photographs) were performed by three experienced observers. Patients were participants in the Collaborative Italian-American Clinical Trial of Nutritional Supplements which is testing the effect of a mineral-multivitamin supplement on age-related cataract (CTNS). Scatterplots and intraclass correlation were used to assess measurement error. RESULTS: Analysis revealed good intra- and interobserver reproducibility of the system. Greatest intraobserver measurement error showed 100% of pairs within 10% areal difference for cortical cataract, 97.5% within 15% areal difference for posterior subcapsular cataract, and 100% within 1 density unit difference for nuclear opacity. Greatest interobserver measurement error showed 95% of pairs within 10% areal difference for cortical cataract, 97.5% within 15% areal difference for posterior subcapsular cataract, and 97.5% within 1.5 density unit difference for nuclear opacity. CONCLUSIONS: The AREDS lens opacities grading system appears to be sufficiently reliable to detect changes of at least 10% areal involvement for cortical, 15% areal involvement for posterior subcapsular, and 1.0 units for nuclear opacities. It therefore seems sufficiently sensitive to adequately monitor progression of lens opacities in a longitudinal study of patients with early cataract. Its applicability in a population with advanced or complex mixed opacities must await further testing.

Cross sectional retrospective study of prevalence of atopy among Italian military students with antibodies against hepatitis A virus.

OBJECTIVE: To investigate the working hypothesis that common infections occurring early in life prevent atopy. DESIGN: Cross sectional, retrospective study of young Italian men with results for hepatitis A serology and atopy. SETTING: Air force school of military students in Caserta, Italy. SUBJECTS: 1659 male students aged 17-24, most of whom (90%) were from central and southern Italy. MAIN OUTCOME MEASURES: Skin sensitisation and specific IgE antibodies to locally relevant airborne allergens; diagnosis of respiratory allergy (asthma or rhinitis, or both); hepatitis A seropositivity. RESULTS: 443 of the 1659 subjects (26.7%) were positive for hepatitis A virus antibody. Atopy was less common among seropositive than seronegative subjects according to skin sensitization (weal reaction > or = 3 mm) to one or more allergens (21.9% (97/443) v 30.2% (367/1216), P < 0.001); polysensitisation (sensitive to three or more allergens) (2.7% (12/443) v 6.4% (78/1216), P < 0.01); high specific IgF concentration (9.7% (43/443) v 18.4% (224/1216), P < 0.00005); and lifetime prevalence of allergic rhinitis or asthma, or both (8.4% (37/443) v 16.7% (203/1216), P < 0.001). Hepatitis A seropositivity remained inversely associated with atopy after adjusting for father's education, the number of older siblings, and the area of residence (based on the number of inhabitants). The prevalence of atopy was constantly low among seropositive subjects, whatever the number of older siblings; by contrast, it increased with a decreasing number of older siblings among seronegative subjects. CONCLUSION: Indirect but important evidence is added to the working hypothesis as common infections acquired early in life because of the presence of many older siblings (among seronegative subjects) or because of unhygienic living conditions (among seropositive subjects) may have reduced the risk of developing atopy.

Location and severity of cortical opacities in different regions of the lens in age-related cataract.

PURPOSE: To examine the distribution of cortical opacities across the lens in the Italian-American Natural History Study of Age-Related Cataract and to study the association between an index of sunlight exposure and the location of cortical cataract within the lens. METHODS: Lens photographs of one eye of 731 persons with cortical opacities (503 with pure and 228 with mixed types of opacity) were included in the analysis. A radial grid superimposed on the photographs was used to assess presence, location, and severity of wedge-shaped cortical opacities. RESULTS: Both the prevalence and the extent of cortical opacities were highest in the inferior-nasal quadrant and lowest in the superior-nasal quadrant of the lens. In polychotomous logistic regression, persons with the greatest excess areal involvement in the inferior half of the lens were more likely to have high exposure to sunlight, as measured by a sunlight index, than persons with excess involvement in the superior half of the lens (odds ratio, 1.73; 95% confidence interval 1.03, 2.93). Excess areal involvement of the inferior lens also was associated with the pure type of cortical cataract and with the total extent of the opacity. CONCLUSIONS: Age-related cortical opacities occur more frequently inferiorly than superiorly and, to a lesser extent, nasally than temporally. Possibly higher exposure of these lens segments to sunlight may explain this preferential location of cortical opacities.

Distribution of cataract types in the Italian-American case-control study and at surgery in the Parma area.

PURPOSE: To compare the distribution of cataract types at surgery with the distribution detected in an ophthalmology clinic-based case-control study in the same geographic area (Parma, Italy). METHODS: The distribution of cataract type assessed according to the Lens Opacities Classification System I in 284 consecutive patients 45 years of age or older, who were admitted for cataract surgery to the Institute of Ophthalmology in Parma during 1994, was compared with the distribution assessed in 1008 participants in the Italian-American case-control study of age-related cataract in the Parma metropolitan area from 1987 to 1989. RESULTS: Analysis of cataract distribution indicates in the surgical group, compared with the case-control population, a significant increase of nuclear (N) and posterior subcapsular (PSC) opacities (any), a reduction of pure forms of cortical and N cataracts, and a marked increase of mixed types of opacities with a simultaneous N and PSC component. CONCLUSION: Although cortical opacities are probably the most prevalent type of age-related lens change in the general population of Parma metropolitan area, the type of cataract most frequently responsible for the decision of patients to undergo cataract surgery is a mixed type of opacity with an N-PSC component.

Haemolytic-uraemic syndrome in childhood: surveillance and case-control studies in Italy. Italian HUS Study Group.

Seventy-six cases of haemolytic-uraemic syndrome (HUS) were collected over a 4-year period during a surveillance and case-control study. The annual incidence of 0.2 per 100,000 children aged 0-14 years is lower than in other countries; 34% had no prodromal diarrhoea. Evidence for verocytotoxin-producing Escherichia coli (VTEC) infection was found in 72% of patients and 3% of controls; 88% of patients with bloody diarrhoea, 67% with non-bloody diarrhoea and 55% without diarrhoea were VTEC positive. Seventy-three percent of patients had creatinine clearance > or = 80 ml/min per 1.73 m2, normal blood pressure, no proteinuria and haematuria < 2+ after 1 year of follow-up. One patient died and none had non-renal sequelae. VTEC positivity was significantly correlated with a good outcome, while the absence of diarrhoea and a high total white blood cell count at onset were not predictors of a bad outcome. Household contacts of HUS patients had diarrhoea more frequently than those of the control group, supporting the hypothesis of person-to-person transmission of VTEC infection.

A dose-response effect between a sunlight index and age-related cataracts. Italian-American Cataract Study Group.

To explore the existence of a dose-response relationship between sunlight exposure and risk of age-related cataracts, we analyzed data collected from 1008 patients with cataracts and 469 control subjects enrolled in the Italian-American Case-Control Study of Age-Related Cataracts. Fourteen variables related to sunlight exposure history were included in the questionnaire administered to the study participants. A sunlight index was constructed and its relationship to the presence of cataracts was modeled by logistic regression. After adjustments for potential confounding variables and for age and sex, a significant dose-response effect (P = 0.01) was detected between the sunlight exposure index and the presence of pure cortical cataracts. With the exception of corticonuclear cataracts, all the other mixed types of opacity also showed a dose-response association with the sunlight index. These data support the hypothesis that sunlight exposure is a risk factor in the development of cortical cataracts, and demonstrate the existence of a dose-response relationship in this association.

Community-wide outbreak of hemolytic-uremic syndrome associated with non-O157 verocytotoxin-producing Escherichia coli.

From 20 April through 13 May 1992, 9 children were hospitalized with hemolytic-uremic syndrome in Lombardia, Italy, where only 14 cases of this syndrome had occurred in the preceding 4 years. Cases were scattered in a large area encompassing five provinces, and the source of the outbreak was not identified. Eight patients needed dialysis, and there was 1 death. Seven of the 9 cases were examined for evidence of infection by Vero cytotoxin (VT)-producing Escherichia coli (VTEC). Six children had serum antibodies to the lipopolysaccharide of E. coli O111, and a VT-producing E. coli O111:NM was isolated from stool in 1 case. This is the first outbreak of VTEC infection recognized in Italy and the first associated with an E. coli serotype other than O157:H7.

Influence of type and severity of pure forms of age-related cataract on visual acuity and contrast sensitivity. Italian American Cataract Study Group.

PURPOSE: To compare the relationship between logMAR visual acuity (VA) and cataract severity and between contrast sensitivity (CS) and cataract severity in pure types of age-related lens opacities. METHODS: Analysis included patients followed in the ongoing Italian-American Study of the Natural History of Age-Related Cataract. Lens opacities were classified and graded according to the Lens Opacities Classification System II (LOCS II). Visual acuity was measured with the Early Treatment Diabetic Retinopathy Study Chart. Contrast sensitivity was measured with the Pelli-Robson chart. RESULTS: Data from 1,076 eyes were used for the analysis (366 clear lenses; 550, 124, and 36 eyes with cortical, nuclear and posterior subcapsular cataract, respectively). In age-adjusted analyses, increasing severity of all three cataract types was associated with progressively higher logMAR VA, which translates into poorer acuity, and lower CS scores. For both VA and CS, the effect of increasing severity was greatest for nuclear and least for cortical opacities. After adjusting for age and VA, CS scores were no longer associated with cataract type and severity, with the exception of advanced cortical opacities. CONCLUSIONS: Increased cataract severity, as determined by LOCS II grading, is strongly associated with both VA and CS scores. Contrast sensitivity scores obtained from testing at low spatial frequency do not seem to offer additional information over standard VA testing in early cortical and posterior subcapsular opacities nor in nuclear cataracts.

A community survey on maternal and child health services utilization in rural Ethiopia.

A household health interview survey on MCH services utilization was carried out in 22 villages of a rural district of Arsi region, Ethiopia, before the launching of an integrated MCH programme. Coverage of antenatal services was 26%, and 61% of the women who received antenatal care reported having had 3 or more visits. Antenatal care was positively associated with living within 10 km of the Health Centre. Twenty-eight percent of the mothers attended the under-5 clinic and most returned for 3 or more visits. In addition, 99% reported having breast-fed their last child but more than 25% started weaning only after the seventh month of age. Differences in practice of treating diarrhoea according to knowledge of ORS were found. Of the 33% of those with knowledge of ORS, almost 90% reported use of ORS for treating child's diarrhoea, showing a positive attitude towards modern health care. The proportion of women using family planning was 5%, with no difference found between Christians and Muslims. Results on EPI coverage validated data from routine reporting. Integration of MCH services including out-reach activities may increase access and coverage of MCH services.

PIP: A community survey of 21 villages in rural Ticho district of Arsi region in Ethiopia was conducted in February 1990 to gather data on utilization of maternal and child health (MCH), family planning, and immunization services. 95% of the villages had a traditional birth attendant. 26% of the 419 mothers had used prenatal services when pregnant with their last child. 61% of these women had at least 3 visits. Women who lived within 10 km of the health center in the district capital, Robe, were more likely to use prenatal services than those who lived at a greater distance (41% vs. 23%; p 0.001). Just 29% of mothers had taken their 1st child to the under-5 clinic, but 64% of these took this child to the clinic for at least 3 visits. All but 4 mothers (99%) breast fed their last child; 77% of them were nursing at the time of the interview. Just 4% of all breast feeding mothers discontinued breast feeding before their child reached 1 year. Just 33% of the mothers were familiar with oral rehydration salts (ORS). Most mothers with ORS knowledge (89%) used ORS to treat diarrhea, reflecting a positive attitude towards modern treatment of diarrhea. Only 5% of women 15-49 years old used contraceptives. Contraceptive usage was significantly associated with age (10% for 40 years, 7% for 20 years, and 4% for 21-39 years; p .05). Christians and Muslims used contraceptives at virtually the same rate (6% vs. 5%). Survey results on immunization coverage supports routine reporting data. Attendance at MCH clinics had a positive effect on complete immunization with the diphtheria, pertussis, tetanus vaccine (p 0.001). Such as association was not observed between prenatal care and tetanus toxoid immunization, however. The researchers propose integration of MCH services in upgraded health stations to increase access and coverage of MCH care.

Census in a rural area of Ethiopia: methodology and results.

A census and an ecologic survey were performed in 39 villages of a rural district of Arsi Region, Ethiopia, in difficult field circumstances. Information on age, ethnic group, education and family relationship, as well as data on health facilities and availability of basic services were collected. Supervised students, working in teams, were used as interviewers. Communities were involved through plenary meetings and community health agents participated in the data collection process. A total of 64,714 people in 12,152 households were registered. The repeatability of age assessment was investigated by comparing the results from two villages with data obtained in a pilot study carried out 6 months earlier. The technical error was only 0.80 and 1.67 in the 0-5 and 6-15 age-groups, respectively. Three percent of the total population was under one year, less than previously estimated. This may, in part, be due to the family planning programme in the region. Eighteen percent of the households were headed by females. School attendance was less common among females and in the Oromo ethnic group. The availability of basic services, including safe water and basic sanitation supplies, was very poor in the area.

PIP: A rural demographic surveillance system was established in the Arsi region of Ethiopia with a census, health interview survey, and ecologic data collection in 1989-90. The methodology, data collection, data processing, and survey results of the census and surveys in 39 villages in Ticho District are reported. Ticho was one of 12 districts in Arsi Region in which the population has been resettled in villages since 1985. The area is situated in highlands, which have difficult field circumstances. Students (18) were used as interviewers in the catchment areas of the Robe health center and 5 health stations. Community participation was included prior to the survey. A pilot study was undertaken 6 months prior to the main surveys in April 1989. Community health agents, who were asked to encourage community involvement, and students were trained prior to survey distribution in October-November 1989 and February 1990 during the dry season. Team supervisors monitored data collection and personally collected the ecologic data. Completeness was checked manually, and computer data entries were checked on 10% of all records. THe operation costs amounted to 12,000 Ethiopian birr ($6000), excluding printing of forms and some purchases of materials necessary for fieldwork. Age reliability was checked for 5% of the sample in 2 villages. Technical error was found to increase with age and was lowest in the 0-5 year old group. The census enumerated 64,714 persons in 12,152 households (5.3 persons per household) in the 39 villages. The population increased by single years of age until the age of 8 years. There appeared to be even number digit preference and 0 and 5 digit preference. The Oromo ethnic group comprised 85% of the population; 14% were Amhara. 66% of the Oromo group were Muslim, and the rest were Orthodox. 39% of the Oromo population under 5 years old and 35% of the Amhara group had never attended school. 31% of the population aged 15-19 years had attended primary school and 23% secondary school; only 13.9% of the 15-19 year olds had not attended any school. There were 2217 households headed by females. The nearest health station was an average of 90 minutes away by foot. 23 villages had not or few latrines. Only 3 villages obtained safe drinking water. Access to unprotected water sources took less than 30 minutes for 90% of the villages. 35% (14) of the villages had a primary school. Environmental health needs to be a priority for Primary Health efforts.

Estimation of early childhood mortality using preceding birth technique in a community-based setting.

The preceding birth technique, an indirect method for estimating early childhood mortality based on ascertaining the survival of previous children, was applied in rural Ethiopia within a system of demographic surveillance. Trained community health workers acted as interviewers and transmission flow of the routine health information system was used for data reporting. Data were collected for a median 12 month period from 39 sampled villages of Ticho district in Arsi region. From 1064 mothers having at least a second birth, the proportion dead of the last birth was 0.138 (95% CI 0.117-0.150), corresponding approximately to the probability of dying between birth and age two. It approximates to an infant mortality rate of about 100 x 1000 live-births. From 974 mothers having at least a higher-order birth, the proportion dead of the second to last birth was 0.203 (95% CI 0.178-0.228), equivalent to the risk of dying between 0 and age 5. In spite of the progressive migration of the surveyed population, the process and the outcome of the study suggest that PBT may well be inserted into a primary health care information system run by trained community health workers.

PIP: The preceding birth technique, an indirect method for estimating early childhood mortality based on ascertaining the survival of previous children, was applied in rural Ethiopia within a system of demographic surveillance. Trained community health workers acted as interviewers and transmission flow of the routine health information system was used for data reporting. Data were collected for a median 12-month period from 39 sampled villages of Ticho district in Arsi region. From 1064 mothers having at least a second birth, the proportion dead of the last birth was 0.138 (95% CI 0.117-0.150), corresponding approximately to the probability of dying between birth and age two. It approximates to an infant mortality rate of about 100 per 1000 live births. From 974 mothers having at least a higher-order birth, the proportion dead of the second to last birth was 0.203 (95% CI 0.178-0.228), equivalent to the risk of dying between age 0 and age 5. In spite of the progressive migration of the surveyed population, the process and the outcome of the study suggest that PBT may well be inserted into a primary health care information system run by trained community health workers.

Time trends in features of cutaneous melanoma at diagnosis: central-south Italy, 1962-1991.

A total of 1360 cases of cutaneous malignant melanoma (CMM) consecutively diagnosed at the Istituto Dermopatico dell'Immacolata (IDI) in Rome, during the period 1962-1991, were reviewed. There was a positive trend of thin (Breslow thickness < 1.49 mm) lesions at diagnosis in comparison to thick lesions, with more severe prognosis (p < 0.05). CMM on the trunk and upper legs increased more than CMM on the face (p < 0.05). There are suggestions that the incidence of CMM in the hospital referral population, resident in Central-South Italy, has been steadily rising. This trend could be due not only to a referral bias related to a growing public concern about "bad moles", but also to a real increase in the incidence of CMM.