Hepatitis B in retreat from dialysis units in United Kingdom in 1973. Public Health Laboratory Service Survey.

A prospective study of hepatitis in over two-thirds of the dialysis units in the United Kingdom has continued since 1968. After the introduction of a control and preventive programme in 1970 there was a sustained decline in the incidence of hepatitis B to the low level of 0-3% among patients and 0-1% among staff in 1973--a greater than tenfold decrease in four years. Comparisons with data from other countries suggest that the almost complete elimination of hepatitis B from dialysis units in the UK was due to the preventive programme.     

Changes in morbidity and mortality during comprehensive community programme to control cardiovascular diseases during 1972-7 in North Karelia.

A comprehensive community programme studying the control of cardiovascular diseases (CVD) was carried out in North Karelia, Finland, between 1972 and 1977. The main objective was to reduce the mortality and morbidity of CVD, particularly in middle-aged men. Changes in the mortality and incidence of CVD were monitored by community-based registers of cases of acute myocardial infarction (AMI) and stroke and data on death certificates. During the programme the total mortality in the area decreased by 5% and the mortality from CVD decreased by 13% among men and 31% among women aged 30-64 years. The incidence of AMI fell by 16% among men and 5% among women, while that of cerebral stroke fell by 38% among men and 50% among women. Changes in mortality in North Karelia were compared with those in a matched control area; the difference between the two areas was not significant. The true effect of the programme cannot be deduced from these results, but mortality from CVD and the incidence of AMI and stroke fell during the five years studied. Thus the changes in mortality and morbidity of CVD accorded with the initial objectives of the programme.     

Clinical Problems: Hepatitis in Dialysis Units in the United Kingdom

A prospective study of hepatitis in 20 dialysis units in the United Kingdom showed that the number of units with outbreaks increased from one in 1968 to three in 1969 and the overall attack rate rose from 1·7 to 5·3% in patients and from 0·5 to 1·3% in staff.In July 1969 a pilot study of patients'' sera showed that all of the outbreaks were associated with Australia (Au) antigen. Au antigen was not detected in the unaffected units or in one unit in which there were several patients with abnormal liver function.In January 1970 systematic prospective testing for Au antigen was begun. Au antigen was detected in single patients in five more of the 20 units. The transfer of the affected patients to isolation for dialysis seemed to prevent the spread of infection in the units. The incidence of hepatitis in 1970 was 5·6% in patients and 0·4% in staff.     

Some effects of the growth-retardant glyphosine [N, N-bis (phosphonomethyl) glycine] on the sugar-beet crop

Four experiments tested a range of doses of the growth-retardant glyphosine on sugar-beet crops between 1970 and 1972. The period of time between application and harvest was varied. One experiment (1972) in nutrient mist culture examined its effect on seedling root development. The growth-retardant decreased root, sugar and top yield of sugar beet at all doses in excess of 0·56 kg a.i. ha^-1 at all treatment times. It increased the α-amino nitrogen content of beet roots significantly (P < 0·05) with doses in excess of 1·12 kg a.i. ha^-1. When applied to the leaves of seedlings with their roots in nutrient mist culture, glyphosine at 500 ppm and 2000 ppm of a.i. in aqueous solution slowed or stopped root elongation.     

Survival Rates of Patients Treated by Home and Hospital Dialysis and Cadaveric Renal Transplantation

Of 109 patients admitted to the renal failure programme of the Royal Free Hospital 80·7% were surviving after six years. For patients on home dialysis the four-year rate was 86·2%, more deaths occurring in women than in men. The short-term survival rate of all patients was high—namely, 96·3% at six months and 94·4% at 12 months. Hence large increases in the rate of acceptance of patients as well as successful transplantation are necessary to balance acceptance and loss from this programme.     

THE ISOLATION AND LIPID COMPOSITION OF MYELIN-FREE AXONS FROM RAT CNS1

—Myelin-free axons were isolated from rat CNS using a modification of the method of De Vries et al. (1972). On a dry weight basis, the axons contained 15·2% lipid composed of 19·4% cholesterol, 56·9% phospholipid and 23·7% galactolipid with a weight ratio of cerebroside to sulfatide of 3·6-1. The phospholipid was composed of 11·0% ethanolamine phosphatides (44·4% in the plasmalogen form), 21·0% choline phosphatides (9·3% in the plasmalogen form), 4·5% sphingomyelin, 4·5% phosphatidyl serine, 4·3% phosphatidyl inositol, 3·0% diphosphatidyl glycerol and 8·5% unidentified phospholipid. The rat axons contained 0·18 μg ganglioside NeuNAc/mg dry wt. In addition to the 4 major brain gangliosides, the rat axons contained gangliosides G_D2 and G_D3. The axonal galactolipid could not be accounted for by myelin contamination as revealed by electron microscopy, absence of the characteristic ratio of myelin specific proteins in the axonal protein profile as shown by polyacrylamide gel electrophoresis, and the axonal level of the myelin marker enzyme 2′,3′-cyclic nucleotide-3′-phosphohydrolase. The relationship between lipids of axons isolated from rat and bovine CNS, and rat whole brain and CNS myelin is discussed.     

Age at first marriage and fertility in rural Anhui, China

This paper examines the changing nuptiality pattern of rural China, particularly rural Anhui in relation to the planned social changes since 1949 and their effect on fertility. The data are from the 1/1000 Fertility Survey of China, conducted by the Family Planning Commission in 1982. Before the family planning programme was introduced to rural Anhui (1972), the changing nuptiality pattern was indirectly affected by the planned social changes; after 1972, the substantial increase in age at first marriage was mainly due to the family planning programme. More recently, the centrally controlled social structure is loosening, due to the economic reform and the nuptiality pattern seems to join the 1972 trend, suggesting that the dramatic change of nuptiality pattern during the early 1970s to early 1980s was a temporary one. But its effect on fertility is clear, and the shortening interval between marriage and first birth may bring difficulties for future population control in rural China.     

Change in risk factors for coronary heart disease during 10 years of a community intervention programme (North Karelia project).

A comprehensive community based programme to control cardiovascular diseases was started in North Karelia, Finland, in 1972. Reductions in smoking, serum cholesterol concentrations, and blood pressure were among the central intermediate objectives. The effect of the programme during the 10 year period 1972-82 was evaluated by examining independent random population samples at the outset (1972) and five (1977) and 10 (1982) years later both in the programme and in a matched reference area. Over 10 000 subjects were studied in 1972 and 1977 (participation rate about 90%) and roughly 8000 subjects in 1982 (participation rate about 80%). Analyses were conducted of the estimated effect of the programme on the risk factor population means by comparing the baseline and five year and 10 year follow up results in the age range 30-59 years. The effect of the programme (net reduction in North Karelia) at 10 years among the middle aged male population was estimated to be a 28% reduction in smoking (p less than 0.001), a 3% reduction in mean serum cholesterol concentration (p less than 0.001), a 3% fall in mean systolic blood pressure (p less than 0.001), and a 1% fall in mean diastolic blood pressure (p less than 0.05). Among the female population the reductions were respectively, 14% (NS), 1% (NS), 5% (p less than 0.001), and 2% (p less than 0.05). During the first five years of the project (1972-7) the programme effectively reduced the population mean values of the major coronary risk factors. At 10 years the effects had persisted for serum cholesterol concentrations and blood pressure and were increased for smoking.     

POPULATION DYNAMICS OF THE FLIGHTLESS CORMORANT NANNOPTERUM HARRISI

A small population of Flightless Cormorants was followed from 1970 to 1975 inclusive. The birds were extremely sedentary, most never moving more than 2 km from where hatched. Many birds bred several times within a year, almost always with different mates. After successful breeding the mean interval to the next attempt among females was significantly shorter than among males, probably because the male continued to attend the juvenile for longer than did the female. There was an annual peak of nesting in April to November, when sea temperatures were lowest; some nesting occurred in other months but these nests were less successful. About 73% of juveniles survived at least three months after going to sea. Adult females had a significantly higher rate of annual survival (91%) than did males (82%). The mean annual survival of both sexes combined over a 13 year period was 87%. The mean age of first breeding was about 30 months for both males and females. In 1972 breeding success (0·14 young fledged per pair) was much lower than in other years (0·60 young per pair), a lower proportion of juveniles survived, no birds bred for the first time and probably many fewer pairs nested. Adult survival was not affected. This reduced breeding output was associated with an influx of anomalously warm sea water to the area (El Niño). The availability of food is probably both the ultimate and the proximate factor controlling the timing of breeding.     

Decline in mortality from coronary heart disease in Finland from 1969 to 1979.

The trends in mortality from coronary heart disease in the 1970s and the differences in trends between counties within Finland were calculated from official mortality statistics among the population aged 35 to 64 years. During this period coronary mortality declined by a mean of 1.1% for men and 2.3% for women annually in the whole of Finland. A community based cardiovascular control programme was started in 1972 in North Karelia, a county in the east of Finland. The decline in coronary mortality in this county between 1969 and 1979 was 24% in men and 51% in women. The decline in the rest of Finland over the same period was 12% in men and 24% in women. The decline in North Karelia was greater than that in other counties of Finland for both men and women and that difference exceeded random variation, with over 95% likelihood for both sexes. Even with adjustment for rates before 1974 with cross-county multiple regression analyses the difference persisted. Although further studies are needed, the changes in coronary mortality in North Karelia suggest that the preventive programme has been effective.     

Limnological studies on some lakes in the Netherlands

Most Dutch lakes are small and shallow, resulting from peat dredging since the late 18th century. However, deep lakes have appeared recently owing to sand digging. Limnological features of one such lake, Wijde Biik (N. Holland), were studied during 1968–70. The lake with an average depth of 11 4 m (maximum depth 31 m) and area of 2·65 × 10⁶m² is one of the deepest and biggest in the Loosdrecht-lakes area. The lake is 125 cm below sea level, and underground water-movements play an important part in the lake's hydrology. The lake exhibits thermal stratification on warm and calm days; since the lake surroundings are open and flat, wind and nocturnal cooling destroy such a stratification. There is continuous circulation from autumn through spring. The O2 saturation (%) in the upper water varies from 70 to 120%. Bottom waters were never anaerobic (lowest values 10% O₂ saturation). CI^? (2·8m-equiv.) and HCO^?₃ (1·9 m-equiv.) were the dominant anions just as Ca⁺⁺ (2·77 m-equiv.) and Na⁺ (2·5 m-equiv.) formed the main cations. Chlorides have increased 2·5-fold in the 40 years as a geochemical consequence of deepening. The surface drainage has minor influence on lake's water chemistry. Part-P (10–140 μg/I) and PO₄-P (2–40 μg/1) recorded maximum and minimum respectively, and NO₃-N (0·05–1·15 mg/1) its minimum, during Microcystis abundance in August 1968. The SiO₂-Si decreased from February 1969 (400 μg/l) to June 1969 as Diatotna elongatum increased. The Si-decrease to <30% of the 1932 values is due to removal of Si-rich clay and silt, due to sand digging. Chlorococcales were the important lake algae. Desmids were poor. Microcystis dominated as a rule from July-September, achieving from 15 to 31 colonies/ml. Poor light transmission rather than nutrients limits plankton growth as also the primary production in the lake. Copepoda were the dominant zooplankton. Bosmina coregoni recorded between 2 and 44 individuaIs/1 in summer 1968 and was the main cladoceran. The average primary production during summers of 1969 and 1970 was 380 and 497 mg C m^?2 day^?1 respectively. Light limited production below 1 m—1 % light in 1969 and 10% in 1970 penetrated down to 4 m. About 70% of the production took place in the upper 2 m. Calculation of production according to theoretical models under-estimated the observed values by 12% because Z_0·5Ik lay much above (0·8–2·8 m) the expected value of 3·5 m. It is suggested that in turbid lakes like Wijde Blik in situ incubations should be done at 0·5 m intervals in the upper 2 or 3 m.     

Effects of powdery mildew on cucumber yields, and its chemical control

Effects of Sphaerotheca fuliginea were deduced from experiments in which cucumber foliage, exposed to naturally occurring inocula, was fungicidally sprayed. Yields increased as the incidence of mildew decreased but the relation was sometimes affected by differing amounts of phytotoxicity. The fungitoxicity and phytotoxicity of a range of chemicals applied as high-volume sprays, fumigants or soil drenches, were tested. Non-phytotoxic concentrations of some fungicides adequately protected cucumber foliage from subsequent attack but were often insufficient to eradicate established infections, the increased amounts needed for this being phytotoxic. Powdery mildew was controlled more effectively when drazoxolon and quinomethionate were applied as sprays with 0·1 and 0·02% a.i. respectively, than when used as fumigants at 2–4 and 1·3 g/28·3 m³(= 1000 ft³). Sprays of drazoxolon (0·1% a.i.) increased yields from 7·0 to 11·2 kg/ plant during 8 weeks picking and in another experiment weights of fruit were increased by applying quinomethionate (0·02% a.i.) from 10·8 to 52·2 kg/plot of four plants. In the former experiment appreciable amounts of phytotoxicity and infection were tolerated before yields decreased but, in the latter, yields were inversely proportional to numbers of dead leaves which were directly related to the incidence of mildew. Spraying with quinomethionate, or drazoxolon plus tetradifon (0·012% a.i.) increased numbers of female flowers from 59·5 in the mildewed controls to 93·0 and 142·8 per plant respectively, and of these 17·6, 32·8 and 16·2 % subsequently produced marketable cucumbers. In addition to decreasing yields, severe S. fuliginea infestations were associated with increased numbers of misshapen cucumbers. Increasing sulphur concentrations from 0·5 to 1·0g/28·3m³during nightly fumigations significantly decreased mildew incidence and increased (a) yields from 35·8 to 52·9 kg during 5 weeks picking, and (b) the proportion of high-quality cucumbers from 49 to 63 %. Similar trends occurred in another trial where sulphur concentrations were increased from 0·75 to 1·0 g/28·3 m³, but comparisons with fortnightly sprays of 0·1% drazoxolon suggest that these sulphur concentrations caused some damage.     

Reasons for the decrease in viral hepatitis morbidity in Orekhovo-Zueve]

Factors of action on the epidemic process in viral hepatitis in Orekhovo-Zuevo leading to a sharp reduction of the incidence of this disease (which before failed to differ from the mean level in the USSR) -- from 154.0 per 100 thousand residents in 1970 to 36.5 per 100 thousand residents in 1975 are considered from the point of view of discussion of the work of Gromashevsky and Birinboim (ZMEI No. 11, 1976). The decisive significance of measures directed to reduction of the incidence of intestinal infections and gamma-globulin vaccinations is refuted. There was revealed a direct 100% correlation between the incidence of positive benzidine tests for blood contamination of medical instruments and the changes in the viral hepatitis morbidity. Planned measures directed to the elimination of factors of parenteral transmission of the infection carried out intensively from 1970 led to reduction of the incidence of viral hepatitis.     

Selective Hepatitis B Virus Vaccination Has Reduced Hepatitis B Virus Transmission in The Netherlands

Background & Aims

In the Netherlands, a selective hepatitis B virus (HBV) vaccination programme started in 2002 for men having sex with men, drug users, commercial sex workers and heterosexuals with frequent partner changes. We assessed the programme''s effectiveness to guide policy on HBV prevention.

Methods

We analysed reports of acute HBV infection in the Netherlands between 2004 and 2010 requesting serum from patients for HBV-genome S- and C-region sequencing. We used coalescence analyses to assess genetic diversity of nonimported genotype-A cases over time.

Results

1687 patients with acute HBV infection were reported between 2004 and 2010. The incidence of reported acute HBV infection decreased from 1.8 to 1.2 per 100,000 inhabitants, mostly due to a reduction in the number of cases in men who have sex with men. Men were overrepresented among cases with an unknown route of transmission, especially among genotype A2 cases mainly associated with transmission through male homosexual contact. The genetic diversity of nonimported genotype-A strains obtained from men who have sex with men decreased from 2006 onwards, suggesting HBV incidence in this group decreased.

Conclusions

The selective HBV-vaccination programme for behavioural high-risk groups very likely reduced the incidence of HBV infection in the Netherlands mainly by preventing HBV infections in men who have sex with men. A considerable proportion of cases in men who did not report risk behaviour was probably acquired through homosexual contact. Our findings support continuation of the programme, and adopting similar approaches in other countries where HBV transmission is focused in high-risk adults.     

The effect on grain yield of adult plant resistance to mildew in oats

Lines were selected from progeny of the crosses Maldwyn × Milford and Maldwyn × Sun II which consistently exhibited small and large amounts of mildew in similar situations. These are referred to as ‘low’ and ‘high’ mildew lines respectively. In small plot field trials conducted in 1971, 1972 and 1973 the low mildew lines produced substantially more grain each year compared with the high mildew lines in plots where mildew was allowed to develop normally. In plots which were kept comparatively free from infection by spraying with tridemorph, both low and high mildew lines gave similar yield. When the unsprayed plots were compared with the sprayed plots the low mildew lines invariably showed very small losses in grain yield and the high mildew lines usually very large losses. This same trend was evident also in the parent cultivars in 1972. Maldwyn, with only 7·9% mildew cover in the unsprayed plots due to its resistance, suffered a decrease of only 9·2% in grain yield compared with losses of 17·1 and 20·3% in the more susceptible cultivars Milford and Sun II. Certain lines and cultivars sustained heavy levels of mildew without corresponding loss of grain yield, i.e. showed low sensitivity to the disease. The importance of combining low sensitivity (or tolerance) with adult plant resistance to mildew is discussed.     

SOME PHYSICAL PROPERTIES OF BOVINE ADRENAL MEDULLARY DOPAMINE β-HYDROXYLASE

(1) Dopamine, β-hydroxylase (EC 1.14.2.1) was purified from bovine adrenal medullae according to the method of Foldes , Jeffrey , Preston and Austin (1972). (2) The kinetics, pH optimum and the effect of Cu²⁺ ions on the purified enzyme were found to resemble those of the enzyme isolated by more involved procedures. (3) The sedimentation coefficient (s₂₀) of the homogeneous enzyme in 10 mM-phosphate buffer, pH 7·2, containing 0·1 M-NaCI was found to be 10·24 ± 0·12 (S.E.M. of 10 determinations). (4) The effect of pH on the mol. wt. of the enzyme was investigated and no large deviation was found from the native mol. wt. of 290,000 in the pH range 3·9 to 11·1. (5) The amino acid analysis of dopamine β-hydroxylase is presented, and is contrasted to that of chromogranin A purified from the same chromaffin granule lysate. (6) Treatment with either 8 M-urea or 0·1% (w/v) sodium dodecyl sulphate was found to dissociate the enzyme into three similar, non-active subunits, each of mol. wt. of the order of 100,000.     

Immunisation of neonates at high risk of hepatitis B in England and Wales: national surveillance.

The results of a voluntary programme of immunisation against hepatitis B in neonates at high risk (mother being positive for hepatitis B surface antigen and without hepatitis B e antibody or having had acute hepatitis B late in pregnancy) are reported. The programme was offered in England and Wales from November 1982. Passive immunisation alone was available in the first six months of life until 1985, after which infants received passive and active immunisation from birth; in addition, some infants received passive immunisation for six months followed by a course of hepatitis B vaccine. All but a few infants received the first immunising dose within 48 hours after birth. Blood samples for analysing markers of hepatitis B virus were available at 1 year from 147 of the 223 infants given passive immunisation, 54 of the 72 given passive followed by active immunisation, and 102 of the 155 given passive and active immunisation at birth. At 1 year 11 of the 127 (9%) infants given four or more doses of specific hepatitis B immunoglobulin were positive for hepatitis B surface antigen compared with four of the 20 given three or fewer doses; 11 had levels of hepatitis B surface antibody greater than 50 IU/l. Only one of the 54 infants given passive then active immunisation was positive for hepatitis B surface antigen at 1 year and four infants had low (less than or equal to 50 IU/l) levels of hepatitis B surface antibody. Four of the 102 infants who received passive and active immunisation at birth were positive for hepatitis B surface antigen. Two had received the fill course of vaccine, whereas in the other two vaccination was incomplete or unstated. In 79 of the 89 infants who received a complete course of vaccination the level of hepatitis B surface antibody was known, and 70 had levels at 1 year greater than 100 IU/1. Reactions to immunisation were not severe at any age. The incidence of side effects was 8% for the immunoglobulin, 11% for the vaccine, and 9% when immunoglobulin and vaccine were given together. Wider collaboration in the programme is requested.     

Study of Childhood Urinary Tract Infection in General Practice

A study of bacteriuria was conducted among 426 of the 436 children under the age of 13 in a general practice in north-west London. Three girls and one boy were found to have asymptomatic bacteriuria, and a further girl with bacteriuria presented with abdominal pain and fever. The calculated incidence of urinary tract infection was 1·4% per annum. Most of the childhood urinary infections in this practice occurred before the age of 5 years, and the incidence of significant bacteriuria in this age group was 4·9% per annum. Five other children (four girls and one boy) in the practice were known to have had proved urinary tract infection. Of the total of eight children known to have had significant bacteriuria and investigated radiologically, three girls and two boys had radiological abnormalities in the urinary tract.Pyuria and proteinuria did not prove to be useful in the prediction of asymptomatic bacteriuria. Urinary tract infection with renal tract abnormality was found in this practice to be at least five times as common as diabetes in childhood.     

Organisation and results of the cervical cytology screening programme in British Columbia, 1955-85

A screening programme to detect preinvasive carcinoma of the cervix was started in British Columbia in 1949. Since 1970 the number of women who have been screened at least once has been maintained at about 85% of the population at risk. More than 500 000 cervical smears are being examined each year in the central laboratory. There has been an appreciable increase in the number of cases and rates of carcinoma in situ seen since 1970, particularly in women between 20 and 30 years of age. Since the programme started over 26 000 cases of squamous carcinoma in situ have been detected and treated. The incidence of clinically invasive squamous carcinoma of the cervix has fallen by 78% during the period under review, and mortality from squamous carcinoma of the cervix has fallen by 72%. A colposcopy programme, introduced throughout British Columbia over the past 12 years, has been important in reducing the problems of managing preinvasive lesions, particularly in younger women.It is concluded that the reduction in morbidity and mortality from invasive squamous cancer of the cervix in British Columbia over the past 30 years is directly attributable to the province wide screening programme and that a large potential increase in invasive cervical cancer rates among younger women is being prevented.