Nephroblastoma: treatment during 1970-3 and the effect on survival of inclusion in the first MRC trial.

In 1970-3 313 children were diagnosed as having nephroblastoma in Great Britain. From the start of the first Medical Research Council nephroblastoma study in October 1970 until the end of 1973, 98 children (57% of all eligible children) were included in the trial. Of the 313 children, 288 (92%) had a nephrectomy, 248 (79%) received a course of radiotherapy, and 267 (85%) were given at least four days'' chemotherapy. The three-year survival rate was 58%; the rate among children in the trial (77%) was significantly better than that among children who were eligible for the trial but not included (58%). Children who had nephrectomies at specialised children''s and teaching hospitals had a higher survival rate than those treated elsewhere. All children with nephroblastoma should be treated according to well-defined protocols which take into account the age of the child and the stage of the tumour and include a full course of maintenance chemotherapy.     

Respiratory distress syndrome in infants of Cardiff residents during 1965-75.

The incidence of respiratory distress syndrome (RDS) among singleton infants of Cardiff residents was greater during 1970-4 than in the preceding five years. This was consistent with changes in the distribution of gestational age and birth weight. Case fatality rates among infants with RDS fell only slightly during the period examined. Detailed examination of secular trends during 1965-75 suggested (a) that increased use of elective delivery without assessment of pulmonary maturity increases the risk of RDS, and (b) that innovations in the management of RDS during the early 1970s cannot be assumed to have had widespread impact on case fatality rates.     

Rh isoimmunization,Manitoba, 1963-75.

The number of Rh-isoimmunized pregnancies in Manitoba has been reduced from 223 and 228 in the years ending Oct. 31, 1963 and 1964 to 60 and 62 in the years ending Oct. 31, 1974 and 1975. The number per 1000 total births in the same years has decreased from 10.0 and 10.6 to 3.4 and 3.5 Perinatal mortality rates in those years decreased from 13.8 amd 15.7% to 0 and 2.2%, respectively. The number of perinatal deaths has been reduced from 55 in the first 2 years reported to 1 in the last 2 years. Among the 121 isoimmunized women pregnant in the 2-year period ending Oct. 31, 1975, isoimmunization was due to failure to give Rh immune globulin after delivery in 33 and failure to give it during pregnancy in 48. Of the remaining 40, 37 were immunized before Rh immune globulin became available. Complete prevention of Rh isoimmunization and therefore of all perinatal deaths from Rh erythroblastosis can only be achieved through universal Rh testing prenatally and immediately after delivery, and institution of an antenatal Rh prophylaxis program.     

Patterns of first-year survival among infants with selected congenital anomalies in Texas, 1995-1997.

BACKGROUND: Few registry-based studies have investigated survival among infants with congenital anomalies. We conducted a registry-based study to examine patterns and probability of survival during the first year of life among infants with selected congenital anomalies. METHODS: Data from the Texas Birth Defects Monitoring Division were merged with linked birth-infant death files for 2,774 infants born January 1, 1995 to December 31, 1997, with at least 1 of 23 common anomalies. Deaths before the first birthday were assessed from infant death files. Kaplan-Meier was used to estimate first-year survival; first-year survival was assessed for specific anomalies and by the number of life-threatening anomalies. RESULTS: Overall, 80.8% of infants with these 23 anomalies survived the first year of life. We observed the highest survival rates for infants with gastroschisis (92.9%, 95% CI = 86.8, 96.3), trisomy 21 (92.3%, 95% CI = 89.5, 94.4) or cleft lip with or without cleft palate (87.6%, 95% CI = 84.0, 90.5). Infants with intermediate survival rates included those with microcephaly (79.7%; 95% CI = 73.6, 84.6), tetralogy of Fallot (75.0%; 95% CI = 65.5, 82.2), or with diaphragmatic hernia (72.8%; 95% CI = 61.8, 81.2). As expected, all infants with anencephaly and almost all infants with trisomy 13 or trisomy 18 died during the first year of life. First-year survival declined as the number of co-occurring life-threatening anomalies increased. CONCLUSIONS: Overall, first-year survival for infants with congenital anomalies was high. Additional population-based studies are needed to quantify improvements in first-year survival.     

Knowledge and experience of young people regarding drug abuse, 1969-89.

OBJECTIVE--To establish a baseline of knowledge to plan an effective health education programme in schools. The survey was repeated at five year intervals from 1969 to 1989. DESIGN--To preserve consistency, the same anonymous questionnaire, which was confidential to the research workers, was used throughout. SETTING--Three secondary schools in Wolverhampton in different parts of the town and representing different social groups. SUBJECTS--Sample sizes ranged from 471 fourth year pupils (aged 14 to 15) in 1969 to 540 in 1984 and 380 in 1989, the decrease being due mainly to the falling birth rate. There were slightly more girls than boys, and the pupils covered the whole range of academic ability. RESULTS--Over the 20 years the proportion of pupils who knew someone taking drugs more than doubled from 15% (71) to 31% (117) and the proportion who had been offered drugs almost quadrupled from 5% (24) to 19% (72). The changes taking place over the past five years were characterised by an increased knowledge about drugs and the first mention of "crack," a purified form of cocaine, and "ecstasy" (methylenedioxymethamphetamine). Peer influence continued to be given as the prime reason for taking drugs. Over the 20 years, though less often mentioned in 1989, television and newspapers remained the most common source of information. CONCLUSIONS--These results suggest the need for responsible coverage by the mass media and for more effective health and social education programmes to prevent the spread of drug misuse.     

Knowledge and experience of young people regarding drug misuse, 1969-94.

OBJECTIVE--To monitor young people''s knowledge and experience of illicit drugs between 1969 and 1994 at intervals of five years. DESIGN--The same anonymously completed questionnaire was used throughout. SETTING--Three Wolverhampton secondary schools representing three different socioeconomic groups. SUBJECTS--392 pupils aged 14 to 15 completed the questionnaire in 1994. Previous sample sizes were 471 in 1969, 523 in 1974, 648 in 1979, 540 in 1984, and 380 in 1989. MAIN OUTCOME MEASURES--Self reported levels of knowledge and experience of illicit drugs. RESULTS--Over 25 years the proportion of pupils who knew someone taking drugs more than quadrupled from 15% (71/471) to 65% (254/392), and the proportion who had been offered drugs increased ninefold from 5% (24) to 45% (175). Both of these proportions more than doubled over the past five years. In 1994 the proportions of pupils mentioning "ecstasy" (methylenedioxymethamphetamine), amphetamines, and crack cocaine increased significantly (P < 0.01) and the proportion mentioning opiates decreased significantly (P < 0.01). "Poppers" (amyl nitrite) were mentioned for the first time. "To feel big, to show off, look grown up" has continued to be the main perceived reason for taking drugs. Television has continued to be the main source of information. CONCLUSIONS--In the past five years in particular young people''s exposure to illicit drugs has increased dramatically. Despite more education about drugs, pupil''s knowledge remains limited. Social pressures remain the first perceived reason for taking drugs. The media have a responsibility not to glamorise drugs.