Parity and breast cancer.

Data from the 1961 and 1971 Censuses in England and Wales were used to estimate the age distribution of women of various parities in 1976. Applying the age-specific incidences of breast cancer for women in England and Wales in 1975 gave the expected number of cases of that disease in 1976 and permitted an estimate of the mean age at diagnosis of breast cancer at each parity. This showed that the highest average age for breast cancer occurred in nulliparous women (65.9 years) and that the lowest age for the disease occurred in women who had borne two children (60.4 years). The figures obtained were similar to those reported in a separate study of women treated in Birmingham. The results of that study, however, may have been due to the age distribution in the population of women by parity, rather than any direct influence of parity on the speed of growth of breast cancer.     

The seasonal pattern of sheep blowfly strike in England and Wales

Abstract. Information on 4049 cases of sheep blowfly strike on 495 farms in England and Wales was gathered in a longitudinal survey conducted in 1991. The breech was the most commonly infested area, accounting for 70.9% of all strikes recorded. Body strikes accounted for 19.7% and foot strikes 11.4% of all strikes. Early in the season the incidences of both breech and body strikes were higher in ewes than in lambs, but from June to October lamb strikes predominated. The incidence of foot strike was greater in ewes than lambs throughout the year, with a peak incidence in September. Regional differences in strike incidence were evident; the highest overall incidences were recorded in the southern regions of England where peak incidence occurred earlier in the year. The highest monthly incidence risk was recorded in August in the south-east of England where there were 14.2 strikes per 1000 lambs and 4.0 strikes per 1000 ewes at risk. The importance of faecal soiling and ambient temperature are discussed.     

Regional variations in the incidence of upper urinary tract stones in England and Wales.

Data from the Hospital In-patient Enquiry were used to define the regional patterns of hospital discharge rates for upper urinary tract stones and renal colic in England and Wales. By combining the rates for stones and colic, and by distinguishing emergency from planned admissions, the biases produced by repeated admissions of the same patient and by regional variations in diagnosis and coding may be reduced. There are regional variations in incidence of upper urinary tract stones: Wales and the southern regions of England have a generally higher incidence than northern regions. These variations may be related to regional differences in diet or occupation; or they may partly depend on associations between stone incidence and atmospheric temperature, exposure to ultraviolet irradiation, and hardness of drinking water.     

Tuberculosis Incidence Correlates with Sunshine: An Ecological 28-Year Time Series Study

Background

Birmingham is the largest UK city after London, and central Birmingham has an annual tuberculosis incidence of 80 per 100,000. We examined seasonality and sunlight as drivers of tuberculosis incidence. Hours of sunshine are seasonal, sunshine exposure is necessary for the production of vitamin D by the body and vitamin D plays a role in the host response to tuberculosis.

Methods

We performed an ecological study that examined tuberculosis incidence in Birmingham from Dec 1981 to Nov 2009, using publicly-available data from statutory tuberculosis notifications, and related this to the seasons and hours of sunshine (UK Meteorological Office data) using unmeasured component models.

Results

There were 9,739 tuberculosis cases over the study period. There was strong evidence for seasonality, with notifications being 24.1% higher in summer than winter (p<0.001). Winter dips in sunshine correlated with peaks in tuberculosis incidence six months later (4.7% increase in incidence for each 100 hours decrease in sunshine, p<0.001).

Discussion and Conclusion

A potential mechanism for these associations includes decreased vitamin D levels with consequent impaired host defence arising from reduced sunshine exposure in winter. This is the longest time series of any published study and our use of statutory notifications means this data is essentially complete. We cannot, however, exclude the possibility that another factor closely correlated with the seasons, other than sunshine, is responsible. Furthermore, exposure to sunlight depends not only on total hours of sunshine but also on multiple individual factors. Our results should therefore be considered hypothesis-generating. Confirmation of a potential causal relationship between winter vitamin D deficiency and summer peaks in tuberculosis incidence would require a randomized-controlled trial of the effect of vitamin D supplementation on future tuberculosis incidence.     

Relationships between airborne fungal spore concentration of <Emphasis Type="Italic">Cladosporium</Emphasis> and the summer climate at two sites in Britain

Cladosporium conidia have been shown to be important aeroallergens in many regions throughout the world, but annual spore concentrations vary considerably between years. Understanding these annual fluctuations may be of value in the clinical management of allergies. This study investigates the number of days in summer when spore concentration exceeds the allergenic threshold in relation to regional temperature and precipitation at two sites in England and Wales over 27 years. Results indicate that number of days in summer when the Cladosporium spores are above the allergenic concentration is positively correlated with regional temperature and negatively correlated with precipitation for both sites over the study period. Further analysis used a winter North Atlantic Oscillation index to explore the potential for long-range forecasting of the aeroallergen. For both spore measurement sites, a positive correlation exists between the winter North Atlantic Oscillation index and the number of days in summer above the allergenic threshold for Cladosporium spore concentration.     

Adenocarcinoma of the uterine cervix compared with squamous cell carcinoma: a 12-year study in Southampton and South-west Hampshire

In a 12-year study of the population of Southampton and South-west Hampshire (SSWH), there was no rise or fall in the incidence of adenocarcinoma of the uterine cervix, although the incidence of squamous cell carcinoma fell from 14 to 7.2 per 100000 women years and the overall fall in age-adjusted incidence of cervical carcinoma was commensurate with that of England and Wales. The majority (59%) of adenocarcinomas were seen in women aged less than 50, supporting the concept of a higher risk in young women. Screen-detected carcinomas accounted for 50% of adenocarcinomas and 41% of squamous cell carcinomas in women aged 20-64 (the difference was not significant). There were more screen-detected adenocarcinomas of less than 3 mm depth of invasion and 7 mm lateral extension during the third period of the study (1991-1993). The results are consistent with reports of an increased risk of cervical cancer in women born since 1940, and lesser effectiveness of screening in preventing adenocarcinoma compared with squamous cell carcinoma. High prevalence of early screen-detected carcinomas may have been a factor in recent reports of increased incidence of adenocarcinoma.     

Association between incidence of non-Hodgkin's lymphoma and solar ultraviolet radiation in England and Wales.

OBJECTIVES--To examine whether the incidence of non-Hodgkin''s lymphoma in different areas of England and Wales is associated with levels of solar ultraviolet radiation. DESIGN--Geographically based study examining the association between incidence of non-Hodgkin''s lymphoma and estimated levels of solar ultraviolet radiation, controlling for social class and employment in agriculture. SETTING--59 counties in England and Wales. SUBJECTS--All registered cases of non-Hodgkin''s lymphoma during the period 1968-85. MAIN OUTCOME MEASURE--Age and sex adjusted odds ratio for non-Hodgkin''s lymphoma in each county. RESULTS--Incidence of non-Hodgkin''s lymphoma was significantly associated with solar ultraviolet radiation levels (P < 0.001), even after social class and employment in agriculture were controlled for (P = 0.004). In a comparison of counties in the highest and lowest quarters of solar ultraviolet radiation, the relative risk of non-Hodgkin''s lymphoma was 1.27 (95% confidence interval 1.24 to 1.29), rising to 1.34 (1.32 to 1.37) after adjustment for social class and employment in agriculture. CONCLUSIONS--The incidence of non-Hodgkin''s lymphoma in different areas of England and Wales is positively associated with levels of solar ultraviolet radiation. These results are consistent with the hypothesis that exposure to solar ultraviolet radiation increases the risk of non-Hodgkin''s lymphoma.     

The increasing incidence of melanoma.

A study of our hospital records has confirmed a striking increase in the number of melanoma cases. An examination of the New York State statistics demonstrates a 202 percent increase in the case rate from 1950 to 1971. The Connecticut statistics extending from 1935 to 1972 show an age-adjusted incidence rate increase of more than 300 percent for men, and more than 600 percent for women. An increased frequency of melanoma has been reported also for Texas, Canada, Australia, England and Wales. The available information on melanoma deaths and mortality rates fails to suggest that these lesions are biologically less significant than those so designated in the past. There has been no change in preferential sites of melanoma location in either sex, despite the increased incidence of the disease reported from these many geographic areas. The cause of the increased incidence remains obscure.     

Congenital anterior abdominal wall defects in England and Wales 1987-93: retrospective analysis of OPCS data.

OBJECTIVES: Analysis of incidence and characteristics of congenital abdominal wall defects, with special reference to the differences between the incidence of gastroschisis and exomphalos (omphalocele). DESIGN: Retrospective analysis using data from the Office of Population Censuses and Surveys (recoded to differentiate exomphalos and gastroschisis) and the National Congenital Malformation Notification Scheme. SETTING: England and Wales, 1987 to 1993. RESULTS: 1043 congenital anterior abdominal wall defects were notified within the seven year study period. Of these, 539 were classified as gastroschisis, 448 as exomphalos, 19 as "prune belly syndrome," and 37 as "unclassified." Gastroschisis doubled in incidence from 0.65 in 1987 to 1.35 per 10,000 total births in 1991, with little further change; the incidence of exomphalos decreased from 1.13 to 0.77 per 10000 births. The overall incidence of notified congenital abdominal wall defects was 2.15 per 10000 total births. Gastroschisis was associated with a lower overall maternal age than exomphalos and with a significantly lower proportion of additional reported congenital malformations (5.0%) than in the cohort with exomphalos (27.4%) (odds ratio 0.14, 95% confidence interval 0.09 to 0.22; P < 0.001). The sex ratio of the two cohorts was the same. The incidence of gastroschisis and exomphalos was higher in the northern regions of England than in the south east of the country. CONCLUSIONS: The national congenital malformation notification system showed an increasing trend in the incidence of fetuses born with gastroschisis and a progressive decreasing incidence of exomphalos in England and Wales between 1987 and 1993. Although the reasons for this are likely to be multifactorial, a true differential change seems likely. The observed increase in incidence of gastroschisis relative to exomphalos and the differentiation in maternal age have implications for resource management within the NHS and warrant further epidemiological monitoring. Regional differences may be due to a dietary or environmental factor, which requires further study.     

Epidemiology of chickenpox in England and Wales, 1967-85

Routine sources of data on chickenpox morbidity and mortality in England and Wales were reviewed for 1967-85. Only two epidemics occurred, one in 1967 and one in 1980, both of which were immediately followed by two to three years of low incidence. The age distribution of the disease appears to be changing, with more cases now being reported in children aged 0-4 years. The number of deaths in adults have, however, increased, particularly those deaths that are associated with pneumonia and immunosuppression. At present in England and Wales more deaths are attributed to chickenpox than to whooping cough and mumps.Widespread use of selective immunisation against chickenpox might be justified in England and Wales, but before routine immunisation of the child population can be considered special surveys to determine the incidence and severity of chickenpox and the effect of the vaccine on the subsequent development of herpes zoster are needed as well as cost-benefit studies of immunisation.     

Epidemiologic data of malignant melanoma in Osijek-Baranya County (Eastern Croatia) during the period of 2000-2008

During the past several decades there has been a substantial increase in the incidence of malignant melanoma worldwide. The highest incidences were reported in New Zealand and Australia. In Europe the northern countries generally have a higher incidence. The aim of this retrospective study was to provide the incidence and mortality for all patients with malignant melanoma diagnosed in Osijek-Baranya County, Eastern Croatia, during 2000-2008. In the past 30 years in the Republic of Croatia the incidence of melanoma increased by 337%. During the period of 2000-2006 in Osijek-Baranja County, the incidence of melanoma increased by 13%. The incidence of melanoma increases with age, but in past decades melanoma is more often diagnosed in people aged 25-40. The mortality between 2000 and 2008 increased by 18%. The incidence of melanoma generally increases equally in men and women. The most common localization of skin melanoma in males was trunk and in females the lower extremities. Presently, in Osijek-Baranya County melanoma is 15th on the list of malignant tumors and represent 2% of all malignant tumors. In New Zealand, Australia and European northern countries mortality is reduced, as result of earlier diagnosis and education of risk groups. Unfortunately, in Osijek-Baranya County, in a comparison with these countries, the mortality is higher although incidence is the same or lower.     

The study of cutaneous melanomas in Camargue-type gray-skinned horses (2): epidemiological survey

An epidemiological survey was made on cutaneous melanomas occurring in Camargue-type, gray-skinned horses in southern France. The population investigated was composed of 264 horses, which were selected from the Camargue horse stud registry and were allowed to be examined by the owners. The presence of tumors was inspected macroscopically according to the standardized protocols of veterinary medicine specialists, and some tumors were subjected to macroscopic histopathological examination. The results indicated that: 1) the prevalence of melanomas in the overall population was 31.4%; 2) the odds ratio was obtained for an age class of 5-9 years, in which most melanomas were presumed to occur; 3) the incidence of melanomas was significantly correlated with age, giving a prevalence of 67% at ages > 15 years; 4) the size and number of tumorous lesions were significantly related to age; 5) little correlation was observed between melanoma incidence and gender; and 6) the most frequently occurring body site of these tumors was underneath the tail. Because of their frequent occurrence in shaded body regions, sun exposure was not likely to be a risk factor for melanoma formation in these horses. In view of the slightly darker skin pigmentation in these horses at younger ages, the unique characteristics of their melanocytes may be associated with melanoma formation.     

Seasonal variation and time trends in childhood asthma in England and Wales 1975-81.

In England and Wales hospital admissions for childhood asthma almost trebled over the period 1975-81. This may have reflected a true increase in the incidence of acute asthma, a swing from primary to hospital care, or both. The trend was not due to a change in diagnostic fashion. Monthly admissions showed a pronounced seasonal variation with fewest admissions in winter, rising in spring and early summer to peak in the autumn. A deep admission trough was present in August. The monthly admission profile was very similar throughout England and Wales, suggesting that major "trigger" factors were responsible.     

Nutrients, algae and grazers in some British streams of contrasting pH

1. The relationship between algal biomass accumulation, invertebrate colonization, and stream-water pH was investigated in seven streams in three regions of England and Wales. Possible nutrient limitation of algal production at all sites was examined with diffusion substrata. 2. Periphyton assemblages on experimental substrata after 30 days were dominated by diatoms, notably Eunotia spp., at all sites. Algal pigment concentration (chlorophyll a and phaeopigments) was not correlated with stream-water pH, and mean concentrations on control (unenriched) substrata ranged from 0.08 to 1.94 μg cm^?2. 3. The growth response of periphyton to nutrient additions was site specific. Algal production was stimulated by nutrient additions at sites in the English Lake District and Llyn Brianne (south-west Wales), but not in the Ashdown Forest (southern England). 4. Larval Chironomidae were the main invertebrates retrieved from substrata at all sites. Within all three regions, larval abundance was positively related to algal pigment concentration (biomass). Abundance of the stonefly Nemurella pictetii was also positively correlated with algal biomass at the one site where it occurred. 5. Our results indicate that epilithic algal production in small, oligotrophic streams is unlikely to be determined primarily by pH. Neither do they support the view that an absence of grazers from acid streams is necessarily due to an inadequate food supply.     

Wartime evacuation and mortality from childhood leukaemia in England and Wales in 1945-9.

OBJECTIVE--To discover whether the wartime government evacuation of children from London and other population centres to rural districts was associated with any increase in childhood leukaemia. DESIGN--Observational study of mortality from leukaemia among the childhood population of England and Wales in relation to the unique population movements during the second world war. The 476 rural districts of England and Wales were ranked according to the ratio of government evacuees (two thirds of them children) to local children in September 1941. The districts were divided into three categories, each with similar numbers of children in 1947 but with different ratios of evacuees to local children ("low," "intermediate," "high"). Mortality from childhood leukaemia was examined in these three rural categories in 1945-9. Urban areas were also examined according to their exposure to evacuees. SETTING--Local authority areas of England and Wales. SUBJECTS--Children aged under 15. RESULTS--47% excess of leukaemia at ages 0-14 years occurred in 1945-9 in the rural "high" category for evacuees relative to the "low" category, with a significant trend across the three categories. There were increases in both the 0-4 and 5-14 year age groups, but these were larger in the older age group. Rates 25% lower than average occurred in rural areas with few evacuees. CONCLUSION--These findings suggest that wartime evacuation increased the incidence of childhood leukaemia in rural areas and that other forms of population mixing may have contributed to the increases in past decades. Overall, they add to the appreciable evidence for an infective basis in childhood leukaemia.     

Regional trends in coastal wintering waders in Britain

Regional trends in the populations of waders wintering largely on estuaries were analysed using data collected by the Wetland Bird Survey between the winters of 1969/70 and 1995/96 to assess whether trends seen at the national level were repeated across regions of Britain. Not all were. Over this period, the numbers of seven of the 12 species studied increased in south and southeast England, but remained static or declined in southwest England and south Wales. Possible explanations for this are proposed. Increases in the number of Curlews Numenius arquata in the north and northeast of Scotland occurred after 1981/82, when the species stopped being a legal quarry species. A rapid decline in Oystercatcher Haematopus ostralegus and Knot Calidris canutus numbers in east England after 1988/89 may be linked to a change in the Wash shell-fisheries. Warmer winters may be making it less essential for birds to winter in the milder west of Britain. In two pairs of regions, northeast and southeast Scotland, and in northwest England/north Wales and northeast England, waders showed similar long-term population changes. The long-term population trends of Oystercatchers in the different regions correlate to those of Ringed Plovers Charadrius hiaticula and Knot, while those of Ringed Plovers are very similar to those of Bar-tailed Godwits Limosa lapponica. In some regions of Britain, the population trends of some species varied a lot between sites, a factor that is an important consideration when determining the size and geographical position of regions for future regional indexing. The present separation of regions based on water catchments and geography has given a useful insight into population changes at a finer spatial scale but it could be improved further with added biological input.     

The Study of Cutaneous Melanomas in Camargue‐Type Gray‐Skinned Horses (2): Epidemiological Survey

An epidemiological survey was made on cutaneous melanomas occurring in Camargue‐type, gray‐skinned horses in southern France. The population investigated was composed of 264 horses, which were selected from the Camargue horse stud registry and were allowed to be examined by the owners. The presence of tumors was inspected macroscopically according to the standardized protocols of veterinary medicine specialists, and some tumors were subjected to macroscopic histopathological examination. The results indicated that: 1) the prevalence of melanomas in the overall population was 31.4%; 2) the odds ratio was obtained for an age class of 5–9 years, in which most melanomas were presumed to occur; 3) the incidence of melanomas was significantly correlated with age, giving a prevalence of 67% at ages> 15 years; 4) the size and number of tumorous lesions were significantly related to age; 5) little correlation was observed between melanoma incidence and gender; and 6) the most frequently occurring body site of these tumors was underneath the tail. Because of their frequent occurrence in shaded body regions, sun exposure was not likely to be a risk factor for melanoma formation in these horses. In view of the slightly darker skin pigmentation in these horses at younger ages, the unique characteristics of their melanocytes may be associated with melanoma formation.     

Invasive cancer of the cervix in women with mild dyskaryosis followed up cytologically.

Mildly dyskaryotic smears are common, and women with such results are often followed up with further cervical smear tests. An important consideration in evaluating this practice would be the annual incidence of invasive cervical cancer. A reanalysis of five previous studies of the cytological follow up of women with mildly abnormal smear test results was undertaken to calculate this incidence. The annual incidence of invasive cancer in these women ranged from 0 to 420 per 100,000 women years. The large studies providing the most precise estimates had annual rates of 143 to 420 per 100,000 women years. This is 16 to 47 times greater than in women aged 15-34 years in England and Wales. The average rate was 208 per 100,000 women years. Women with mild dyskaryosis are at high risk of developing invasive cervical cancer despite cytological follow up. A full appraisal of the costs and benefits of colposcopy in this situation is urgently required.     

Randomised trial of high doses of stilboestrol and ethisterone in pregnancy: long-term follow-up of mothers.

In 1950 a trial was set up to evaluate the effects of large doses of stilboestrol and ethisterone on rates of fetal loss in pregnant diabetic women. Eighty women were allocated at random to receive the hormonal treatment and 76 to receive inactive tablets of identical appearance. At follow-up 27 years later, information was obtained about 97% of the women, all but four being traced. All respondents were unaware of who had received hormones. The overall mortality was 4.5 times that of women of comparable age in England and Wales, most deaths being from complications of diabetes. More tumours, mainly benign, of the reproductive tract were reported in the hormone-exposed than the non-exposed group (14 (18%) and two (3%) respectively). Four cases of malignant breast disease were reported in the hormone-exposed women and none in the non-exposed. These findings support other evidence linking oestrogen treatment and breast cancer and suggesting that the latent period before the tumour becomes clinically apparent may be 15 years or longer.     

Spatiotemporal Dynamics of Hand-Foot-Mouth Disease and Its Relationship with Meteorological Factors in Jiangsu Province,China

Hand, foot and mouth disease (HFMD) is an important public health issue in mainland China, including Jiangsu Province. The main purpose of this study was to depict the epidemiological characteristics of HFMD and evaluate the effects of meteorological variables on its dynamics via spatiotemporal analytic methods, which is essential for formulating scientific and effective prevention and control strategies and measures. In total, 497,910 cases of HFMD occurred in the 2009-2013 period, with an average annual incidence of 126.3 per 100,000 in Jiangsu. Out of these, 87.7% were under 5 years old with a male-to-female incidence ratio of 1.4. The dominant pathogens of the laboratory-confirmed cases were EV71 and CoxA16, accounting for 44.8% and 30.6% of all cases, respectively. Two incidence peaks were observed in each year, the higher occurring between April and June, the lower between November and December. The incidence ranged between 16.8 and 233.5 per 100,000 at the county level. The incidence in the South of the province was generally higher than that in the northern regions. The most likely spatiotemporal cluster detected by space–time scan analysis occurred in May-June of 2012 in the southern region. Average temperature and rainfall were positively correlated with HFMD incidence, while the number of days with rainfall ≥ 0.1mm, low temperature, high temperature and hours of sunshine were negatively related. Particularly, relative humidity had no relationship. In conclusion, the prevalence of HFMD in Jiangsu Province has an obvious feature of seasonality. The etiological composition changed dynamically and might be a latent driving force for the temporal variation of the incidence of HFMD. A moderately warm environment promotes the transmission of the HFMD viruses, while particularly cold and hot climate conditions restrain their transmission.