Holger Hansen

Fruit and vegetable consumption in the prevention of oesophageal and cardia cancers.

The incidence of adenocarcinoma of the oesophagus has increased rapidly in recent decades. In order to appreciate the potential for prevention by means of dietary modification, we estimated the aetiological fractions and the increments in absolute risk attributable to low intake of fruit and vegetables for adenocarcinoma and squamous cell carcinoma of the oesophagus and for adenocarcinoma of the gastroesophageal junction. We conducted a nationwide population‐based case–control study in Sweden, with participation of 608 cases and 815 controls. We used unconditional logistic regression to estimate relative risks, from which we calculated aetiological fractions. Individuals in the highest exposure quartile (median 4.8 servings/day) versus the lowest (median 1.5 servings/day) showed approximately 50% lower risk of oesophageal adenocarcinoma and 40% lower risk of oesophageal squamous cell carcinoma, but no risk reduction for gastric cardia adenocarcinoma. Approximately 20% of oesophageal adenocarcinoma, and likewise squamous cell carcinoma, in Sweden was attributed to consuming less than three servings of fruit and vegetables per day. A very large number of individuals (over 25 000) would need to increase their fruit and vegetable consumption moderately in order to prevent one oesophageal cancer per year. Moderate relative risk reductions translate into weak absolute risk reductions for oesophageal cancers in Sweden.

Utilization of prenatal genetic diagnosis in women 35 years of age and older in the United States, 1977 to 1978

As a measure of access to and acceptability of prenatal chromosomal diagnosis among older gravidas, we determined the ratio of use of prenatal diagnosis among women 35 years of age and older in Alabama, California, Manhattan, and Nebraska for the period 1977-1978. Utilization ratios were higher in 1978. Overall, utilization ratios were between 6% and 28%, well below the adjusted rates of 40% to 50% found in certain United States and British localities. Urban women tended to have higher utilization ratios than had rural women, and white women had higher ratios than had black women. Ratios were extremely low for black and rural residents. The oldest women (those greater than or equal to 40 years), who were at fivefold greater risk than women 35 to 36 years of age, had less than a onefold increase in utilization over the latter groups. The vast majority of older gravidas initiated prenatal care sufficiently early in their pregnancies to receive prenatal diagnosis. Current program strategies need to ensure access to prenatal diagnosis, especially for women greater than or equal to 40 years of age, women who are black, and women who live in rural areas.

Management information support for district health systems based on primary health care.

The authors consider the overall information requirements for a district health system. After reviewing the context of information support to operational management for primary health care (PHC) district health systems based upon PHC are defined with their principal features described. District management information systems typically have important information missing available data of inappropriate quantity and quality health staff with only limited skills in processing and using information and available information insufficiently used for local decision-making. District decision-making and information use are described in terms of resource allocation and use; use of services coverage and quality; policy and strategy; and assessment of health needs and program effects and impact. Increasing the scope of available information clarifying district needs resources objectives targets and indicators; streamlining procedures for data management; improving the skills of district staff in managing and using information; and broadening the use of information especially within districts and communities can improve district management information support. Closing sections consider the role and potential of microcomputer support for district health systems and policy implications at national and international levels.

A model curriculum for public health bioterrorism education.

Beginning with the spring semester of 2001, a course designed to prepare future public health leaders for potential bioterrorism events has been offered by the University of Connecticut Graduate Program in Public Health. Entitled “The Public Health Response to Bioterrorism,” this popular course was one of the few developed by academic programs in the United States prior to the attack of September 11, 2001. The course utilizes innovative teaching methods and presentations by distinguished guest speakers to educate public health personnel, public health and medical students, and physicians and nurses about the complex issues involved in the public health response to bioterrorism. The instructional methods and curriculum can serve as prototypes for similar efforts.

Mental health services in independent secondary boarding schools: The need for a model

Independent secondary schools assume responsibility for the mental health needs of their boarding student populations generally with little guidance other than their own staff and anecdotal experiences. Given the prevalence of mental health problems affecting adolescents and the developmental challenges inherent to this population, inadequate services can pose serious adverse consequences. In an attempt to clarify early guidelines of a model of mental health for such schools, this study sought to qualitatively define the types of services available to students in these settings, and the factors which appear to influence adolescents access to mental health care. Through the use of an open-ended, 22-item, interview questionnaire, the authors interviewed the “director” of mental health services at 19 identified schools in a small sample of independent, secondary, college-preparatory, boarding schools in one northeastern state. Through the use of descriptive statistics, the authors found that tremendous diversity exists within this sample and offer some early guidelines of mental health services for such schools in the areas of administration, structure of services, confidentiality/repercussion issues, and systems issues.

Stomach cancer patterns in European immigrants to Connecticut, United States

Age-adjusted annual incidence rates of stomach cancer (ICD-9 code #151) were examined for the period 1973–88 among Connecticut residents who were born in the United States or who emigrated from one of five European nations (Italy, Poland, the United Kingdom, Germany, Portugal). Risk of stomach cancer among each of the five immigrant groups was elevated significantly above that of US-born residents. The magnitude of difference ranged from a 1.62-fold excess among persons born in Italy to a 4.27-fold increase in risk among persons born in Portugal. Cancer risk to foreign-born residents was less than that observed in their native countries, with decreases of 25–64 percent found here. Several differences in patient and disease characteristics were observed according to country of birth. Compared with US-born residents, there was a lesser predominance of males among patients born in Italy, Poland, and the UK. Among all foreign-born groups, the gastric cardia was involved less frequently, and the pyloric region more frequently, than in US-born patients. Adenocarcinomas were significantly less common among Polish-born cases. The findings suggest different etiologies in foreign and US-born patients.