Abstract

Design - Case-control study of 16 primary household cases and 32 controls of similar age and dietary habit. Packets of the implicated foodstuff manufactured on a range of days were examined for salmonella. All isolates of the epidemic phage type were further characterised by pulsed field gel electrophoresis.

Results - 27 cases were identified, of which 26 were in children. The case-control study showed a strong association between infection with S agona phage type 15 and consumption of a peanut flavoured ready to eat kosher savoury snack imported from Israel. S agona phage type 15 was isolated from samples of this snack. The combined food sampling results from the United Kingdom, Canada, the United States, and Israel showed that contaminated snacks were manufactured on at least seven separate dates during a four month period between October 1994 and February 1995. Voluntary recalls of the product successfully interrupted transmission.

Conclusions - Rapid international exchanges of information led to the identification of the source of a major outbreak of S agona in Israel and of associated cases in North America. The outbreak showed the value of the Salm-Net surveillance system and its links outside Europe, both for increasing case ascertainment and for improving the information on the duration of the fault at the manufacturing plant.

Public Health Laboratory Service,
Communicable Disease Surveillance Centre,
London NW9 5EQ
D Killalea, senior registrar
J de Louvois, head, Environmental Surveillance Unit
J M Stuart, consultant epidemiologist
P G Wall, consultant epidemiologist
O N Gill, deputy director (information)
C L R Bartlett, director

Public Health Laboratory Service,
Central Public Health Laboratory,
London NW9 5HT

Salmonella Reference Laboratory,
Laboratory of Enteric Pathogens
L R Ward, clinical scientist

Food Hygiene Laboratory
D Roberts, deputy director

Laboratory of Enteric Pathogens
B Rowe, director

Public Health Laboratory Service,
Statistics Unit,
London NW9 5EQ
F Sufi, statistician

Barnet District Health Authority,
Colindale Hospital,
London NW9 5HG
M Susman, consultant in communicable disease control

Correspondence to: Dr Gill.

Abstract

Design - Randomised trial.

Setting - Hospital department of obstetrics and gynaecology.

Subjects - 278 women with simple cysts randomly allocated to simple observation (143) or ultrasound guided fine needle aspiration (135) between 1990 and 1994.

Main outcome measures - Resolution of cyst or development of malignancy.

Results - After six months 269 were available for follow up. The rate of resolution was 46% (59/128) with aspiration and 44.6% (63/141) with observation. Only the diameter of the cyst (P<0.0001) was a significant independent prognostic factor for resolution in a multivariate analysis. Age and treatment had no significant effect. One woman was subsequently found to have borderline malignant changes on histopathological examination. Her cyst was detected by transabdominal ultrasonography.

Conclusions - Expectant management for up to six months does not cause risks for the patients and allows spontaneous resolution in over a third of cases, avoiding the costs and risks of unnecessary surgery. Aspiration does not provide better results than simple observation

Department of Obstetrics and Gynaecology,
Ospedale San Gerardo di Monza,
III Branch of the University of Milan,
Milan,
Italy

Gerardo Zanetta, consultant
Andrea Lissoni, consultant
Cristina Dalla Valle, senior registrar
Diego Trio, consultant
Giovanni Rangoni, consultant
Costantino Mangioni, chief

Department of Oncology,
Istituto di Ricerche Farmacologiche Mario Negri,
Milan,
Italy

Valter Torri, medical statistician

Correspondence to: Dr G Zanetta,
Gynecologic Surgery,
Eisenberg 5A,
Mayo Clinic,
Rochester 55905 MN,
USA

Design - Cross sectional survey with questionnaires on reproductive history.

Setting - Tien Hai, a district in Red River Delta area, where the population density is one of the highest in Vietnam.

Subjects - 1132 women who had at least one child under 5 years of age in April 1992.

Main outcome measures - Birth spacing and probability of having a third child.

Results - The mean age at first birth was 22.2 years. The average spacing between the first and the second child was 2.6 years. Mothers with a lower educational level, farmers, and women belonging to the Catholic religion had shorter spacing between the first and second child and also a higher probability of having a third child. In addition, women who had no sons or who had lost a previous child were more likely to have a third child.

Conclusion - Most families do not adhere to the official family planning policy, which was introduced in 1988, stipulating that each couple should have a maximum of two children with 3-5 years' spacing in between. More consideration should be given to family planning needs and perceptions of the population, supporting the woman to be in control of her fertility. This may imply improved contraceptive services and better consideration of sex issues and cultural differences as well as improved social support for elderly people.

Department of Environment,
Hygiene and Epidemiology,
Hanoi School of Medicine,
Hanoi,
Vietnam

H T Hoa, lecturer in epidemiology
N V Toan, lecturer in epidemiology

Department of Public Health Sciences,
Division of International Health Care Research (IHCAR),
Karolinska Institute,
S-171 77 Stockholm,
Sweden

A Johansson, sociologist
B Hojer, associate professor

Department of Biology,
Thai Binh Medical College,
Thai Binh,
Vietnam

V T Hoa, lecturer in biology

Department of Epidemiology and Public Health,
Umea University,
S-901 85 Umea,
Sweden

L A Persson, associate professor

Correspondence to: Dr H T Hoa c/o Dr Hojer.

Design - Prospective community based surveillance of elderly people, without intervention. Subjects were telephoned weekly to identify symptomatic upper respiratory tract infections. Symptoms and impact of illnesses were monitored, and specimens were collected for diagnostic serology and human rhinovirus polymerase chain reaction.

Setting - Leicestershire, England.

Subjects - 533 subjects aged 60 to 90.

Main outcome measures - Symptoms, restriction of activity, medical consultations, and antibiotic use during 96 rhinovirus infections. Adjusted odds ratios for lower respiratory syndromes with respect to smoking and health status.

Results - A viral cause was established in 211 (43%) of 497 respiratory illnesses; rhinoviruses were identified in 121 (24%) and as single pathogens in 107. The median duration of the first or only rhinovirus infection in the 96 people with 107 rhinovirus infections was 16 days; 18 of the 96 patients were confined to bed and 25 were unable to cope with routine household activities. Overall, 60 patients with rhinovirus infections had lower respiratory tract syndromes; 41 patients consulted their doctor, 31 of them (76%) receiving antibiotics. One patient died. Logistic regression analysis showed that chronic medical conditions increased the estimated probability of lower respiratory rhinovirus illness by 40% (95% confidence interval 17% to 68%) and smoking by 47% (14% to 90%.). There were almost six times as many symptomatic rhinovirus infections as influenza A and B infections.

Conclusions - Rhinoviruses are an important cause of debility and lower respiratory illness among elderly people in the community. Chronic ill health and smoking increase the likelihood of lower respiratory complications from such infections. The overall burden of rhinovirus infections in elderly people may approach that of influenza.

Leicester University School of Medicine,
Department of Microbiology and Immunology,
Leicester LE1 9HN

Karl G Nicholson, senior lecturer in infectious diseases
Julie Kent, research assistant
Victoria Hammersley, research assistant
Esperanza Cancio, postdoctoral research fellow

Correspondence to: Dr Nicholson.