The Peutz-Jeghers syndrome is an autosomal dominant hereditary disease characterized by hamartomatous polyps of the gastrointestinal tract and by mucocutaneous melanin deposits. The frequency of cancer in this syndrome has not been studied extensively. Therefore, we investigated 31 patients with the Peutz-Jeghers syndrome who were followed from 1973 to 1985. All cases of cancer were verified by histopathological review. Cancer developed in 15 of the 31 patients (48 percent)--gastrointestinal carcinomas in 4, nongastrointestinal carcinomas in 10, and multiple myeloma in 1. In addition, adenomatous polyps of the stomach and colon occurred in three other patients. The cancers were diagnosed when the patients were relatively young, but after the Peutz-Jeghers syndrome had been diagnosed (interval between diagnoses, 25 +/- 20 years; range, 1 to 64). According to relative-risk analysis, the observed development of cancer in the patients with the syndrome was 18 times greater than expected in the general population (P less than 0.0001). Our results suggest that patients with the Peutz-Jeghers syndrome have an increased risk for the development of cancer at gastrointestinal and nongastrointestinal sites.

Health information about total populations is a prerequisite for sound decision-making and planning in the health care field. Experience with a population-based health data system in Vermont reveals that there are wide variations in resource input, utilization of services, and expenditures among neighboring communities. Results show prima facie inequalities in the input of resources that are associated with income transfer from areas of lower expenditure to areas of higher expenditure. Variations in utilization indicate that there is considerable uncertainty about the effectiveness of different levels of aggregate, as well as specific kinds of, health services. Informed choices in the public regulation of the health care sector require knowledge of the relation between medical care systems and the population groups being served, and they should take into account the effect of regulation on equality and effectiveness. When population-based data on small areas are available, decisions to expand hospitals, currently based on institutional pressures, can take into account a community's regional ranking in regard to bed input and utilization rates. Proposals by hospitals for unit price increases and the regulation of the actuarial rate of insurance programs can be evaluated in terms of per capita expenditures and income transfer between geographically defined populations. The PSRO's can evaluate the wide variations in level of services among residents of different communities. Coordinated exercise of the authority vested in these regulatory programs may lead to explicit strategies to deal directly with inequality and uncertainty concerning the effectiveness of health care delivery. Population-based health information systems, because they can provide information on the performance of health care systems and regulatory agencies, are an important step in the development of rational public policy for health.

No abstract

This study uses Maryland hospital discharge data for the period 1979-82 to determine whether Black children are more likely to be hospitalized for asthma and whether this difference persists after adjustment for poverty.The average annual asthma discharge rate was 1.95

Since the recognition of the potential of fluorides as caries preventatives, the interest of many dental epidemiologists has shifted from descriptive to experimental studies of oral disease, resulting in unprecedented advances in the control of caries and its sequelae. Judging from the proportion of effort in this direction, there has been a tendency to overlook the fact that the descriptive epidemiology of caries remains vague in several important, if undramatic, areas. Among these can be cited the equivocal explanations of differential caries experience between the sexes and among various racial groups, incomplete understanding of the relative magnitude of the genetic component in caries susceptibility, and a lack of careful documentation of attack patterns in specific teeth over time. Most of the existing body of information on the natural history of dental caries was developed some 20 years ago from the cumulative results of many cross-sectional, often non-comparable, observations of various population groups. Of the hundreds of such studies reported the most significant were probably those conducted by who utilized time-specific prevalence data to infer a very large amount of information about the influence of several variables, including duration of exposure, on patterns of caries incidence. These investigators have pointed out, however, that complete understanding of certain aspects of the epidemiology of caries requires longitudinal, rather than cross-sectional, studies of the same, stable population.2 4' 8 Information