I I 80 — — 70 = 60h 3 not be matched anywhere. 35 50h 3 40 2 30 -- 4 o—o Unexposed ¥=70.20-0.t6X% @---© Exposed = hb oOo Y¥ =72.47-0.24% So this problem has been requested by Trust Territory medical personnel. Second, the situation of scattered, sequestered population groups and the large contrast in living conditions between home atolls and district centers makeit an ideal area for investigating the relative importance of pathogenetic elements. In this respect, the situation may I 30 ! 40 Age I 50 I 60 1 70 80 Figure 24. Age-related change in lymphocyte transformation in peripheral blood cultures showing the mean per- cent transformation for each decade with standard deviation.!8 were nearly doubled but aneuploid levels were not affected. In summary, several indications have been seen of reduction or borderline deficiency of the immunologicalstatus in the exposed Rongelap people in earlier years, but no evidence that such deficiency was related to disease incidence, with the possible exception that the increased development of malignancy in the exposed Rongelap people may be an indication of reduced immunological surveillance. Recentrises of leukocyte and gamma globplin levels to control values indicate some degree of recovery, but better tests for immunological status are needed. 6. Diabetes Survey Diabetes is a major problem in all the Marshall Islands, and investigation ofit is important for two reasons. First, the disease is dificult to manage; rules developed for U.S. and European conditions may not apply. Choiceofdiet is limited. The hygienic conditionsfavorinfections and makefoot care a major consideration; also, home useofinsulin is precludedin all but a few cases. It would bea significant contribution to the welfare of the people to diagnose the condition early and to define the optimum rules for management, and advice on During early 1974, 375 people from Utirik and Rongelap Atolls, some of whom are nowresidents of Majuro and Ebeye, were examinedin orderto establish the incidence and nature ofdiabetes in the Marshall Islands.* The 28 previously diagnosed diabetic patients from otheratolls were also examinedbut are not includedin this analysis. On Majuro, 120 subjects were surveyed; on Ebeye, 116; on Utirik, 81; and on Rongelap, 58. Blood and urine glucose determinations were made, a questionnaire was filled out, and pertinent physical examination was doneto assess the presence or absenceof degenerative complicationsofdiabetes. Blood wasalso obtained for uric acid, cho- lesterol, and triglyceride determinations. Plasma glucose was measuredin the fasting state and/or 2 hr after the ingestion of 75 g carbohydrate (Glucola). In this survey a plasma glucoselevel, either fasting or post-prandial, >120 mg % was considered indicative of abnormal glucose tolerance. In some cases glycosuria was accompanied by normal plasma glucose and these were not included in the group with diabetes. Some subjects with glycosuria did not have plasma glucose determinations (for a variety of reasons); these are categorized as possible diabetics. Although attempts were madeto obtain complete data on all subjects aged ee ee pm f >15, these were not always successful. The failure to supply requested information on some questionnaires accounts for the discrepancies in the numbers given in Table 20. The results are also categorized on the basis of whether the subject previously knew of the abnormality in glucose tolerance. Obesity is evaluated on the basis of height and weight but frequently this informationis not complete. The data are being analyzed in their pres- ent form, but the missing information will be obtained,ifat all possible, as the program continues. Preliminary evaluation of the data (see Table 20), with the limitations mentioned, strongly suggests that the incidenceof diabetes mellitus in the *Weare grateful to Drs. James B. Field and Catherine Detre at the University of Pittsburgh Schoot of Medicine for analysis of the diabetes data. we me ee mee ee + = we T neg .°4.g ne ewe owe aREk 7 + In vitro transformation I vm i ee ee ee ee ee ee we ee ee a ee oe 1 2 wee tee ies oe ee eM ‘ Le 33