Much medical data unrelated to radiation exposure is acquired during each medical mission. Some of this information. from exposed and unexposed individuals. is relevant to heaith care throughout the Marshall Islands. Consequently, public health reports. baséd on medical team observations unrelated to radiation. have been submitted periodically to the Health Services of the Republic of the Marshall Islands. The topics during this reporting period have included the following: 1) Serum lipids in Marshallese 2) Pediatric growth and development (an analysis prompted by observations of medical team physicians that Rongelap children, following their transfer to Mejato. were not maintaining their positions on charted growth curves) 3) Pediatric audiometry 4) Dental conditions on Rongelap and Utirik 5) Chlamydia infections in Marshallese women 6) Large optic disks (a relatively frequent finding by medical team ophthalmologists) Some significant observations in these and earlier public health reports were published in medical journals. Moderately elevated serum uric acid levels were noted in many Marshallese and the frequency of this finding and that of gout were analyzed (Adamsetal.. 1984). Toxoplasmosis was identified as a serious health hazard in the Marshall Islands. with an estimated 200 personsbeing visually impaired and an incidence of chorioretinitis of 273 cases/ year/ 100,000 seropositive persons (Adams et al., 1987). Hepatitis B, the subject of a serological survey described in a previous Brookhaven National Laboratory report (Adams et al., 1985), constituted anotherserious public health problem (Adamset al, 1986). The prevalence of anemia in children was described, and normal ranges for hemoglobin level and erythrocyte mean corpuscular volume for Marshallese children were derived (Dungy et al.. 1987). The latter were found to be identical to those of children in the United States. Because of the devastating effects of diabetes mellitus among the Marshallese, an effort was made to determine if a dietary deficiency of chromium, atrace element that is relevant to glucose tolerance. contributed to the problem. The analytic proce- 20048103 dure used was too insensitive to quantitate blood levels of chromium, but during the analvsis it was found that bromine levels were higher than those reported for any other population (Wielopoiski et al.. 1986). The reason forthis is unknown: further, the levels of bromine that were detected fall far short of its known toxic levels. The observation by team ophthaimolo- gists of large optic disks in many persons prompted another report to the Marshallese Health Services because the associated increase in disk cupping could be misconstrued by physicians as representing glaucoma. The high prevalence of the condition indicates Marshallese are unique among all populations in whom such measurementshave been obtained (Maisel etal., 1989). , Procedures: The exposed population, which now numbers 163, must be considered at increased risk for malignant disease as a late complication of radiation injury. Therefore. the medical program has in place a cancer-oriented annual health evaluation. The examination follows the ‘guidelines of the American CancerSociety and includes a medical history, complete physical examination, advice on decreasing risk factors for cancer, advice on self-detection of lesions, annual pelvic examinations and Papanicolaou smears, stool testing for blood, blood count, and urinalysis. Several new diagnostic procedures were incorporated into the medical missions in the past three years. Because of the development of x-ray films and cassettes that significantly decrease radiation exposure, annualmammographyis offered to all exposed women and to all unexposed womenforty years of age or older. For personsoverthe age offifty years, flexible sigmoidoscopy is offered every three years or wheneverclinically indicated. An ultrasound machine has been acquired that greatly increases the diagnostic capabilities of the medical team, especially in managing acute problems seen at the time of team visits. For thyroid diagnosis, needle biopsy of selected thyroid nodules has beeninstituted in an effort to avoid surgery and the subsequent loss of normal thyroid tissue in patients with benign nodular lesions. Because of earlier medical program | observations it is known that the exposed are at greater risk for certain endocrine problems and for this reason they receive annual thyroid-