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PubMed1999

Secular changes in anthropometric data in cystic fibrosis patients.

The aim of this study was to study the secular changes in anthropometric data over calendar time in patients with cystic fibrosis (CF). Growth curves were constructed for 270 patients based on height and weight registrations from the medical files. Height, body mass index (BMI), magnitude of pubertal peak height velocity (PHV) and age at PHV were analysed for possible secular changes from the 1960s to the 1990s. There was a significant change in height over calendar time in only 1 of 12 age groups. BMI showed a significant increase in 10- and 15-y-old boys and girls and in 5-y-old girls. The magnitude of PHV changed significantly over time, whereas age at PHV was constant. No significant changes in height and age at PHV over calendar time were observed; this was probably due to a selection bias since the oldest patients, who survived to be part of the present investigation, represented milder forms of the disease. The increase in BMI and change in magnitude of PHV over calendar time may reflect the improvement in treatment leading to a better survival and clinical status through puberty. The increase in BMI and change in magnitude of PHV were sufficient to overcome the selection bias from older patients with milder disease.

Adolescent↗
PubMed2005

Effects of faith and secular factors on locus of control in middle-aged and older cardiac patients.

The complex relationships between faith factors and health locus of control were explored. Different from general expectancy, internal control was conceptualized as event-specific self-efficacy. Both control and faith are multidimensional phenomena and affect an individual's health and wellbeing. Yet, how faith and secular factors (e.g., demographic variables) are jointly related to personal control of patients in the face of medical crises remains empirically under-examined. Based on a comprehensive review of different aspects of perceived personal control, spiritual surrender, and faith factors, we presumed a multivariate association among them. Using data from two sequential interviews and the Society of Thoracic Surgeons' Adult Cardiac Database, the study examined the association between these faith factors and different health loci of control among 224 middle-aged and older patients 1 day prior to major cardiac surgery. Primary findings from multiple regression analyses generally supported our hypotheses. Greater internal control was positively related to using private prayer for coping, an event-specific "vicarious" control strategy, but negatively related to subjective religiosity, a general faith measure, after controlling for effects of other secular factors, especially cardiac-significant ones. Several factors in the medical history affected different loci of control. Older age and minority status were associated with greater external control.

Adaptation, Psychological↗
PubMed2005

Secular trends of candidemia in a large tertiary-care hospital from 1988 to 2000: emergence of Candida parapsilosis.

OBJECTIVE: To analyze the secular trends of candidemia in a large tertiary-care hospital to determine the overall incidence, as well as the incidence by ward and by species, and to detect the occurrence of outbreaks. DESIGN: Retrospective descriptive analysis. Secular trends were calculated using the Mantel-Haenszel test. SETTING: A large tertiary-care referral center in Spain with a pediatric intensive care unit (ICU) to which more than 500 children with congenital cardiac disease are admitted annually. PATIENTS: All patients with candidemia occurring from 1988 to 2000 were included. Cases were identified from laboratory records of blood cultures. RESULTS: There were 331 episodes of candidemia. The overall incidence of nosocomial candidemia was 0.6 episode per 1,000 admissions and remained stable throughout the study period (P = .925). The species most frequently isolated was Candida albicans, but the incidence of C. parapsilosis candidemia increased (P = .035). In the pediatric ICU, the incidence of C. parapsilosis was 5.6 episodes per 1,000 admissions and it was the predominant species. Outbreaks occurred occasionally in the pediatric ICU, suggesting nosocomial transmission. CONCLUSIONS: During this 13-year period, the incidence of candidemia remained stable in this hospital, but C. parapsilosis increased in frequency. Occasional outbreaks of candidemia suggested nosocomial transmission of Candida species.

Candida↗
PubMed2001

Height and body weight in elderly adults: a 21-year population study on secular trends and related factors in 70-year-olds.

BACKGROUND: Body size in elderly adults is partly due to aging and partly to secular trends. This study describes secular trends in three anthropometric measures (i.e., height, body weight [BW], and body mass index [BMI]) of 70-year-olds over a period of 21 years and their relation to social and lifestyle factors. METHODS: A total of 3128 70-year-olds from four birth cohorts born between 1901 and 1922 in Gothenburg, Sweden, were examined between 1971 and 1992 in the Geriatric Medicine Department, Göteborg University. Trends in anthropometric measures were examined by permutation test. Influence of the subjects' birth year, physical activity, smoking habits, and education on anthropometric measures were investigated by multiple linear regression. RESULTS: Individuals in later-born cohorts were found to be 1 to 2 cm taller and 1.5 to 6.3 kg heavier than earlier-born cohorts. For BMI, a positive trend was significant only in 70-year-old male participants. "Year of birth" was a positive predictor for BW (p <.001) and BMI (p <.001) in male participants and for height (p <.05) and BW (p <.01) in female participants. Physical inactivity was a positive (p <.01) and "current smoking" a negative (p <.001) predictor for BMI in both sexes. "More than basic education" was a positive predictor for height (p <.001) in both sexes and a negative predictor for body weight (p <.01) and BMI (p <.001) in female participants only. CONCLUSIONS: Trends of increasing height, BW, and BMI were found among the Swedish elderly participants. This may be partly due to differences in smoking habits, physical activity, education, food habits, childhood nutrition, and living conditions between the cohorts.

Aged↗
PubMed1997

Secular trends in monitors of reproductive hazard.

There is concern that our reproductive systems are exposed to environmental hazards. A number of potential monitors of these hazards have been proposed (reported rates of cryptorchidism, testicular cancer, hypospadias, dizygotic twinning, sperm count, ectopic pregnancy and sex ratios). To discover whether these are monitoring the same hazards, secular movements in these measures are considered here. It is suggested that the secular movements of cryptorchidism and hypospadias are insufficiently reliable to give guidance on the movements of such hazards as cause them. With one possible exception, rates have not moved in parallel and so, in general, they are not monitoring the same hazards. The exception is dizygotic twinning rates and sperm counts which may have a lagged correlation. If this is true, it may be important and throw light on the hitherto unexplained movements of both. The hazards themselves are largely unidentified, but may be presumed to include: (i) the well-publicized rise in environmental oestrogens; (ii) an increasing number of women with suboptimal oestrogens (because of dieting and arduous exercise); and (iii) hormonal consequences of these two opposing trends, e.g. an increasing number of women with suboptimal androgens (possibly accounting for the increasing rates of cryptorchidism and testicular cancer).

Environmental Exposure↗
PubMed1997

Age and secular trends in bone lead levels in middle-aged and elderly men: three-year longitudinal follow-up in the Normative Aging Study.

The goal of this study was to examine age and secular trends in bone and blood lead levels of community-exposed men. Bone and blood lead levels were measured twice, with a 3-year interval between measurements, among participants in a longitudinal study of aging. Seventy subjects (mean age = 66 years, age range = 52-83 years) with repeated measurements of bone and blood lead levels were studied. At the first evaluation, geometric mean lead levels in patella, tibia, and blood were 29.1 (standard deviation (SD) 1.8) microg/g, 17.5 (SD 2.0) microg/g, and 6.7 (SD 1.8) microg/dl, respectively. At the second evaluation, these levels were 22.2 (SD 1.8) microg/g, 17.9 (SD 1.7) microg/g, and 5.1 (SD 1.4) microg/dl, respectively. Cross-sectional analysis of each set of measurements indicated that, on average, a 1-year-older individual would have 2.7% and 2.4-3.2% higher levels of lead in patella and tibia, respectively. In contrast to the increasing age trend in cross-sectional analysis, the secular trend over time was decreasing for patella lead levels and stable for tibia lead levels. The authors conclude that in community-exposed middle-aged and elderly men, the biomarkers of exposure to lead are decreasing in patella and blood and unchanging in tibia as of the early 1990s. The increasing age trend in bone lead levels in cross-sectional studies should be carefully interpreted in light of the birth cohort effect.

Aged↗
PubMed1985

Secular trends in age at onset, sex ratio, and type index in leprosy observed during declining incidence rates.

Epidemiologic surveillance in Norway, the United States, Nigeria, Japan, Venezuela, India, and China, covering periods from 1851 to 1981, demonstrates a consistent decline in incidence rates of leprosy. At the same time, secular trends have been observed which imply an increasing age at onset, an increasing male excess, and an increasing fraction of new cases represented by multibacillary leprosy. Theoretically, an increasing age at onset may be caused by two mechanisms, namely postponement of infection to a later age and/or an increasing fraction of patients with long incubation periods. Cohort analyses have shown no increase in age at onset in subsequent birth cohorts, but rather have shown a decrease. The latter mechanism, the increasing importance of long incubation periods, is consistent with the shift toward multibacillary cases in which the incubation period is longer than that in paucibacillary cases. Apparently, this mechanism has also been present during the decline of tuberculosis. An increasing fraction of new patients with long incubation periods, resulting in an increasing age at onset, is proposed as a general principle to be expected in any disease in rapid decline which also has a long and varying incubation period. This theory offers a basis for assessment of secular trends.

Adolescent↗
PubMed1991

Changes in commingled body mass index distributions associated with secular trends in overweight among Danish young men.

The authors present results from a novel approach to understanding recent secular trends in overweight in terms of changes in underlying component distributions. On the basis of an examination of two large overlapping samples of Danish young men (ns = 16,557 and 21,747) spanning birth cohorts 1939-1958, the authors found evidence for two-component distributions, normal and overweight, in all cohorts. In cohorts born after 1940, the authors observed an increase in the size of the overweight component with no corresponding changes in overall mean or component means. On the basis of these results and other published reports, the authors speculate that the secular increase in overweight may be understood as a differential response to environmental change that may be mediated by genotype. The net effect appears to have been an increased penetrance in obesity-prone Danish young men.

Adult↗
PubMed1993

Secular trends in coronary heart disease mortality in Norway, 1966-1986.

In most countries of the western world, the health statistics demonstrate similar secular trends in coronary heart disease mortality. There was a relatively marked increase in the mortality rates until the 1970s, followed by a decline. A cohort analysis was performed to examine these trends. Poisson regression with models that included the effects of age, period, and cohort was applied to Norwegian vital statistics. The results demonstrate that cohort effects explain the secular variations in coronary heart disease mortality in Norway from 1966 to 1986. The author relates these findings to the development of primary and secondary preventive means of coronary heart disease mortality.

Age Factors↗
PubMed1995

Paracelsus confronts the saints: miracles, healing and the secularization of magic.

The sixteenth and seventeenth centuries witnessed an erosion of the role played by the church in healing. Magical practices mediated by the church were replaced by the resources of medicine. This represented an important cultural development and it is often regarded as a manifestation of increasing secularization, the decline of magic and rise of science. This paper examines this issue with special reference to miraculous healing associated with saints, which constituted one of the most important facets of magic controlled by the church. It will be suggested that Paracelsus (Theophrast von Hohenheim, 1493-1541) played an important part in the argument concerning the miraculous powers of saints. Many works by Paracelsus produced at various points in his career were relevant to this issue, but De causis morborum invisibilium, the sequel to his important Opus Paraminum (1531), was especially significant. The question of miraculous healing was therefore important in the first, full presentation of the new system of medicine developed by Paracelsus. Modern commentators have understandably found De causis morborum invisibilium less intelligible and congenial than the more accessible Opus Paramirum. But the former was important to Paracelsus, and it addressed problems that were fundamental to his audience. This case-study shows how conclusions reached by Paracelsus about medical questions were integrally tied up with his theological standpoint and with his wider reaction to the acute crisis of confidence which affected the church and the established social order at the beginning of the sixteenth century. By eliminating the miraculous intervention of saints and promoting the secularization of magic, Paracelsus was contributing to one of the important cultural changes associated with the Reformation.

Christianity↗
PubMed1995

Medicalization and secularization: the Jewish ritual bath as a problem of hygiene (Germany 1820s-1840s).

In the 1820s and 1840s the Jewish ritual bath in Germany was criticized on the basis of medical arguments. Associated with this critique were demands for a change in the traditional Jewish way of life in general, especially as concerning the Jewish religion. The new role assigned to religion can be seen as part of a process of 'secularization'. The criticism of the ritual bath was justified by medical arguments and entailed a demand for an extension of the medical sphere of competence, and thus formed part of a development described as 'medicalization'. An historical investigation of the debate on the Jewish ritual bath illuminates the way in which medicalization and secularization were different aspects of the same process of the attribution of complementary circumscribed spheres of medicine and religion.

Baths↗
PubMed2000

Secular trends of HBeAg prevalence among HBsAg-positive delivery mothers in a hepatitis B endemic area.

A high prevalence of HBeAg among HBsAg-positive mothers at the time of delivery results in a high prevalence of hepatitis B vertical transmission. From 1990 to 1995, 896 pregnant HBsAg-positive women, including 411 (46 per cent) HBeAg-positive subjects, were enrolled in our study to analyse the secular change in HBeAg prevalence. Their mean age, number of pregnancies and parity were 29.5 +/- 4.1 years, 2.0 +/- 1.2, and 0.6 +/- 0.7, respectively. The prevalence rates of HBeAg were 48, 54, 49, 47, 40, and 40 per cent among the subjects enrolled in 1990, 1991, 1992, 1993, 1994, and 1995, respectively. In univariate analyses, prevalence of HBeAg decreased by the calendar year of pregnancy (p = 0.01), and also by age (p < 0.00001), number of pregnancies (p < 0.0001) and parity (p < 0.0002). After adjusting for age in multiple logistic regression, the calendar year of pregnancy was still the independent variable, while gravida and parity became insignificant. The odd ratios (95 per cent confidence interval) of HBeAg negative-seroconversion in the equations were 1.09 (1.00-1.19) per calendar year and 1.14 (1.10-1.18) per year of age. Our results have shown a secular decrease in HBeAg-prevalence among pregnant HBsAg-positive women in Taiwan.

Adolescent↗
PubMed1985

The secularization of pain.

After Morton's demonstration in the Ether Dome of the Massachusetts General Hospital, anesthesia for surgery was accepted around the world at a speed unusually fast for any medical or scientific innovation. However, the concept of surgical anesthesia had been rejected on four occasions during the preceding 40 years. The rapid acceptance of anesthesia in 1846 appears to have had a political and social basis as well as medical. Two factors are particularly important. First was a change in the perception of disease and pain; both lost religious connotations and became biologic phenomena as part of a process of secularization that affected all aspects of Western society. Second was the growth of a sense of well-being and progress, which imbued patients and physicians alike with confidence in their ability to control natural processes. During the last half century, pain has remained secular, but the confidence in both progress and the ability to control nature may have diminished.

Anesthesia↗
PubMed1992

A secular increase in child and adolescent onset affective disorder.

Both longitudinal and cross-sectional studies utilizing population and family study samples have found evidence for a secular increase in major affective disorders in adults. Applying techniques used in cross-sectional studies in adults to family study data of children and adolescents, the authors demonstrate evidence of a parallel secular increase for child and adolescent onset affective disorders. Normal and depressed prepubertal probands were identified. All full siblings were directly interviewed for lifetime episodes of affective disorder. Analysis of the siblings (probands not further analyzed in this article) by the Cox proportional hazards model demonstrates that the risk for affective disorder is higher in siblings born more recently.

Bias↗
PubMedDate not supplied

Evidence for a secular trend in menopausal age: a population study of women in Gothenburg.

OBJECTIVE: To describe secular trends in age of natural menopause. DESIGN: A prospective study based on a random sample of the total female population in Gothenburg, Sweden, started in 1968 with follow-ups in 1974-75, 1980-81, 1992-93, and 2000-02. PARTICIPANTS: 1,462 women born in 1930, 1922, 1918, 1914, and 1908 (participation rate, 90.1%) representative of women of the same ages in the general population. Information regarding menopausal age was provided by 1,373 of the 1,462 women (93.9%). The number was further reduced to 1,017 after exclusion of women who had taken hormones, undergone a surgical menopause, or both. RESULTS: The mean age at natural menopause showed a steady increase across birth cohorts. Trends were similar in women who had smoked and women who had never smoked, even after adjusting for different covariates. The upward trend was 0.1 years per birth year (SE 0.020, P < 0.0001). Interestingly, women with earlier menarche had a somewhat earlier age at menopause, independent of the cohort effect. When hormone users were included in the sample, the cohort effect was also found to be independent of oral contraceptive use and hormone therapy. CONCLUSIONS: This study has shown that, independent of variations in socioeconomic status, smoking status, oral contraceptive use, or hormone therapy use, as well as other potential confounders, there was a highly significant secular trend of increase in menopausal age. The observation of a positive association between menarche and menopausal age has, to our knowledge, not previously been described.

Adult↗
PubMed2004

The 21-year follow-up of the Cardiovascular Risk in Young Finns Study: risk factor levels, secular trends and east-west difference.

OBJECTIVES: The Cardiovascular Risk in Young Finns Study is an on-going multicentre study of atherosclerosis precursors in Finnish children and young adults. We have collected risk factor data in the 21-year follow-up performed in 2001. The aims of this analysis were to examine the levels, secular trends and east-west difference in risk factors amongst young adults. DESIGN: Population based follow-up study. SUBJECTS: A total of 2283 participants aged 24-39 years in 2001 (63.5% of the original cohort). MAIN OUTCOME MEASURES: Levels of serum lipids, apolipoproteins, blood pressure and smoking. RESULTS: The mean serum total cholesterol, low density lipoprotein cholesterol, high density lipoprotein (HDL) cholesterol and triglyceride concentrations in 24-39-year-old adults were 5.16, 3.27, 1.29 and 1.34 mmol L(-1), respectively. Total cholesterol (5.21 vs. 5.12 mmol L(-1), P = 0.046), HDL cholesterol (1.31 vs. 1.28 mmol L(-1), P = 0.027), systolic blood pressure (118 vs. 115 mmHg, P < 0.0001) and diastolic blood pressure (72 vs. 70 mmHg, P < 0.0001) were higher in subjects originating from eastern Finland compared with those from western Finland. Significant secular trends between 1986 and 2001 in 24-year-old subjects (n = 783) included an increase in serum triglycerides and body mass index (BMI), a decrease in blood pressure and HDL cholesterol and a modest 5% decrease in total cholesterol levels. CONCLUSIONS: During the past 15 years, BMI and triglyceride levels have increased in young adults in Finland. At the same time, the reduction in cholesterol concentration has been slow. Consistent with persistent regional differences in cardiovascular morbidity within Finland, our data demonstrate significant differences in the levels of cardiovascular risk factors between subjects originating from eastern and western Finland.

Adult↗
PubMed1986

Secular trend of twin concordance in late fetal death.

In the present paper the secular trend of twin concordance for late fetal death rate has been analysed. The results show that, while the correlation remains unchanged in MZ twins, it is greatly reduced in DZ twins. This renders untenable the assumption of comparable secular trends in the intrauterine environment of the two types of twins. An appropriate model is given for the estimation of the environmental (intrauterine) factors in late fetal concordance, under the assumption of a wide range of frequencies for unconditional lethals.

Diseases in Twins↗
PubMed1993

Towards an equal distribution of health? Socioeconomic and regional differences of the secular trend of the age of menarche in Finland from 1979 to 1989.

The purpose of this study was to investigate if a secular trend towards an earlier age of menarche still existed in Finland in the 1980s and if social class and regional differences observed previously in the mean age of menarche had disappeared. Questionnaires were mailed to nationwide representative samples of 16- and 18-year-old girls every other year from 1979 to 1989. At the national level, the secular trend towards an earlier menarche was not observed in the 1980s but the trend was significant among girls living in the North-West and rural areas. Clearly observed regional and urban-rural differences in 1979 disappeared in the 1980s. Social class differences persisted: farmers' daughters had a higher mean age of menarche than those of other occupational groups. Adolescents in the 1980s displayed a more even distribution of health than the cohorts born before them. Improved welfare of the Finnish society and reorganization of the primary health care are probable explanations.

Adolescent↗