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PubMed1998

Secular trends in nosocomial bloodstream infections in a 55-bed cardiothoracic intensive care unit.

BACKGROUND: Although bloodstream infections (BSIs) occur more frequently in intensive care unit patients than in ward patients, most studies of nosocomial BSIs in critically ill patients have not distinguished between intensive care unit populations beyond surgical, medical, and pediatric patients. METHODS: The primary objective of this study was to characterize the secular trends in rates of nosocomial BSIs for all pathogens among patients admitted to a busy cardiothoracic intensive care unit in a single tertiary care institution between January 1986 and December 1995. Patients with nosocomial BSIs were identified through continual prospective surveillance. RESULTS: A total of 40,207 patients were admitted to the cardiothoracic intensive care unit during the 10-year study period, and 804 episodes of nosocomial BSIs among 681 patients were identified. The mean crude BSI infection rate was 6.0 per 1,000 patient-care days and increased linearly during the study period (range, 4.4 to 8.1 per 1000 patient-care days), and approached statistical significance (p value = 0.07). The most common organisms causing BSIs were Staphylococcus aureus (12%), coagulase-negative staphylococci (11%), Candida albicans (11%), Pseudomonas aeruginosa (10%), and Enterococci (9%). The leading sources of nosocomial BSIs were primary BSIs (33%), intravascular devices (27%), lower respiratory tract infections (17%), and surgical wound infections (12%). The etiologic fraction or the proportion of deaths in cardiothoracic intensive care unit patients with BSIs was 15-fold higher than those patients without BSIs (37% versus 2.5%, p < 0.001). CONCLUSIONS: Rates of nosocomial BSIs among patients in our cardiothoracic intensive care unit have increased linearly during the past decade and patients with nosocomial BSIs have an increased risk of in hospital mortality.

Candida albicans↗
PubMed1977

A secular increase in the incidence of juvenile diabetes mellitus.

Data from a 1973 survey of diabetes mellitus among schoolchildren in Michigan have been analyzed to derive age-specific incidence and prevalence rates. The annual incidence of new cases of diabetes is approximately 20/100,000 children from age four through age 17, with the highest incidence rates at age nine through age 12. The prevalence rates to be expected, if the most recent incidence rates persist, are approximately 50/100,000 at age five, 150/100,000 at age ten, 270/100,000 at age 15, and 325/100,000 by age 18. The incidence rate of diabetes in Michigan children appears to have doubled between 1959 and 1972. Data from Erie County, New York, suggest that this secular trend has been evident since 1949, and data from Norway suggest that the trend could be noted 50 to 70 years ago.

Adolescent↗
PubMed1995

Secular changes in the outcomes to eighteen to twenty-four months of age of extremely low birth weight infants, with adjustment for changes in risk factors and severity of illness.

OBJECTIVES: To analyze secular changes in the rates of death and of major impaired outcome in surviving outborn infants who weighted < or = 800 gm at birth and were admitted in 1980 to 1989, with adjustment for changes in risk factors and severity of illness around the time of birth; and to identify changes in these factors that might explain changes in outcomes. DESIGN: Retrospective cohort study with follow-up to a minimum of 18 months of postterm age. After preliminary screening, multivariate models of association between risk/severity of illness factors and outcomes were constructed, validated, and used to adjust outcomes (death and major impairment to 18 to 24 months of age). SETTING: Regional neonatal intensive care unit for referral of "outborn" infants. PATIENTS: Two hundred eighty-seven consecutively admitted infants who weighted < or = 800 gm at birth (97% follow-up). RESULTS: The death rate during the 1980s did not fall significantly (p adjusted for risk factors = 0.115). The major impairment rate fell (odds ratio, 0.24 (95% confidence interval, 0.10, 0.60); p = 0.002, adjusted for delivery route and respiratory failure measures), mainly because of a reduced rate of blindness, not attributable to cryotherapy. The risk factors that improved and were possibly related to the reduced impairment rate were blood pH and glucose concentration, and serum sodium concentration in the first 48 hours of life. CONCLUSIONS: Despite an increasing selection for referral of less mature and more severely ill outborn babies near the "limit of viability," and despite more aggressive care, the rate of major impairment fell significantly during the 1980s. This trend was enhanced by adjustment for severity of illness. The fall was attributable to a reduced rate of blindness, and was associated with evidence of improved control of physiologic balance after birth.

Apgar Score↗
PubMed2001

A study of the secular equation for rayleigh waves using the root locus method.

In a recent note Rahman and Barber [Trans. ASME 62 (1995) 250] proposed an exact expression for the roots of the secular equation for the Rayleigh waves in an isotropic half-space. Using the root locus method, we describe in a very simpler manner the evolution of the roots versus the Poisson's ratio and we derive easily the critical value for which the nature of the roots changes.

Journal Article↗
PubMed2003

Secular trends in leisure-time physical activity in men and women across four decades.

BACKGROUND: We examined secular trends in leisure-time physical activities (LTPA) in health-conscious men (n = 1359) from 1958 to 1998 and in women (n = 839) from 1978 to 1998, who were participants of the Baltimore Longitudinal Study of Aging (BLSA). METHODS: LTPA was the self-reported time spent performing 97 activities, and was converted to metabolic equivalent of oxygen uptake (MET) minutes per day. Evaluations of LTPA were averaged for each decade. The prevalence of a sedentary lifestyle in each decade was assessed based on compliance with widely publicized recommendations for participation in physical activity. All analyses were adjusted for age, education, and race differences across decades. RESULTS: Median high-intensity LTPA, defined as activities >/=6 METs, increased from 30 to 80 MET min/day from the 1960s to the 1990s for men (P < 0.01) but did not change between the 1970s and the 1990s in women. Moderate-intensity LTPA, defined as 4-5.9 METs, did not change significantly over these periods in either sex. The percentage of sedentary men, defined as those performing <40 MET min/day of high-intensity LTPA, declined across the four decades, whereas for women it did not change significantly. CONCLUSIONS: In a health-conscious sample across a broad age range, national recommendations appear to have made modest progress in decreasing the proportion of sedentary adults.

Baltimore↗
PubMed2003

High lipid levels and coronary disease in women in Göteborg--outcome and secular trends: a prospective 19 year follow-up in the BEDA*study.

AIMS: To provide contemporary data on the effect of high cholesterol and high triglycerides on the risk of coronary heart disease (CHD) and mortality in Swedish women and to describe secular trends with respect to serum lipids, body mass index (BMI) and smoking in the source population. METHODS: We followed 1372 women aged 39-64 years and without prior cardiovascular disease from 1980 to 1999 through record-linkage with the Swedish hospital discharge and cause-specific death registers. Risk factor measurements were done at baseline. Every fifth year between 1980 and 1995 coronary risk factors were assessed in independent samples of the source population. RESULTS: In multivariate analyses, a 1 mmol increase in cholesterol was associated with a 51% increased risk of myocardial infarction (MI) and/or revascularisation (MI; p<0.0001) and a 30% increased risk of being hospitalised for CHD (p<0.0004). Women with cholesterol, 7-7.9 mmol/l, had a threefold risk of MI (HR 3.44 (1.63-7.23)) and hazard ratios in the highest cholesterol category, > or =8 mmol/l, was 4.49 (1.92-10.50) as compared to women with cholesterol below 6 mmol/l. A 1 mmol increase in triglycerides was associated with a 49% increased risk of MI (p=0.002) and a 45% increased risk of being hospitalised for CHD (p=0.001) after adjustment for major coronary risk factors. A moderate increase in triglycerides, 1.0-1.5 mmol/l, conferred no significant increase in risk of coronary events as compared to below 1.0 mmol/l. Women with high triglycerides, 1.5-1.9 mmol/l, had a doubled risk of MI (HR 2.55 (1.20-5.42)) and hazard ratios in the highest triglyceride category, > or =2.0 mmol/l, was 3.35 (1.48-7.60). Both high cholesterol and high triglycerides predicted mortality but the magnitude was smaller than for coronary events. During the study period the proportion of women with low cholesterol profile, below 6.0 mmol/l, increased on average from 49 to 68% and the proportion of women with low triglyceride levels, below 1.0 mmol/l, decreased from 59 to 36% in the source population. A modest increase in BMI was noted. CONCLUSIONS: Both high fasting cholesterol and high fasting triglycerides strongly predicted coronary events in middle-aged Swedish women. The favourable decline in cholesterol levels and smoking rates during the study period was offset by a marked increase in triglyceride levels. The findings suggest that interventional strategies directed to correct abnormalities in the triglyceride metabolism may be specifically warranted in women.

Adult↗
PubMed2001

Secular and seasonal cycling of IA2-ab autoantibody in Slovak diabetic children.

The concept of seasonal and secular cycling of initial autoantibody plasma levels in children with diabetes mellitus 1 is not common, despite the known fluctuations in one of the triggering factors, i.e., various enteroviral infections. The aim of this study was therefore to assess the trends and cycles in the time series of IA2-autoantibody (ab) blood plasma levels measured in each patient at the moment of diagnosis of the disease, before the first injection of insulin. In a retrospective study, the IA2-ab data, with each item related to a calendar day, were analyzed from 83 male and 108 female patients aged up to 14 years, with the date of disease menifestation between January 1993 and December 1999. The data source was the Slovak National Register of Childhood Diabetes. The plasma levels of the autoantibody against pancreatic tyrosine phosphatase (IA2-ab) were measured by radioimmunoassay. The chronogram of the daily observed values, modified by moving averages, from three successive data items per patient, was processed by Halberg's cosinor method to test the presence of seven-year sinusoids and one-year rhythms. One seven-year sinusoid, peaking in February 1998 (boys) and in October 1996 (girls), and a seasonal rhythm culminating in May/June each year were significant. There are some similarities to the cycling of other variables such as the incidence of diabetes, the birth of future diabetics, Coxsackie virus epidemics and pancreatic glutamic acid decarboxylase (GAD 65) autoantibody. Moreover, some cosmo-geophysical periods also seem to be cycling in a parallel manner. The novelty of this contribution is that it examines the seasonal cycling of the autoantibody, connected with the pathogenesis of diabetes and directed against IA2-ab.

Adolescent↗
PubMed2003

The secular trend in human physical growth: a biological view.

Nutritionists and anthropometric historians alike are familiar with the secular trend-height and weight in adults, and the rate of physical development in children, increasing since at least the mid 19th century. The social conditions which drive this trend are of interest to anthropometric historians, but the underlying biology is also important. Here the trends for height, weight and menarcheal age are summarised and contrasted. In Northern Europe, adult height has largely stabilised, and the age of menarche has also settled at around 13 years, while weight continues to increase due to obesity. The increase in height from one generation to the next occurs mainly in the first 2 years of life, due to increases in leg length. The height trend has lasted for 150 years or more, i.e. for six generations, because the rate of catch-up from one generation to the next is biologically constrained to avoid the cost of too rapid catch-up.

Adult↗
PubMed1997

Evidence for secular change in Paget's disease.

Death certification data has shown that death rates due to Paget's disease of bone and osteosarcoma in older people (assumed to be attributable to Paget's) declined in the latter part of the 19th and in the early 20th century, suggesting that there may be a secular trend toward less severe disease. We have reviewed a 21 year experience in a clinic specializing in Paget's disease. Data from all 1041 patients attending the clinic in this period were reviewed. Despite an increase in the susceptible population and an increased rate of referral to the clinic over this time (p = 0.012), there was a fall in the absolute numbers of patients referred with severe disease, as judged by the initial plasma alkaline phosphatase activity at presentation. In the years 1973-1978 the initial plasma alkaline phosphatase was > 500 U/L in an average of 22 new patients per year and > 1000 U/L in 12 per year. In the years 1988-1993, the figures were 12 and 3 per year, respectively. During this period, there were no other facilities offering scintigraphy or intravenous treatment for Paget's disease in the Auckland region, making it unlikely that patients with severe disease were being seen and treated elsewhere. The average age of newly referred patients rose steadily from a mean 62 years, in 1971-1973 to 71 years in 1991-1993 (p < 0.001). 534 subjects had scintiscans (52%) from which the extent of skeletal involvement was calculated. Skeletal involvement showed a significant negative correlation with year of birth (p < 0.01) but not with age or year of presentation. The proportion of patients with > 20% skeletal involvement had fallen by a third in the cohort born after 1926, compared to the cohort born before 1915. Our data demonstrate that, on average, newly referred patients with Paget's disease have less severe disease and are significantly older at diagnosis than was the case two decades ago.

Aged↗
PubMed1992

Secular trend and associated factors of twinning in Taiwan.

Delivery records of public hospitals and local health centers were analyzed to investigate the secular trend of multiple births from 1955 to 1990 in Taiwan. Twinning rates decreased gradually from the late 1950s to 1973, slightly increased and remained stable from 1974 to 1980, and then increased strikingly from 1981 to 1990. During the study period, MZ rates were consistently higher than DZ rates except in 1986 when a higher DZ rate was observed. The highest MZ rate of 7.7 per 1,000 deliveries was observed in 1985, while the highest DZ rate of 4.6 per 1,000 deliveries was observed in 1986. The triplet incidence rate also declined from the early 1960s to 1973 and then increased markedly from 1974 to 1990. A case-control study including 482 MZ and 252 DZ twin pairs and 1,496 singletons was carried out in four teaching hospitals in Taipei City between October 1985 and June 1989 to examine factors related to twinning. The zygosity of twin pairs was determined by sex, placentation and red blood cell antigens. Multiple logistic regression analysis showed that the higher the maternal age, the lower the MZ and DZ rates, while the higher the parity, the higher the rates. There was no association of paternal age or of maternal educational level with twinning rates.

Adult↗
PubMed1991

Effects of socioeconomic factors on secular trends in suicide in Japan, 1953-86.

The effects of socioeconomic factors on secular trends in suicide rates in Japan for the periods 1953-72 and 1973-86 were investigated using twelve socioeconomic indicators. Multiple regression analysis showed that the socioeconomic indicators affecting suicide rates were not identical in the two periods. The rates in both sexes in 1953-72 were closely related to unemployment rate and the labour force but between 1973 and 1986, divorce rate and the proportion in tertiary industry were most influential. The changes reflect the socioeconomic changes in industrial structure in Japan in transition from an industrial to a service economy.

Adolescent↗
PubMed1999

Secular trend in age at menarche in China: a case study of two rural counties in Anhui Province.

There is increasing evidence that age at menarche has decreased in Europe and the United States during the last century and in Japan over the last several decades. Data from a community-based survey conducted in two rural counties of Anhui Province in China indicate a similar, downward secular trend in age at menarche for Chinese women. The present study shows the mean age at menarche decreased by 2.8 years, from 16.5 to 13.7, over an approximate 40-year time interval. This rapid decrease in age at menarche may partly be due to better nutrition and living standards reflected by the improved socioeconomic standards experienced in China over the past few decades. To test this hypothesis, a number of determinants of age at menarche were assessed; year of birth, literacy status, county of residence, amount of physical labour, general health status, pesticide exposure before age at menarche, and drinking water source were all found to be associated with age at menarche.

Adolescent↗
PubMed1998

Secular trends of weight, height and obesity in cohorts of young Portuguese males in the District of Lisbon: 1960-1990.

OBJECTIVE: To examine the secular trend of weight, height and obesity among young Portuguese males at the time of military inspection for national conscription purposes in the region of Lisbon, during the last thirty years. DESIGN: Cross-sectional study, based on the review of military census files. SETTING: Military selection centre of Lisbon. SUBJECTS AND METHODS: In Portugal, military service is obligatory and medical inspections are carried out every year on males at the age of twenty. For study purposes, representative samples were taken from the young male population undergoing inspection for the Armed Forces on a five year basis, between 1960 and 1990 in the region of Lisbon. Weight and height were evaluated by a trained team, using standard measurement instruments and procedures. RESULTS: A progressive and significant increase in weight, height and BMI of the young male population was found between 1960 and 1990. For certain variables the increase was also statistically significant within a five-year period, as it was the case for height between 1965-1980 and for weight between 1985-1990. The increase in BMI experienced some minor fluctuation along the reference period, however, it was statistically significant between 1985-1990. The increase in weight and in BMI was greater in the highest percentiles and particularly noticeable between 1985 and 1990. The percentage of young males with BMI over 25 kg/m2 was of 8.1% in 1960 and of 18.0% in 1990, while those having a BMI over 27 kg/m2 varied between 3.6% and 6.4% in the same period, respectively. The percentage of young adult males with BMI higher than 25 kg/m2 doubled between 1960 and 1990.

Adult↗
PubMed1998

Secular trends in the osteoporotic fractures of the distal humerus in elderly women.

Osteoporosis, with its sequelae of fracture, is a major, continuously increasing threat to the health of the elderly, and therefore reliable epidemiological information is needed for assessment of the fracture development in the future and for effective fracture prevention. However, very little population-based information is available concerning the nationwide numbers, incidences and especially secular trends of osteoporotic fractures other than those occurring at the hip. We determined the current trends in the number and incidence of osteoporotic fractures of the distal humerus in Finnish women in 1970-1995 by collecting from the National Hospital Discharge Register all female patients aged 60 years or more who were admitted to our hospitals in 1970-1972, 1974-1975, 1978-1980, 1983-1985 and 1988-1995 for primary treatment of first osteoporotic fracture of the distal humerus. The fracture was defined as osteoporotic if it occurred on individuals aged 60 years or more as a consequence of a moderate or minimal trauma only (a fall from standing height or less). We also predicted the fracture development till the year 2030 by a regression model, a model that took into account the predicted changes in the fracture incidences and population at risk. The number and incidence (per 100,000 women) of osteoporotic fractures of the distal humerus in Finnish women aged 60 years or more increased from 42 (number) and 11 (incidence) in 1970 to 175 and 30 in 1995. The age-adjusted incidence of osteoporotic fractures of the distal humerus also increased, from 12/100,000 women in 1970 to 28/100,000 women in 1995. If this trend continues, the number of these fractures in Finnish women will be almost three-fold in the year 2030 compared with that in 1995. We conclude that the number of osteoporotic fractures of the distal humerus in elderly Finnish women is increasing more rapidly than can be accounted for by the demographic changes alone and therefore effective preventive measures are imperative to keep this problem in control.

Age Factors↗
PubMed2003

Secular trends in acute myocardial infarction in relation to physical activity in the general Danish population.

Secular trends in AMI rates were analyzed in relation to physical activity levels. The population attributable risk of physical inactivity was calculated. Participants were randomly selected subjects from a suburb of Copenhagen, Denmark, screened during the years 1964-1991. Occupational physical activity and in leisure time were assessed 1964, 1974, 1976, 1982, 1987 and 1991 by self-administered questionnaire along with smoking habits and alcohol consumption. Blood pressure, weight, height and serum lipids were measured according to WHO-standards. Mortality data were obtained from death certificates, from hospital records or autopsies. Acute myocardial infarctions (AMI) 1964-1994 were included. 13.925 men and women aged 30, 40, 50 and 60 years, were drawn as random samples from a background population of 300.000 inhabitants. A cohort born in 1914 was examined in 1964 and 1974, a cohort born in 1936, was examined in 1976 and 1987; Monica (Monitoring trends and determinants in cardiovascular diseases) I cohort were examined in 1982 and 1987; MONICA II in 1986, and MONICA III in 1991. Mean physical activity level at leisure adjusted for age and sex increased over time (P < 0001). 25% of the men were sedentary, and more women reported a sedentary lifestyle than men. The overall trend was from 1964 to 1992 a decline in physical activity at work (P < 0001) in both gender and all age groups. The difference in AMI incidence rates between leisure time physical activity (LTPA) levels increased over time. No change was found in AMI rates comparing sedentary in different time periods. A remarkable decrease over time in the AMI incidence rate was found in physically active during leisure time. Population attributable risk (PAR) exceeded 40% in both genders in the late 1980s. In conclusion the difference in AMI rates between LTPA subgroups has increased over time. The low AMI rates observed among the most physically active reveal a substantial potential for the prevention of AMI through physical activity. A population attributable risk of more than 40% for physical inactivity suggests a potential for primary prevention through increased physical activity.

Adult↗
PubMed1986

Secular variation in carbon isotope ratios from Upper Proterozoic successions of Svalbard and East Greenland.

Analyses of stratigraphically continuous suites of samples from Upper Proterozoic sedimentary successions of East Greenland, Spitsbergen and Nordaustlandet (Svalbard) provide an approximation to the secular variation in carbon isotope ratios during a geologically and biologically important period of change from around 900 million years ago to the beginning of the Cambrian period. Late Riphean carbonates and organic material show a stratigraphically useful pattern of enrichment in 13C relative to Phanerozoic or earlier Proterozoic samples. Isotopic compositions of isolated samples from other localities are consistent with a worldwide extended interval of enhanced organic burial and consequent net survival of oxidized material, probably O2, just before the initial radiation of metazoans.

Animals↗
PubMed1991

Intestinal and diffuse types of gastric cancer: secular trends in Sweden since 1951.

In order to test the hypothesis that the general decline in gastric cancer observed in many countries is due to a selective decline in Laurén's intestinal type, we re-examined all 427 histologic sections obtained from gastric carcinomas diagnosed at the Department of Pathology, University Hospital, Uppsala, Sweden, in 1951, 1961, 1971-72 and 1981. The relative proportions of intestinal and diffuse type cancers were compared. The intestinal type was significantly (P less than 0.001) more common among elderly people than in the younger age groups. The relative proportions of intestinal type carcinoma in the four periods under study were 65%, 55%, 42% and 60%, respectively. The absence of any clearly discernible trend over time contradicts the hypothesis of diverse secular trends for intestinal and diffuse types of gastric carcinoma.

Age Factors↗
PubMed2005

Secular trends in cardiovascular risk factors among school-aged boys from Crete, Greece, 1982-2002.

OBJECTIVE: The aim of the present study was to examine secular trends in major cardiovascular disease (CVD) risk factors, that is, obesity and dyslipidaemia, among Cretan children during 1982-2002. DESIGN: Epidemiological survey. SETTING AND SUBJECTS: A total of 528 boys in 1982 and 620 boys in 2002, aged 12.1+/-0.1 y, were randomly selected from urban and rural regions throughout the county of Iraklio, Crete, Greece. Care was taken so that all procedures in 2002 closely matched those in 1982. RESULTS: Mean height, weight, and body mass index (BMI) were 1.1, 9.6, and 8.4% higher, respectively, in 2002 vs 1982 (P<0.001). The prevalence of overweight and obesity has risen by 63 and 202%, respectively (P<0.001). Contemporary children were found to have 3.6% higher total cholesterol (TC), 24.9% lower high-density lipoprotein-cholesterol (HDL-C), 25.3% higher low-density lipoprotein-cholesterol (LDL-C), 19.4% higher triacylglycerol, 36.6% higher TC/HDL-C ratio, and 60.3% higher LDL-C/HDL-C ratio compared with their peers in 1982 (P<0.003). These differences persisted even when adjusting for BMI (P<0.02). The proportion of children having abnormal lipid values was much greater nowadays than in the 1980s, yielding odds ratios of 1.4-8.8 (P<0.005). CONCLUSIONS: Results are indicative of a largely deteriorated CVD risk profile in Cretan children since 1982, and predict an unfavourable CVD morbidity and mortality for this population in the foreseeable future.

Body Mass Index↗