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PubMed1993

Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990. National Nosocomial Infections Surveillance System.

To identify pathogens causing nosocomial fungal infections and the secular trend in their incidence in US hospitals, data from the National Nosocomial Infections Surveillance System, 1980-1990, were analyzed. During that period, 30,477 fungal infections were reported. The rate rose from 2.0 to 3.8 infections/1000 discharges. The highest number of nosocomial fungal infections/1000 discharges was reported from the burn/trauma service (16.1). Candida albicans was the most frequently isolated fungal pathogen (59.7%), followed by other Candida species (18.6%). The rate increased at all four major anatomic sites of infection. Patients with bloodstream infections who had a central intravascular catheter were more likely to have a fungal pathogen isolated than were other patients with bloodstream infection (relative risk = 3.2; P < .001): 29% of fungemia patients and 17% of patients with bloodstream infection due to other pathogens died during hospitalization (P < .001). Fungi are emerging as important nosocomial pathogens and control efforts should target fungal infections, especially fungemia.

Cross Infection↗
PubMed1993

The common good in a secular society: the relevance of a Roman Catholic notion to the healthcare allocation debate.

This essay analyzes Roman Catholic social teaching on the right to health care and the legitimacy of healthcare rationing. It considers that discussion at two levels: (1) the specific warrants that undergrid key terms; and (2) the accessibility and applicability of those warrants to policy choices in a secular society. The essay concludes with a number of broader reflections meant to reserve an appropriate place for religious voices in the process of policy-making, as distinguished from its justification.

Catholicism↗
PubMed1983

Secular trends in the distributions of the breast cancer risk factors--menarche, first birth, menopause, and weight--in Hiroshima and Nagasaki, Japan.

The results of a mail survey completed by approximately 21,000 female atomic bomb survivors in Hiroshima and Nagasaki in 1970 are studied with respect to menarche, first birth, menopause, and weight. These known risk factors for breast cancer can be used to explain some but not all of the differences in Japanese and US breast cancer rates. The results for age at menarche are the most striking, with the presence of a strong secular trend. The average age at menarche in Japan was observed to decrease from 16.4 years for women born in 1902 to 14.4 years for women born in 1942. However, a temporary increase was observed in women whose menarche was expected to occur during the war years of the early 1940s. Differences between US and Japanese women were also observed in age at first birth and nulliparity rates. Age at menopause was similar for the two groups, although US women have a considerably higher rate of surgically induced menopause. Within each birth cohort, it is shown that body weight is negatively correlated with age at menarche and positively correlated with age at menopause.

Adult↗
PubMed1987

Secular changes in early neonatal mortality in Norway, 1967-1981.

Two five-year cohorts, 1967-1971 and 1977-1981, of the Medical Birth Registry of Norway, were utilized to analyze secular trends in early neonatal mortality rates, controlling simultaneously for birth weight, parity, maternal age, and sex. Improvement in the crude early neonatal mortality rate, from 6.5 to 2.9 per 1,000, was partitioned into one portion (18.4%) attributable to changes in the distribution of the birth weight or the other independent variables and another portion (81.6%) attributable to improved survival within each specific subgroup in the multivariate table. The early neonatal mortality rate was found to decrease in all subgroups, the low birth weight groups showing a significantly greater decline than the normal birth weight groups. Women with diabetes, epilepsy, or blood group antibodies were studied in separate analyses. For women with diabetes, the odds ratio of the early neonatal mortality rate between the first and the second periods was found to be three times the odds ratio for women without diabetes, and 2.9% of the total improvement of the crude early neonatal mortality rate was attributable to an improved survival in these infants.

Birth Weight↗
PubMed1994

Secular trends in blood pressure among adult blacks and whites aged 18-34 years in two body mass index strata, United States, 1960-1980.

Secular trends in blood pressure among young adults reflect the proportion of the population at risk of developing hypertension and may be markers of progress in primary prevention. National health examination data from three successive surveys were analyzed to assess blood pressure trends for adult blacks and whites aged 18-34 years in two body mass index (BMI; weight (kg)/height (m)2) strata (< 25 or > or = 25). Blood pressure was categorized into a four-point ordinal scale using the weighted, within-sex 50th, 75th, and 90th percentiles for 18- to 24-year-old adults in the 1960-1962 survey. The effects were analyzed with cumulative logit models with alpha = 0.01. The systolic blood pressure decreased moderately for 25- to 34-year-old males and for females except those aged 25-34 years with a BMI of > or = 25. Diastolic blood pressure increased among males with a BMI of > or = 25 and among white males with a BMI of < 25, but did not show a significant overall trend among females. A BMI of > or = 25 was associated with substantially higher blood pressure in each survey, except for one age-sex-race subgroup. Racial differences within BMI were less consistent than the differences across BMI strata. In summary, the situation with respect to hypertension among females may have improved during this time period but for males may have worsened with respect to diastolic blood pressure. Data for both sexes support a need for population-wide obesity prevention to reduce the incidence of hypertension.

Adolescent↗
PubMed2001

Secular trends in antidepressant prescribing in the UK, 1975-1998.

BACKGROUND: We have examined secular trends in age- and sex-specific prescribing of antidepressants to determine whether these mirror changes in other population measures of mental health. METHOD: An analysis was carried out of age- and sex-specific rates of antidepressant prescribing by a representative sample or panel of UK general practitioners (GPs) in the period 1975-1998. RESULTS: The number of antidepressant prescriptions issued increased more than twofold in the period 1975-1998 and, in 1998, a total of 23.4 million antidepressant prescriptions were issued by GPs in the United Kingdom. Rates of antidepressant prescribing increased markedly in all age and sex groups with as much as a threefold increase in the older age groups. With the exception of 12-19-year-olds, these increases have been more marked in males, although absolute levels of prescribing are still at least two times higher in females. CONCLUSIONS: Antidepressant prescribing has increased in all age and sex groups. This indicates either that there have been changes in the presentation, recognition and management of depression in general practice or that the prevalence of depression has increased, or a combination of these two phenomena. The higher prescribing rate in females is in keeping with evidence from psychiatric morbidity surveys suggesting that women experience higher levels of psychiatric morbidity than men. Decreases in the ratio of female to male prescribing, however, support other data indicating that, relative to females, the mental health of young males has declined in recent years. Changes in patterns of help-seeking may also contribute to the observed trends.

Adolescent↗
PubMed2004

Secular trend of colon cancer incidence and mortality in relation to fat and meat intake in Japan.

Mortality from colon cancer has rapidly increased in the past decades in Japan, and the increase has generally been ascribed to the Westernized diet, characterized by a high intake of fat and meat. However, fat and meat consumption in Japan stopped increasing in the 1970s. The secular trend of colon cancer incidence and mortality was examined in relation to changing patterns of the consumption of selected foods and nutrients and other related factors in Japan, focusing on the relationship with fat and meat consumption. The incidence and mortality rates of colon cancer both increased almost linearly on a log scale until the early 1990s, the increase then ceasing. The temporal change in fat and meat intake coincided with the incidence of colon cancer approximately 20 years later. Although figures for the consumption of red meat was not available in the early years, red meat accounted for 70-80% of the total meat intake in the mid 1960s and thereafter. Cereal consumption showed a continuous decrease even after the 1970s, that of vegetables showing no marked change. The current observation adds to evidence that red meat intake is an important determinant of colon cancer risk.

Adult↗
PubMed2006

Pubertal development in girls: secular trends.

PURPOSE OF REVIEW: To provide an overview of recent studies from the US and other parts of the world that provide conflicting data as to whether there has been a secular trend for earlier onset of puberty and menarche from about 1960 to the present. RECENT FINDINGS: Studies from the US suggest a decrease in the age of onset of puberty over the past 40 years of between 0.5 and 1.0 years, with black girls maturing 0.5 to 1 year earlier than white girls. There has been a smaller decrease in the mean age at menarche, on the order of 0.2 years. Northern European countries have not reported such a trend, but several other countries have. The most likely explanation for this trend is an increase in the prevalence of obesity in children. SUMMARY: In light of the above trends, the view that onset of any pubertal changes prior to age 8 years requires an extensive evaluation should be reevaluated. The majority of such early-maturing girls are normal girls at the early end of the age distribution for pubertal onset. As much attention should be paid to the rate of progression of pubertal findings as to their age of appearance.

Adolescent↗
PubMed2003

Streptococcus pneumoniae-related illnesses in young children: secular trends and regional variation.

BACKGROUND: Children <2 years old have been targeted for routine pneumococcal conjugate vaccine. Laboratory-confirmed illnesses represent a minority of all medical care utilization for pneumococcal disease. OBJECTIVES: To evaluate trends in medical care utilization for Streptococcus pneumoniae-related illnesses before introduction of pneumococcal conjugate vaccine (1995 to 1999) and to evaluate regional variation in utilization. METHOD: Retrospective cohort analysis with the use of computerized billing data of children <2 years old enrolled in Tennessee (Medicaid program) and the Rochester, NY area (commercial and Medicaid managed care plans). Secular trends (1995 to 1999) analysis included 316 519 person-years in Tennessee Medicaid. Regional variation (1998 to 1999) analysis included 130 525 person-years in Tennessee and 26 140 and 3184 person-years in commercial and Medicaid plans, respectively, in the Rochester, NY area. RESULTS: From 1995 to 1999 in Tennessee, the net increase in medical care visits was 12% for pneumococcal and nonspecific pneumonia and invasive disease, 11% for otitis media and 11% for other acute respiratory conditions. Analysis of trends indicated that a significant vaccine effect could be detected if utilization rates declined by 32, 9 and 21%, respectively. In the Tennessee Medicaid population, rates of pneumococcal and nonspecific pneumonia and invasive disease were 60% higher than in either the New York Medicaid or the commercial populations. Children with commercial insurance had the highest medical care utilization for otitis media. CONCLUSIONS: Geographic variation and large population differences in medical care utilization among children < 2 years old in three study populations suggest that the benefits of vaccination may vary by region and by population. In the Tennessee Medicaid population, temporal trends and year-to-year variability of pneumococcal-related outcomes were observed from 1995 to 1999. In this population a 10% decline in otitis media visits after the introduction of pneumococcal conjugate vaccine could be detected by trend analysis.

Age Distribution↗
PubMed2004

Resonance overlap, secular effects, and nonintegrability: an approach from ensemble theory.

The time evolution of a classical multiresonance nonintegrable Hamiltonian system with few degrees of freedom is analyzed on the ensemble level. Time-dependent perturbation analysis is applied to the Liouville equation to determine the most secular series for the time evolution of the expectation value of some physical observables. In contrast to the so-called lambda(2) t expansion for thermodynamic systems, which is well known in nonequilibrium statistical physics, we find a square root of lambda t expansion in small nonintegrable systems with few degrees of freedom. This asymptotic expansion exists only on the level of ensemble but not on the level of trajectories. Moreover, the time symmetry of this expansion is broken as in nonequilibrium statistical mechanics. The relation of the Chirikov overlapping criterion to our approach is discussed.

Journal Article↗
PubMedDate not supplied

Secular trends in the incidence of female breast cancer in the United States, 1973-1998.

Statistical modeling suggests a causal association between the rapid increase in the incidence of female breast cancer (FBC) in the United States and the widespread use of screening mammography. Additional support for this suggestion is a shift in the stage at diagnosis that consists of an increase in early stage diagnosis followed by a decrease in late-stage diagnosis. This has not been reported in the United States. The objective of this study was to examine the secular trends in the incidence of FBC in search of empirical support for this shift. FBC cases in the Surveillance, Epidemiology, and End Results (SEER) database from 1973 through 1998 were dichotomized into early and late detection based. Early detection included all the in situ and invasive cases with local spread. Late detection included cases with regional spread and distant metastasis. Joinpoint segmented regression modeling was used for trend analysis. Early detection in white and black women followed a similar pattern of significant increase in the early 1980s that continued through 1998 with slight modification in 1987. The expected shift in stage was noticed only for white women when the incidence of late detection in them began to decline in 1987. The incidence of late detection in black women has remained stable. These results provide further support for the previously implied causal association between the use of screening mammography and the increased incidence of FBC in the United States. It also shows that the expected stage shift appeared in white women 50-69 years of age after an estimated detection lead time (DLT) of about 5 years. This is the first estimate of DLT in the United States that is based on actual data. The subsequent increase in late detection in white women since 1993 may be due to changes in case management and the increased use of sentinel lymph node biopsy (SLNB) rather than changes in the etiology or biology of FBC.

Adult↗
PubMed2006

Recent data on pubertal milestones in United States children: the secular trend toward earlier development.

Tracking secular trends in the pubertal development of a country's children is important for social and public health reasons. Although comparable studies are largely lacking for US children over the last half century, existing data on girls, particularly that for menarche, indicate that the trend for earlier sexual maturatin has continued and that racial differences are significant, with African-American girls developing earlier than white girls. Data on boys, though less reliable, suggest that they may be beginning maturation earlier as well. More studies on boys with reliable methodologies are needed. Earlier development may not be healthy and may indicate environmental problems that need to be further researched and addressed.

Black People↗
PubMed1994

Secular trends of sudden infant death syndrome in Norway 1967-1988: application of a method of case identification to Norwegian registry data.

In Norway, towards the end of the 1980s, sudden infant death syndrome (SIDS) was the most frequent cause of infant death. Both SIDS and the total post-perinatal mortality rates had increased. This paper presents a procedure for identifying SIDS from death certificates. Supplemented with additional information, a database was established to evaluate secular trends of SIDS and for further analytical research. The Medical Birth Registry of Norway comprises 1.3 million births from 1967 to 1988. Of these, 5447 infants died in the post-perinatal period. The cause of death was reviewed by an expert panel and 1984 cases of SIDS were retrieved. Low maternal age, higher birth order, male gender, and lower birth-weight were confirmed as risk factors for SIDS. In 1988, the rate for SIDS and for total post-perinatal deaths reached 2.69 and 5.02 per 1000 infants at risk. The incidence of SIDS increased 2.2 times from the period 1967-1971 to the period 1987-1988. Adjusted for maternal age, birth order, and birthweight, the odds ratio was 3.1. The increase is due to factors not yet accounted for. Adjusted mortality rates for the other post-perinatal deaths were not different from the crude rates.

Algorithms↗
PubMed2006

Secular trends in socio-economic status and the implications for preterm birth.

The rate of preterm birth in the developed world has been shown to be increasing, in part attributable to obstetric intervention. It has been suggested that this may be a differential increase between socio-economic groups. We aimed to assess whether the preterm rate in Norway is different in socio-economic groups defined by maternal education, and to determine the extent to which a difference is attributable to a socio-economic differential in obstetrical intervention, in terms of caesarean section or induction of labour. We used data from the Medical Birth Registry of Norway from 1980 to 1998 with preterm rate as the outcome and maternal educational level, marital status and obstetric intervention as exposure variables. In multivariable analyses, adjustment was made for maternal age, year of birth and birth order, and secular trends were assessed according to year of birth. The preterm birth rate was highest in the lowest socio-economic group. An increase of 25.2% in the preterm rate was seen over the observation period. No apparent differential was seen in the increase of the crude preterm rates between socio-economic groups, although in multivariable analyses there was a significant interaction between socio-economic group and time, implying a stronger effect of low education towards the end of the observation period attributable to demographic change. In conclusion, the preterm birth rate increased over time, but was mainly due to an increase in obstetric interventions. No closing of the gap between socio-economic groups was observed.

Cesarean Section↗
PubMed1985

Secular trends in fatal and disabling child trauma.

Types and rates of childhood accidents are constantly varying. From the point of view of the potential child victim, the danger-safety equilibrium is disturbed by changes in lifestyles, availability of new consumer goods, and changes in social order. Balance is achieved by the implementation of preventive measures, particularly safety legislation. 'Old' hazards affecting children in pre-industrial societies can re-emerge at any time as wealthy sophisticated societies aspire to recapture the delights of open space, the water, and 'country-style' living. Age-specific fatal accident rates are given for Australian children for the period 1960-1982. Whereas the total child (1-14 y) death rate has fallen from 159 per 100000 (in 1960) to 86 (in 1982), road traffic deaths have risen from 8.3-11.7 (1-4 year olds) and have remained static (8.3-8.9) for 5-14 year old children. Drowning in older children has been reduced, but drownings among toddlers are still high (9.2 in 1960; 11.7 in 1982). The causes of secular trends, and factors which are known to influence these, are discussed.

Accidents, Traffic↗
PubMed1990

Seasonal, regional and secular variations of cardiovascular and cerebrovascular mortality in New Zealand.

Numbers of deaths from coronary heart disease (CHD) and cerebrovascular disease (CVD) were available for five years (1980-84) in the North and South Islands of New Zealand; estimated death rates were determined, and age correction made. There was a major seasonal variation by month in coronary and cerebrovascular deaths in both sexes and both islands, with a zenith in June/July/August (winter) and a nadir in December/January/February (summer). There was a less obvious, and less complete, linear trend, with declining secular (annual) mortality over the five years. This was more obvious in North Island but not proven in South Island. After standardising for age, coronary mortality rates (but not cerebrovascular mortality rates), were significantly higher in South Island than in North Island. Mortality from both CHD and CVD was significantly higher in males than in females.

Age Factors↗
PubMed2005

The use of the kidneys in secular and ritual practices according to ancient Greek and Byzantine texts.

The use of kidneys in secular and spiritual practices was very common for centuries. In this article we present some references on their employment as sacrificial offers, as plain food or as a source for medicaments. Our material derives from Greek texts of the Classical, Hellenistic, Roman, and Byzantine eras. Relevant extracts from the Old Testament are also included, as they have become part of a common cultural heritage in that period of syncretism, when Jews were Hellenized and Greeks orientized. From the fragments cited in this article, it is obvious that the practical use of kidneys by priests, doctors, and lay persons in the periods under discussion was widespread. The sacrificial offering was based on the religious significance of the organ. The dietary consumption of the kidneys was limited by their function as urine producers. Their medicinal use was dictated first, by the abundance of the adipose tissue surrounding them, which was an ideal warming and binding substance. Second, it may be explained by the deeply rooted conviction that eating a particular organ led to the incorporation of its strength, thus protecting the corresponding eater's organs. Those practices should not surprise us in view of their corresponding modern use. Currently, kidney donors offer their organs in a sacrificial gesture, kidneys are consumed as a delicacy worldwide, and renal tissue is therapeutically used in transplantations and, until very recently, as a source for hormonal substances.

Animals↗