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PubMed2000

Secular trends in birth weight, BMI, and diabetes in the offspring of diabetic mothers.

OBJECTIVE: The offspring of mothers who had diabetes during pregnancy experience increased risk later of diabetes and obesity later. We hypothesized that, in light of the historical improvements in the management of diabetes during pregnancy, these late consequences of the early environment might be diminishing with time. RESEARCH DESIGN AND METHODS: Birth weight and information on BMI and glucose tolerance have been collected as part of the epidemiological survey of the Gila River Indian Community in Arizona. We examined birth weight, BMI, and diabetes in offspring of mothers with type 2 diabetes during pregnancy born in four 10-year time intervals since 1955 compared with offspring whose mothers either had not developed diabetes or were prediabetic (i.e., developed diabetes after the index pregnancy). RESULTS: Offspring of diabetic mothers (ODM) were heavier at birth, had a higher BMI at all ages throughout childhood, and had an increased incidence rate of diabetes in childhood and early adulthood (7- to 20-fold, offspring of nondiabetic mothers [ONDM]; 3- to 5-fold, offspring of prediabetic mothers [OPDM]). Relative differences in birth weight and BMI between ODM and ONDM were greatest for those born before 1965. In those born after 1965, despite secular trends to higher BMI and diabetes incidence in the ONDM, differences in BMI and birth weight of ODM versus ONDM and OPDM appeared to have been maintained. CONCLUSIONS: With the possible exception of individuals born before 1965, the increased risk of diabetes and obesity experienced by ODM does not seem to be diminishing with time.

Age of Onset↗
PubMed1978

Secular tendencies of the incidence of fracture of the upper end of the femur.

On the basis of an epidemiological study of the incidence of fracture of the upper end of the femur, undertaken in the city of Malmö for the period 1951-1960, the expected number of fractures in 1967 and 1968, and in 1974 and 1975, was calculated taking into account the changes in the size and the composition of the population. It was demonstrated that during the first period the previously described increasing trend continued so that more fractures were observed than could be expected from changes in the population only, whereas later on this trend became insignificant. The changes observed after 1968 could be explained by the increasing number of old residents in the city, and there was no obscure secular trend.

Age Factors↗
PubMed1996

Intake ratio of water-insoluble dietary fiber to the water-soluble one in Japanese: an estimation on dietary records and the secular consideration on the national nutrition survey.

Thirty-four foods were analyzed in order to determine the content of water-soluble dietary fiber (SDF) and insoluble dietary fiber (IDF). Using the results with the standard table for 227 foods, the intake ratio of IDF/SDF of an average Japanese was calculated for the period 1946-1990. The ratio was 3.22 in 1990 as calculated on the food intakes shown in the national nutrition survey, and the secular change was not detected since 1946 when the ratio was 3.30. The ratio was also shown to be well preserved between types of households including the age of the head. Using dietary records of 60 healthy city workers (average 42.8 years) for 4 weeks, however, the weekly average ratio for an individual was found to vary in the range of 2.25-5.13 although the total average for 60 individuals was 3.33. Thus, the well preserved IDF/SDF intake ratio for an average Japanese showed, on the contrary, a wide variation of food selection between each person.

Adult↗
PubMed2003

Secular trends in uncertain-sex births and proportion of male births in Norway, 1967-1998.

It has been hypothesized that environmental factors influence sex differentiation in the fetus, thus causing a reduced sex ratio (male/female) at birth, an increase in the prevalence of ambiguous-sex infants, and possibly an increase in spontaneous abortion rates. In Norway, subsequent to 1967, all deliveries, including late abortions after 16 wk of gestation, have been reported to the Medical Birth Registry of Norway. The authors used these data to assess birth-weight-specific secular trends of uncertain-sex infants and the proportion of male births, from 1967 through 1998. Total rates of uncertain-sex infants increased from 2.3/10,000 births in 1967 to 8.0/10,000 births in 1998 in the birth weight strata of less than 600 gm. The total proportion of male births was stable; however, there was a reduction in the proportion of male births among births weighing less than 400 gm--from 58.4% to 53.4%. Incomplete ascertainment of abortions may have biased the results, but it would not have accounted for the increased occurrence of uncertain-sex infants and the decreased proportion of males observed among late-term abortions.

Abortion, Spontaneous↗
PubMed2004

Evidence-based therapies for myocardial infarction: secular trends and determinants of practice in the community.

OBJECTIVES: To examine secular trends in the use of evidence-based therapies in a geographically defined cohort of patients with myocardial infarction (MI) and to test the hypotheses that baseline use is increasing and that disparities in use are diminishing, PATIENTS AND METHODS: All consecutively hospitalized patients who were dismissed from Olmsted County, Minnesota, hospitals between 1979 and 1998 with a diagnosis of MI were identified using standardized criteria (biomarkers, cardiac pain, and electrocardiography). The entire community medical record, available via the Rochester Epidemiology Project, was reviewed to ascertain baseline characteristics including comorbidity, presence of ST-segment elevation on electrocardiography, and treatment. Logistic regression models were used to examine the association of treatment with age and sex, independent of other baseline characteristics. RESULTS: Between 1979 and 1998, 2317 incident MIs (patient mean +/- SD age, 67+/-14 years; 43% women; 57% aged > or = 65 years) occurred in Olmsted County. The use of all evidence-based therapies increased over time, primarily reflecting the introduction of these medications at the time of Index MI. Between 1989 and 1998, age was not independently associated with use of aspirin or ACE inhibitors. Disparities in use persisted for reperfusion therapy and beta-blockers. Reperfusion therapy or revascularization was used less frequently in older persons, particularly in elderly women (P<.001). Use of beta-blockers decreased 16% among persons aged 65 years or older, independent of measurable differences in baseline characteristics and MI severity (hazard ratio, 0.84; 95% confidence interval, 0.74-0.93). CONCLUSIONS: The use of all evidence-based therapies for MI increased markedly over time; however, residual gaps in use were noted. Reperfusion therapy or revascularization is used less frequently in women and elderly persons, and beta-blockers are used less frequently in elderly persons. These differences are not explained by measurable differences in baseline characteristics. Women and elderly persons represent an increasing proportion of patients with MIs in the community; therefore, these findings define therapeutic opportunities.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Dietary fat consumption in a cohort of American adults, 1985-1991: covariates, secular trends, and compliance with guidelines.

PURPOSE: To examine compliance with the guideline for dietary fat (i.e., 30% of total daily colonies) and covariates of fat intake in a cohort of adults using both 24-hour recall and food frequency questionnaire (FFQ). DESIGN: Prospective, observational cohort study over 5 years. SETTING: Community-based sample in Reno, Nevada. SUBJECTS: Equal numbers of male and female, lean and overweight adults (n = 508), recruited from 1985 to 1986, of whom 348 completed all relevant surveys. MEASURES: Subjects underwent repeated anthropometric measures and completed extensive surveys on diet, weight cycling, lifestyle, and physical activity. RESULTS: Mean fat intake by 24-hour recall declined from 36.9% to 33.6% of calories between years 1 and 5 (p < .001), while calorie intake increased (p = .2). As measured by FFQ at year 2, mean fat intake was 39.1% of calories, and only 11.8% of subjects were in compliance with the guideline for dietary fat intake. Fat intake by FFQ at year 2 was statistically higher than by 24-hour recall in year 1 for lean women (p = .02) and lean men (p = .02), but not for the overweight of either gender, and was significantly higher than the year 5 24-hour recall for all categories of gender and weight (p < .001). Calorie intake, gender, and body mass index were significant in regression models that explained less than 10% of total variability in fat intake (r2 = .08; p < .01). CONCLUSIONS: Compliance with the nationally recommended level of dietary fat intake was poor in this cohort, especially as measured by FFQ. Variability in fat intake was largely unexplained by host characteristics, including education. Further study is required to corroborate secular trends in population fat intake, elucidate the determinants of such intake, and identify cost-effective strategies for reducing the consumption of dietary fat.

Adult↗
PubMed1988

The secularization of health affairs.

Medicine, in Western Civilization, traces its ancestry to the School of Hippocrates on the Isle of Cos in the 5th Century B.C. Its history is intertwined with the Judeo-Christian ethic and manifests a significant ecclesiastical heritage. In the role of healer, the physician has a spiritual as well as a scientific character. Since World War II, health care has experienced vast changes in its cultural, economic, political, social, and technoscientific dimensions. This transition from the temple to the marketplace, characterized as The Secularization of Health Affairs has pervasive societal implications.

Delivery of Health Care↗
PubMed1976

[Sugar consumption and prenatal acceleration. II. Studies on the etiology and pathophysiology of secular prenatal acceleration].

The pathophysiologic considerations support the causal relationship between the secular trend of sugar consumption in industrialized society and the development of prenatal acceleration, which is evident on the basis of epidemiological data. The excessive consumption of sugar and the other quickly absorbed "refined" carbohydrates enhances the hormonogenic effect of food which is also potentiated by the proteins. Together with the caloric overloading, provoked also by the excess in fat, characteristic for the affluent society, the excessive sugar consumption enhances in the pregnant women obesity and "protodiabetes" (PFEIFFER), in the predisposed child the tendency to hyperinsulinism with its consequences. In a prediabetic mother with normal glucose-tolerance the regularly repeated postprandial overfloating of the fetus with maternal glucose changes the feto-maternal hormonal regulation and enhances together with the overloading of substrate, i.e. energy and elements of biosyntheses, the accelerated fetal growth and especially the obesity of the large baby.

Birth Weight↗
PubMed1999

[The secular trend in growth].

The secular changes in growth of the Spanish male population throughout the current century are presented. Data are adult mean height: 163.4 cm in 1910 and 174.5 cm in 1995. The increase was produced after 1950 and specially after 1965. From this last date, the increase by decade was between 2 and 2.9 cm. Lately the increase is gone on but more slowly. It was possible establish a direct relationship between height and culture and income of population. Maturation of female was studied using the menarcheal age. In 1998 it was 12.5 years. The menarcheal ag is now 0.3 years before than 15 years ago.

Adult↗
PubMed1999

[Secular increase of adipose tissue in adolescents from Zaragoza from 1980 to 1995].

BACKGROUND: To quantify the differences between anthropometric measurements obtained nowadays in male and female adolescents and those obtained 15 years ago in a sample of similar characteristics. SUBJECTS AND METHODS: We have studied 658 healthy individuals, 329 males and 329 females from 10.0 to 15.0 years of age, from different socioeconomic levels. Weight, height, arm circumference and left skinfold thickness (biceps, triceps, subscapular and suprailiac) have been measured. We have calculated the body mass index (BMI), density, total body fat, percentage of body fat and the body adipose muscular index (BAMI), which is the ratio between body fat (kg) and non fat mass (kg). The values obtained have been compared with those obtained fifteen years ago, in another sample of 1,465 children with similar characteristics. The research team and the material used were the same in both studies. Mean differences were compared using the unpaired t-test. RESULTS: Weight has increased significantly (p < 0.05), except for males at 12 years and females at 13 and at 14 years. Height has increased significantly at all ages and in males and females (p < 0.05). BMI has only increased significantly at 10 and at 11 years in males, and at 10 years in females. Skinfold thicknesses have also increased significantly, except for biceps in males between ages of 12 and 14 years and biceps and subscapular in females at 14 years. Body fat mass and percentage of body fat have also increased significantly and, in consequence, the density has decreased and BAMI has increased both significantly (p < 0.05). CONCLUSIONS: Secular increase in weight and height during fifteen years has occurred. In general, BMI has not increased but skinfold thicknesses and body fat have increased significantly, this fact demonstrates that there has been increase in the body fat compartment.

Adipose Tissue↗
PubMed2000

Secular trends in peri- and neonatal mortality in breech presentation; Norway 1967-1994.

OBJECTIVES: To assess secular trends in mortality rates in breech presentation in Norway and the effects of gestational age, birth defects and delivery method. MATERIAL AND METHODS: The Medical Birth Registry of Norway 1967-1994, with 45,579 breech presentation births from 24 weeks of gestation onwards, with mortality rate comprising all stillbirths from 24 completed weeks of gestation and all neonatal deaths (extended peri- and neonatal mortality) as main outcome variable. RESULTS: The extended peri- and neonatal mortality rate in breech presentation births declined during the study period from 9.2% in 1967-76 to 5.5% in 1977-86 and to 3.0% in 1987-94. The highest relative risk of mortality in breech presentation versus the total birth population was observed in intrapartum death and in mortality less than 24 hours after delivery. Stillbirth represented about half of the extended peri- and neonatal mortality throughout the study period. Also in infants with birth defects, the survival increased during the study period. The extended peri- and neonatal mortality was highest in vaginal deliveries, but decreased during the period, irrespective of delivery method. CONCLUSIONS: Probably due to improved obstetrical and neonatal care, mortality associated with breech presentation has substantially decreased. Increased focus especially on stillbirth, might be instrumental in further reducing the mortality associated with breech presentation.

Adult↗
PubMed2000

Secular trends in the survival of HIV-infected homosexual men in Amsterdam and Vancouver estimated from a death-included CD4-staged Markov model.

BACKGROUND: The purpose of this study was to investigate secular trends in waiting times in CD4-based stages of human immunodeficiency virus (HIV) disease progression in two cohorts of homosexual men, one in Vancouver and one in Amsterdam. All HIV-positive men with two or more CD4 counts in their AIDS-free period between 1 January 1985 and 1 January 1997 were included in this study. Data regarding clinical AIDS diagnoses (using the 1987 Centers for Disease Control and Prevention [CDC] AIDS case definition) and death were collected through active follow-up, review of hospital records, and municipal/national registries. The Vancouver Lymphadenopathy-AIDS Study (VLAS), was started in November 1982 and had enrollment until December 1984. Both HIV-negative and HIV-positive men were followed at intervals of 3-6 months until 1986 and annually thereafter. The Amsterdam cohort study on HIV and AIDS (ACS) started in December 1984, has ongoing enrollment and follow-up of both HIV-negative and HIV-positive homosexual men. The HIV-positive men were followed at intervals of 3 months. METHODS: The CD4-based stage of an individual at each visit was determined using smoothed data. For each cohort and in each calendar time period, a CD4-based Markov model with death as the absorbing stage was fitted to the data. The parameters in this model were estimated using the method of maximum likelihood and confidence intervals were calculated using bootstrap methods. RESULTS: A total of 509 homosexual men participating in the VLAS were included in this study, providing 5356 visits. Some 292 men developed AIDS before 1 January 1997 and 239 died before this date. In all, 232 of the 239 deaths were AIDS related. Thirty-seven per cent of all visits were related to treatment. A total of 543 homosexual men participating in the ACS were included in this study, providing 10 043 visits; 277 men developed AIDS before 1 January 1997 and 250 died before this date. The date of AIDS diagnosis was known for 225 of the 250 deaths. Twenty per cent of all visits were related to treatment. We found that in both cohort studies the stage-specific waiting times were longer in the low CD4-based stages (stages 4, 5 and 6: i.e. CD4 count <500 cells per mm(3)) after March 1990 compared to waiting times before March 1990. The increase in mean waiting time in these stages with low CD4 count was 21%, 33% and 53%, respectively in the ACS and 20%, 2% and 29% in the VLAS. Because waiting times alone are not exclusive for progression in a reversible model we also calculated the stage-specific median incubation periods till death. Men spent considerably longer in these CD4-based stages after March 1990 compared to before March 1990. CONCLUSIONS: Data from these population-based cohort studies showed that HIV disease progression in the calendar period where treatment was administered was slower for individuals in stages with low CD4 counts. We found no evidence for shortening of the incubation period that may have appeared from increasing virulence of the HIV in the population.

Adolescent↗
PubMed2000

[Environment and secular sperm trend. Stallion's semen quality during the last two decades].

BACKGROUND: Several reports have suggested that human semen quality has declined throughout the world over the last few decades. Chemicals in the environment acting as endocrine disruptors have been implicated as a possible cause. If this is indeed the case, then similar effects may be observed in animals. We report data on secular trends in semen quality of stallions collected during the last two decades by French National Studs. METHODS: We analyzed 1489 ejaculates collected from 390 Breton draught stallions between 1981 and 1996 and 341 ejaculates from 86 anglo-arab thoroughbred stallions from 1985 and 1995. We employed a standardized semen collection and analysis protocol for evaluating the semen quality. RESULTS: For both stallion breeds studied, we observed a decreased seminal volume (around 2% per year) whereas total sperm production remains unchanged. CONCLUSIONS: Seminal fluid volume is controlled by accessory sex glands, which are regulated by androgens. Chemicals with anti-androgenic properties have been detected in the environment. By affecting the development or function of accessory sex glands, these chemicals may be at least partly responsible for the observed decrease in semen volume.

Age Factors↗
PubMed1998

Cardiovascular disease: risk factors, secular trends, and therapeutic guidelines.

A brief review of cardiovascular disease incidence and risk factors for coronary heart disease and cardiac failure is presented. Secular trends in cardiovascular disease risk factors, morbidity, and mortality are a major focus. Declines in cardiovascular disease mortality over the past 30 yr, a more modest decline in coronary heart disease, and an increase in cardiac failure are demonstrated. Emphasis is placed on evidence from large-scale, prospective, observational and interventional studies, and the pertinent U.S. guidelines and recommendations for care are provided. Consideration is given to the major risk factors, including lipids, blood pressure, smoking, and diabetes mellitus. Additional information is also given concerning the role of vitamins, homocysteine metabolism, and left ventricular hypertrophy. Although this review focuses on commonly accepted risk factors in the general population, where appropriate, specific information that is relevant to patients with chronic renal disease is provided.

Cardiovascular Diseases↗
PubMed1975

Crohn's disease in a defined population. An epidemiological study of incidence, prevalence, mortality, and secular trends in the city of Malmö, Sweden.

A prospective epidemiological study of Crohn's disease in Malmö, Sweden, was carried out during the years 1958 to 1973. The mean annual incidence rate for the disease was 4.8 per 10(5) inhabitants at risk. The recorded incidence increased from 3.5 per 10(5) inhabitants during the initial 8-year period, to 6.0 per 10(5) inhabitants during the last 8 years of the study. The maximum annual incidence rate, 8.3 per 10(5) inhabitants in 1971, is the highest hitherto on record. A prevalence rate of 75.2 per 10(5) inhabitants on December 31, 1973 was recorded. The death rate was low: 0.15 per 10(5) inhabitants per year. The alidity of the observed high incidence rates and the rising secular trends are discussed.

Adolescent↗
PubMed1995

[Medicine as ars in the Roman world. Its advance from sacral to secular approach, its trading and public diffusion: socio-political considerations and their legal consequences].

The close linkage between empiric knowledge and its magic religious background in the archaic period appears clearly as a main feature characterizing the medical ars at its beginning, at least till it advances to a full secular approach during the fifth and fourth century B.C. The medical knowledge, which had been a privileged inheritance of the ruling class underwent a rapid transformation with the rise of the Roman Empire and its hegemonic politics that reached its climax during the Punic wars. As it was spread to all social classes it achieved an ever increasing importance leading to its specialisation and trading. This socio-political change had repercussions on the legal field: indeed conventiones concerning medical service came into effect. As far as action was concerned, doctors were permitted to avail themselves of the cognitio extra ordinem in order to get the rewards they were entitled to. The application of the legal tool cognition was however a device embedded in a set of other remedies aiming at granting rewards and incentives i.e. privilegia and salarium. Their development over the period of the Roman Empire was linked with a growing monopoly run by the supreme authority.

Commerce↗
PubMed1991

From theurgical to secular medicine in ancient Greece: pínakes and sanationes.

Although rational secular medicine, i.e. medicine founded on clinical observation and on the exploration of the natural causes of diseases, prevailed in Greece as late as the IV century B.C., testimonies of theurgical medicine survive in temples dedicated to the gods of medicine, e.g. Maleatas, Amphiaros and Asklepios. Votive inscriptions (Latin sanationes) show clinical cases, solved with the aid of the physician-god, who acts during the dream, which is an essential component in classical medicine and art of the medical treatment. It is worth noting that sanationes have been found in temples of many healing cities, e.g. Epidauros and Lebena and in Tiberine Island in Rome, but not in Kos and Pergamon, where Hippocrates and Galen were active, respectively. Is it just fortuitousness or testimony of the prevailing "scientific" meaning due to the work of the two most representative physicians of the classical world?

Clinical Medicine↗
PubMedDate not supplied

Religion and the secularization of bioethics.

Daniel Callahan, in an autobiographical reflection, describes how the unfolding secularization of bioethics has culminated in a speculative and linguistic narrowness. The pluralism we celebrate as a moral achievement may become oppressive if it is not open to the insights of particular traditions and communities.

Advisory Committees↗