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Results for “Secularism”

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At least 505 records · Page 28Linked to original sources
PubMed2003

Secular trends in nosocomial infections and mortality associated with noninvasive ventilation in patients with exacerbation of COPD and pulmonary edema.

CONTEXT: Randomized controlled trials have shown that the use of noninvasive ventilation (NIV) reduces the need for endotracheal intubation and invasive mechanical ventilation and reduces complication rates and mortality in selected groups of patients. But whether these benefits translate to a clinical setting is unclear. OBJECTIVE: To evaluate longitudinally the routine implementation of NIV and its effect on patients admitted to the intensive care unit (ICU) with acute exacerbation of chronic obstructive pulmonary disease (COPD) or severe cardiogenic pulmonary edema (CPE). DESIGN: Retrospective, observational cohort study using prospectively collected data from January 1, 1994, through December 31, 2001. SETTING: A 26-bed medical intensive care unit (ICU) of a French university referral hospital. PARTICIPANTS: A cohort of 479 consecutive patients ventilated for acute exacerbation of COPD or CPE. MAIN OUTCOME MEASURES: The ICU mortality and incidence rates of ICU-acquired infections. RESULTS: A significant increase in NIV use and a concomitant decrease in mortality and ICU-acquired infection rates were observed over the study years. With adjustment for relevant covariates and propensity scores, NIV was identified as an independent factor linked with a reduced risk of death in the cohort (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.18-0.78), whereas a high severity score on admission (OR, 1.05; 95% CI, 1.01-1.10) and the occurrence of a nosocomial infection (OR, 3.08; 95% CI, 1.62-5.84) were independently associated with death. Rates of ICU-acquired pneumonia decreased from 20% in 1994 to 8% in 2001 (P =.04). CONCLUSION: Implementing routine use of NIV in critically ill patients with acute exacerbation of COPD or severe CPE was associated with improved survival and reduction of nosocomial infections.

Acute Disease↗
PubMed2005

Secular trends in cardiovascular disease risk factors according to body mass index in US adults.

CONTEXT: Prevalence of obesity in the United States has increased dramatically in recent decades, but the magnitude of change in cardiovascular disease (CVD) risk factors among the growing proportion of overweight and obese Americans remains unknown. OBJECTIVE: To examine 40-year trends in CVD risk factors by body mass index (BMI) groups among US adults aged 20 to 74 years. DESIGN, SETTING, AND PARTICIPANTS: Analysis of 5 cross-sectional, nationally representative surveys: National Health Examination Survey (1960-1962); National Health and Nutrition Examination Survey (NHANES) I (1971-1975), II (1976-1980), and III (1988-1994); and NHANES 1999-2000. MAIN OUTCOME MEASURES: Prevalence of high cholesterol level (> or =240 mg/dL [> or =6.2 mmol/L] regardless of treatment), high blood pressure (> or =140/90 mm Hg regardless of treatment), current smoking, and total diabetes (diagnosed and undiagnosed combined) according to BMI group (lean, <25; overweight, 25-29; and obese, > or =30). RESULTS: The prevalence of all risk factors except diabetes decreased over time across all BMI groups, with the greatest reductions observed among overweight and obese groups. Compared with obese persons in 1960-1962, obese persons in 1999-2000 had a 21-percentage-point lower prevalence of high cholesterol level (39% in 1960-1962 vs 18% in 1999-2000), an 18-percentage-point lower prevalence of high blood pressure (from 42% to 24%), and a 12-percentage-point lower smoking prevalence (from 32% to 20%). Survey x BMI group interaction terms indicated that compared with the first survey, the prevalence of high cholesterol in the fifth survey had fallen more in obese and overweight persons than in lean persons (P<.05). Survey x BMI changes in blood pressure and smoking were not statistically significant. Changes in risk factors were accompanied by increases in lipid-lowering and antihypertensive medication use, particularly among obese persons. Total diabetes prevalence was stable within BMI groups over time, as nonsignificant 1- to 2-percentage-point increases occurred between 1976-1980 and 1999-2000. CONCLUSIONS: Except for diabetes, CVD risk factors have declined considerably over the past 40 years in all BMI groups. Although obese persons still have higher risk factor levels than lean persons, the levels of these risk factors are much lower than in previous decades.

Adult↗
PubMed2006

Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence.

CONTEXT: School immunization requirements have played a major role in controlling vaccine-preventable diseases in the United States. Most states offer nonmedical exemptions to school requirements (religious or personal belief). Exemptors are at increased risk of acquiring and transmitting disease. The role of exemption policies may be especially important for pertussis, which is endemic in the United States. OBJECTIVE: To determine if (1) the rates of nonmedical exemptions differ and have been increasing in states that offer only religious vs personal belief exemptions; (2) the rates of nonmedical exemptions differ and have been increasing in states that have easy vs medium and easy vs difficult processes for obtaining exemptions; and (3) pertussis incidence is associated with policies of granting personal belief exemptions, ease of obtaining exemptions, and acceptance of parental signature as sufficient proof of compliance with school immunization requirements. DESIGN, SETTING, AND PARTICIPANTS: We analyzed 1991 through 2004 state-level rates of nonmedical exemptions at school entry and 1986 through 2004 pertussis incidence data for individuals aged 18 years or younger. MAIN OUTCOME MEASURES: State-level exemption rates and pertussis incidence. RESULTS: From 2001 through 2004, states that permitted personal belief exemptions had higher nonmedical exemption rates than states that offered only religious exemptions, and states that easily granted exemptions had higher nonmedical exemption rates in 2002 through 2003 compared with states with medium and difficult exemption processes. The mean exemption rate increased an average of 6% per year, from 0.99% in 1991 to 2.54% in 2004, among states that offered personal belief exemptions. In states that easily granted exemptions, the rate increased 5% per year, from 1.26% in 1991 to 2.51% in 2004. No statistically significant change was seen in states that offered only religious exemptions or that had medium and difficult exemption processes. In multivariate analyses adjusting for demographics, easier granting of exemptions (incidence rate ratio = 1.53; 95% confidence interval, 1.10-2.14) and availability of personal belief exemptions (incidence rate ratio = 1.48; 95% confidence interval, 1.03-2.13) were associated with increased pertussis incidence. CONCLUSIONS: Permitting personal belief exemptions and easily granting exemptions are associated with higher and increasing nonmedical US exemption rates. State policies granting personal belief exemptions and states that easily grant exemptions are associated with increased pertussis incidence. States should examine their exemption policies to ensure control of pertussis and other vaccine-preventable diseases.

Adolescent↗
PubMed1998

Secular changes in standards of bodily attractiveness in women: tests of a reproductive model.

OBJECTIVE: Since success at work is favored by a more slender body build while reproduction is favored by curvaceousness, standards of women's bodily attractiveness should be predictable from economic and reproductive variables. METHODS: This hypothesis was tested in a replication and extension of a study by Silverstein, Perdue, Peterson, Vogel, and Fantini (1986) which looked at correlates of curvaceousness of Vogue models over time. RESULTS: As economic prosperity increased, and as women's participation in the economy, and higher education, increased, curvaceousness of the standards declined. As the proportion of single women to men, both aged 20-24 years, increased, and as the birth rate declined, curvaceousness was reduced. DISCUSSION: Results suggest that cultural standards of attractiveness are influenced by an evolved psychology of mate selection.

Adult↗
PubMed1984

Secular and age distribution of scrotal cancer in Connecticut and a review of United States literature.

In contrast with the expectations of the authors and with reports suggesting a decline in risk for scrotal cancer, Connecticut Tumor Registry data neither showed detectable decrease in risk over the 45-year-period for all 95 scrotal malignancies nor for the 71 epithelial cancers. The age distribution of scrotal cancer in Connecticut was similar to that of the more common tumors thought to be caused by exogenous agents. The risk increased up to age 75 in a geometric fashion, followed by a plateau and decline in risk among the very elderly. United States literature on scrotal cancer points to a change in occupational risks; this literature and recent occupational data from Connecticut suggest that metalworking may have been associated with a high proportion of cases in recent decades. Evidence is lacking that scrotal cancer and its most recent marker of carcinogenic risk have been fully eliminated.

Adolescent↗