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PubMed2000

Method availability and the prevention of suicide--a re-analysis of secular trends in England and Wales 1950-1975.

BACKGROUND: In England and Wales in the 1960s there were marked declines in suicide rates. These reductions were partly attributable to the detoxification of the domestic gas supplies; however, their extent varied by age and gender, with the most striking effects seen in older men. The objective of this study was to investigate method-specific trends in suicide between 1950 and 1975 to elucidate possible explanations for the patterns seen in different demographic groups. METHODS: An analysis of age-standardised method-specific suicide rates for England and Wales between 1950 and 1975 was carried out using routinely available mortality and population statistics. RESULTS: As has previously been shown, there were marked reductions in suicides by gassing in men and women of all ages between 1960 and 1975. In women and younger men, the effects of these reductions on overall suicide rates were partially offset by rises in drug overdose deaths (method substitution), but there were no immediate increases in the use of other suicide methods. In contrast, in older men, reductions in suicide by gassing were accompanied by only a slight increase in overdose suicides as well as reductions in rates of suicide using all other methods. The modest rise in overdose fatalities in older men occurred despite the fact that they were more often prescribed barbiturates and tricyclic antidepressants than younger men. CONCLUSIONS: Accessibility to and the lethality of particular methods of suicide may have profound effects on overall suicide rates. Such effects appear to depend upon the popularity of the method and the extent to which alternative methods that are acceptable to the individual are available. Social and psychological interpretations of fluctuations in suicide rates should only be made after assessing the possible contribution to these of changes in method availability and lethality.

Adolescent↗
PubMed1999

A secular trend in hip fracture incidence in East Germany.

The central Inpatient Register of the former German Democratic Republic was used to study the population-based epidemiology of hip fractures among 16.5 million East Germans. Incidence rates for hospital discharges for proximal femoral fractures for the age group 60 years and over were calculated for the years 1971 to 1989, the year before unification. Incidence rates for 1989 are similar to figures reported from the UK and The Netherlands, but lower than Scandinavian rates. A decrease in the admission rate was noted from 1971 to 1974 of 4.5% each year on average, and an increase from 1974 onwards of 4.4% on average. This change was observed to a different extent in all age groups. The female:male ratio of the standardized discharge incidence was stable at 2.3:1 and the female:male ratio of manifest cases increases from 4.1:1 in 1971 to 5.1:1 in 1989. An exponential increase in the incidence rates was observed with age. This apparent rate overestimated both the rate for true incident cases (by about 25-30%, if adjustments are made for readmissions and transfers) and their trend. Adjusted estimates for incident fractures show an increase of 2% annually. Cohort effects due to changed selective forces appear to be one reasonable causal explanation.

Aged↗
PubMed1996

Secular trends in osteoporotic pelvic fractures in Finland: number and incidence of fractures in 1970-1991 and prediction for the future.

To improve the knowledge of the current trends in the number and incidence of osteoporosis-related pelvic fractures, patients who were admitted to Finnish hospitals in 1970, 1975, 1980, 1985, 1988, and 1991 for primary treatment of first osteoporotic pelvic fracture were selected from the National Hospital Discharge Register. The overall incidence (per 100,000 inhabitants) of osteoporosis-related pelvic fractures (high energy traumas were excluded) in a population aged 60 years or more was 20 in 1970 and 63 in 1991. The increase was most pronounced in the older age groups (patients aged 80 years or more) and was observed in both sexes. The proportion of these osteoporotic pelvic fractures of all pelvic fractures increased from 18% in 1970 to 52% in 1991. Similarly, the proportion of patients over 60 years of age increased from 28% in 1970 to 62% in 1991. In 1991, 78% of the patients with an osteoporotic pelvic fracture were women. Across the study period, the age-adjusted total incidence of osteoporotic pelvic fractures also increased in both women and men 60 years of age and over. The proportional increase was more pronounced in men. We conclude that the number of osteoporotic pelvic fractures in Finland is increasing more rapidly than can be accounted for by the demographic changes only and that effective preventive measures are urgently needed to control the increasing number of these age-related fractures.

Accidental Falls↗
PubMed2005

Secular changes in health care utilization and work absence for migraine and tension-type headache: a population based study.

OBJECTIVE: To assess changes in consultation rates, medication use and work absences due to migraine and tension-type headache (TTH) in Denmark over a 12-year period. METHODS: Surveys of the general population in 1989 and 2001. Medical doctors conducted all headache diagnostic interviews based on ICDH-I and II. The participation rate was 76% (740) in 1989 and 74% (711) in 2001. Headache status was categorized as pure migraine, pure frequent TTH (frequent episodic or chronic TTH), coexisting migraine and frequent TTH, and healthy subjects (no primary headache or only infrequent TTH). RESULTS: Headache-related consultation rates (OR = 1.6 (1.1-2.2)), especially specialist consultations (OR = 3.6 (2.3-5.6)), increased for all headache groups. Use of prescription medication because of headache increased moderately (OR = 2.1 (1.1-3.9)) while the use of prophylactic medication was stable (OR = 1.1 (0.3-4.0)). Both headache-related (OR = 1.1 (0.7-1.7)) and overall (OR = 0.9 (0.7-1.2)) absence rates were largely unchanged. Headache-related absence rates were higher for subjects with both headache types (OR = 7.5 (4.3-13.1)) or with pure migraine (OR = 3.6 (2.0-6.6)) than for subjects with frequent TTH alone. Triptans users had higher migraine headache frequency and tended to have higher absence rates than non-users. Overall absence rates were higher for subjects with both headache types (OR = 2.3 (1.3-4.0)) or with frequent TTH (OR = 1.9 (1.4-2.7)) than for healthy subjects. Pure migraine was not associated with higher overall absence rates (OR = 1.0 (0.6-1.6)). CONCLUSION: Despite an increase in headache consultation rates and in use of prescription medication and triptans, no improvement in work absence rates was observed. Consultations, medication use, and absence rates were highest for individuals with both migraine and frequent TTH.

Absenteeism↗
PubMed1981

Secular trends in nosocomial infections: 1970-1979.

Nosocomial infection data from a mean of 81 hospitals has been reported to the National Nosocomial Infections Study (NNIS) each year since 1970. Surveillance has been conducted by the hospitals on an average of 1.16 million patients annually. The median nosocomial infection rate is 341 per 10,000 patients discharged, ranging from 312 in 1970 to 358 in 1975. Since 1975, the rate has steadily declined to 329 in 1979. By category of hospital, infection rates for community-teaching and municipal hospitals have declined in recent years whereas those for community and university hospitals have not. Infection rates for patients on the surgical service have declined steadily since 1975 to the lowest levels reported, 457 per 10,000 surgical patients discharged in 1979, primarily due to a decrease in the rate of surgical wound infections. On obstetrics, infection rates have increased steadily since 1970, also primarily due to surgical wound infections. Bacteremias have increased in frequency, particularly those associated with infection at other sites. No major shifts have been noted in the relative frequency of the most common sites of infection or pathogens causing infections.

Cross Infection↗
PubMed1991

Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989. National Nosocomial Infections Surveillance System.

More than 25,000 primary bloodstream infections (BSIs) were identified by 124 National Nosocomial Infections Surveillance System hospitals performing hospital-wide surveillance during the 10-year period 1980-1989. These hospitals reported 6,729 hospital-months of data, during which time approximately 9 million patients were discharged. BSI rates by hospital stratum (based on bed size and teaching affiliation) and pathogen groups were calculated. In 1989, the overall BSI rates for small (less than 200 beds) nonteaching, large nonteaching, small (less than 500 beds) teaching, and large teaching hospitals were 1.3, 2.5, 3.8, and 6.5 BSIs per 1,000 discharges, respectively. Over the period 1980-1989, significant increases (p less than 0.0001) were observed within each hospital stratum, in the overall BSI rate and the BSI rate due to each of the following pathogen groups: coagulase-negative staphylococci, Staphylococcus aureus, enterococci, and Candida species. In contrast, the BSI rate due to gram-negative bacilli remained stable over the decade, in all strata. Except for small nonteaching hospitals, the greatest increase in BSI rates was observed in coagulase-negative staphylococci (the percentage increase ranged between 424% and 754%), followed by Candida species (219-487%). In small nonteaching hospitals, the greatest increase was for S. aureus (283%), followed by enterococci (169%) and coagulase-negative staphylococci (161%). Our analysis documents the emergence over the last decade of coagulase-negative staphylococci as one of the most frequently occurring pathogens in BSI.

Bacteremia↗
PubMed1986

Recent incidence and secular trends in Hodgkin's disease and its histologic subtypes.

Incidence data from national cancer surveys (1947, 1969-71, 1973-80) in selected regions of the United States were used to describe the epidemiology of Hodgkin's disease (HD) in whites over all regions by age, sex and Rye histologic subtype in the 1970s, and time trends for HD overall. Before 1971, rates increased in young adults, notably men, and in older persons. During the 1970s, rates in children were stable, but young adult rates were high and rose slightly, particularly among women; both trends reflected elevated incidence of Nodular Sclerosis, the only subtype with increasing rates. For adults over 40, rates of all subtypes declined after 1969-71. Thus HD incidence in this country is not static, even over the last decade. Rate stability in younger children may indicate disappearance of environmentally caused HD. Incidence declines for older persons suggest a cohort effect, depletion of young adult susceptibles, or improvements in diagnostic accuracy.

Age Factors↗
PubMedDate not supplied

Secular trends in age at onset of major depressive disorder in a clinical sample of children.

Using a psychiatrically referred, depressed, school-age sample, we sought to cross-validate the clinically pertinent epidemiologic finding that the distribution of age at onset of first episode of major depressive disorder (MDD) is subject to birth-cohort and period effects. Demographic and historical variables also were considered in attempting to explain the variability in age-at-onset. The results indicated a birth-cohort effect, but no discernable period effect on age at onset of MDD; successive birth cohorts were younger when they first developed MDD even after stringent analyses were conducted that corrected for structural sampling biases in the sample. In view of the relatively small size and clinical nature of the sample and the restricted birth-year span that characterizes children, the results are presented to stimulate further discussion of this topical area.

Adolescent↗
PubMed1989

Twinning in southern Israel; secular trends, ethnic variation and effects of maternal age and parity.

Twin births in southern Israel between 1970 and 1986 were examined in the Jewish and Bedouin populations. An increase in dizygotic twinning in the whole population, largely due to an increase of rate in the Bedouin population was found. The dizygotic twinning rate in the Bedouin population rose until it reached the level found in the Jewish population. No change with time was found in the monozygotic twinning rates in either population. This suggests that while dizygotic twinning rates are influenced by environmental factors, the monozygotic twinning rates are not. The effects of maternal age and parity on dizygotic and monozygotic twinning rates differed in the two ethnic groups examined. In the Jewish population the dizygotic twinning rate was related to maternal age and parity, while in the Bedouins only maternal age affects the rate. The monozygotic twinning rate has an inverted U shape with maternal age in the Jewish population and is linearly related to maternal age in Bedouin women. No effect of parity on the Jewish monozygotic twinning rate is found but this rate is directly affected by parity in Bedouin women. The effects of maternal age and parity together were examined in both populations. Both maternal age and parity affected the twinning rates; however, the effects are not additive and no interaction between maternal age and parity was found.

Adult↗
PubMed1991

Secular trends in psychiatric diagnoses of suicide victims.

Post-mortem psychiatric diagnoses are compared in two cohorts of male suicides from St. Louis (1956-1957) (Robins, 1981) and San Diego (1981-1982) (Rich et al., 1986). Similar structured interviews and diagnostic criteria had been used in both assessments. Substance/alcohol abuse has remained the major diagnosis in suicides under age 60. Rates of depressive disorder alone have decreased overall, due mostly to decreased rates in the elderly. Thus, depression occurs more frequently in younger ages. Comorbid depression and substance/alcohol abuse has also increased in younger ages. Implications in terms of the so-called 'cohort effect' are discussed.

Adolescent↗
PubMed1984

Medicalization and secularization in selected English Canadian fiction.

This paper presents an analysis of the role of medical and religious values in Canadian society during the past two centuries as described in Canadian book-length fiction. It has been argued that medical institutions are increasingly becoming powerful social control agencies. More and more of human behavior is seen as having a medical explanation, cause or cure. At the same time, religious institutions are believed to be diminishing in their social control abilities. Normality and abnormality tend now to be defined as medical conditions. What was once seen as sin may now be considered illness; and what once was grace or holiness, now may be viewed as health. An empirical examination of this theoretically conceived and seldom empirically examined trend is documented.

Attitude to Death↗
PubMed1996

The spiritual dimension of hospice: the secularization of an ideal.

There is increasing concern that the original hospice ethos is becoming subject to routinization and bureaucratization. Authors, drawing on Weber's concept of rationalization, have suggested that this has resulted from the loss of the original charismatic impetus and the commitment to care for the terminally ill and dying as inspired by the spiritual 'calling'. This paper argues that this original ethical ideal has been fundamental to the humane care of the dying and terminally ill. Using Alasdair MacIntyre's analysis it is suggested that as the ideal attenuates there are inevitable shifts in the ethos and culture of care. An emotivist culture in which the aesthete, the therapist and the manager are dominant characters, may seem to be occurring in palliative care. The focus on management skills and the values of efficiency and effectiveness influence attitudes to death. This brings increased medicalization, a reliance on psychosocial techniques, a predominant focus on education, research and audit and most particularly redefined attitudes to the spiritual component of care. The paper asks the question whether the original ethic has a place in preventing palliative care becoming merely a technique for professional empowerment.

Empathy↗