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PubMed1984

Age and secular distributions of virus-proven influenza patients in successive epidemics 1961-1976 in Cirencester: epidemiological significance discussed.

A general practice population of around 3900, under continuous clinical and laboratory surveillance, experienced 20 outbreaks of influenza between March 1960 and March 1976. Four epidemics were caused by subtype H2N2 type A viruses, seven by subtype H3N2 type A viruses and nine outbreaks by type B viruses. The age of every person proved virologically to have influenza is related to the age structure of the community and to the phase of the epidemic in which the virus-positive specimens were collected. Children 0-15 years old suffered a higher incidence rate than adults 16-90+. Pre-school children 0-4 suffered the highest rate of infection by viruses of both influenza A subtypes, whereas older schoolchildren 10-15 suffered the highest rate of type B infections. Despite these high incidence rates neither pre-school nor schoolchildren appear to have been the major disseminators of any of these influenza viruses in the community. Adults of all ages suffered a high rate of infection even into extreme old age, and the indiscriminate age distribution among adults was sustained in the successive epidemics. Such age-patterns are not those caused by a highly infectious immunizing virus surviving by means of direct transmissions from the sick, whose prompt development of the disease continues endless chains of transmissions. An alternative epidemic mechanism--whereby the virus does not spread from the sick but becomes latent in them, reactivating seasonally so that they later infect their companions--would produce age patterns similar to those recorded here for influenza patients. The suggested mechanism is illustrated by a simple conceptual model and the influenzal age patterns are discussed in relation to the recycling of influenza A subtypes.

Adolescent↗
PubMed1986

Nosocomial bloodstream infections: secular trends in a statewide surveillance program in Virginia.

Over a 7-year period (1978-1984) the authors studied the rates of nosocomial bloodstream infections in acute-care hospitals participating in a statewide surveillance network in Virginia. A total of 4,617 hospital-acquired bloodstream infections were documented among 1,807,989 patients at risk for an overall rate of 25.5 cases per 10,000 patient admissions/discharges (annual range = 22.1 to 30.7). Compliance of reporting for Virginia hospitals averaged 58% (1 to 5 monthly reports in a study year), and 39% (greater than or equal to 6 monthly reports annually). Significant changes in bloodstream infection rates (cases per 10,000 patient admissions/discharges) due to specific pathogens included the following: coagulase-negative staphylococci increased from a rate of 1.3 to 4.5 (P = .0003), and those due to all gram-positive cocci increased from a rate of 7.5 to 11.4 (P = .03). Candida species increased from a rate of 0.1 to 1.5 (P = .005). The data show a continuing rise of nosocomial Candida BSI and clearly document the re-emergence of gram-positive cocci as major nosocomial bloodstream pathogens.

Candidiasis↗
PubMed2001

Secular trends in incidence and antimicrobial resistance among clinical isolates of Salmonella at a university hospital in Taiwan, 1983-1999.

The incidence and antimicrobial resistance among clinical isolates of salmonella at a university hospital in Taiwan between 1983 and 1999 are summarized in this report. A total of 7986 isolates were analysed. Serogroup B has been the most prevalent over the years, with an apparently continuous decline after 1995. Concordant decrease was also found among S. choleraesuis and S. typhi isolates in recent years. In contrast, the proportion of serogroup D strains increased significantly after 1996. S. typhi remained relatively susceptible to most of the antimicrobial agents examined. For non-typhoidal isolates, antimicrobial resistance to ampicillin (62%), chloramphenicol (67%), and sulfamethoxazole-trimethoprim (37%) was relatively higher than that reported elsewhere. Newer generation cephalosporins and fluoroquinolones remained effective over the years, although emerging resistance to these drugs has been noticed since 1992. A more prudent selection and use of antimicrobial agents, in both humans and animals, and a continuous surveillance of resistance are essential in the future.

Drug Resistance, Microbial↗
PubMed2004

In the shadows of medicine and modernity: medical integration and secular histories of religious healing in Turkey.

Building upon the World Health Organization's recent publication WHO Strategy for Traditional Medicine (WHO 2002), this paper examines the historical position of "traditional medicines" at their intersection with the development and modernization of a biomedically based health care system in Turkey. This paper considers how the historical development of Turkey's health care system, as a prominent site for the articulation of the state's broader modernization project, sustained particular formulations of subjectivity and citizenship that were defined in opposition to a set of cultural practices and modes of religious-political authority represented by "traditional medicines." Consequently, projects and policies seeking to formally integrate "complementary" or "alternative" therapies directly confront this past and the various ways in which it is reenacted in constituting the present.

Complementary Therapies↗
PubMed2003

Secular trends in body dimensions and physical fitness among adolescents in Sweden from 1974 to 1995.

AIM: To investigate changes over time in body dimensions, and muscular and aerobic fitness in a representative sample of 16-year-old-girls and boys in secondary schools in Sweden from 1974 to 1995 (n = 855). METHOD: Height and weight were measured and five tests were performed: run-walk, two-hand-lift, Sargent jump, sit-ups, and bench-press. RESULTS: In 1995, girls and boys had higher body mass index (BMI) than in 1974. Girls and boys performed less well in bench-press, sit-ups, and run-walk-tests in 1995. Boys, but not girls, performed better in Sargent jump in 1995 than in 1974. Girls and boys performed better in two-hand-lift in 1995 than in 1974. However, after adjustment for body dimensions, there were no differences in performance in two-hand-lift or run-walk-tests between 1974 and 1995. CONCLUSION: There was a decreased aerobic fitness and an increased maximal static strength among adolescents in Sweden between 1974 and 1995. These changes were partly due to increased BMI. However, decreased daily physical activity level cannot be excluded as a contributing factor to the decreased aerobic fitness. The reduced performance in muscular endurance in 1995 was not related to increased BMI. Instead, it is suggested that it is to be related to a specific decrease in hip flexion and arm muscle endurance.

Adolescent↗
PubMed2006

Secular change in size at birth from 1973 to 2003: national data from Denmark.

OBJECTIVE: To explore whether birth weight (BW) has been increasing in Denmark at the same level as in other countries and whether this increase is paralleled by an increase in birth length (BL) or whether body proportionality, expressed as ponderal index (PI), has changed. RESEARCH METHODS AND PROCEDURES: This study used data analysis of information from The Danish Medical Birth Registry including all single live births in Denmark from 1973 to 2003 (n = 1,863,456). BW, BL, gestational age, maternal age, and smoking status (only from 1991 on) were measured. RESULTS: Mean BW increased steadily during the period (160 grams; equivalent to approximately 5 g/yr) at a rate higher than that reported from other countries. BL showed only a minor increase (2.4 mm), leading to an increase in PI (0.8 kg/m3) during the period. Controlling for the effect of increasing maternal age and decreasing gestational age and maternal smoking prevalence (only data after 1991), there was still an increase in BW of approximately 4 g/yr. DISCUSSION: During the last 30 years, neonates have become bigger, with a larger relative increase in BW than BL, leading to an increase in PI. The increasing BW and PI, which may be caused by increased maternal weight, could further promote the obesity epidemic.

Adult↗
PubMed2001

Secular trends in body mass index by birth cohort in eastern Finland from 1972 to 1997.

OBJECTIVE: To describe changes in body mass index (BMI) with age over a 25 y period, and to investigate whether those changes differed by birth cohort, gender or education. DESIGN: Six cross-sectional population surveys repeated in eastern Finland every fifth year between 1972 and 1997. Synthetic birth cohorts were created by dividing subjects into twelve 5 y groups according to birth year. SUBJECTS: Independent random samples from the national population register including men and women aged 25-64 y, the final sample comprising 18 439 men and 19 501 women. The oldest birth cohort included subjects born in 1913-1917 and the youngest were born in 1968-1972. MEASUREMENTS: Weight and height were measured, and data on educational level were collected by a self-administered questionnaire. RESULTS: A BMI increase with age was more prominent in women (4.2 kg/m(2) in 25 y) than in men (3.3 kg/m(2) in 25 y), and was very similar in all birth cohorts. In men, the BMI increase with age varied across cohorts. Among birth cohorts participating in each survey, the BMI increase over the 25 y period was most prominent (3.9 kg/m(2) in 25 y) in men born between 1943 and 1947. Among all birth cohorts, the strongest upward trend (0.2 kg/m(2) per year) was observed in men born between 1953 and 1957. CONCLUSIONS: Weight gain with age has remained unchanged in women over the 25 y period, whereas in men, the younger the birth cohort, the more prominent was the BMI increase with age.

Adult↗
PubMed2001

Secular changes in body fat patterning in children and adolescents of Zaragoza (Spain), 1980-1995.

OBJECTIVE: To examine whether children and adolescents of Zaragoza (Spain) are becoming centrally obese to a greater extent than would be predicted by their relative body weights. DESIGN: Two cross-sectional surveys conducted in 1980 and 1995. SUBJECTS: The samples selected for the 1980 and 1995 surveys comprised 1553 and 701 male children, and 1311 and 659 female children, respectively, with ages ranging from 6.0 to 14.9 y. MEASUREMENTS: We measured four skinfold thicknesses (biceps, triceps, subscapular, suprailiac) and calculated some indices of fat patterning: triceps/subscapular skinfolds (T/SS), biceps+triceps/subscapular+suprailiac skinfolds (B+T/SS+SI), and (subscapular+suprailiac/biceps+triceps+subscapular+suprailiac skinfolds)x100 (trunk-to-total skinfolds %). RESULTS: In males, B+T/SS+SI, and trunk-to-total skinfolds % showed a significant trend to a central pattern of fat distribution from 1980 to 1995, at the ages of 6.5-11.5 y. In females, B+T/SS+SI and trunk-to-total skinfolds % showed a significant trend to a central pattern of fat distribution from 1980 to 1995, at the ages of 6.5 and 7.5 y. Similar results were obtained when we adjusted for BMI values. CONCLUSION: We have observed a trend to a central pattern of adipose tissue distribution, especially in males and at the youngest ages studied (6-11 y in males, and 6-7 y in females). These observations were independent of trends in BMI.

Adipose Tissue↗
PubMed2002

Secular trends in overweight and obesity among Finnish adolescents in 1977-1999.

OBJECTIVE: To study the trends in overweight and obesity among Finnish adolescents in 1977-1999. DESIGN: Mailed surveys every other year. SUBJECTS: Nationally representative samples of 12, 14, 16 and 18-y-olds (n = 64,147, response rate 78.9%). METHODS: Overweight and obesity were measured by body mass index (BMI) and relative weight (RW) based on self-reported height and weight. BMI > or = the 85th percentile cut-off point for BMI in each age- and sex-specific group in the entire data set was considered as overweight, and BMI > or = 95th percentile cut-off point as obesity. RW > or = 110% and > or = 120%, calculated as the individual's weight divided by the mean weight in each age- and sex-specific height percentile group in the entire data set, were considered as overweight and obesity, respectively. The trends in overweight and obesity are described by the change in the 85th and 95th percentile cut-off points of BMI over time. The prevalence of overweight and obesity is also reported using BMI reference values recommended for international comparisons. Because of the similarity of the BMI and the RW criteria in classifying adolescents as overweight and obese, only results based on BMI are presented. RESULTS: Overweight and obesity increased linearly in all sex and age groups from 1977 to 1999. Depending on the age group, the average increase in the 85th percentile cut-off point of the BMI per 10 y was 0.6-1.1 kg/m2 in boys and 0.3-0.7 kg/m2 in girls. The 95th percentile cut-off point of the BMI for boys and girls increased by 1.1-1.6 kg/m2 and by 0.6-1.0 kg/m2 per 10 y, respectively. In boys, the increase in overweight and obesity was largest in the two youngest age groups. In girls, the increase in overweight was largest in the oldest age group, and that of obesity both in the 14 and 18-y-olds. Overweight and obesity increased more in boys than in girls in all age groups except in the 18-y-olds among whom the increase was similar in both sexes. Examination of the entire BMI distribution showed that there was little or no change over time at the lower (5th, 15th) and middle (50th) percentiles, but increasing differences at the upper end of the distribution, the increases in the 95th percentile being even more marked than those in the 85th percentile curves. According to international reference values, the age-standardized prevalence of overweight increased in boys from 7.2 to 16.7%, and in girls from 4.0 to 9.8%, between 1977 and 1999. The prevalence of obesity in boys was 1.1% in 1977 and 2.7% in 1999, and in girls 0.4 and 1.4%, respectively. CONCLUSION: Overweight and obesity increased remarkably among Finnish adolescents from 1977 to 1999. The changes concentrated at the upper end of the BMI distribution, suggesting that factors behind this development have influenced only a part of the adolescent population.

Adolescent↗
PubMed2006

Changes in the BMI of Polish conscripts between 1965 and 2001: secular and socio-occupational variation.

OBJECTIVE: To describe changes in the body mass index (BMI) of nationally representative samples of young adult Polish males between 1965 and 2001, and to investigate variation in the incidence of underweight, overweight and obesity between 1965 and 2001 in the young adult males in the context of the socio-political transformation that occurred in Poland since 1989. SUBJECTS: Four 10% nationwide random samples of 29-year-old Polish conscripts examined in 1965, 1986, 1995 and 2001. The conscripts were divided into four socio-occupational groups based on paternal education, occupation and degree of urbanization. MEASUREMENTS: Height, weight and BMI (weight (kg)/height (m2)). RESULTS: The proportion of overweight and underweight young adult males in the population increased between 1965 and 2001. The fraction of underweight decreased only among sons of farmers and entrepreneurs between 1986 and 1995 and then increased in all socio-occupational groups between 1995 and 2001. On the other hand, the proportion of overweight young adults gradually increased in all groups between 1965 and 2001. CONCLUSION: Socio-occupational position of the family is an important factor influencing underweight and overweight in young adult males. This factor apparently operates through a differential distribution of income, which influences components of lifestyle most likely associated with level of habitual physical activity and/or diet.

Adult↗
PubMed2006

Putative contributors to the secular increase in obesity: exploring the roads less traveled.

OBJECTIVE: To investigate plausible contributors to the obesity epidemic beyond the two most commonly suggested factors, reduced physical activity and food marketing practices. DESIGN: A narrative review of data and published materials that provide evidence of the role of additional putative factors in contributing to the increasing prevalence of obesity. DATA: Information was drawn from ecological and epidemiological studies of humans, animal studies and studies addressing physiological mechanisms, when available. RESULTS: For at least 10 putative additional explanations for the increased prevalence of obesity over the recent decades, we found supportive (although not conclusive) evidence that in many cases is as compelling as the evidence for more commonly discussed putative explanations. CONCLUSION: Undue attention has been devoted to reduced physical activity and food marketing practices as postulated causes for increases in the prevalence of obesity, leading to neglect of other plausible mechanisms and well-intentioned, but potentially ill-founded proposals for reducing obesity rates.

Age Factors↗
PubMed2002

Secular changes in blood pressure in childhood, adolescence and young adulthood: systematic review of trends from 1948 to 1998.

One plausible reason for the decline in cardiovascular disease (CVD), and in particular stroke, in the last century is population reductions in blood pressure. Blood pressure tracks from childhood into adulthood, and early-life blood pressure is associated with increased cardiovascular risk but few studies have reported on blood pressure trends among young individuals who are free of CVD and not taking antihypertensive medication. Knowledge of such trends may improve understanding of the causes of hypertension and enhance prevention. We report that declines in blood pressure have been taking place in high-income countries in 5 to 34-year-olds of both sexes and from a range of ethnic groups for at least the last 50 years, indicating that exposures acting in early life are important determinants of blood pressure. Possible explanations for these favourable trends include improvements in early-life diet and there is also intriguing evidence suggesting that blood pressure may be programmed by sodium intake in infancy. Occurring throughout the blood pressure distribution, these trends may have made important contributions to declining CVD rates. There may therefore be scope for intervening in early life to prevent high blood pressure in adulthood, and the downward trends reported in several recent studies suggest that the prevalence of adult hypertension and cardiovascular risk will continue to decline. However, persisting high rates of CVD in the developed world, the impending CVD epidemic in developing countries, along with increasing childhood obesity, and the possibility that favourable blood pressure trends may be plateauing point to the need for enhanced measures to control blood pressure, and for further research to improve understanding of its determinants.

Adolescent↗
PubMed2005

Secular trends in cesarean delivery rates among macrosomic deliveries in the United States, 1989 to 2002.

OBJECTIVES: We describe national trends in cesarean delivery rates among macrosomic infants during 1989 to 2000 and evaluate the maternal characteristics and risk factors for macrosomic infants delivered by cesarean section as compared to macrosomic infants delivered vaginally. STUDY DESIGN: We analyzed US 1989 to 2000 Natality files, selecting term (37 to 44 week) single live births to U.S. resident mothers. We compare macrosomic infants (4000 to 4499, 4500 to 4999 and 5000+ g infants) to a normosomic (3000 to 3999 g) control group. RESULTS: The proportion of cesarean deliveries among 5000+ g infants increased significantly over the time period. The adjusted odds ratio of cesarean delivery increased for all macrosomic categories over the 12-year period, as compared to normal birth weight infants. CONCLUSIONS: Rates of cesarean delivery among macrosomic infants continue to increase despite a lack of evidence of the benefits of cesarean delivery within this population. Further exploration of the rationale for this trend is warranted and should include the development of an optimal delivery strategy for such patients.

Cesarean Section↗