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At least 703 records · Page 39Linked to original sources
PubMed1992

Reevaluation of secular trends in depression rates.

Results of numerous community surveys of psychiatric illness suggest a striking change in the occurrence of depression, with younger generations experiencing higher lifetime risk and earlier age of onset. Data from the National Institute of Mental Health Epidemiologic Catchment Area Survey (a cross-sectional survey of psychiatric morbidity in five US communities conducted between 1980 and 1984) were reexamined for evidence of methods effects which might contribute to these unexpected findings. A pattern of higher lifetime risk and earlier age of onset among recent birth cohorts was observed for every psychiatric disorder examined, with schizophrenia, major depression, and panic disorder showing equally strong trends. For respondents of all ages, reported first onset of major depression clustered in the 10-year period prior to the study interview, in contrast to the expectation that older respondents would report onset in early adulthood. Examination of individual psychiatric symptoms revealed a nearly universal pattern of decreasing lifetime prevalence among older respondents, a reversal of the expected accumulation of lifetime symptoms with age. These findings suggest that effects of study methods may contribute to the apparent temporal trends in prevalence of depression and that cross-sectional surveys may underestimate lifetime psychiatric morbidity among older respondents. Generational changes in the lifetime risk of depression or other psychiatric disorders may not be reliably assessed by cross-sectional survey data.

Adolescent↗
PubMed1994

Myocardial infarction 1979-1988 in Denmark: secular trends in age-related incidence, in-hospital mortality and complications.

All admissions to a coronary care unit (CCU) in Copenhagen County were prospectively registered over a 10-year period, from 1979 to 1988, i.e. after the introduction of CCUs but before the era of intervention with thrombolytic or prophylactic medical treatment. The catchment area remained nearly constant throughout the study period; all patients with MI were admitted to the CCU regardless of age and concomitant diseases, and treatment and discharge policy of the department was unchanged. A total of 4176 MI admissions were registered. During the study period, the age-specific incidence of MI decreased in males above 50 years of age, but was virtually unchanged in females, increasing the proportion of women in the MI population from 26 to 33%. In-hospital and 30-day mortality was unchanged. The occurrence of atrial fibrillation during the admission increased significantly (from 11 to 18%), while the incidence of ventricular fibrillation, heart failure and pulmonary oedema was unchanged.

Adult↗
PubMed1989

Analysis of secular trends in surgery for glue ear in the North Western Region (1975-1984).

Hospital Activity Analysis (HAA) data relating to operations for glue ear and tonsillectomy performed on residents of the North Western Region, aged 0-9 years during the period 1975-1984 were studied. The rate of surgery for glue ear has risen from 45/10,000 to 107/10,000 representing an increase of 137 per cent. The tonsillectomy rate by comparison has undergone a more modest increase of 19 per cent. The study casts doubt on a 'vacuum effect', as has been argued by Black. Marked variation in rates of surgery between Districts in the Region were noted, and the possible explanations discussed. A review of the literature revealed considerable controversy concerning the management of glue ear and the need for a definitive trial is highlighted.

Child↗
PubMed2000

Secular trends in the management of hypertension and atrial fibrillation in patients presenting with stroke.

We studied changes in stroke prevention in 2000 ischaemic stroke patients using prospectively collected data from an incident stroke register over 3 years. Patients were divided into those with risk factors but no previous history of a vascular event (asymptomatic vascular disease) and those with risk factors and a previous history of stroke or TIAs, ischaemic heart disease, angina, myocardial infarction or peripheral vascular disease (symptomatic vascular disease). Time trends were analysed for the use of aspirin, management of hypertension and atrial fibrillation prior to the presenting episode. Median age of those with known risk factors included in the study was 75 years (range 44-99 years); 60% were women. Year-by-year analysis showed no differences in demography, stroke characteristics or vascular risk profile. The use of aspirin for symptomatic vascular disease increased with time (28% to 72%) (p<0.001), but did not increase for asymptomatic vascular disease, despite risk factors being present. The proportion of patients receiving antihypertensive treatment for symptomatic vascular disease was unchanged with time (66% to 64%) but there was a significant increase in the number of patients receiving antihypertensive treatment for asymptomatic vascular disease (28% to 44%) (p<0.05). The proportion of patients with atrial fibrillation receiving antithrombotic treatment did not increase for asymptomatic vascular disease (23% to 21%) (p=0.54) but did increase for symptomatic vascular disease (19.5% to 37%) (p<0.01) over 3 years. The use of warfarin in atrial fibrillation increased both in the case of asymptomatic (4.5% to 42%) (p<0.01) and symptomatic vascular disease (12.5% to 33.0%) (p<0.01).

Adult↗
PubMed2006

Secular stroke trends: early life factors and future prospects.

Stroke mortality rates have declined during the second half of the 20th century in developed countries. Possible reasons for this include preventive measures, recent environmental changes impacting on adult health risks, and more distant environmental influences on childhood health. Data from a number of populations in Europe and the USA suggest that a decrease in early life blood pressure, occurring since the beginning of the 20th century, may have been an important determinant of declining stroke incidence rates and cardiovascular disease mortality in general. Advances in stroke epidemiology are increasing the accuracy of case ascertainment, and neuroimaging refinements (particularly MRI) are improving the accuracy of stroke type and subtype diagnoses. Although some risk factors are common to ischaemic and haemorrhagic stroke, there is accumulating evidence of differing aetiology. There is also an increasing recognition that early life factors may influence stroke risk. Despite the encouraging decline in stroke incidence, there is evidence of a recent increase in mean blood pressure in young people observed in the USA and UK, prompting concern that favourable trends in stroke risk may not be maintained. Reducing early life blood pressure in a population and delaying the onset of hypertension, along with effective measures to combat obesity, are required to avoid a reversal in stroke incidence trends in developed countries, and to prevent the anticipated increase in the burden of stroke in developing countries.

Age Factors↗
PubMed1998

Secular changes in rates of respiratory complications and diarrhoea among measles cases.

It has been observed that the occurrence of respiratory complications and diarrhoea among measles cases has changed over time but this change has not been quantified. A study was carried out in the city of Gweru, Zimbabwe, to quantify these changes. Rates of respiratory complications and diarrhoea among measles cases were determined in each year for the period 1968-89. It was found that mean rates of respiratory complications and diarrhoea during 1968-78 were 17.2 per cent (95 per cent CI = 11.6-22.8) and 5.2 per cent (95 per cent CI = 0-11) respectively while during 1979-89, mean rates of respiratory complications and diarrhoea were 6.5 per cent (95 per cent CI = 1-12.1) and 16.4 per cent (95 per cent CI = 10.1-22.0) respectively. Analysis of variance (ANOVA) to determine the main effects and the interaction showed that the main effects were not statistically significant (F = 0.01, d.f.1,2 = 1,40, p = 0.935; and F = 0.13, d.f.1,2 = 1,40, p = 0.725 respectively) Meanwhile the interaction term of complications and period was statistically significant (F = 15.7, d.f.1,2 = 1,40, p < 0.001). It was concluded that a change in rates of respiratory complications and diarrhoea had occurred among measles cases. It is suggested that the increase in vaccination coverage in 1979-89 and the shift in age at infection to older age groups in the same period may have brought about this change through selective suppression of respiratory complications among measles cases.

Age Distribution↗
PubMed2002

Secular trends of candidemia over 12 years in adult patients at a tertiary care hospital.

The incidence of fungal infections has been increasing for the last 3 decades, especially among neutropenic, cancer, and critically ill patients. These infections are associated with high mortality rates. We retrospectively reviewed medical charts of adult patients with fungemia from 1989 to 2000 at our institution. The characteristics of the population groups served by the hospital were described. Of 328 patients with fungemia, we reviewed 315 (96%) medical records, and focused on those with candidemia (n = 294). The species distribution in patients with candidemia showed that the most commonly identified species were Candida albicans (66%), followed by C. glabrata (17%), and C. parapsilosis (6%). The incidence of candidemia ranged from 0.2 to 0.46 per 10,000 patient-days with the highest incidence in 1993 and the lowest in 1997. Although most studies show an increased incidence of candidemia, we observed a reduction over the study period. Furthermore, we observed no shift from C. albicans to non-albicans Candida species despite a significant increase in the use of fluconazole. The overall mortality among patients with candidemia was 44%, with the highest rate in patients over 65 years (52%). Factors independently associated with higher mortality were patient age greater than 65 years, intensive care unit admission, and underlying cancer.

Adolescent↗