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The secular changes of skin and venereal diseases in Nigeria.

A retrospective review of the changing phase of the incidence of dermatological and venereal diseases, as seen in University Teaching Hospital practice in Lagos, Nigeria is presented. About 8,849 new patients were seen over a 5-year-period. An analysis of the dermatological conditions encountered is made, while brief reports of few common skin conditions are also given. The clinical pattern was similar to those of Western countries, but with addition of a great number of dermatoses. This similarity has been modified by epidemiological factors. A national program for improvement of the environmental health including control of industrial and communicable diseases will ameliorate the increasing morbidity of tropical dermatology.

Female↗

Secular rates of twinning in Asia: recent observations and review of literature.

OBJECTIVE: To study the rates of twinning in Asian countries using the most recent data available. METHOD: A Medline search was performed and all primary and secondary references obtained. RESULTS: Data was obtained from 5 Asian countries from reports published between 1983 and 1993. Total twinning rates varied. CONCLUSION: Twinning among Asians is much more variable than had been reported previously. Further documentation in this area is indicated.

Asia↗

Thirty-year secular trends in the cognitive abilities of Danish male school-leavers at a high educational level.

A nationally representative sample of Danish males finishing school in 1989, or shortly before, with a studentereksamen (the highest qualification in the Danish school system) was found to score generally lower on a battery of four cognitive tests than a comparable sample of Danish males who had taken the same tests shortly after finishing school in the late 1950s or early 1960s. This decline appears attributable to the increasing proportions of students who obtain the studentereksamen and is quite compatible with an overall increase in test scores, also found in our data, for the general population over the same time period. For those who obtain the studentereksamen, the decline has been most marked in a test of verbal analogies. It has been smaller for tests of logical and spatial reasoning, and scores on a test of numerical ability have actually improved over the 30 years. This differential pattern may be the result of both student changes and curricular changes within Danish schools.

Adult↗

Secular trends in mortality associated with bloodstream infections in 4268 patients hospitalized in a cancer referral center between 1975 and 1989.

OBJECTIVE: To study the trends in mortality over 15 years in hospitalized cancer patients with bloodstream infection. METHODS: The yearly incidence rates and risk of death, by type of microorganism, were calculated for 4268 cancer patients hospitalized between 1975 and 1989 in a French cancer referral center. The relative risk of death (RR) associated with each type of microorganism was estimated using the proportional hazards model, taking into account age, hospital ward, underlying disease, geographical origin and year of the first positive blood culture. RESULTS: The incidence of these infections was five-fold higher in 1989 than in 1975. The largest increases were for coagulase-negative staphylococci (CNS), yeasts and Staphylococcus aureus. For the 3756 patients who had a single-microorganism bloodstream infection, the risk of death compared with that of patients with CNS infection was significantly increased in those with Pseudomonadaceae (RR=5.0), yeasts (RR=3.4), Enterobacteriaceae (RR=3.2), S. aureus (RR=2.8) and streptococci (RR=2.1). The risk of death was not significantly different between patients with a single or several positive blood cultures nor between those with nosocomial or non-nosocomial infections. When the study period was divided in two time periods (1975 to 1982 vs 1983 to 1989), a significant variation (p=0.001) in risk of death associated with the different microorganisms was observed. Most risks were lower from 1983 to 1986 than before 1982. This decrease reached 60% for both S. aureus and Pseudomonadaceae. CONCLUSIONS: These data support of continuing use of aggressive empirical antimicrobial therapy for cancer patients with fever.

Journal Article↗

Secular trends in nosocomial candidaemia in non-neutropenic patients in an Italian tertiary hospital.

A retrospective study was performed in an Italian tertiary hospital to evaluate trends in candidaemia between 1992 and 2001, and to compare the characteristics of episodes of fungaemia between 1992--1997 and 1998--2001. In total, 370 episodes of candidaemia were identified, with an average incidence of 0.99 episodes/10 000 patient-days/year (range 0.49--1.29 episodes). On an annual trend basis, the overall incidence was essentially stable in surgical and medical wards, but decreased in intensive care units (ICUs) (p 0.0065). The average use of fluconazole was 37.9 g/10 000 patient-days/year (range 21.4--56.1 g), and did not change significantly during the 10-year period. Nearly two-thirds of patients were in ICUs at the onset of candidaemia, but none was neutropenic in either study period. Candida albicans remained the predominant species isolated (53.8% vs. 48.1%), followed by Candida parapsilosis, Candida glabrata and Candida tropicalis, the distribution of which did not change significantly. The 30-day crude mortality rate was essentially similar (44% vs. 35%) in both study periods. Thus the incidence of nosocomial candidaemia, although high in this institution, decreased among critically-ill patients during the 10-year period. This finding seemed to be related to an improvement in infection control practices, particularly regarding the prevention of intravascular catheter-related infections in ICUs. Although the overall use of fluconazole was considerable, no increase in azole-resistant non-albicans Candida spp. was detected.

Antifungal Agents↗

Comparison of secular trends in pneumococcal serotypes causing invasive disease in Denver, Colorado (1971-2004) and serotype coverage by marketed pneumococcal vaccines.

Invasive pneumococcal isolates from three hospitals in Denver, CO, USA were serotyped between 1971 and 2004. Serotype 14 was most common (13.2%), and other prevalent serotypes (3, 4, 6, 9 and 19) together accounted for 44.1% of the isolates. All prevalent serotypes and 91.3% of the total isolates were covered by pneumococcal polysaccharide vaccine, while 79.1% of prevalent serotypes and 56.7% of total isolates were covered by pneumococcal conjugate vaccine. Serotypes 6, 9 and 14 were more common in the final decade than in the first decade studied (37.3% vs. 20.2%), whereas serotypes 3 and 23 were more common in the first decade (18.5% vs. 11.0%).

Colorado↗

Cerebral palsy and newborn care. I: secular trends in cerebral palsy.

Reports of cerebral palsy prevalence rates per live births in recent decades in western nations show a mixed pattern. Declining rates were noted in Bristol, England, and in Denmark; but more recently a rising rate was noted in Ireland. In Western Sweden a decline has been followed by a recent rise, and in Western Australia a rise has been followed by a decline. Rates with not statistically significant changes have been found in Iceland and Birmingham, England, and over the seven-year span of the US Collaborative Perinatal Project, although their over-all direction was downward. No single factor is likely to explain the trends observed.

Australia↗

Secular trend in the rate of small-for-gestational-age infants: Haguenau Study 1971-1985.

Between 1971 and 1985, at the Haguenau Maternity Hospital, a 20% decrease was observed in the rate of small-for-gestational-age infants (birthweight less than 10th centile using figures from all the study births) among 20,101 births between 28 and 42 weeks. This decrease could not be explained by simultaneous changes in socio-demographic and anthropometric characteristics of the pregnant women, nor a recruitment bias. The earliness of prenatal care at the Maternity Hospital may have played a role in the downward trend. Further research is needed to confirm the influence of prenatal care on the rate of small-for-gestational-age babies.

Adult↗

Alternative medicine use by Canadian ambulatory gastroenterology patients: secular trend or epidemic?

OBJECTIVES: To assess the prevalence and determinants of alternative medicine (AM) use in gastroenterology outpatients and those with inflammatory bowel disease (IBD). METHODS: An 80-item questionnaire, addressing symptoms, general health, quality of life, and AM use, was administered and analyzed using logistic regression. RESULTS: 52.5% of 341 participants used AM in the previous year. Most commonly used were herbal medicine (45.2% of users; 95% CI 35.4-52.5%), chiropractor (40.7%; 95% Cl 31.4-48.0%), and massage therapy (22.9%; 95% CI 15.9-29.1%). Reasons prompting AM use were ineffective medical therapy (39.5%; 95% CI 30.4-46.8%), a greater sense of self-control (29.1%; 95% CI 21.2-35.7%), agreement with personal beliefs (19.5%; 95% CI 13.1-25.4%), and conventional drug adverse-effects (17.3%; 95% CI 11.2-22.9%). AM use was predicted as follows: (1) higher education (odds ratio (OR) 2.10; 95% CI 1.22-3.60), (2) comorbid medical conditions (OR 1.80; 95% CI 1.08-3.00), 3) poor mental component summary score of the SF-12 health survey (OR 1.04; 95% CI 1.01-1.07), and (4) higher annual income (OR 1.17; 95% CI 1.001-1.36), but was not related to response to conventional medical therapy. AM practitioners had instructed 8.6% to change prescription medications. AM usage for gastrointestinal disease was greater in patients with IBD (44.6% vs 10.0%; p < 0.05), who were more likely to cite adverse drug effects as a reason for AM use (28.9 vs 14.4%; p = 0.03). CONCLUSIONS: AM was used by 52.5% of gastroenterology outpatients and its use was greater in those with a higher level of education, comorbid conditions, poorer mental health-related quality of life, and higher income. Drug-related side effects also led to increased AM use.

Adult↗

Noncardia gastric adenocarcinoma remains an important and deadly cancer in the United States: secular trends in incidence and survival.

BACKGROUND: Noncardia gastric adenocarcinoma is not frequently mentioned in the United States. However, it is unclear if the previously reported decline in noncardia gastric adenocarcinoma has continued, and if detection and management has affected overall survival outside the setting of clinical trials. METHODS: We used the Surveillance, Epidemiology, and End Results registry (SEER) to identify all cases of noncardia gastric adenocarcinoma diagnosed between 1973 and 2002. The yearly age-adjusted incidence rates and the relative survival rates were calculated. Cox proportional hazards (PH) models were used to examine temporal trends from 1983 to 2003. RESULTS: Between 1973 and 2002, there were 24,103 cases of noncardia gastric adenocarcinoma. The age-adjusted yearly incidence rate declined by 23% between 1973 and 2002 from 4.3 to 3.3 per 100,000 person-years. However, the incidence of localized noncardia gastric adenocarcinoma (invasive neoplasm confined to the organ of origin) remained without change between 0.9 and 1.0 per 100,000 person-years, and increased with age, especially in the 85+ yr age group (a 47% increase between 1973 and 2002). The incidence rates in men were double those in women, and 1.6-fold and 2.6-fold higher in blacks and other races (mostly Asians), respectively, compared with whites. Patients with radiation and chemotherapy after gastrectomy had a 22% better mortality risk compared with those treated with gastrectomy alone. The Cox PH analysis shows no significant change in mortality risk related to year of diagnosis between 1983 and 2002, both in unadjusted as well as adjusted analyses. However, there were significant independent regional and racial variations in survival. Asians had a 17% lower mortality risk compared with whites. CONCLUSIONS: Despite the overall decline in noncardia gastric adenocarcinoma, the incidence of local stage disease has remained stable in most ages and even increased in old ages. Unfortunately, there has been no significant improvement in survival during the past 20 yr. Moreover, there remain considerable regional as well as racial variations in mortality.

Adenocarcinoma↗

Mortality rate of Alzheimer's disease in Japan: secular trends, marital status, and geographical variations.

The death rate from Alzheimer's disease (AD) in Japan was analyzed using death certificates for the years 1979 through 1990. The AD death rate has increased gradually year by year for both sexes. The overall death rates per 100,000 population of 35 years and over were 0.127 for men and 0.144 for women. Age-specific AD death rate increased exponentially up to the 65-69 age group and decreased thereafter. There were remarkable differences in the AD death rates among the four marital categories, among different prefectures and among the six occupational categories. Overall mean age at death was 63.5 years for men and 65.3 years for women.

Adult↗

Secular trends of caries prevalence in 6- and 12-year-old Dutch children.

Recently two papers have been published dealing with possible changes in the downward trend of caries experience among Dutch schoolchildren in the late 1980s. To answer the question if the decline of caries has come to an end, a meta-analysis was carried out on epidemiological data collected in 5-6 and 11-12-yr-old children between 1980 and 1990. From results of the present analysis it appears that after 1983 a halt in the decline of caries prevalence among 6-yr-olds occurred, whereas among 12-yr-olds, the earlier decrease in mean DMFS scores continued in the period 1980-89.

Child↗