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PubMedDate not supplied

Impact of future cigarette smoking scenarios on mortality of the adult population in the United States, 2000-2050.

The prevalence of cigarette smoking in the United States has declined over the past few decades. However, some leveling-off in prevalence rates has been observed in recent years, and the rate for teenagers and young adults has even turned upward. This paper considers four alternative scenarios of future cigarette smoking patterns in the United States for the population 25 and over and measures the impact these different scenarios would have on excess mortality due to smoking and on the sex and age distributions of deaths. Scenarios reflecting higher levels of smoking prevalence produce considerably more deaths than scenarios tied to lower levels. As many as two and one-half million excess deaths would take place in the decade of the 2020's if a high prevalence, rather than low prevalence, assumption proves correct. Even when a constant prevalence, assumption proves correct. Even when a constant prevalence assumption is compared with a moderately-declining prevalence assumption, as many as one million excess deaths would be generated during that decade alone. Lowering smoking prevalence rates would also change the population sex ratio by reducing deaths for males more than deaths for females, and by contributing to the aging of the population. The results are interpreted in terms of the overall impact of smoking on mortality and with regard to public and private policy decisions related to cigarette smoking.

Adult↗
PubMedDate not supplied

Reproductive change in Sri Lanka: analysis of intermediate variables, 1982 and 1987.

This study examines the intermediate determinants of fertility in Sri Lanka by making use of the data collected in the 1982 Sri Lanka Contraceptive Prevalence Survey and the 1987 Sri Lanka Demographic and Health Survey. The analysis shows that the most important inhibitor of potential fertility is deliberate control. The marital structure of the population is also an important fertility-inhibitor, but lactational infecundability is increasingly becoming an unimportant contributor. The findings show the success of the family planning program in Sri Lanka, which propelled fertility to a substantial lower level. Achievement of the replacement level fertility by the turn of the century, set by the Sri Lankan government, would largely depend on the efforts to increase the quality and quantity of contraceptive use and the duration of breastfeeding.

Adolescent↗
PubMed1997

An introduction to time-trend analysis.

Healthcare professionals often are presented with data that appear to indicate an upward or downward trend over time. For example, admissions of acquired immunodeficiency syndrome (AIDS) patients appear to be increasing, cesarean section rates appear to be decreasing, or nosocomial pneumonia rates appear to be increasing. Critical decisions sometimes are based on such trends, which often are presented without a statistical analysis. Those responsible for decision making may be left wondering whether these apparent trends represent only chance variation. Graphs showing trends over time generally present one of three kinds of outcome data: counts (eg, three AIDS admissions), proportions (eg, 10 cesarean sections per 100 total deliveries), or person-time data (eg, 13 cases of nosocomial pneumonia per 10,000 patient days). Using familiar examples and a minimum of technical language, we illustrate the analysis of time trends.

Data Interpretation, Statistical↗
PubMed2006

The long-term cost-effectiveness of cardiac resynchronization therapy with or without an implantable cardioverter-defibrillator.

AIMS: Cardiac resynchronization therapy (CRT-P) is an effective treatment for patients with heart failure and cardiac dyssynchrony with moderate or severe symptoms despite pharmacological therapy. The addition of an implantable cardioverter-defibrillator (ICD) function may further reduce the risk of sudden death. We assessed the cost-effectiveness of CRT-P compared with medical therapy (MT) alone, and the cost-effectiveness of CRT-ICD + MT compared with CRT-P + MT, on incremental cost per quality adjusted life year (QALY) and life year using data from two landmark clinical trials. METHODS AND RESULTS: A Markov model with Monte Carlo simulation to assess costs, life years, and QALYs associated with CRT (+/- ICD) and MT in patients with heart failure and cardiac dyssynchrony, on the basis of a UK healthcare perspective was constructed. NYHA class distribution and transitions, associated health utilities, rates and cause of hospitalization and death were estimated from individual patient data from the CArdiac REsychronization in Heart Failure (CARE-HF trial). The estimated additional benefit on survival of an ICD was based on results from COMPANION. The base case analysis used 10 000 individual life-time simulations assuming a battery life of 6 years for CRT-P and 7 years for CRT-ICD. From a life-time perspective in a 65-year-old patient, the incremental cost-effectiveness of CRT-P compared with MT is 7538 euros (95% CI 5325-11,784 euros) per QALY gained and 7011euros (95% CI 5346-10,003 euros) per life year gained. The incremental cost-effectiveness of CRT-ICD compared with CRT-P is 47,909 euros (95% CI 35,703-79,438 euros) per QALY gained, and 35,864 euros (95% CI 26,709-56,353 euros) per life year gained. CONCLUSION: Long-term treatment with CRT-P appears cost-effective compared with MT alone. From a life-time perspective, assuming a reasonable life expectancy when receiving effective treatment for heart failure, CRT-ICD may also be considered cost-effective when compared with CRT-P + MT.

Adolescent↗
PubMed2000

Conferences.

International Conference on Humanization of Childbirth * November 2-4, 2000 * Fortaleza, Ceara, Brazil The XVth International Conference on the Social Sciences & Medicine - Societies & Health in Transition * October 16-20, 2000 * Eindhoven, The Netherlands

Journal Article↗
PubMed1997

Projected cancer incidence rates in Bulgaria, 1968-2017.

BACKGROUND: Incidence predictions are applicable when planning preventive or screening health care programmes, diagnostic, treatment and rehabilitation facilities. The aim of this study was to predict future (1993-2017) incidence rates of the most common sites of cancer in Bulgaria: breast, cervix and corpus uteri in females, and lung, prostate and stomach in males. METHOD: Observed numbers of incident cases in the period 1968-1992 and observed (predicted) population size were employed. Age-cohort and age-cohort-period log-linear models were fitted to the observed data, assuming no change in the observed trends. RESULTS: The incidence rates for all the studied primary sites, except stomach cancer, were predicted to increase. The observed rates in the period 1988-1992 and the predicted rates in the period 2013-2017 per 100000 were in females: breast-from 38.8 to 64.6, cervix-from 12.8 to 19.3, corpus uteri-from 12.4 to 26.5. In males similar rates were: lung-from 41.0 to 73.8, prostate-from 10.1 to 15.0 and stomach-from 17.5 to 10.2. Due to the increasing incidence rates and ageing of the population the predicted number of new cases in the studied sites of cancer in the period 2013-2017 is 62% higher than that observed in the period 1988-1992.

Adolescent↗
PubMed2004

Ageing populations and childhood infections: the potential impact on epidemic patterns and morbidity.

BACKGROUND: Population decline, arising from below replacement fertility and possibly giving rise to substantial changes in age distribution, is a feature of many industrialized developed countries; Italy is one of the most notable European examples. The potential influence of this phenomenon on prevalence of chronic non-infectious disease is well known, but little attention to date has been paid to the impact on severe disease due to childhood infections in those cases where control is insufficient to achieve elimination. METHODS: A transmission dynamics model incorporating realistic demography is used to investigate the possible impact of population decline and ageing and suboptimal vaccination uptake on the age distribution of incidence of measles infection and of consequent mortality. Data from Italy is used to parameterize the model. RESULTS: Population ageing in the absence of vaccination is shown to reduce per capita incidence of infection but also to increase average and upper quartile ages at infection. The effect is substantially enhanced by significantly suboptimal vaccination uptake, when disease-induced mortality has, for a period, the potential to exceed that in the absence of vaccination. CONCLUSIONS: Although a substantially increased burden from chronic non-infectious disease has frequently been proposed as a consequence of population decline, there is also potential for an increase in morbidity and mortality from measles and other childhood infectious diseases, particularly where vaccine uptake is substantially below the optimum. Rubella is highlighted as a particular cause for concern. This work also has implications for less-developed countries.

Adolescent↗
PubMed1999

Prisoners of the proximate: loosening the constraints on epidemiology in an age of change.

"Modern epidemiology" has a primary orientation to the study of multiple risk factors for chronic noncommunicable diseases. If epidemiologists are to understand the determinants of population health in terms that extend beyond proximate, individual-level risk factors (and their biological mediators), they must learn to apply a social-ecologic systems perspective. The mind-set and methods of modern epidemiology entail the following four main constraints that limit engagement in issues of wider context: 1) a preoccupation with proximate risk factors; 2) a focus on individual-level versus population-level influences on health; 3) a typically modular (time-windowed) view of how individuals undergo changes in risk status (i.e., a life-stage vs. a life-course model of risk acquisition); and 4) the, as yet, unfamiliar challenge of scenario-based forecasting of health consequences of future, large-scale social and environmental changes. The evolution of the content and methods of epidemiology continues. Epidemiologists are gaining insights into the complex social and environmental systems that are the context for health and disease; thinking about population health in increasingly ecologic terms; developing dynamic, interactive, life-course models of disease risk acquisition; and extending their spatial-temporal frame of reference as they perceive the health risks posed by escalating human pressures on the wider environment. The constraints of "the proximate" upon epidemiology are thus loosening as the end of the century approaches.

Epidemiology↗
PubMed1994

Bringing quality to the customer: a new paradigm for quality managers.

The transition of health care organizations to total quality improvement (TQI) models has significant consequences for quality manager roles and quality systems. Changing paradigms regarding one's quality role and programs requires critical self-awareness, new knowledge, and a fresh approach to employee-customer relations. The quality manager's challenges are to discover one's own learning needs, integrate new philosophies into one's behavior, and successfully model and mentor TQI to fellow health care providers. Quality managers have an opportunity to develop a vital and powerful leadership role vis-à-vis TQI and the point of contact between health care provider and patient.

Humans↗
PubMed2001

Occurrence of trichomoniasis in women in Denmark, 1967-1997.

BACKGROUND: The Neisseria Unit at Statens Serum Institut (SSI), Copenhagen, Denmark administers laboratory surveillance systems for gonorrhea and chlamydia, however, no similar system has been available for trichomoniasis. OBJECTIVES: To describe changes in the occurrence of trichomoniasis in women and in the distribution according to age, and to compare these changes with those observed in women with gonorrhea or chlamydia. STUDY DESIGN: Data on the epidemiology of trichomoniasis were based on the annual laboratory records at the Neisseria Unit at SSI. Data on gonorrhea (1967-1997) and chlamydia (1994-1997) originated from the National Laboratory Surveillance Systems. RESULTS: During the period 1967 to 1997, the percentage of Trichomonas vaginalis-positive specimens showed a constant decrease from 19 to fewer than 2. The annual number of specimens received varied between a maximum of 31,626 in 1975 and a minimum of 3,291 in 1997. The median age of women with trichomoniasis increased from 31 to 39 years as compared with a change from 21 to 24 years in women with gonorrhea (1967-1997) and a median age of 22 years in women with chlamydia (1994-1997). CONCLUSIONS: A significant decline in the occurrence of trichomoniasis in women concurrent with a significant rise in the median age of women with the disorder was observed. During the periods investigated, women with trichomoniasis were significantly older than women with gonorrhea or chlamydia.

Adolescent↗
PubMed2006

Decline in the prevalence of antibodies to herpes simplex virus types 1 and 2 among Israeli young adults between 1984 and 2002.

OBJECTIVE: The objective of this study was to estimate the seroprevalence of herpes simplex virus (HSV) types 1 and 2 in male and female soldiers discharged from the Israel Defense Force (IDF) over a period of 18 years. GOAL: The goal of this study was to study the secular trends of HSV-1 and HSV-2 infection rates in Israeli young adults. STUDY DESIGN: Three consecutive cross-sectional studies were carried out on stored sera of systematic random samples of soldiers (median age = 20.8) discharged from the IDF in 1984-1985, 1992-1993, and 2001-2002. HSV-1 and -2 seroprevalence was analyzed using indirect IgG enzyme-linked immunosorbent assay for type-specific antibodies. RESULTS: There was a significant decrease in HSV-1 and HSV-2 seropositivity rates at discharge from the army and an estimated 10-fold decline in the incidence rates of HSV-2 infection during the military service over the last 2 decades. CONCLUSIONS: The decline in HSV-1 seroprevalence rate is similar to that reported from other industrialized countries. The decrease in HSV-2 seroprevalence and transmission rates among Israeli young adults is steeper than that reported from Western countries.

Adult↗