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PubMed1991

Prevalence of neural tube defects in 20 regions of Europe and the impact of prenatal diagnosis, 1980-1986. EUROCAT Working Group.

STUDY OBJECTIVE: The aims were (1) to determine whether in Europe, 1980-86, geographical differences in total prevalence of neural tube defects persist; (2) to examine the stability of total prevalence rates over time; (3) to evaluate the impact of prenatal diagnosis in terms of frequency and timing of termination of pregnancy. DESIGN: Prevalence rates of neural tube defects were determined from case registration data in 20 EUROCAT regional registers of congenital anomalies, 1980-86. The chi 2 test for homogeneity in proportions was used to test whether differences in total prevalence rates were significant between regions or over time. SETTING: Geographically defined populations were used in the Republic of Ireland, United Kingdom, Belgium, The Netherlands, Luxemburg, Denmark, France, Italy, Yugoslavia, and Malta. PATIENTS: The patients were 3113 cases of anencephaly, spina bifida, encephalocele, and iniencephaly. Total cases (livebirths, stillbirths and induced abortions following prenatal diagnosis) were registered in 14 regions. Induced abortions were excluded from registration in six regions. MEASUREMENTS AND MAIN RESULTS: Total prevalence rates (including livebirths, stillbirths and induced abortions) were 24 to 38 per 10,000 in six areas of Ireland and United Kingdom. Average total prevalence rate in eight continental European areas was 11.5 per 10,000. There was a secular decline in total prevalence in Dublin (Republic of Ireland) and Northern Ireland (United Kingdom) and a fluctuation in Glasgow, Liverpool, and South Glamorgan (United Kingdom). Total prevalence in continental Europe was stable over time. There was no significant geographical or secular variation in the spina bifida to anencephaly ratio (1.3). The ratio of encephalocele to other neural tube defects was lower in the British Isles (0.09) than in continental Europe (0.18). The impact of prenatal diagnosis and termination of pregnancy is increasing over time. Terminations were performed 1984-86 in at least 80% of total cases of anencephaly in 6/11 centres registering induced abortions, and in at least 40% of total cases of spina bifida in four centres. Serum alpha fetoprotein screening in British centres was associated with earlier prenatal diagnosis of spina bifida than ultrasound screening in other centres. CONCLUSIONS: Geographical and secular variation in total prevalence of neural tube defects persists in Europe 1980-86, independent of the practice of prenatal diagnosis. There is considerable regional variation in the impact of prenatal diagnosis in terms of frequency and timing of diagnosis and pregnancy termination linked to different policies and practices of prenatal screening.

Abortion, Induced↗
PubMed1996

Incidence of hypertension and non-insulin dependent diabetes mellitus and associated risk factors in a rapidly developing Caribbean community: the St James survey, Trinidad.

OBJECTIVE: To compare the incidence rates of hypertension and non-insulin dependent diabetes mellitus in relation to ethnicity and other characteristics in a rapidly developing community. DESIGN: Prospective surveillance of a total community for five years. SUBJECTS: Cohort of 2491 men and women aged 35 to 69 years (79% response), of African, Indian and "other' (mainly Afro-European) descent. RESULTS: During surveillance, secular increases occurred in fasting blood glucose concentrations in both sexes and in body mass index (BMI) in men, with apparent secular reductions in systolic blood pressure in both sexes. Incidence rates of hypertension did not differ significantly with ethnicity, ranging between 33 and 41 per 1000 person-years in men and between 27 and 32 per 1000 person-years in women. In men, the incidence of diabetes (per 1000 person-years) in Indians (24) was significantly higher than in Africans (13) and others (11). In women, the diabetic incidence was similar to that for men in Indians (23) and Africans (14), but in others was twice that in men (21). In both sexes, weight gain was an important risk factor for hypertension, whereas risk of diabetes increased with BMI at baseline. The increased risk of diabetes in Indians among men was independent of baseline BMI and blood glucose. CONCLUSION: Apart from the increased risk of diabetes in Indians, ethnicity had no significant influence on incidence rates of hypertension and diabetes in Trinidad. Secular increases in blood glucose in both sexes and in BMI in men probably contributed to the concurrent increase in mortality from coronary heart disease in this community.

Adult↗
PubMed2007

The possibility of a universal declaration of biomedical ethics.

Statements on issues in biomedical ethics, purporting to represent international interests, have been put forth by numerous groups. Most of these groups are composed of thinkers in the tradition of European secularism, and do not take into account the values of other ethical systems. One fifth of the world's population is accounted for by Islam, which is a universal religion, with more than 1400 years of scholarship. Although many values are held in common by secular ethical systems and Islam, their inferences are different. The question, "Is it possible to derive a truly universal declaration of biomedical ethics?" is discussed here by examining the value and extent of personal autonomy in Western and Islamic biomedical ethical constructs. These constructs are then tested vis-à-vis the issue of abortion. It is concluded that having a universal declaration of biomedical ethics in practice is not possible, although there are many conceptual similarities and agreements between secular and Islamic value systems, unless a radical paradigm shift occurs in segments of the world's deliberative bodies. The appellation "universal" should not be used on deliberative statements unless the ethical values of all major schools of thought are satisfied.

Abortion, Therapeutic↗
PubMed2006

Pragmatic help seeking: How sexual and gender minority groups access mental health care in a rural state.

OBJECTIVE: This qualitative study examined how lesbian, gay, bisexual, and transgender (LGBT) people in rural areas of the poor and multiethnic state of New Mexico access secular (professional and lay) and sacred (indigenous and Christian) mental health care resources. METHODS: In-depth, semistructured interviews were used to document the help-seeking processes of 38 rural LGBT people. RESULTS: Obtaining assistance was complicated by the ideal of self-reliance and the view of mental illness as a sign of weakness. Financial considerations and a lack of and community-based LGBT social networks also exerted substantial influence on help seeking. Many LGBT people would strategically remain silent about their sexuality or gender status and rely on their family ties to access the range of secular and sacred resources that are most commonly available in medically underserved rural communities. CONCLUSIONS: Although persons from sexual and gender minority groups often experience positive outcomes as a result of help seeking, some LGBT people remain vulnerable to anti-LGBT sentiments that persist within secular and sacred sectors of rural health care systems.

Bisexuality↗
PubMed1994

CATCH: process evaluation of environmental factors and programs.

The Child and Adolescent Trial for Cardiovascular Health (CATCH) is a multicenter trial designed to test the effectiveness of school and family-based cardiovascular health promotion for preadolescents. CATCH interventions target multiple cardiovascular health behaviors such as dietary intake of fat and sodium, physical activity, and tobacco use. Evaluation includes physiological, psychosocial, behavioral, and process measures. An important aspect of the process evaluation is the assessment of environmental factors and "secular events" in both intervention and control schools that may affect outcomes independently of the CATCH interventions. With such information, CATCH investigators are able to isolate the impact of the CATCH intervention from competing (non-CATCH) factors as well as "track" proximal (i.e., immediate and short term) changes related to the intervention that may in turn lead to "distal" (long-term) behavior change. The School Health Questionnaire, the major process evaluation tool for monitoring secular and environmental changes in the schools, is described in detail, and data describing tobacco-related environmental factors and secular events are presented.

Adolescent↗
PubMedDate not supplied

Breast cancer trends in two oblasts of Belarus and the Chernobyl accident.

The 1986 Chernobyl accident contaminated 23% of Belarus with radioactive iodine and long half-life radionuclides. Radiation causes breast cancer. Population-based breast cancer incidence data from the Belarus National Cancer Registry were used to study secular trends and urban-rural differences, and determine whether an effect of Chernobyl radiation exposure was discernable. Trends in age-standardized incidences in Gomel and Vitebsk oblasts maximally and minimally exposed to Chernobyl radiation, respectively, were compared for 1978-2003 among all women, and women aged 30-49, separately for urban and rural areas. Incidences were higher and increasing more rapidly in urban than rural areas of both oblasts, annually increasing 0.150 +/- 0.008 vs. 0.098 +/- 0.007 new cases per 10,000 persons, p < 0.00005. Levels were similar in urban Gomel and Vitebsk, and slightly higher in rural Vitebsk than rural Gomel. For ages 30-49 trends in urban and rural Gomel and rural Vitebsk were similar to the all-ages rural trend: common urban/rural Gomel slope 0.098 +/- 0.015, rural Vitebsk slope 0.091 +/- 0.022. In urban Vitebsk, significant but erratic nonlinearity suggested stabilizing incidence since the mid-nineties after a sharp rise. However, recent declines in slopes, greater in Vitebsk, are nonsignificant. Secular breast cancer increases in Gomel have been generally consistent for 26 years. Secular increases in Vitebsk have been similar, but could be slowing. However, these data provide no convincing evidence for Chernobyl-induced breast cancer in Belarus.

Adult↗
PubMed2006

Is the prevalence of Paget's disease of bone decreasing?

UNLABELLED: Secular trends in the severity and prevalence of Paget's disease over a 30-year period are described. Paget's disease has become less prevalent and patients are presenting later, with less severe disease than previously. These data suggest that environmental factors are important in the etiology of Paget's disease. INTRODUCTION: Data from several countries support the view that there are important secular trends in the prevalence and severity of Paget's disease. In this paper, recent trends in the epidemiology of Paget's disease are described. MATERIALS AND METHODS: A database of all newly referred patients (n = 1487) with Paget's disease (1973-2002 inclusive, 30 years) was examined. Of these subjects, 56% had scintiscans. Plasma total alkaline phosphatase (total ALP) activity and disease extent on scintiscan were used as indices of severity. A radiographic prevalence survey of 1019 subjects of European origin >55 years of age in Dunedin was undertaken- approximately 20 years after an earlier survey had shown New Zealand to be a high prevalence area. RESULTS: The number of new referrals with Paget's disease declined sharply from 1994 onward, to one half the rate seen 20 years earlier, whereas the mean age at presentation increased by 4 years per decade (p < 0.0001). Total ALP at diagnosis, disease extent on scintiscan, and the number of bones involved were all negatively correlated with both date of birth (p < 0.0001) and year of presentation (p < 0.0001), indicating that more recently born and presenting subjects had substantially less severe bone disease. The radiographic survey showed that the current prevalence was only approximately 50% of that in the 1983 survey (p = 0.012). CONCLUSIONS: Although there are a number of potential biases, these data are consistent with a continued secular trend to presentation in older subjects with less extensive skeletal involvement and a declining prevalence of Paget's disease.

Alkaline Phosphatase↗
PubMed1999

[Adult body height in women in Cordoba, Argentina, and exploration of the current trend (1978-198)].

The objective of this work was to contribute local data concerning the full adult height of women in Cordoba, Argentina, and to explore the possibility of a secular trend in their heights. For the study, 513 women were examined during May and June 1994. All of the women were between 18 and 40 years of age and were mothers of children who were included in a study on lactation, feeding, growth, and development in Córdoba. The measurements were carried out applying standardized techniques and using as a reference standard the 50th-percentile level data from the U.S. National Center for Health Statistics. The mean full height of the Córdoba population studied was 157.9 cm, 0.97 standard deviation (SD) below the reference norm. For the women from the highest of six socioeconomic strata, the mean height was 159.7 cm (-0.67 SD); the mean for women from the lowest stratum was 156.2 cm (-1.25 SD). The difference in the means of those two socioeconomic groups was statistically significant (P < 0.001). Of the population studied, 2.3% (6.4% of the lowest social stratum) were shorter than 145 cm. In order to explore the possibility of a secular trend, the resulting data were categorized into two groups according to the mother's age at the time of the anthropometric examination, one group with a mean age of 24 and a second group with a mean age of 34. The younger women had a mean adult height 0.4 cm greater than that of the older women (P = 0.47). This secular increase in height is notably smaller than that reported for other Argentine provinces (1.2 and 1.4 cm/decade) and somewhat lower than the average reported in population studies in Australia, Belgium, the United States, Japan, and Norway (0.6 cm/decade). The authors conclude that in the period analyzed, 1978-1988, the living conditions in the city of Córdoba have not improved in a way that is reflected in a significant increase in the height of adult women. The authors recommend that maternal health and nutrition programs concentrate their resources on the mothers from the lowest socioeconomic stratum who are shorter than 145 cm.

Adolescent↗
PubMed1983

Growth deceleration in Japanese schoolchildren with special reference to those in the city of Sendai.

From the national and regional statistics on the body dimensions of schoolchildren at the 6th year grade in primary schools (i.e., 11-year-olds) and at the 3rd year grade in junior high schools (i.e., 14-year-olds), the secular gains in height and weight by the children of the same age were calculated for the three periods of 1960-4, 1972-76 and 1976-81. Compared with the first period (i.e., 1960-4) when the growth acceleration was maximal, the secular gain was apparently reduced in the second and third study periods (i.e. 1970's) to the level of 1/2 to 1/3 of that in the first period, and was next to nil in some districts. Such deceleration was coupled with changes in seasonal growth patterns and diminution of urban-rural gaps both in the body size and the secular gain. For example, the body dimensions of the children in the City of Sendai did not differ in 1981 between the core part of the city and the surroundings, while the difference had been observed till late 1970's. The 1979 measurements of height and weight of Japanese children are compared with counterpart values observed in other countries.

Adolescent↗
PubMed1999

Evidence for decline in disability and improved health among persons aged 55 to 70 years: the Framingham Heart Study.

OBJECTIVES: This study detected secular change in disability and health among persons aged 55 to 70 years, the life period when increases in disability and morbidity begin and retirement occurs. METHODS: Cross-sectional comparisons were completed with data from similarly aged members of the original (n = 1760) and offspring (n = 1688) cohorts of the Framingham Heart Study, which represent 2 generations. Analyses were conducted by gender and on chronic disease subgroups by logistic regression. RESULTS: There was substantially less disability in the offspring cohort than in the original cohort. Thirty-six percent of offspring men were disabled vs 52% of original cohort men (P = .001); among women, these proportions were 54% vs 72% (P = .001). Fewer offspring perceived their health as fair or poor and fewer had chronic diseases. Offspring were more physically active and less likely to smoke or consume high amounts of alcohol, but their average weight was greater. The secular decline in disability was strongly evident among individuals with chronic diseases. CONCLUSIONS: Our findings depict a secular change toward a less disabled and globally healthier population in the period of life when retirement occurs.

Activities of Daily Living↗
PubMed1993

Hospital control and decision making: a financial perspective.

A study was conducted to test the hypothesis that there are no significant differences in financial decision making among hospitals in different control categories. Significant differences were found in financial decision making in for-profit hospitals, voluntary hospitals with religious affiliations, and secular voluntary hospitals. Managers of for-profit hospitals base their financial decisions more on the need to achieve operating efficiency and profitability than do managers of voluntary hospitals. Managers of voluntary hospitals with religious affiliations and secular voluntary hospitals give about the same emphasis to efficiency. Surprisingly, however, managers of voluntary hospitals with religious affiliations emphasize profitability and financial leverage more than managers of secular voluntary hospitals do.

Decision Making, Organizational↗
PubMed1999

[Results of the study of selected head measurements of Jena children].

Secular changes of head measurements (frontal breadth, bizygomatic breadth, bigonial breadth, auricular height, morphological facial height, lower face height) are analysed. The data are based on the Jena anthropological investigations of school children from 1975 and 1985. The inclusion of the data of the Jena longitudinal study carried out since 1985 allows an analysis of the further secular trend. Noticeable changes are proved in most of the analysed traits (frontal breadth, bigonial breadth, auricular height, morphological facial height, lower face height) between 1975 and 1985. The vertical measurements show greater percentage differences than the horizontal measurements, which, among other things, results in a relative narrowing of the face. In some head measurements (frontal breadth, bigonial breadth, auricular height) the trends continue after 1985. The secular trends show no obvious connection with the temporal acceleration of the dentition in the probands of the longitudinal study. However, a connection seems to be possible between the accelerated puberal growth spurt of the body height and the puberal growth spurt in some head dimensions.

Adolescent↗
PubMed2000

Birthweight percentiles by gestational age in multiple births. A population-based study of Norwegian twins and triplets.

OBJECTIVE: To assess secular trends for birthweight by gestational age in twins in Norway and to develop current national birthweight standards by gestational age for twin and triplet births using population-based data. MATERIAL AND METHODS: The analysis of secular trends for birthweight and gestational age in twins was based on 32,379 twin livebirths (1967-95). Taking into account the observed secular trends in birthweight for 35-40 weeks of gestation, data on twins born during 1987-95 only were included in the calculation of birthweight percentiles for 35-40 weeks, while for lower and upper weeks, data on twins born during 1967-95 were used. The construction of birthweight-for-gestation curves for triplets was based on the data on 690 triplets. RESULTS: Whereas the overall mean birthweight and gestational age decreased in 1987-95 compared with the previous years, the mean birthweights by gestational age for the 35-40 weeks of gestation was significantly higher in 1987-95. Male twins weighed more than female twins throughout the gestation with consistent and significant differences from 27 to 42 weeks of gestation. Smoothed curves for birthweight-by-gestational-age percentiles of male and female twins are plotted. The birthweight-by-gestational-age curves of triplets were almost identical with twin curves before 30 weeks of gestation, starting to diverge from them progressively thereafter. The intrauterine growth of twin births also starts to differ markedly from singletons at approximately 30 weeks of gestation. CONCLUSION: This study shows that plurality-specific birthweight-by-gestation standards should be used for assessment of fetal growth in multiple births rather than singleton standards.

Birth Weight↗
PubMed2000

Obstetric history and the risk of placenta previa.

OBJECTIVE: To evaluate secular trends in the occurrence of placenta previa and whether placenta previa is associated with the outcome of previous pregnancies, cesarean section, and sociodemographic factors. DESIGN: A cohort study based on the Medical Birth Registry of Norway. Placenta previa in the second pregnancy was investigated for associations with outcomes in the first pregnancy and sociodemographic factors. RESULTS: In birth orders 1 and 2 the occurrence of placenta previa was 1.2 and 2.2 per 1,000, respectively, with no secular trend. The occurrence increased with maternal age and was lowest in women aged 20-29 years. The recurrence rate was 23 per 1,000 (adjusted odds ratio (OR) of recurrence=9.7). In women with prior delivery at < or =25 gestational weeks the risk of placenta previa was 6.7 per 1,000 (adjusted OR=3.0). In women with prior placental abruption the risk was 5.8 per 1,000 (OR=2.6). In women with prior perinatal death the risk was 4.4 per 1,000 (adjusted OR= 1.8). No independent relationship emerged with socio-economic factors, previous birthweight, and a history of pregnancy induced hypertension. Cesarean section was associated with subsequent development of placenta previa (adjusted OR= 1.3). CONCLUSIONS: We found no secular trends in the occurrence of placenta previa. Placenta previa is associated with previously described risk factors for placental abruption. The increased risk of placenta previa subsequent to placental abruption supports the theory of a shared etiologic factor. However, placenta previa and placental abruption do not share a common etiology in relation to a history of pregnancy induced hypertension, fetal growth retardation, and socio-economic factors.

Abruptio Placentae↗
PubMed2001

[Auxological study of contemporary and historical samples of the population of madrid].

OBJECTIVES: To describe statural growth in a sample of both sexes using the Preece-Baines model 1 (PB1) in order to obtain smoothed percentiles for use in reference growth charts. To apply the PB1to several historical samples, with different age ranges, obtained from the literature (1896-1983) in order to study secular changes in stature. MATERIAL AND METHODS: The sample consisted of 1,525 schoolchildren, aged 6-18 years. The PB1was fitted to the percentile curves, which were corrected for deviation from normal distribution by the LMS model. The PB1was applied to the historical samples and the variables describing growth spurt and adult height were compared. RESULTS: The age of peak height velocity (PHV) was 13.73 years in males and 11.02 years in females. Estimated adult height, in this model, was 176.22 cm for males and 163.53 cm for females. Mean velocity of secular change in males was estimated as 1.2 cm/decade. The age at PHV increased by 0.2 years/decade. CONCLUSIONS: The PB1did not achieve smoothed percentile curves for use in reference growth charts. Right skewness of the distribution was corrected by application of the LMS method. However, the PB1is useful for studying secular trends in statural growth.

Adolescent↗
PubMed2001

[Congenital malformations in Chile. An emerging problem (period 1995-1999)].

BACKGROUND: The Latin American collaborative study of congenital malformations (ECLAMC) is a surveillance program designed to monitor the frequency of congenital malformations and detect abrupt changes in their frequency, look for the cause of such change and implement primary prevention measures. AIM: To construct a secular trend curve with the frequency of congenital malformations in Chile. MATERIAL AND METHODS: Using the ECLAMC protocol, every malformed newborn or stillbirth, weighting more than 500 g at birth is registered using a standard protocol, and the next non malformed child of the same sex born in the same hospital is assigned as control. Using the gathered data, secular trend curves of congenital malformations were constructed. RESULTS: Between 1982 and 1999, there is a secular tendency in the rate of congenital malformations and maternal age, with a correlation coefficient of 0.8 and slope of 13.5 (p < 0.05). The rates of congenital malformations at the moment of birth are higher at the University of Chile Clinical Hospital than in the rest of Chilean hospitals and other Latin American Hospitals. Anencephaly is a defect with a high frequency in Concepción and spina bifida has a high frequency in Rancagua, Viña del Mar, Concepción and Valdivia. There is an impressive increase in malformations dependent on prenatal diagnosis such as kidney agenesis, polycystic kidney and diaphragmatic hernia. CONCLUSIONS: Congenital malformations are having an increasing importance as causes of morbidity or mortality in the newborn.

Chile↗
PubMed2003

Use of hormone replacement therapy by menopausal women in six family-practice teaching clinics in Israel.

BACKGROUND: The necessity of hormone replacement therapy (HRT) remains a controversial subject, but guidelines suggest that the subject be discussed with all menopausal women. AIM: To determine the rate of HRT use among women cared for in family-practice, university-affiliated teaching clinics. METHODS: Physicians from six family-practice teaching clinics enrolled all menopausal patients, aged between 50 and 70 years, registered in their practice. A detailed questionnaire was completed regarding demographic and health variables, gynecological history and the nature of HRT use. RESULTS: In total, 682 women were invited to participate in the study; 587 (86%) participated. Some 74% of the women were married, 64% were secular and 43% stated that they performed regular exercise. Current HRT use was reported by 156 women (26.6%). Most women (83%) had been treated for over 1 year. Common indications for starting treatment were hot flushes (75%), and routine recommendation by their physician (68%). Eighty-three (14%) women were past HRT users. It was stated by 45% of never-users that HRT had never been offered to them. Current users of HRT were found to be younger than non-users (mean age 58.2 years vs. 61.5 years, p < 0.0001), more secular than traditional or religious (p < 0.0001) with more years of formal education (p < 0.0001), and more likely to be of Western or European ("Ashkenazi") origin (p < 0.0001). Current HRT users reported fewer chronic illnesses than did non-users (p = 0.001); they were more likely to report being engaged in regular exercise (p < 0.002) and were less likely to be obese (p < 0.005). In a multiple regression model, HRT use was associated with more years of formal education and a secular identity. CONCLUSION: Our study found a higher proportion of women using HRT than in other Israeli studies. HRT use was more prevalent among women with improved health status and higher socioeconomic status. The most common reason given for not using HRT was that a physician had not raised the subject, indicating that physician-related factors might contribute to using HRT. Thus, comparing HRT prescribing rates in non-teaching clinics should clarify this factor.

Aged↗
PubMedDate not supplied

Comparative epidemiological characteristics of oesophageal adenocarcinoma and other cancers of the oesophagus and gastric cardia.

Secular trends and epidemiological characteristics of 1,581 oesophageal cancers, diagnosed in South Australian residents in 1977-2000, were analysed by histological type and diagnostic period, using multivariable Poisson regression and logistic regression. The age-adjusted incidence of squamous cell carcinoma did not vary significantly by diagnostic period, either in males (p = 0.195) or females (p = 0.087). By comparison, variations were observed for adenocarcinomas in males (p<0.001) and females (p = 0.015), with an increase in age-adjusted incidence of 169% for males and 150% for females between 1977-81 and 1997-2000. Most of these increases occurred in the 1990s. Secular differences were not evident for tumours of other or unknown histological type. The ratio of adenocarcinomas to squamous cell carcinomas was higher in patients who were aged 80 years or more, male, residents of high socio-economic areas, and those born in the United Kingdom/Ireland. Conversely, relatively low ratios presented for patients born in Southern and other parts of Europe. These differences by country of origin accord with differences between the national incidence rates for these countries, as indicated by international data. Differences in secular trend and country of birth between adenocarcinomas of the oesophagus and gastric cardia suggest that they are not expressions of the same disease. Preventive implications of these results are discussed.

Adenocarcinoma↗