Time trends of upper gastrointestinal diseases in Nigeria

BACKGROUND

The changing epidemiology of a disease often provides valuable insight into possible etiopathogenic mechanisms. There have been significant changes over the last several decades in disease manifestations of the foregut in Western Europe, North America and Asia. This time trend analysis was carried out to determine if any changes have occurred in the prevalence of diseases of the upper gastrointestinal tract in Nigeria.

METHOD

Records of patients who underwent upper gastrointestinal endoscopy during two time periods (1995 to 1999 and 2006 to 2010) in Enugu, South-East Nigeria were analyzed with regard to biodata of patients, indications for upper gastrointestinal endoscopy and endoscopic findings.

RESULTS

During the two time periods, 1,365 patients had upper gastrointestinal endoscopy (575 patients in the period 1995-1999 and 790 in the period 2006-2010). Dyspepsia was the commonest indication for upper gastrointestinal endoscopy for both periods (81.9% and 72.9%, respectively; p= 0.9052). Heartburn and dysphagia were more frequent during the second time period (p<0.0001). Duodenal ulcer was more common in the first time period (p<0.0001), while esophagitis, gastric ulcer and bile reflux were significantly more common in the second period (p<0.0001, p=0.0007 and p=0.0019, respectively).

CONCLUSION

Over the 15-year period, the prevalence of duodenal ulcer has declined while that of gastric ulcer has increased. There has also been an increase in the prevalence of gastroesophageal reflux disease. Putative explanations for this trend may include widespread availability and use of very potent acid suppressant drugs, increasing use of non steroidal anti-inflammatory drugs, change towards western diet and increasing obesity.

Trendwatcher or trendsetter; 50 years of MTAA

The development on neutron activation analysis (NAA) into a technique of practical interest effectively started about 60 years ago, when nuclear reactors became available and widely accessible as intense sources of neutrons. During 50 out these 60 years, the series of Modern Trends in Activation Analysis (MTAA) Conferences acted as a true companion and facilitator of this growth. As trendwatcher they signalized the many initiatives that contributed to the development of activation analysis and its applications. A period has come to an end of impressive development resulting from sometimes revolutionary changes in radiation detection and data processing, and much improved irradiation facilities, NAA has reached a full stage of development, with emphasis on routine application and with remaining developments of in marginal impact. NAA is being challenged increasingly in the last 30 years by alternative techniques for multi trace element analysis. The MTAA Conference and with it the ICAA, the International Committee on Activation Analysis, can play an important and active role in this process of identifying and selecting key areas, and even promoting concerted action in those areas. Such an evolution of focus from retrospective to prospective, from trendwatcher to trendsetter, may well allow the MTAA Conference to continue and even expand its role in future development of NAA and its applications. The ideas about the future of the MTAA Conferences and its organization are elaborated upon and some possible subjects for focused development activities are indicated.

Causes of different estimates of the prevalence of metabolic syndrome in Korea

BACKGROUND/AIMS

Reports of the prevalence of and trends in metabolic syndrome in Korea have been inconsistent. Thus, we investigated the reasons underlying these inconsistencies.

METHODS

We estimated the prevalence of metabolic syndrome using different diagnostic criteria, exclusion criteria, and sampling weights among 5,509 respondents, aged 20-79, who participated in the 2001 Korean National Health and Nutrition Examination Surveys (KNHANES). Trends in metabolic syndrome were assessed by examining the 1998 (n = 6,747), 2001 (n = 4,337), and 2005 (n = 5,139) KNHANES.

RESULTS

The estimated prevalence of metabolic syndrome in 2001 ranged from 1.6 to 29.6% in males and from 10.1 to 32.8% in females, depending on the diagnostic criteria used. The exclusion criteria and sampling weights did not significantly affect the prevalence estimates. The prevalence of metabolic syndrome first significantly increased and then decreased between 1998, 2001, and 2005 in males (26.2, 29.6, and 27.2%, respectively) and females (29.2, 32.8, and 24.7%, respectively). Among the individual metabolic variables, triglyceride levels in 2001 were significantly higher than in 1998 and 2005, whereas other variables remained relatively constant during the same period. The exceptionally high triglyceride levels in 2001 might have contributed to the increased prevalence of metabolic syndrome between 1998 and 2001.

CONCLUSIONS

Different diagnostic criteria for metabolic syndrome represent a major cause of the inconsistent estimates of prevalence, and the absence of standardized laboratory methods might have affected the trend estimates.

Trends of genitourinary cancer among Saudis

INTRODUCTION

Saudi Arabia has a low incidence of cancer; the age-standardized rate of cancer is only 83/100,000, compared to the world rate of 181/100,000. Recent reports confirm a yearly increase in cancer in general, and of genitourinary cancer (GUC) in particular. The aim of the study was to assess the trends of GUC among Saudi nationals.

METHODS

All available annual reports of the Saudi Cancer Registry (SCR) from 1994 to 2006 were analysed and compared with worldwide data.

RESULTS

Over a period of 13 years, 7132 GUCs were identified among Saudis, comprising 8.9% of all cancers reported, compared to 12.7% worldwide. The incidence rate of GUC increased over the study period, with the greatest increase in prostate and kidney cancer, at 48% and 33%, respectively. Summary stage data (Surveillance, Epidemiology and End Results programme) showed late presentation of GUC at the time of diagnosis. An improvement in stage was only found in testicular and prostate cancer, at 79% and 50%, respectively. While prostate and bladder cancer ranked sixth and ninth in the male population, penile cancer continued to be a rare disease.

CONCLUSIONS

The incidence of GUC in Saudi Arabia is still low, but there was a significant increase in prostate and kidney cancer. More effort is needed to detect GUC at an earlier stage. A national cancer control programme is suggested.

Trends in Cancer Screening Rates among Korean Men and Women: Results from the Korean National Cancer Screening Survey (KNCSS), 2004-2010

Purpose

The Korean National Cancer Screening Survey (KNCSS) is a continuous nationwide survey implemented by the National Cancer Center in Korea since 2004. The purpose of the present study was to report trends in cancer screening rates for the five major cancers (stomach, liver, colorectal, breast, and cervix uteri) in Korean men and women.

Materials and Methods

The study used KNCSS data collected between 2004 and 2010. The survey was conducted on Korean men aged 40-74 years and Korean women aged 30-74 years with no history of cancer diagnosis. The annual percentage change and corresponding 95% confidence intervals were used to examine changes in annual screening rates.

Results

Screening rates with recommendation increased by 4.4% annually for stomach cancer, 1.5% for liver cancer, 2.8% per year for colorectal cancer, 4.5% for breast cancer, and 1.2% for cervix uteri cancer. The increasing trend in cancer screening rates, with the exception of liver cancer, was significant.

Conclusion

Cancer screening rates have increased consistently from 2004 to 2010 among Korean men and women. Stomach and breast cancer screening rates in particular have increased markedly.

Trends of VOC exposures among a nationally representative sample: Analysis of the NHANES 1988 through 2004 data sets

Exposures to volatile organic compounds (VOCs) are ubiquitous due to emissions from personal, commercial and industrial products, but quantitative and representative information regarding long term exposure trends is lacking. This study characterizes trends from1988 to 2004 for the 15 VOCs measured in blood in five cohorts of the National Health and Nutrition Examination Survey (NHANES), a large and representative sample of U.S. adults. Trends were evaluated at various percentiles using linear quantile regression (QR) models, which were adjusted for solvent-related occupations and cotinine levels. Most VOCs showed decreasing trends at all quantiles, e.g., median exposures declined by 2.5 (m, p-xylene) to 6.4 (tetrachloroethene) percent per year over the 15 year period. Trends varied by VOC and quantile, and were grouped into three patterns: similar decreases at all quantiles (including benzene, toluene); most rapid decreases at upper quantiles (ethylbenzene, m, p-xylene, o-xylene, styrene, chloroform, tetrachloroethene); and fastest declines at central quantiles (1,4-dichlorobenzene). These patterns reflect changes in exposure sources, e.g., upper-percentile exposures may result mostly from occupational exposure, while lower percentile exposures arise from general environmental sources. Both VOC emissions aggregated at the national level and VOC concentrations measured in ambient air also have declined substantially over the study period and are supportive of the exposure trends, although the NHANES data suggest the importance of indoor sources and personal activities on VOC exposures. While piecewise QR models suggest that exposures of several VOCs decreased little or any during the 1990's, followed by more rapid decreases from 1999 to 2004, questions are raised concerning the reliability of VOC data in several of the NHANES cohorts and its applicability as an exposure indicator, as demonstrated by the modest correlation between VOC levels in blood and personal air collected in the 1999/2000 cohort. Despite some limitations, the NHANES data provides a unique, long term and direct measurement of VOC exposures and trends.

Pediatric fractures: temporal trends and cost implications of treatment under general anesthesia

PURPOSE

Pediatric fractures are common and are often managed by manipulation under general anesthesia (MUA). This study's aim was to assess the changing pattern of pediatric fractures over 6 years and use this data to perform a workload forecast and estimate cost implications of treatment under general anesthesia.

METHODS

The Emergency Department (ED), operating theater and ward admissions data of children aged 1-11 years presenting with fractures was analyzed. We calculated caseload trends, delay to operation, various parameters of service provision, and the current cost of treating each fracture. We then performed predictive cost analysis for the next 3 years to estimate potential savings by manipulating fractures in ED under ketamine sedation.

RESULTS

The case load has increased >350% in 6 years (total fractures increasing at 23% and MUAs increasing at 17% per year, respectively). The summer months and evenings have been consistently busier. 72% of fractures were managed by pure reduction alone (MUA), 22% by reduction + K-wires, and various other procedures were performed in 1%. The median delays from ED presentation to admission, definitive procedure and discharge were 4, 21 and 33 h, respectively. Each MUA took 52 min and cost the hospital £723. Assuming that the current trends continue, the expenditures would be £101 K, £114 K, and £128 K for 2010, 2011 and 2012, respectively.

DISCUSSION

Fracture manipulation in children under general anesthesia often requires an overnight hospital stay, which is not only uncomfortable for the child and inconvenient for the parents but it also increases the burden on the limited National Health Service (NHS) resources. There is a 23% annual increase in fractures and children have to wait for 21 h before the definitive procedure. Using ketamine to manipulate children's fractures in the ED could offer potential service and cost improvements.

Time trend and age-period-cohort effects on acute myocardial infarction mortality in Korean adults from 1988 to 2007

We examined time trend and age-period-cohort effects on acute myocardial infarction (AMI) mortality in Korean adults from 1988 to 2007. Annual AMI mortality data and population statistics from 1988 to 2007 were obtained from the STATISTICS KOREA website. Age adjusted mortality for four 5-yr calendar periods (1988-1992 to 2003-2007) was calculated by direct standardization using the Year 2000 WHO world standard population. A log-linear Poisson regression model was used to estimate age, period, and cohort effects on AMI mortality. In both genders, age-adjusted AMI mortality increased from period one (1988-1992) to period three (1998-2002) but decreased in period four (2003-2007). An exponential age effect was noted in both genders. The rate ratio of the cohort effect increased up to the 1943 birth cohort and decreased gradually thereafter, and the rate ratio of the period effect increased up to period three (1998-2002) and decreased thereafter. Our results suggest that AMI mortality in Korean adults has decreased since the period 1998-2002 and age, period, and cohort effects have influenced on AMI mortality.

Prediction of Daily Patient Numbers for a Regional Emergency Medical Center using Time Series Analysis

Objectives

To develop and evaluate time series models to predict the daily number of patients visiting the Emergency Department (ED) of a Korean hospital.

Methods

Data were collected from the hospital information system database. In order to develop a forecasting model, we used, 2 years of data from January 2007 to December 2008 data for the following 3 consecutive months were processed for validation. To establish a Forecasting Model, calendar and weather variables were utilized. Three forecasting models were established: 1) average; 2) univariate seasonal auto-regressive integrated moving average (SARIMA); and 3) multivariate SARIMA. To evaluate goodness-of-fit, residual analysis, Akaike information criterion and Bayesian information criterion were compared. The forecast accuracy for each model was evaluated via mean absolute percentage error (MAPE).

Results

The multivariate SARIMA model was the most appropriate for forecasting the daily number of patients visiting the ED. Because it's MAPE was 7.4%, this was the smallest among the models, and for this reason was selected as the final model.

Conclusions

This study applied explanatory variables to a multivariate SARIMA model. The multivariate SARIMA model exhibits relativelyhigh reliability and forecasting accuracy. The weather variables play a part in predicting daily ED patient volume.

Trends in nosocomial bloodstream infections following health care restructuring in Alberta between 1999 and 2005

OBJECTIVE

A previous study at the University of Alberta Hospital/Stollery Children's Hospital in Edmonton, Alberta, revealed an increase in hospital-acquired bloodstream infection (BSI) rates associated with an increase in patient acuity during a period of public health care delivery restructuring between 1993 and 1996. The present study assessed trends in BSIs since the end of the restructuring.

DESIGN

Prospective surveillance for BSIs was performed using Centers for Disease Control and Prevention (USA) criteria for infection. BSI cases between January 1, 1999, and December 31, 2005, were reviewed. Available measures of patient volumes, acuity and BSI risk factors between 1999 and 2005 were also reviewed from hospital records.

SETTING

The University of Alberta Hospital/Stollery Children's Hospital (617 adult and 139 pediatric beds, respectively).

PATIENTS

All pediatric and adult patients admitted during the above-specified period with one or more episodes of BSIs.

RESULTS

There was a significant overall decline in the BSI number and rate over the study period between 1999 and 2005. The downward trend was widespread, involving both adult and pediatric populations, as well as primary and secondary BSIs. During this period, the number of hospital-wide and intensive care unit admissions, intensive care unit central venous catheter-days, total parenteral nutrition days and number of solid-organ transplants were either unchanged or increased. Gram-positive bacterial causes of BSIs showed significant downward trends, but Gram-negative bacterial and fungal etiologies were unchanged.

CONCLUSIONS

These data imply that, over time, hospitals can gradually adjust to changing patient care circumstances and, in this example, control infectious complications of health care delivery.

Trends of Gastrointestinal Diseases at a Single Institution in Korea over the Past Two Decades

Background/Aims

The lifestyle changes that have accompanied economic growth have influenced disease patterns in Korea. Changing patterns of gastrointestinal (GI) diseases over the past two decades were investigated in the present study.

Methods

Data from inpatients with specific GI diseases, as defined by the International Classification of Diseases code, were extracted from the database at a tertiary medical facility for 1990, 1996, and 2006.

Results

Admission rates for GI diseases increased between 1990 and 2006. The most prevalent disease in 1990 was gastric cancer, followed by appendicitis and colorectal cancer. However, by 2006, gastric cancer, colon cancer, and colon adenoma or polyps had become the most prevalent diseases. Although gastric cancer showed a decreasing trend, the rate of colon cancer doubled over two decades. Furthermore, rates of detection and endoscopic treatment of early gastric cancer and adenoma of the stomach and colon have increased noticeably. Newly emerging diseases include inflammatory bowel disease and gastroesophageal reflux. There was no change in the incidence of peptic ulcer, but ulcer-related complications and the numbers treated surgically decreased.

Conclusions

The findings of this study indicate that the clinical trends of GI diseases in Korea have changed in a similar way to those in the West. Early detection of a GI neoplasm will continue to increase with the establishment of cancer-screening programs, resulting in a rising need for minimally invasive treatments.

Assessing Trends in Women's Violence via Data Triangulation: Arrests, Convictions, Incarcerations, & Victim Reports

Constructionist theories suggest the national rise in female violence arrests may be policy-generated because arrest statistics are produced by violent behavior and changing official responses (e.g., net-widening enforcement policies). Normative theories attribute the rise to female behavior changes (e.g., in response to increased freedoms or hardships). We examine whether any narrowing of the arrest gender gap is borne out across offense types of varying measurement reliability, in victimization data, and across two post-arrest criminal justice stages. Advanced time-series analyses over 1980-2003 support the constructionist position - first, all sources show little or no increase in women's rates for the more reliably measured offenses of homicide and robbery, and for rape; second, the assault gender gap narrows for arrests, but holds stable in victimization data; third, the assault gender gap narrows moderately for convictions, but is stable for imprisonment, indicating spill-over effects of more expansive arrest policies. Several factors have produced greater female representation in "criminal assault" arrests including (i) proactive policing targeting and formally responding to minor violence and in private contexts, (ii) interventionist developmental epistemologies that blur distinctions among violence types and circumstances, (iii) the rise of social movements recognizing "hidden" victims, (iv) law and order political messages stressing greater accountability, and (v) the somewhat greater decline in male compared to female violence in the late 1990s. The problem of women's violence is largely a social construction. Rather than women becoming more violent, changes in the management of violence increasingly mask differences in the violence levels of women and men.

Trends in disability-free life expectancy at age 65 in France: consistent and diverging patterns according to the underlying disability measure

Disability-free life expectancy estimates (DFLE) are summary measures to monitor whether a longer life expectancy (LE) is associated with better health or whether additional years of life are years of poor health or disability. Disability is a generic term defined as the impact of disease or injury on the functioning of individuals. It covers various situations from the rather common functional limitations to restrictions in daily activities and finally dependency. Disentangling these dimensions is essential to monitor future needs of care and assistance; but this is not always feasible since surveys do not systematically cover a large range of disability dimensions in their questionnaires. This study aims to cover different disability dimensions by using data from different French population surveys. We computed ten disability-free life expectancies, based on both specific and generic disability indicators from four population health surveys, in order to describe and compare trends and patterns for France over the 1980s and the 1990s. We used the Sullivan method to combine prevalence of disability and life tables. In 2000, two thirds of total LE at age 65 are years with physical or sensory functional limitations and 10% are years with restrictions in personal care activities. Trends in DFLE over the two last decades seem to have remained stable for moderate levels of disability and to have increased for more severe levels of disability or activity restrictions. We found that patterns are consistent from one survey to the other when comparing indicators reflecting similar disability situations.

CAESAREAN SECTION - CHANGING TRENDS DURING LAST TWO DECADES

Changing trends of caesarean section during last twenty years have been studied. There seems to be a gradual increase in the incidence of caesarean section over the years with a simultaneous decline in the perinatal mortality rate. The incidence of caesarean section has slowly been increasing for post-caesarean pregnancy, breech presentation and foetal distress. This opens up a debate as to what extent this increase is justifiable. The trend needs a close observation.