Injuries to pedestrians in road traffic accidents.

Although there have been many reports on injuries to occupants of cars in road traffic accidents, there have been few prospective studies of injuries to pedestrians in such accidents. For this reason a two year prospective study of pedestrians in road traffic accidents in the Oxford region was carried out. The incidence of death in pedestrians was significantly higher than in car occupants or motorcyclists. The principal determinant of death was the weight of the vehicle concerned. The most common site of injury was the head because of a high incidence of brief concussion, but the most common site of serious injuries was the leg. Injuries to all regions of the body increased with age and with the weight of the vehicle in the collision. Accidents most often concerned young children or the elderly.     

Breast cancer trends in women younger than 40 years in Brazil

BackgroundA recent Brazilian populational database analysis showed a concerning increase in breast cancer mortality rates among patients under 40 years. We aimed to evaluate the trends in the proportion of new breast cancer cases and deaths occurring in patients younger than 40 years over the last decade in Brazil.MethodsWe evaluated all consecutive breast cancer patients treated from 2009 to 2020 in a Brazilian tertiary cancer center. The proportions of new cases and deaths in patients younger than 40 years was compared between two time periods (2015–2020 versus 2009–2014) using Chi-squared test. Linear regression was used to evaluate the trends in the proportion of new cases and deaths in young patients over the years.ResultsFrom 2009 to 2020, a total of 12,569 breast cancer patients started treatment at our institution; 1441 were younger than 40 years. From 2009 to 2014, 9.9% (95% CI 9.2–10.7%) were patients younger than 40 years compared to 12.9% (95% CI 12.1–13.8%) from 2015 to 2020. Similarly, the proportion of deaths among breast cancer patients younger than 40 years increased during the period (2009–2014: 9.6%, 95% CI 7.8–11.6%; 2015–2020: 12.4%, 95% CI 10.9–14%). The linear regression model showed a trend for an increasing proportion of new breast cancer cases occurring in patients under 40 years (P = 0.005). Proportion increased from 7.9% (95% CI 6.2–9.8%) in 2009 to 21.8% (95% CI 19.1–24.8%) in 2020. The trend for the increase in the proportion of deaths in this young population was also observed in the linear regression model (P = 0.01).ConclusionsThe proportion of new breast cancer cases and deaths among patients younger than 40 years has increased in a public Brazilian cancer center over the past decade. These results raise the concern for the need to reconsider primary and secondary prevention strategies for young women.     

Increased incidence of colon cancer among individuals younger than 50 years: A 17 years analysis from the cancer registry of the municipality of Milan,Italy

BackgroundColorectal cancer (CRC) overall incidence has been decreasing in the last decade. However, there is evidence of an increasing frequency of early-onset CRC in young individuals in several countries. The aim of this study is to evaluate the trends of CRC occurrence over 17 years in the municipality of Milan, Italy, focusing on early-onset CRC.Population and methodsThis retrospective study was performed using the Cancer Registry of the municipality of Milan, including all cases of CRC diagnosed 1999-2015. Incidence rates were stratified by age and anatomic subsite, and trends over time were measured using the estimated annual percentage change. Age-period-cohort modelling was used to disentangle the different effects.Results18,783 cases of CRC were included. CRC incidence rates among individuals aged 50–60 years declined annually by 3% both in colon and in rectal cancer. Conversely, in adults younger than 50 years, overall CRC occurrence increased annually by 0.7%, with a diverging trend for colon (+2.6%) and rectal (−5.3%) cancer. Among individuals aged 60 years and older, CRC incidence rates increased by 1.0% annually up to 2007, and decrease thereafter by 4% per year, both for colon and rectal cancer. Age-period-cohort models showed a reduction of CRC risk for the cohorts born up to 1979, followed by an increase in younger cohorts. In contrast, rectal cancer among women showed a systematic risk decrease for all birth cohorts.ConclusionsThe study highlights increasing incidence of colon cancer in younger subjects and a decrease in incidence rates for rectal cancer in females.     

Inequality of gender,age and disabilities due to leprosy and trends in a hyperendemic metropolis: Evidence from an eleven-year time series study in Central-West Brazil

The present study aimed to investigate the epidemiological situation of leprosy (Hansen’s Disease), in a hyperendemic metropolis in the Central-West region of Brazil. We studied trends over eleven years, both in the detection of the disease and in disabilities, analyzing disparities and/or differences regarding gender and age. This is an ecological time series study conducted in Cuiabá, capital of the state of Mato Grosso. The population consisted of patients diagnosed with leprosy between the years 2008 and 2018. The time series of leprosy cases was used, stratifying it according to gender (male and female), disability grade (G0D, G1D, G2D, and not evaluated) and age. The calendar adjustment technique was applied. For modeling the trends, the Seasonal-Trend decomposition procedure based on Loess (STL) was used. We identified 9.739 diagnosed cases, in which 58.37% were male and 87.55% aged between 15 and 59 years. Regarding detection according to gender, there was a decrease among women and an increase in men. The study shows an increasing trend in disabilities in both genders, which may be related to the delay in diagnosis. There was also an increasing number of cases that were not assessed for disability at the time of diagnosis, which denotes the quality of the services.     

Direct costs of coronary artery bypass grafting in patients aged 65 years or more and those under age 65

BACKGROUND: Over the past 20 years, there have been marked increases in rates of coronary artery bypass grafting (CABG) among older people in Canada. The objectives of this study were to accurately estimate the direct medical costs of CABG in older patients (age 65 years or more) and to compare CABG costs for this age group with those for patients less than 65 years of age. METHODS: Direct medical costs were estimated from a sample of 205 older and 202 younger patients with triple-vessel or left main coronary artery disease who underwent isolated CABG at The Toronto Hospital, a tertiary care university-affiliated hospital, between Apr. 1, 1991, and Mar. 31, 1992. Costs are expressed in 1992 Canadian dollars from a third-party payer perspective. RESULTS: The mean costs of CABG in older and younger patients respectively were $16,500 and $15,600 for elective, uncomplicated cases, $23,200 and $19,200 for nonelective, uncomplicated cases, $29,200 and $20,300 for elective, complicated cases, and $33,600 and $23,700 for nonelective, complicated cases. Age remained a significant determinant of costs after adjustment for severity of heart disease and for comorbidity. Between 59% and 91% of the cost difference between older and younger patients was accounted for by higher intensive care unit and ward costs. INTERPRETATION: CABG was more costly in older people, especially in complicated cases, even after an attempt to adjust for severity of disease and comorbidity. Future studies should attempt to identify modifiable factors that contribute to longer intensive care and ward stays for older patients.     

Trend breaks in incidence of non-cardia gastric cancer in the Netherlands

IntroductionThe incidence of gastric cancer declined over the past decades. Recently, unfavorable trend breaks (i.e. rise in incidence) were seen for non-cardia cancer in younger age groups in the US. It is unclear whether these also occur in other Western countries. We aimed to analyze the gastric cancer incidence trends by age, sex, subsite and stage in the Netherlands.MethodsData on all patients with gastric adenocarcinoma diagnosed from 1973 to 2011 (n = 9093) were obtained from the population-based Eindhoven cancer registry. Incidence time trends (European standardized rates per 100,000) were separately analyzed by sex, age group (<60, 60–74, and >75 years), subsite, and pathological stage. Joinpoint analyses were performed to discern trend breaks, age–period–cohort analyses to examine the influence of longitudinal and cross-sectional changes.ResultsThe incidence of non-cardia cancer declined annually by 3.5% (95% CI −3.8; −3.3). However, in males <60 years, the incidence flattened since 2006, and tended to rise in those >74 years. This pertained to corpus cancers. The incidence of cardia cancer peaked in 1985 and decreased subsequently by 2.4% (95% CI −3.2; −1.5) yearly. The absolute incidence of stage IV disease at first diagnosis initially decreased, but then remained stable over the past 15–20 years.ConclusionsThe incidence of non-cardia cancer declined over the past four decades in the Netherlands, but now seems to be stabilizing particularly in males. Unfavorable trend breaks are seen for corpus cancer in younger and older males. The trend breaks in the Netherlands are however not similar to those observed in the US.     

Seasonal trends of diagnosis of childhood malignant diseases and viral prevalence in South Korea

BackgroundSeveral studies have reported a seasonal trend in the diagnosis of childhood cancer suggesting seasonal factors such as infection. The present study aimed to analyze the diagnosis pattern of childhood malignant diseases using public health data, and to compare this pattern with seasonal viral infection trends.MethodUsing the open data source of the Health Insurance Review and Assessment Service, we extracted data regarding all patients under 21 years of age and who had any cancer, aplastic anemia or myelodysplastic syndrome between September 2009 and December 2013. The positive detection rates of 11 viruses was collected from the surveillance data of Korea Centers for Disease Control and Prevention, and seasonality analysis were conducted with both data.ResultsIn total, 9085 patients were diagnosed with malignant disease during the study period; there were about 175 new cases per month on average. Monthly stacked time series by year showed an apparent seasonal variation with the highest monthly average in January as 236, and the lowest in September as 120. In winter, significantly more patients were diagnosed with acute lymphoblastic leukemia, acute myeloid leukemia, neuroblastoma, and Hodgkin’s lymphoma than in other seasons. There was a temporal correlation with the diagnostic trends of several diseases and the prevalence of recent human parainfluenza virus.ConclusionThis study tentatively suggests that the diagnosis of childhood malignancy follows a seasonal trend in Korea, and has a possible correlation with viral prevalence in several diseases. Further long-term analysis of epidemiological data is needed to explore possible causality.     

Time Trends in Epidemiologic Characteristics and Imaging Features of Lung Adenocarcinoma: A Population Study of 21,113 Cases in China

Objectives

This study aims to describe time trends of epidemiologic characteristics and imaging features over 14 years among histologically confirmed lung adenocarcinoma (ADC) in China and to discuss the possible reasons for these changes.

Materials and Methods

Data of 21,113 pathologically confirmed lung cancer patients from January 1999 to December 2012 were analyzed retrospectively. Preoperative high-resolution computer tomography (HRCT) images were available and reviewed in 5,439 lung ADC patients since 2005. Time trends of the ADC proportion of lung cancer cases, gender distribution, age at diagnosis, the proportion of early-stage ADC and imaging features were investigated.

Results

The proportion of ADC increased during the 14 years (P = 0.000). The ratio of female to male ADC cases was higher than both squamous cell carcinoma (SQCC) and total lung cancer cases (P = 0.000). The median age at diagnosis of ADC patients was younger than that of both SQCC and total lung cancer during the 14 years (P = 0.000). The proportion of age group 45–59 years increased in total lung cancer cases (P = 0.000). When stratified by lung cancer histopathologic subtypes, this trend was also observed in ADC (P = 0.001) and SQCC (P = 0.007). The proportion of early-stage cases of ADC increased from 2008 to 2012 (P < 0.001). The proportion of subsolid nodules (SSN) in ADC increased (P = 0.001) from 2005 to 2012.

Conclusion

The data suggests that the proportion of ADC increased from 1999 to 2012 especially in middle-aged, female patients; early-stage ADC and SSN on HRCT images gradually increased, which may have been caused by a change in smoking habits and increased application of HRCT.     

Trends in colorectal cancer incidence and related lifestyle risk factors in 15⿿49-year-olds in Canada, 1969⿿2010

BackgroundWhile the overall incidence rate of colorectal cancer (CRC) in Canada has been decreasing, some countries show an increasing incidence in those under the age of 50. We examined the trends in CRC incidence and associated lifestyle risk factors in Canadians aged 15⿿49.MethodsIncidence data for colorectal, colon and rectum/rectosigmoid cancers were obtained for 1969⿿2010 from the Canadian Cancer Registry, and trends in age-standardized incidence rates (ASIRs) were examined by Joinpoint regression for three age groups (15⿿29, 30⿿39, 40⿿49 years) and by sex. Trends in the prevalence of some CRC risk factors were similarly examined from national health surveys for various periods ranging from 1970 to 2012.ResultsIn both sexes combined, ASIRs rose by 6.7%/year (1997⿿2010) for 15⿿29-year-olds, 2.4%/year (1996⿿2010) for 30⿿39-year-olds, and 0.8%/year (1997⿿2010) for 40⿿49-year-olds. Similar trends were observed by sex. The rise in ASIR was more rapid for cancers of the rectum/rectosigmoid compared to colon for all age groups. Risk factor trends varied: excess weight rose substantially, vegetables and fruit consumption increased slightly, physical inactivity rates declined but remained high, alcohol consumption changed little, and smoking rates declined. Data on red/processed meat consumption were unavailable.ConclusionThe ASIR of CRC in young Canadians has increased since about the mid-1990s. The rising prevalence of excess weight in younger generations has likely played a role in the CRC trend, but more research is needed.     

EVALUATION OF THE ALASKA HARBOR SEAL (PHOCA VITULINA) POPULATION SURVEY: A SIMULATION STUDY

We used simulation to investigate robust designs and analyses for detecting trends from population surveys of Alaska harbor seals. We employed an operating model approach, creating simulated harbor seal population dynamics and haul-out behavior that incorporated factors thought to potentially affect the performance of aerial surveys. The factors included the number of years, the number of haul-out sites in an area, the number and timing of surveys within a year, known and unknown covariates affecting haul-out behavior, substrate effects, movement among substrates, and variability in survey and population parameters. We found estimates of population trend were robust to the majority of potentially confounding factors, and that adjusting counts for the effects of covariates was both possible and beneficial. The use of mean or maximum counts by site without covariate correction can lead to substantial bias and low power in trend determination. For covariate-corrected trend estimates, there was minimal bias and loss of accuracy was negligible when surveys were conducted 20 d before or after peak haul-out attendance, survey date became progressively earlier across years, and peak attendance fluctuated across years. Trend estimates were severely biased when the effect of an unknown covariate resulted in a long-term trend in the fraction of the population hauled out. A key factor governing the robustness and power of harbor seal population surveys is intersite variability in trend. This factor is well understood for sites within the Prince William Sound and Kodiak trend routes for which at least 10 consecutive annual surveys have been conducted, but additional annual counts are needed for other areas. The operating model approach proved to be an effective means of evaluating these surveys and should be used to evaluate other marine mammal survey designs.     

A survey on maternal age and karyotype in Down's syndrome in Japan, 1947–1975

Summary Data on karyotype and maternal age of 1954 cases of Down's syndrome were analyzed to see if the rate of chromosome mutations leading to this abnormality has been enhanced during the last 20 years. Comparison of the data for patients born in 1947–1960 with those in 1961–1975 revealed little change with time in the proportions of cases due to different karyotypes, the overwhelming majority being of 21 trisomy type in both periods. However, there has been a remarkable decline in the mean maternal age from 33.1 years to 29.7 years as well as in the variance from 50.5 to 29.4. While the rate of decline in the variance was almost the same as that for all births occurring in the same periods, the decline in the mean maternal age was much greater for the patients than for all births, suggesting that the rate of nondisjunction might have increased in younger rather than in older mothers. However, when the risk of brearing a child with Down's syndrome for mothers aged 40–44 is taken as unity, no evidence was found for an increase with time in the relative risk for younger mothers. Moreover, results of surveys made in 1960 and thereafter in different parts of Japan indicate that the crude incidence rate of Down's syndrome at birth has been around 0.10%, giving no indication of an upward trend. These findings are discussed with reference to the serious environmental pollution, including possible genetic hazards, with which Japan has been faced since the 1960s.     

The relative influence of age and weight on the reproductive behaviour of male grey seals Halichoerus grypus

The breeding behaviour of male grey seals Halichoerus grypus of known age and weight was studied on Sable Island, Nova Scotia. Branded males ranged in age from 8 to 16 years and although there was a positive relationship between age and weight, there was a large overlap between age classes. In general, there was an increase in length of tenure and rates of copulation with increasing male age but this was less marked among males between the ages of 13 and 16 years. Compared to older ones, males of 8 and 12 years were observed at more sites, travelled more extensively around the breeding colony, were transient more frequently and were unable to lie as close to females. There was no correlation between male body weight and either length of tenure or rates of copulation when males of age 8 (the smallest males) were excluded from the analysis. Most agonistic behaviour was made by larger, older males towards smaller, younger ones and appeared to be responsible for the short length of tenure and low reproductive rates of young bulls.     

10-Year Overview of the Hospital-Based Prevalence and Treatment of Congenital Cataracts: The CCPMOH Experience

A review of 6 years of hospitalization charts from Zhongshan Ophthalmic Center (ZOC) revealed that congenital cataracts (CC) accounted for 2.39% of all cataract in-patient cases and that the age at surgery was decreasing before the establishment of the Childhood Cataract Program of the Chinese Ministry of Health (CCPMOH) in December 2010. We aimed to investigate data from the 4 years (January 2011 to December 2014) following the establishment of the CCPMOH, compared, and combined with data from the previous study period (January 2005 to December 2010) to generate a 10-year overview of the hospital-based prevalence and treatment of CC. In the 4-year period after CCPMOH establishment, the prevalence of CC was 2.01% in all hospitalizations, and was 2.78% in all cataract in-patients. Most of the eligible CC in-patients (71%) lived in south China. The ratio of boys to girls was 1.42:1. Nearly 2/3 of the patients underwent cataract extraction with primary intraocular lens (IOL) implantation at a mean age of 78.40±51.45 months, and cataract extraction surgeries without IOL implantation were performed in the remaining 1/3 of patients at a mean age of 10.03±15.92 months. After CCPMOH establishment, an increased incidence of CC was revealed, and the CC in-patients were younger than the patients in the previous period. The 10-year overview (2421 CC in-patients from 206630 hospitalizations) revealed upward trends in both the number and the prevalence of CC and a further reduction in age at surgery. In conclusion, the data from 4-year period after CCPMOH establishment and the 10-year overview showed upward trends in the hospital-based prevalence of CC cases and a further reduction in age at surgery, likely reflecting the effects of the CCPMOH establishment and providing useful information for further CC studies and a valuable foundation for the prevention and treatment of this cause of childhood blindness.     

Frequent loss of the BLID gene in early-onset breast cancer

The BH3-like motif-containing inducer of cell death (BLID) is an intronless gene localized on 11q24.1. Loss of that region has frequently been reported in early-onset breast cancer and is significantly associated with poor prognosis and reduced survival. Downregulation of BLID is associated with younger age, triple-negative phenotype, and reduced disease-free and overall survival of breast cancer patients. In this study, we investigated allelic loss of BLID in breast tumor specimens from 78 women with invasive breast cancer using 2 dinucleotide polymorphic markers closely linked to the BLID gene (no intragenic marker for BLID is available). Seventy-three cases were informative. Overall, loss of heterozygosity (LOH) at the BLID locus was detected in 32% of the informative cases (23/73). However, in patients 40 years old and younger, LOH was detected in 50% of the cases (9/18). Patients aged 40 years and younger were significantly more likely to experience LOH than those aged 41-55 years (p = 0.04). Specifically, the odds of BLID loss for patients aged 40 years and younger were 3.7 times the odds of loss for patients aged 41-55 years (95% CI, 1.1-13). Our findings suggest a tumor suppressor role of the BLID gene in early-onset breast cancer.     

Twenty years of melanoma in Victoria,Queensland, and South Australia (1997 – 2016)

BackgroundGiven the high incidence of melanoma in Australia alongside high mortality with later stage disease, we investigated the populations and locations most at risk, to optimise public health activities in areas where intervention is most needed. This study examines trends and identifies significant prognostic factors and potential disparities in incidence, mortality and survival between population groups in Victoria, Queensland and South Australia.MethodsThe analysis includes data from the population-based cancer registries of the three states over a twenty-year period (1997–2016). Age-standardized and age-specific incidence rates were calculated, and long-term trends analysed using Joinpoint Regression. Five-year relative survival estimates for the study population were calculated using the cohort method and multivariable flexible parametric survival models were applied for each jurisdiction to calculate adjusted excess mortality hazard ratios for the key characteristics.ResultsThere were more males with melanoma than females in all the three states. Over 60% of the cases occurred in the 40–74 years age group. Most melanomas had a Breslow thickness less than or equal to 1.0 mm. For males, Victoria and Queensland had a statistically significant increasing trend whereas in South Australia there was a decreasing trend. For females, the incidence rate trend was stable in Victoria but significantly decreasing in South Australia. In Queensland there was an increasing and statistically significant trend from 2006 to 2016. Across all three states there was a reducing incidence rate in the youngest cohort, stabilizing incidence in the 40–59-year-old age group, and increasing in the oldest cohorts. Five-year relative survival decreased with increasing age and with Breslow thickness across all three jurisdictions. Males had between 43%− 46% excess mortality compared to females in all the three states. There was higher risk with increasing age and Breslow thickness, with the largest risk among the 75 + age group and those with a Breslow thickness of > 4 mm.ConclusionIt is the first time that data from these three registries has been analysed together in a uniform way, covering more than half of the Australian population. This study compares the epidemiology of melanoma across three states and provides a better understanding of trends and factors affecting outcome for Australians with melanoma. While there has been some improvement in aspects of incidence and mortality, this has not been evenly achieved across Australia.     

Responses in the start of Betula (birch) pollen seasons to recent changes in spring temperatures across Europe

A shift in the timing of birch pollen seasons is important because it is well known to be a significant aeroallergen, especially in NW Europe where it is a notable cause of hay fever and pollen-related asthma. The research reported in this paper aims to investigate temporal patterns in the start dates of Betula (birch) pollen seasons at selected sites across Europe. In particular it investigates relationships between the changes in start dates and changes in spring temperatures over approximately the last 20 years. Daily birch pollen counts were used from Kevo, Turku, London, Brussels, Zurich and Vienna, for the core period from 1982 to 1999 and, in some cases, from 1970 to 2000. The sites represent a range of biogeographical situations from just within the Arctic Circle through to North West Maritime and Continental Europe. Pollen samples were taken with Hirst-type volumetric spore traps. Weather data were obtained from the sites nearest to the pollen traps. The timing of birch pollen seasons is known to depend mostly on a non-linear balance between the winter chilling required to break dormancy, and spring temperatures. Pollen start dates and monthly mean temperatures for January through to May were compiled to 5-year running means to examine trends. The start dates for the next 10 years were calculated from regression equations for each site, on the speculative basis that the current trends would continue. The analyses show regional contrasts. Kevo shows a marked trend towards cooler springs and later starts. If this continues the mean start date will become about 6 days later over the next 10 years. Turku exhibits cyclic patterns in start dates. A current trend towards earlier starts is expected to continue until 2007, followed by another fluctuation. London, Brussels, Zurich and Vienna show very similar patterns in the trends towards earlier start dates. If the trend continues the mean start dates at these sites will advance by about 6 days over the next 10 years. Following this work, amendments will be needed to pollen calendars and local predictive models. It will also be important to assess the implications of earlier seasons for allergy sufferers.     

Pediatric and Youth Traffic-Collision Injuries in Al Ain,United Arab Emirates: A Prospective Study

Aim

To study the mechanism of road traffic collisions (RTC), use of safety devices, and outcome of hospitalized pediatric and youth RTC injured patients so as to give recommendations regarding prevention of pediatric RTC injuries.

Methods

All RTC injured children and youth (0–19-year-olds) who were admitted to Al Ain City’s two major trauma centers or who died after arrival to these centers were prospectively studied from April 2006 to October 2007. Demography of patients, road-user and vehicle types, crash mechanism, usage of safety devices, injured body regions, injury severity, Revised Trauma Score, Glasgow Coma Scale, intensive care unit admissions, hospital stay and mortality were analyzed.

Results

245 patients were studied, 69% were vehicle occupants, 15% pedestrians, 9% motorcyclists and 5% bicyclists. 79% were males and 67% UAE citizens. The most common mechanism of RTC was rollover of vehicle (37%) followed by front impact collision (32%). 32 (13%) of vehicle occupants were ejected from car. 63% of ejected occupants and 70% of motorcyclists sustained head injuries. Only 2% (3/170) vehicle passengers used seatbelts and 13% (3/23) motorcyclists a helmet.

Conclusions

Male drivers and UAE nationals were at high risk of RTC as drivers and as motorcyclists. Ejection rate was high because safety restraint use was extremely low in our community. More education and law enforcement focusing especially on car/booster seat use is needed.     

Treating hyperuricemia of gout: safety and efficacy of febuxostat and allopurinol in older versus younger subjects

Despite an increasing incidence of gout in older age patients with multiple metabolic and cardiovascular comorbidities, there are limited data addressing whether currently available urate-lowering therapy is comparably effective and safe in older (≥65 years of age) versus younger (<65 years of age) patients. In this secondary analysis of data from the CONFIRMS trial, we found that among 374 older subjects, urate-lowering therapy with approved doses of febuxostat or commonly prescribed doses of allopurinol was at least comparable to that in 1894 younger subjects and was well tolerated despite high rates of renal impairment and cardiovascular comorbidities in the older subjects.