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PubMed2005

Biodiversity trends in Europe: development and testing of a species trend indicator for evaluating progress towards the 2010 target.

This paper presents a trial of a species population trend indicator for evaluating progress towards the 2010 biodiversity target in Europe, using existing data. The indicator integrates trends on different species (groups), and can be aggregated across habitats and countries. Thus, the indicator can deliver both headline messages for high-level decision-making and detailed information for in-depth analysis, using data from different sources, collected with different methods. International non-governmental organizations mobilized data on over 2800 historical trends in national populations of birds, butterflies and mammals, for a total of 273 species. These were combined by habitat and biogeographical region to generate a pilot pan-European scale indicator. The trial indicator suggests a decline of species populations in nearly all habitats, the largest being in farmland, where species populations declined by an average of 23% between 1970 and 2000. The indicator is potentially useful for monitoring progress towards 2010 biodiversity targets, but constraints include: the limited sensitivity of the historical data, which leads to conservative estimates of species decline; a potential danger of ambiguity because increases in opportunistic species can mask the loss of other species; and failure to account for pre-1970 population declines. We recommend mobilizing additional existing data, particularly for plants and fishes, and elaborating further the criteria for compiling representative sets of species. For a frequent, reliable update of the indicator, sound, sensitive and harmonized biodiversity monitoring programmes are needed in all pan-European countries.

Biodiversity↗

PubMed2005

Increasing trend of reflux esophagitis and decreasing trend of Helicobacter pylori infection in patients from a multiethnic Asian country.

OBJECTIVES: This study aimed to determine time trends in the frequency of endoscopic esophagitis, and Helicobacter pylori (H. pylori) infection in a large Singaporean teaching hospital over a 10-yr period. METHODS: We studied a consecutive series of 16,375 patients who had been newly referred for diagnostic esophagogastroduodenoscopy from 1992 to 2001. All endoscopic findings were prospectively recorded. From 1995, an antral biopsy was taken from 6,185 unselected patients for an in-house biopsy urease test. Endoscopic esophagitis was defined as the presence of erosions and/or ulceration. The relationship between erosive esophagitis and various relevant factors was analyzed. RESULTS: The overall prevalence of endoscopic esophagitis was 6.9% (95% CI, 6.5-7.3). It was 7.3% (95% CI, 6.2-8.4) in patients with a positive urease test, and 9.0% (95% CI, 8.1-9.9) in those in whom the urease test was negative (p < 0.001). From 1992 to 2001, the frequency of endoscopic esophagitis increased (p < 0.001 for trend) while that of positive urease test decreased from 1995 to 2001 (p < 0.001 for trend). The increase in the prevalence of endoscopic esophagitis (RR 1.99, 95% CI 1.18-3.36, p= 0.0098), and its inverse relationship with positive urease test results (RR 0.991, 95% CI 0.983-0.999, p= 0.049) remained significant even after adjusting for age, gender, ethnic distribution, and hiatal hernia. CONCLUSIONS: The frequency of endoscopic esophagitis increased in Singapore from 1992 to 2001. This increase within a short period of time suggests that environmental factors, of which the decreasing rate of H. pylori infection may be one, are important in the pathogenesis of gastroesophageal reflux disease.

Breath Tests↗

PubMed1994

Relationship between risk factor trends and disease trends.

To what extent can trends in risk factor levels in populations explain trends in disease rates? Some methodological difficulties in answering this question include weaknesses of ecological studies, small sample size, time lags and multiple sources of variability. Two possible approaches are to apply predictive equations derived from longitudinal studies of individuals to average data for populations, or to use results from overviews of randomized, controlled trials and cohort studies to estimate the magnitude of effects achievable through various risk factor changes. These methods are illustrated with Australian data on trends in mortality from ischaemic heart disease and cigarette smoking, blood pressure and cholesterol during the 1980s. If it is assumed that time lags are short between reductions in risk factor levels and reductions in risk, then both methods suggest that about half the mortality decline in men, and less in women, may be related to changes in these three well-established risk factors. Improvements in population levels of blood pressure and, for men, reductions in smoking appear to be the main contributors. It is argued that such ecological analyses can provide valid results as long as care is taken to avoid various epidemiological pitfalls.

Adult↗

PubMedDate not supplied

Worldwide trends in asthma morbidity and mortality. Explanation of trends.

The aim of this paper is to outline, in the light of present understanding of the disease, some of the likely causes for the increasing prevalence and mortality associated with asthma in different communities in the world. It seems important both to understand the causes of asthma and to taking action to reverse the trends. There is an increasing sense of urgency in addressing the problems of morbidity and mortality caused by asthma. In this regard the respiratory community is a long way behind the cardiovascular community who have been documenting the risk factors for vascular disease for many years. In the absence of a reliable definition of asthma, it is difficult to make definite statements about trends in its prevalence, morbidity and mortality. Nevertheless, as already summarised, asthma appears to be an increasing problem. the trend towards increasing deaths in some countries is particularly worrying. The mortality data are most accurate for the 5 to 34 year olds and this paper is confined to reviewing data from this age group.

Adolescent↗

PubMed1997

Doctor in the house: trends in GPs home visiting in Croatia 1990-1995 compared to current trends in USA and UK.

During the period of intensive economic, political and epidemiological transition in Croatia (1990-1995), significant changes in patterns, intensity and organization of home visiting were registered and reported. Quantitative instruments were employed to determine changes in trends of financing, health manpower policy and use of services before and after 1993 health care reforms. The qualitative part of research (e.g., cross-sectional and cross-national comparison of trends) was used to compare the significance of a reduction in the number of home visits as well as how its pattern fitted into the international trends (outburst of home visits in the USA and stagnation or decrease in the UK).

Croatia↗

PubMed2005

Temporal trend of bis(4-chlorophenyl) sulfone, methylsulfonyl-DDE and -PCBs in Baltic guillemot (Uria aalge) egg 1971-2001--a comparison to 4,4'-DDE and PCB trends.

The dynamics of organohalogen contaminants and their metabolites are best studied over time by analysis of biota at high trophic levels. In this study, time trends, 1971-2001, of bis(4-chlorophenyl) sulfone (BCPS) and of methylsulfonyl-substituted metabolites of PCBs and 4,4'-DDE, were investigated in eggs of guillemot (Uria aalge) hatching in the Baltic Proper. Temporal trends of PCBs, trans-nonachlor, beta-HCH, 4,4'-DDT, and 4,4'-DDE were also assessed. Tris(4-chlorophenyl) methane (TCPMe), a 4,4'-DDT by-product, was detected in the eggs. The concentration of BCPS ranged between 2.6-0.76 microg/g on a lipid weight basis over the three decades and showed a significant 1.6% annual decrease. Three metabolites of PCBs, i.e. 3'-MeSO2-CB101, 4'-MeSO2-CB101 and 4-MeSO2-CB149, were quantified in all samples over time and showed an annual decrease of approximately 3% compared to MeSO2-DDE with a decrease of 8.9%. The methylsulfonyl-PCB and -DDE metabolites are eliminated more slowly than the persistent PCB congeners and 4,4'-DDE. Trans-nonachlor decreases by 16% compared to 19% and 9% for 4,4'-DDT and beta-HCH, respectively. The concentration of TCPMe in guillemot decreased by 8.2% per year. A linear relationship was found between TCPMe and 4,4'-DDE concentrations which supports the theory that TCPMe has an origin as a contaminant in commercial 4,4'-DDT products. The very slow decrease in BCPS concentrations is notable and remains to be explained. BCPS is still present at rather high concentrations in the guillemot eggs. The enantiomeric fraction varied between 0.27 and 0.67 which indicates less of a specific retention of the chiral MeSO2-PCBs in guillemot eggs than in grey seal tissues, for example. Independent of meta- or para-substitution of the sulfone group, the most accumulative atropisomer of each of four MeSO2-PCB pairs has been assigned an absolute R structure.

Animals↗

PubMed1999

Trends in safe driving behaviors and in relation to trends in health maintenance behaviors in the USA: 1985-1995.

Specific health and safe driving behaviors of the American adult population during the period 1985-1995, were examined for trends and for consistencies in observing them. The data base consisted of the results of annual surveys conducted on representative samples of 1250 people of the US adult population. Two indices were developed: a Health Index (HI) and a Safety Index (SI). The Health Index reflects the level of practice of six health and disease preventing behaviors (in order of decreasing importance: not smoking, frequent exercises, avoiding fat foods, having an annual blood pressure test, avoiding high-cholesterol foods, and having an annual dental exam). The Safety Index reflects the level of practice of three safe driving behaviors (in order of decreasing importance: wearing safety belts, avoiding drinking and driving, and observing the speed limit). Only a weak association was found among the individual safe driving behaviors, among the individual health maintenance behaviors, and between the two sets of behaviors. Over the 11-year study period the change in the Health Index has been practically and statistically insignificant, whereas the change in the Safety Index was both statistically and practically significant. The small improvement in the Safety Index actually masked a complex pattern of changes in safe driving habits. The three component Safety Index behaviors did not change in the same manner over the 11-year period. The greatest and most consistent increase was in the use of safety belts, with the reported percent who use it all the time increasing from 41.5% in 1985 to 74.1% in 1995 (an increase of 80%). There was also a consistent positive trend in refraining from drinking and driving, but the overall improvement was less dramatic than that reported for use of safety belts: from 71.6% reporting they never drink and drive in 1985 to 79.1% in 1995 (an increase of 10%). Still, it is noteworthy that by 1995 nearly 80% of the people reported they never drink and drive. Finally, obeying the speed limit did not improve over the 11-year period.

Accidents, Traffic↗

PubMed2005

Using passive air samplers to assess urban-rural trends for persistent organic pollutants and polycyclic aromatic hydrocarbons. 2. Seasonal trends for PAHs, PCBs, and organochlorine pesticides.

This is the second of two papers demonstrating the feasibility of using passive air samplers to investigate persistent organic pollutants along an urban-rural transect in Toronto. The first paper investigated spatial trends for polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs). This second paper investigates the seasonality of air concentrations for polycyclic aromatic hydrocarbons (PAHs), PCBs, and OCPs along this transect. Air samplers, consisting of polyurethane foam (PUF) disks housed in stainless steel domed chambers, were deployed for three 4-month integration periods from June 2000 to July 2001. The seasonal variations of derived air concentrations for PAHs, PCBs, and OCPs reflected the different source characteristics for these compounds. PAHs showed a strong urban-rural gradient with maximum concentrations at urban sites during the summer period (July-October). These high summer values in Toronto were attributed to increases in evaporative emissions from petroleum products such as asphalt. PCBs also exhibited a strong urban-rural gradient with maximum air concentrations (approximately 2-3 times higher) during the spring period (April-June). This was attributed to increased surface-air exchange of PCBs that had accumulated in the surface layer over the winter. alpha-HCH was fairly uniformly distributed, spatially and temporally, as expected. This pattern and the derived air concentration of approximately 35 to approximately 100 pg m(-3) agreed well with high volume air data from this region, adding confidence to the operation of the passive samplers and showing that site-to-site differences in sampling rates was not an issue. For other OCPs, highest concentrations were observed during the spring period. This was associated with either (i) their local and/or regional application (gamma-HCH, endosulfan) and (ii) their revolatilization (chlordanes, DDT isomers, dieldrin, and toxaphene). Principal component analysis resulted in clusters for the different target chemicals according to their chemical class/source type. The results of this study demonstrate how such a simple sampling technique can provide both spatial and seasonal information. These data, integrated over seasons, can be used to evaluate contaminant trends and the potential role of large urban centers as sources of some semivolatile compounds to the regional environment, including the Great Lakes ecosystem.

Air↗

PubMed1998

Secular trends in social patterning of cardiovascular risk factor levels in Sweden. The Northern Sweden MONICA Study 1986-1994. Multinational Monitoring of Trends and Determinants in Cardiovascular Disease.

OBJECTIVES: In the Northern Sweden MONICA Study, levels of cardiovascular risk factors were determined in 1986, 1990 and 1994. The aim of this study was to assess the trends in cardiovascular risk factors, and to analyse the relationship between levels of risk factors and level of education. DESIGN: Cardiovascular risk factors were determined in cross-sectional population studies of randomly selected 25-64 year old men and women in 1986, 1990 and 1994 (a total of 4742 individuals). RESULTS: Throughout the years 1986 to 1994, cardiovascular risk factor levels showed a marked social pattern, generally being more favourable among people with a university education. Serum cholesterol levels declined in all educational groups, but blood pressure declined significantly only in women with a university education. Body mass index increased, most markedly in men with university and in women with a secondary school education. Prevalence of cigarette smoking decreased significantly in young men. It increased markedly in low-educated women so that the social gaps in smoking widened substantially over time. The improved level of education in the population at large was calculated to explain only a little of the risk factor changes between 1986 and 1994. CONCLUSIONS: Trends in risk factor levels in different educational groups have been more diverging for women than for men. The most marked change in risk factor levels has been the decline in total serum cholesterol for both men and women in all educational groups.

Adult↗

PubMed1997

Trends in HIV-1 prevalence may not reflect trends in incidence in mature epidemics: data from the Rakai population-based cohort, Uganda.

OBJECTIVES: To assess whether trends in serial HIV-1 prevalence reflect trend in HIV incidence, and to decompose the effects of HIV-1 incidence, mortality, mobility and compliance on HIV-1 prevalence in a population-based cohort. DESIGN: Two-year follow up (1990-1992) of an open cohort of all adults aged 15-59 years, resident in a sample of 31 representative community clusters in rural Rakai District, Uganda. METHODS: A detailed household enumeration was concluded at baseline and in each subsequent year. All household residents were listed, and all deaths and in- and out-migrations that occurred in the intersurvey year wee recorded. In each year, all consenting adults were interviewed and provided a serological sample; 2591 adults aged 15-59 years were enrolled at baseline. RESULTS: HIV prevalence among adults declined significantly 1990 and 1992 (23.4% at baseline, 21.8% in 1991, 20.9% in 1992; P < 0.05). Declining prevalence was also observed in subgroups, including young adults aged 15-24 years (from 20.6 to 16.2% over 3 years; P < 0.02), women of reproductive age (from 27.1 to 23.5%; P < 0.05), and pregnant women (from 25.4 to 20.0%; not significant), However, HIV incidence did not change significantly among all adults aged 15-59 years (2.1 +/- 0.4 per 100 person-years of observation (PYO) in 1990-1991 and 2.0 +/- 0.3 per 100 PYO in 1991-1992], nor in population subgroups. HIV-related mortality was high (13.5 per 100 PYO among the HIV-positive), removing more infected persons that were added by seroconversion. Net out-migration also removed substantial numbers of HIV-positive individuals. CONCLUSIONS: In this mature HIV epidemic, HIV prevalence declined in the presence of stable and incidence. HIV-related mortality contributed most to the prevalence decline. Prevalence was not an adequate surrogate measure of incidence, limiting the utility or serial prevalence measures in assessing the dynamics of the HIV epidemic and in evaluating the impact of current preventive strategies.

Adolescent↗

PubMed1998

Time trends in long-term survival after stroke: the Northern Sweden Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, 1985-1994.

BACKGROUND AND PURPOSE: Stroke mortality rates and case fatality of stroke have declined since the beginning of the 1970s in Sweden, but the incidence of stroke has been stable. The aim of this study was to analyze trends in long-term survival after stroke. METHODS: Within the framework of the population-based WHO Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Project, all acute stroke events were recorded in the age group 25 to 74 years in northern Sweden during the period 1985 to 1994. All first-ever stroke patients were followed for information on vital status (minimum follow-up time was 1 year). Survival time was related to time period of stroke onset, stroke diagnosis, and concomitant diseases. RESULTS: Survival times for a total of 6819 first-ever stroke patients (4057 men and 2762 women) were analyzed. Age-adjusted odds ratio for death within 1 year after stroke was 0.70 (95% confidence interval [CI], 0.55 to 0.88) in the period 1993 to 1994 as compared with the period 1985 to 1986 in men and 0.69 (95% CI, 0.53 to 0.90) in women. Corresponding odds ratios were 0.73 in men and 0.70 in women among those who survived the first 28 days. Similar improvements were seen for 3- and 5-year survival. Improvements in survival over time were most marked among patients with ischemic stroke. There was no improvement in survival over time among patients with the most severe deficits at onset. CONCLUSIONS: Gradually improved survival, both short and long term, was observed during the 10-year study period. The improvements are not explained by changes in known confounding prognostic factors.

Adult↗

PubMedDate not supplied

Drug information systems, early warning, and new drug trends: can drug monitoring systems become more sensitive to emerging trends in drug consumption?

Drug Information Systems (DIS) are called upon to provide an early warning of emerging trends in drug use. However, little theoretical attention is directed toward exploring conceptual issues in this area. In this paper a typology of existing DIS is offered. Among the features that distinguish DIS are their structure (human network or organization systems) and the range of information sources used. Indicators of drug use can be placed on a continuum of sensitivity ranging from leading edge indicators to lagged indicators. Sensitivity implies volatility as sensitive indicators also react to fluctuations that do not become trends. DIS conventionally are largely reliant upon lagged indicators. What is required are DIS that combine a critical information processing function with the ongoing systematic collection of data from a range of data sources.

Data Collection↗

PubMed1997

[Infant mortality trends compared with trends in handicapped children in Isere, 1976-1985].

Since 1960 progress in obstetric and neonatology modified the survival chance of babies and the pattern of mortality causes. With the information available in the death certificates the aim was to analyse the trends in infant mortality for all 0-1 year children deaths occurring from 1976 to 1991, and to look at its influence on disabled children prevalence rates. The study was conducted in Isere (France) and include 1702 infant deaths. A part from death groups with perinatal disease and/or with congenital defects, a group of deaths with risk factor of disability was identified. This group represented 43% of all the infantile deaths and showed a significant decreasing trend, very similar to the decrease of the early neonatal mortality component (until 1983). However, during the same period, for the disabled children prevalence and for the other infant mortality components, no significant variation was found. The decrease of the deaths with risk factor of disability suggests some influence on the disabled children prevalence.

Cause of Death↗

PubMed1998

Ten-year trends of heart disease risk factors in the Halifax County MONICA population. MONItoring of trends and determinants in CArdiovascular disease.

OBJECTIVE: To investigate trends in heart disease risk factors (RFs) in the general population of Halifax County, Nova Scotia during a 10-year period. DESIGN: Two independent random samples of the population of Halifax County were surveyed in 1985 and 1995; age ranges were 25-64 years and 25-74 years. Blood pressure, cholesterol and body weight were measured. Smoking and health history were obtained by questionnaire. MAIN RESULTS: Participation rate was 66.3% in 1985 and 1995. All RFs were negatively correlated with education attainment. RF changes from 1985 to 1995 were related to education level. Among survey participants, mean body mass index increased from 26.7 kg/m2 to 27.6 kg/m2 (P + 0.005) for men, and from 25.5 kg/m2 to 27.3 kg/m2 (P < 0.00001) for women. Average smoking rate increased from 32.0% to 34.6% (not significant) in men and from 27.7% to 29.1% (not significant) in women. Age-specific smoking rate increased by 13% (P = 0.14) in younger women and decreased by 10% in older women. (P = 0.00). Mean levels of blood cholesterol decreased by 0.2 mmol/L (P = 0.002) in men and 0.1 mmol/L (P = 0.20) in women. Systolic blood pressure increased by 6.3 mmHg (P < 0.0001) in men and by 7.9 mmHg (P < 0.0001) in women, being steepest in the lower education group. Mortality predicted from RFs declined between the survey years, but less than the observed mortality. This discrepancy may result from the effect of medical care or the delayed effect of RF changes. CONCLUSIONS: Some risk factors show a disturbing trend, indicating that an increased effort or a change in strategy is needed to combat the risk of ischemic heart disease.

Adult↗

PubMed1978

The changing trends of uterine cancer and cytology: a study of morbidity and mortality trends over a twenty year period.

Data on squamous carcinoma of the cervix from a 20 year study period (1955 to 1974) in metropolitan Toledo revealed a 66% reduction of the average annual age-adjusted incidence rate and a 61% reduction in death rate of cervical squamous carcinoma when the first time period (1955 to 1958) was compared with the last time period (1971 to 1974). The decrease for both morbidity and mortality rates was more pronounced in women age 50 years and younger. The age-adjusted death rate during this study period revealed 15.5/100,000 for black women and 8.7/100,000 for white women. The reduction in death rate of 83% in black women is more prominent than 54.5% in white women. The decrease in both morbidity and mortality for cervical squamous carcinoma has a close relation to cytologic screening activity. The factors of age and race, probably related to socioeconomic status, are two known determinants of risk for cervical squamous carcinoma. Data for endometrial carcinoma during this study period revealed 15.5/100,000 women in the average age-adjusted incidence and an increase of 13.8% in average yearly rates when the first time period (1955 to 1958) were compared with the last time period (1971 to 1974). The peak age was 60 to 64 years old in the first time period and shifted to 70 to 74 years old in the last time period. The trend in metropolitan Toledo is comparable to that of Louisville, Kentucky. The mass cytologic screening program which contributed to a remarkable reduction in morbidity and mortality for the cervical squamous carcinoma, did not have any beneficial effect on endometrial carcinoma.

Adult↗

PubMed1991

Trends in cervical and breast cancer in Iceland. A statistical evaluation of trends in incidence and mortality for the period 1955-1989, their relation to screening and prediction to the year 2000.

The time trends in incidence and mortality from cervical cancer and breast cancer in Iceland, from 1955 to 1989, were analyzed by fitting curvilinear regressions to the age-standardized rates. The effect of the screening was evaluated by comparing the curvature of the fitted regression lines and changes in screening activity. The incidence and mortality rates for both cancer types were predicted up to the year 2000. At the commencement of cervical cancer screening in 1964, both the incidence and mortality rates were on the increase. After 1970, both rates decreased significantly. Assuming that regular attendance at screening will be 85%, it is predicted that the incidence and mortality rates will level out at about 7.5 and 2 cases per 100,000 women per year, respectively, by the year 1995 and remain at that level. The incidence of breast cancer has increased steadily since 1955. A sharp rise has been observed since 1987, due to screening with mammography. The mortality rate has shown small but significant fluctuations with time. The incidence rate is predicted to increase at the same rate as before 1987 (i.e. at 1.1 cases per 100,000 women per year), but at a slightly higher level and is predicted to reach 84 cases per 100,000 women per year by the year 2000. Breast cancer mortality is predicted to decrease to about 17 cases per 100,000 women per year by 1995 and to remain at that level.

Adenocarcinoma↗

PubMed2000

Trends in dietary sources of nutrients among middle-aged men in southern Germany. Results of the MONICA Project Augsburg: dietary surveys 1984/1985 and 1994/1995. MONItoring trends and determinants in CArdiovascular disease.

The study analyses 10-year trends (1984/1985-1994/1995) in southern Germany in the food sources of nutrients. In two phases of the MONICA Project in Augsburg, dietary surveys were conducted in subsamples of 45 to 64 year-old men. Responses in 1984/1985 and 1994/1995 were 69.8% and 70.8% with eligible samples of 603 and 607, respectively. Seven-day records were collected and coded with the German food composition database. Percentage contribution of food groups to selected nutrient intakes were calculated. Meat and meat products and eggs decreased in importance as contributors to the intake of energy and several nutrients, whereas fish and fish products, milk and milk products and various food groups of plant origin became more important. In 1984/1985, for instance, meat and meat products delivered 23.4% of energy, 47.5% of protein and 38.1% of fat, whereas in 1994/1995 the respective contributions declined to 21.4%, 44.0% and 34.5%. The new product group of supplements has already become an important contributor to the intake of vitamin C. Both static intakes and changes in intake of certain nutrients can be explained by corresponding fluctuations in patterns of intake of the underlying food sources. Therefore it is recommended that dietary assessments use food source lists derived from the most recent dietary surveys.

Diet↗

PubMed1997

Ten-year time trends of psychopathology in Dutch children and adolescents: no evidence for strong trends.

The 10-year time trends in competencies and problem scores in children and adolescents were assessed. Children and adolescents randomly selected from the Dutch general population in 1983 were assessed with the Child Behavior Checklist and the Teacher's Report Form. Their problem scores and competence scores were compared with those obtained by the same method 10 years later. No significant differences were found between the 1983 and 1993 total problem scores obtained from parents or teachers. On the level of problem items and scales, a few differences indicating an increase in problems were found. However, the magnitude of these differences was very small. Our results did not provide evidence for a clear secular increase in malfunctioning of Dutch children and adolescents.

Adolescent↗