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1.
Antje Wienecke Klaus Kraywinkel 《Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz》2018,61(11):1399-1406
Background and Objectives
Tobacco consumption is the most important cancer risk factor. In Germany, about 15% of all new cancer cases can be attributed to smoking. The aim of this paper is to analyze the incidence and mortality trends in tobacco-associated cancer cases in Germany for the last two decades.Materials and Methods
Age standardized incidence and mortality rates were calculated for tumors of the upper aerodigestive tract and lower urinary tract for the period from 1995 to 2014/2015. In addition, average annual percentage changes were calculated with joinpoint regression analysis. Regarding lung cancer, trends in incidence and mortality rates were also stratified by different age groups and trends in mortality rates were analyzed by birth cohorts.Results
The incidence and mortality rates among men are declining for all tobacco-associated cancers except esophageal cancer. Lung cancer mortality rates showed the greatest decrease with ?1.9% on average per year. The incidence rates among women increased for all tobacco-associated cancers except lower urinary tract cancers. The increase in lung cancer incidence was greatest with 3.3% on average per year. Among men there was a continuous decline over all birth cohorts regarding the chance of dying of lung cancer at a certain age. Among women, the chance of dying of lung cancer increased for all birth cohorts until 1960.Conclusions
The present analyses regarding tobacco-associated cancers in Germany reflect the changes in smoking prevalence with a deferment of multiple decades.2.
Johannes Pollmanns Maria Weyermann Max Geraedts Saskia E. Drösler 《Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz》2018,61(11):1462-1471
Background
Hospitalizations and lower limb amputations related to diabetes mellitus (DM) are considered to be potentially avoidable. Appropriate outpatient care of diabetes prevents complications. Rates on potentially avoidable hospitalizations for diabetes are core indicators of the German diabetes surveillance program. International comparisons showed high hospitalization rates in Germany for both indicators.Objectives
The objective of this analysis is to describe time trends on hospitalizations and inpatient lower limb amputations (major amputations) for DM. Furthermore, we analyze small area variations.Materials and methods
Based on the German diagnosis related groups (DRGs) dataset we calculated age-standardized rates covering 2005–2015. Calculations rely on the Organisation for Economic Co-operation and Development (OECD) indicator definitions. Time trends are obtained by linear regression modelling. We also stratified into age groups and analyzed 2015 small-area variations using age-adjusted rates.Results
Crude hospitalization rates were 310 admissions per 100,000 inhabitants in men (amputation rate: 15.6) and 216 admissions per 100,000 inhabitants in women (amputation rate: 7.1) in 2015. Age-adjusted hospitalizations and amputations rates in women decreased over time (10.3 and 1.2 cases per 100,000 inhabitants and year, respectively). In men, the amputation rate decreased significantly (1.5 cases per 100,000 inhabitants and year). We found higher rates for men than for women in almost all age categories. In eastern Germany and parts of Bavaria and North Rhine-Westphalia rates are particularly high.Conclusions
A decrease in hospitalization rates may indicate improvements in ambulatory diabetes care over time. Future studies should consider age-specific differences and small-area variations.3.
Daniel M. A. McCartney Declan G. Byrne Marie M. Cantwell Michael J. Turner 《Zeitschrift fur Gesundheitswissenschaften》2017,25(2):197-213
Aim
This observational ecological study aims to compare Ireland’s age-specific cancer incidence rates (ASRs) with equivalent European and global data and to highlight possible dietary, nutritional and lifestyle contributors to cancer in Ireland.Subjects and methods
Using the International Agency for Research on Cancer’s (IARC) GLOBOCAN database, Irish ASRs for all-site cancer and for “lifestyle-related” cancers such as those of the colo-rectum, oesophagus, breast, lung and prostate were compared with European and global incidence data. Irish dietary and nutrient intake data were reviewed and evaluated in the context of these cancer incidence data and in relation to the established dietary, nutritional, lifestyle and anthropometric predictors of increased cancer risk previously articulated in the literature.Results
Incidence rates of colorectal, oesophageal, breast, lung, prostate and all-site cancer are higher in Ireland than in most other countries. National nutrition surveys in Ireland indicate that dietary, nutritional, lifestyle and anthropometric risk factors for cancer occur with high frequency in the Irish population. For example, low fruit and vegetable consumption, high red and processed meat intake, low fish intake, low dairy consumption, high saturated fat intake, low folate and vitamin D intakes, and excessive alcohol consumption are all common amongst Irish adults.Conclusions
Our data suggest that unfavourable diet and nutrient intakes prevail in Ireland and that these may contribute to Ireland’s excess cancer burden. These risk factors should be targeted by interventions seeking to sustainably redress Ireland’s high cancer incidence. Such initiatives may provide a template for intervention in other high-risk countries.4.
5.
Chuen Seng Tan Nathalie Støer Yilin Ning Ying Chen Marie Reilly 《Population health metrics》2018,16(1):18
Background
To quantify temporal trends in age-standardized rates of disease, the convention is to fit a linear regression model to log-transformed rates because the slope term provides the estimated annual percentage change. However, such log-transformation is not always appropriate.Methods
We propose an alternative method using the rank-ordered logit (ROL) model that is indifferent to log-transformation. This method quantifies the temporal trend using odds, a quantity commonly used in epidemiology, and the log-odds corresponds to the scaled slope parameter estimate from linear regression. The ROL method can be implemented by using the commands for proportional hazards regression in any standard statistical package. We apply the ROL method to estimate temporal trends in age-standardized cancer rates worldwide using the cancer incidence data from the Cancer Incidence in Five Continents plus (CI5plus) database for the period 1953 to 2007 and compare the estimates to their scaled counterparts obtained from linear regression with and without log-transformation.Results
We found a strong concordance in the direction and significance of the temporal trends in cancer incidence estimated by all three approaches, and illustrated how the estimate from the ROL model provides a measure that is comparable to a scaled slope parameter estimated from linear regression.Conclusions
Our method offers an alternative approach for quantifying temporal trends in incidence or mortality rates in a population that is invariant to transformation, and whose estimate of trend agrees with the scaled slope from a linear regression model.6.
Alexander Hirst Chris Knight Matt Hirst Will Dunlop Ron Akehurst 《The European journal of health economics》2016,17(2):217-227
Introduction
Opioid treatment for chronic pain is a known risk factor for falls and/or fractures in elderly patients. The latter cause a significant cost to the National Health Service and the Personal Social Services in the UK. Tramadol has a higher risk of fractures than some other opioid analgesics used to treat moderate-to-severe pain and, in the model described here, we investigate the cost effectiveness of transdermal buprenorphine treatment compared with tramadol in a high-risk population.Methods
A model was developed to assess the cost effectiveness of tramadol compared with transdermal buprenorphine over a 1-year time horizon and a patient population of high-risk patients (female patients age 75 or older). To estimate the total cost and quality-adjusted life years (QALYs) of treatment, published odds ratios are used in combination with the published incidence rates of four types of fracture: hip, wrist, humerus and other.Results
The model shows tramadol to be associated with 1,058 more fractures per 100,000 patients per year compared with transdermal buprenorphine, resulting in transdermal buprenorphine being cost-effective with an incremental cost-effectiveness ratio of less than £7,000 compared with tramadol. Sensitivity analysis found this result to be robust.Limitations
In the UK data, there is uncertainty regarding the transdermal buprenorphine odds ratios for fractures. Odds ratios published in Danish and Swedish studies show similar point estimates but are associated with less uncertainty.Conclusion
Transdermal buprenorphine is cost-effective compared to tramadol at a willingness-to-pay threshold of £20,000 per QALY.7.
Laure Rouch F. Farbos C. Cool C. McCambridge C. Hein S. Elmalem Y. Rolland B. Vellas P. Cestac 《The journal of nutrition, health & aging》2018,22(3):328-334
Objectives
To evaluate the overall rate of adherence by general practitioners (GPs) to treatment modifications suggested at discharge from hospital and to assess the way communication between secondary and primary care could be improved.Design
Observational prospective cohort study.Setting
Patients hospitalized from the emergency department to the acute geriatric care unit of a university hospital.Participants
206 subjects with a mean age of 85 years.Measurements
Changes in drug regimen undertaken during hospitalization were collected with the associated justifications. Adherence at one month by GPs to treatment modifications was assessed as well as modifications implemented in primary care with their rationale in case of non-adherence. Community pharmacists’ and GPs’ opinions about quality of communication and information transfer at hospital-general practice interface were investigated.Results
5.5 ± 2.8 drug regimen changes were done per patient during hospitalization. The rate of adherence by GPs to treatment modifications suggested at discharge from hospital was 83%. In most cases, non-adherence by GPs to treatment modifications done during hospitalization was due to dosage adjustments, symptoms resolution but also worsening of symptoms. The last of which was particularly true for psychotropic drugs. All GPs received their patients’ discharge letters but the timely dissemination still needs to be improved. Only 6.6% of community pharmacists were informed of treatment modifications done during their patients’ hospitalization.Conclusion
Our findings showed a successful rate of adherence by GPs to treatment modifications suggested at discharge from hospital, due to the fact that optimization was done in a collaborative way between geriatricians and hospital pharmacists and that justifications for drug regimen changes were systematically provided in discharge letters. Communication processes at the interface between secondary and primary care, particularly with community pharmacists, must be strengthened to improve seamless care.8.
Douglas G. Manuel Philippe Finès Christina Bancej William Flanagan Karen Tu Kim Reimer Larry W. Chambers 《Population health metrics》2016,14(1):37
Background
Worldwide, there is concern that increases in the prevalence of dementia will result in large demands for caregivers and supportive services that will be challenging to address. Previous dementia projections have either been simple extrapolations of prevalence or macrosimulations based on dementia incidence.Methods
A population-based microsimulation model of Alzheimer’s and related dementias (POHEM:Neurological) was created using Canadian demographic data, estimates of dementia incidence, health status (health-related quality of life and mortality risk), health care costs and informal caregiving use. Dementia prevalence and 12 other measures were projected to 2031.Results
Between 2011 and 2031, there was a projected two-fold increase in the number of people living with dementia in Canada (1.6-fold increase in prevalence rate). By 2031, the projected informal (unpaid) caregiving for dementia in Canada was two billion hours per year, or 100 h per year per Canadian of working age.Conclusions
The projected increase in dementia prevalence was largely related to the expected increase in older Canadians, with projections sensitive to changes in the age of dementia onset.9.
Jai K Das Rohail Kumar Rehana A Salam Stephen Freedman Zulfiqar A Bhutta 《BMC public health》2013,13(Z3):S9
Introduction
Diarrheal diseases are the second leading cause of childhood morbidity and mortality in developing countries and an important cause of malnutrition. An estimated 0.75 million children below 5 years of age die from diarrhea. Vomiting associated with acute gastroenteritis (AGE) is a distressing symptom and limits the success of oral rehydration in AGE leading to an increased use of intravenous rehydration, prolonged emergency department stay and hospitalization. In this review we estimate the effect of antiemetics in gastroenteritis in children.Methods
We conducted a systematic review of all the efficacy and effectiveness studies. We used a standardized abstraction and grading format and performed meta-analyses for all outcomes with more than two studies. The estimated effect of antiemetics was determined by applying the standard Child Health Epidemiology Reference Group (CHERG) rules.Results
We included seven studies in the review. Antiemetics significantly reduced the incidence of vomiting and hospitalization by 54%. Antiemetics also significantly reduced the intravenous fluid requirements by 60%, while it had a non-significant effect on the ORT tolerance and revisit rates.Conclusion
Antiemetics are effective for the management of gastroenteritis in children and have the potential to decrease morbidity and mortality burden due to diarrhea, when introduced and scaled up.10.
Background
Respiratory Medication Therapy Adherence Clinic (RMTAC) is an initiative by the Ministry of Health (MOH) Malaysia to improve patients’ medication adherence, as an adjunct to the usual physician care (UC). This study aimed to evaluate the cost-effectiveness of combined strategy of RMTAC and UC (RMTAC?+?UC) vs. UC alone in asthma patients, from the MOH Malaysia perspective.Methods
A lifetime horizon dynamic adherence Markov model with monthly cycle was developed, for quality-adjusted life year (QALY) gained and hospitalization averted outcomes. Transition probabilities of composite asthma control and medication adherence, utilities, costs, and mortality rates due to all causes were measured from local data sources. Effectiveness, exacerbation rates, and asthma mortality rates were taken from non-local data sources. One-way sensitivity analysis (SA) was conducted for assessing parameter uncertainties, whereas probabilistic SA (PSA) was conducted on a different set of utilities and effectiveness data. Costs were adjusted to 2014 US dollars ($). Both costs and benefits were discounted at a 3% rate annually.Results
RMTAC?+?UC was found to be a dominant alternative compared to UC alone; $??13,639.40 ($??109,556.90 to $104,445.54) per QALY gained and $??428.93 ($??521.27 to ($??328.69)) per hospitalization averted. These results were found to be robust against changes in all parameters except utilities in the one-way SA, and for both scenarios in PSA.Conclusions
RMTAC?+?UC is more effective and yet cheaper than UC alone, from the MOH perspective. For the benefit of both MOH and patients, RMTAC is thus recommended to be remained, and expanded to more healthcare settings where possible.11.
Piet Ter Wee M. Kuhn H. van der Woude D. van de Looverbosch H. Heyman L. Mikušová D. Fouque 《The journal of nutrition, health & aging》2016,20(9):944-951
Background/Objective
High protein oral nutritional supplements (ONS) are regularly prescribed to undernourished patients; however usage of these in older adults is being discussed, as their renal function might have declined with age. Therefore, the aim of the current study was to evaluate the effects of 8 week long consumption of high protein ONS on the renal function of nursing home residents in need of supplementation. Furthermore, within the same setup, differences in gastro-intestinal tolerance between a standard and a more concentrated version of an ONS were investigated.Design
Randomized, controlled, single-blind, parallel-group, multi-country trial (NTR2565).Setting
Nursing home.Participants
67 nursing home residents in need of ONS (energy-dense, small volume group n=32; standard volume group n=35).Intervention
Protein supplementation was provided by either a standard (200ml, 300kcal, 20g protein) or an energy-dense, small volume (125ml, 300kcal, 18g protein) ONS during the 8 week long study.Measurements
Primary outcome was gastro-intestinal tolerance, assessed by daily stool frequency and consistency, and occurrence and intensity of self-reported gastrointestinal symptoms. Safety was measured via the occurrence of (serious) adverse events, vital signs, as well as liver-and kidney function monitoring.Results
No clinically relevant and, except for flatulence, no statistically significant differences in gastro-intestinal tolerance were observed between groups. No significant difference between groups was found for estimated glomerular filtration rate (eGFR) and urinary albumin/creatinine ratio at baseline and week 8, nor for the changes from baseline. Adverse events and the changes in monitored renal parameters over the study period did not point to a deterioration of renal function.Conclusion
High protein ONS seems to be well-tolerated and safe; there is no indication that it affects renal function in nursing home residents, including patients with stage 3 chronic kidney disease, under the conditions tested. Results did not suggest a difference in the effect on renal function between standard and energy-dense small volume ONS format.12.
Background
Many adults in Germany do not receive immunizations as recommended. False assumptions about vaccinations and the risk of infectious diseases are important reasons why people fail to receive recommended immunizations.Aim
Our aim was to provide new possibilities to improve vaccination rates among adults. We directed special attention to some newsworthy infectious diseases (e.g. measles, pertussis).Results
Owing to their special range of responsibilities and their numerous medical attendances, occupational health physicians are in a position to improve the immunization rates of adults as well as to collect epidemiologic data of this broad age group.Conclusions
The use of a mobile cart vaccination program in the workplace might increase vaccination rates.13.
Geller AC Rutsch L Kenausis K Selzer P Zhang Z 《Environmental health : a global access science source》2003,2(1):13
Background
Melanoma incidence is rising at a rate faster than any other preventable cancer in the United States. Childhood exposure to ultraviolet (UV) light increases risk for skin cancer as an adult, thus starting positive sun protection habits early may be key to reducing the incidence of this disease.Methods
The Environmental Protection Agency's SunWise School Program, a national environmental and health education program for sun safety of children in primary and secondary schools (grades K-8), was evaluated with surveys administered to participating students and faculty.Results
Pretests (n = 5,625) and posttests (n = 5,028) were completed by students in 102 schools in 42 states. Significant improvement was noted for the three knowledge variables. Intentions to play in the shade increased from 68% to 75%(p < 0.001) with more modest changes in intentions to use sunscreen. Attitudes regarding healthiness of a tan also decreased significantly.Conclusions
Brief, standardized sun protection education can be efficiently interwoven into existing school curricula, and result in improvements in knowledge and positive intentions for sun protection.14.
Joseph Sheehan T DeChello LM Kulldorff M Gregorio DI Gershman S Mroszczyk M 《International journal of health geographics》2004,3(1):17
Background
The aims of this study were to determine whether observed geographic variations in breast cancer incidence are random or statistically significant, whether statistically significant excesses are temporary or time-persistent, and whether they can be explained by covariates such as socioeconomic status (SES) or urban/rural status?Results
A purely spatial analysis found fourteen geographic areas that deviated significantly from randomness: ten with higher incidence rates than expected, four lower than expected. After covariate adjustment, three of the ten high areas remained statistically significant and one new high area emerged. The space-time analysis identified eleven geographic areas as statistically significant, seven high and four low. After covariate adjustment, four of the seven high areas remained statistically significant and a fifth high area also identified in the purely spatial analysis emerged.Conclusions
These analyses identify geographic areas with invasive breast cancer incidence higher or lower than expected, the times of their excess, and whether or not their status is affected when the model is adjusted for risk factors. These surveillance findings can be a sound starting point for the epidemiologist and has the potential of monitoring time trends for cancer control activities.15.
David Lee Dominic Muston Alison Sweet Chris Cunningham Andrew Slater Kevin Lock 《Applied health economics and health policy》2010,8(3):141-154
Background
Screening of populations at risk for colorectal cancer (CRC) allows the detection and successful treatment of tumours and their precursor polyps. The current UK CRC screening programme is faecal occult blood testing (FOBT), despite evidence from modelling studies to suggest that more cost-effective technologies exist.Objective
To assess the cost effectiveness of CT colonography (CTC) for colorectal cancer screening from the perspective of the UK NHS.Methods
A state-transition Markov model was constructed to estimate lifetime costs and health outcomes of a cohort of individuals screened at age 60–69 years using four different CRC screening technologies: FOBT, flexible sigmoidoscopy, optical colonoscopy and CTC.Results
CTC screening offered every 10 years was cost saving compared with the current UK programme of biennial FOBT screening. This strategy also yielded greater health benefits (QALYs and life-years) than biennial FOBT screening. The model fit observed CRC epidemiology data well and was robust to changes in underlying parameter values. CTC remained cost effective under a range of assumptions in the univariate sensitivity analysis. However, in the probabilistic sensitivity analysis, CTC dominated FOBT in only 5.9% of simulations and was cost effective at a threshold of £30 000 per QALY gained in 48% of simulations.Conclusions
CTC has the potential to provide a cost-effective option for CRC screening in the UK NHS and may be cost saving compared with the current programme of biennial FOBT. Further analysis is required to assess the impact of introducing CTC to the UK CRC screening programme on the NHS budget and capacity.16.
Marlen Zurek Ivana Kern Ulf Manuwald Joachim Kugler Thoralf Stange Peter Fischer Thomas Richter Ulrike Rothe All members of the Pediatric IBD Registry of Saxony Leipzig’ Gastroenterologists 《Zeitschrift fur Gesundheitswissenschaften》2018,26(4):437-442
Aims
Valid data on the incidence of inflammatory bowel disease (IBD) in children and adolescents in Germany have not yet been published. Unpublished data of the Pediatric IBD Registry of Saxony (primary data source) have shown a decrease in age-specific incidence rates after the 14th year of age; therefore, a second data source was collected from adult gastroenterologists in Leipzig.Methods
All patients up to 25 years of age with a newly diagnosed IBD from adult gastroenterologists in Leipzig between 2005 and 2009 were included in the second data source: a total of 150 young patients with only two patients before age of 16 and 11 patients before age of 18 years.Results
Using a second data source, the incidence of IBD in children and adolescents up to the completion of the 18th year, as determined by IBD Registry, was corrected from 6.6/100,000 (95%-CI 5.4–8.4) to an actual incidence of 11.0/100,000 (95%-CI 9.1–12.9). Age-specific incidence of IBD was also corrected, increasing continuously until the 18th year was completed.Conclusions
Nearly all patients up to 15 years (completeness 87.5%) were recorded by pediatricians to the IBD Registry. The actual incidence up to the age of 18 years for IBD in Leipzig is one of the highest worldwide. To obtain valid epidemiologic data up to the age of 18, the inclusion of adult gastroenterologists are necessary.17.
18.
Introduction
The long average incubation time from HIV infection to AIDS makes it difficult to estimate the recent tendencies of HIV from AIDS incidence data. The objective of this study was to investigate the effects of three temporal components in AIDS incidence in the state of Rio de Janeiro, Brazil - age, period, and cohort.Methods
Age-specific AIDS incidence rates per 100,000 from Rio de Janeiro (Brazil) were calculated for both sexes using five-year age classes from 1985 to 2009 based on reported data from the Notifiable Disease Information System of the Brazilian Ministry of Health and from census population counts. Multivariate negative binomial models were used to analyze the risk of AIDS by age, period, and birth cohort.Results
From 1985 to 2009, AIDS incidence initially increased with age in each birth cohort and then decreased (except for individuals born from 1971–1979 to 1986–1994). High peaks in the rates in each birth cohort were detected in 1995–1999 for males and in 2000–2004 for females. Multivariate analysis showed the maximum risk of AIDS in the 30–34 age group and 1958–1962 birth cohort.Conclusion
Age, birth cohort, and period effects all may have influenced the AIDS incidence rates over the period investigated. From 1985 to 1999, comparison of the tendencies (by age) of the period with the birth cohort revealed opposing tendencies in individuals older than 29 years and in the youngest age groups (0 to 14 years). From 2000 to 2009, a strong age effect can be observed in both sexes. Consistent changes in period tendency curves suggest the occurrence of period effects. A reduction in the intensity of the risk of AIDS can be observed after 2000–2004.19.
Background
Women with BRCA1 and BRCA2 mutation carriers are at substantially elevated risk of developing ovarian cancer. The aim of the meta-analysis is to clarify the role of risk-reducing salpingo-oophorectomy (RRSO) to reduce ovarian cancer risk and mortality in women with BRCA 1 and BRCA 2 mutation carriers.Methods
Pubmed, Medline and Scopus were searched to select English-language articles. Two investigators independently extracted characteristics and results of selected studies. Articles were included only if prospective and if absolute numbers of ovarian cancer and death events were available or derivable from the test. Pooled hazard ratio (HR) with 95% confidence interval (CI) was calculated using fixed effects model.Results
Meta-analysis of 3 prospective studies demonstrated a significant risk reduction of ovarian cancer with RRSO in BRCA 1 and BRCA 2 mutation carriers, as well as benefit in all-causes mortality incidence.Conclusions
It may be justified to recommend RRSO to reduce ovarian cancer risk and all-causes mortality in women with a mutation in BRCA 1 and BRCA 2.20.