Highest Increase In Incidence Research Articles

Non-communicable diseases in the world over the past century: a secondary data analysis.

We analyzed the changes in the top 10 non-communicable diseases (NCDs) over the past century across the World Health Organization (WHO) regions. The data were extracted from the Global Burden of Disease (GBD) studies. After we accessed this source, all NCDs were sorted according to their prevalence in 2019, and the 10 most common NCDs were selected. Then, the incidence, prevalence, and mortality rates of these 10 NCDs were compared to the rates in 2000. Diabetes and kidney disease had the highest increase in incidence (49.4%) and prevalence (28%) in the Eastern Mediterranean region. Substance use disorders had a huge increase (138%) in the mortality rates among women in the Americas region. On the other hand, women in Southeast Asia experienced the greatest decrease in incidence (-19.8%), prevalence (-15.8%), and mortality rates (-66%). In recent years, nearly all NCDs have shown an increase, yet mortality rates have declined across all regions. Lifestyle can be a major cause of this increase, but advancements in health and medical services, such as screening and treatment, have played a crucial role in improving survival rates.

Regional disparities, age-related changes and sex-related differences in knee osteoarthritis

BackgroundThe objective of the study is to analyse the regions, age and sex differences in the incidence of knee osteoarthritis (KOA).MethodsData were extracted from the global burden of diseases (GBD) 2019 study, including incidence, years lived with disability (YLD), disability-adjusted life-years (DALYs) and risk factors. Estimated annual percentage changes (EAPCs) were calculated to quantify the temporal trends in age standardized rate (ASR) of KOA. Paired t-test, paired Wilcoxon signed-rank test and spearman correlation were performed to analyze the association of sex disparity in KOA and socio-demographic index (SDI).ResultsThere were significant regional differences in the incidence of knee osteoarthritis. In 2019, South Korea had the highest incidence of knee osteoarthritis (474.85,95%UI:413.34–539.64) and Thailand had the highest increase in incidence of knee osteoarthritis (EAPC = 0.56, 95%CI = 0.54–0.58). Notably, higher incidence, YLD and DALYs of knee osteoarthritis were associated with areas with a high socio-demographic index (r = 0.336, p < 0.001; r = 0.324, p < 0.001; r = 0.324, p < 0.001). In terms of age differences, the greatest increase in the incidence of knee osteoarthritis was between the 35–39 and 40–44 age groups. (EAPC = 0.52, 95%CI = 0.40–0.63; 0.47, 95%CI = 0.36–0.58). In addition, there were significant sex differences in the disease burden of knee osteoarthritis (P < 0.001).ConclusionsThe incidence of knee osteoarthritis is significantly different with regions, age and sex.

Changes in the Prevalence, Incidence, and Disability-Adjusted Life Years of Non-alcoholic Fatty Liver Disease in the United States Between 1990 and 2019.

This study aimed to determine trends in the prevalence, incidence, and disability-adjusted life years (DALYs) of Non-alcoholic Fatty Liver Disease (NAFLD) in the US across different states and age groups between 1990 and 2019. Using the Global Burden of Disease database, this study analyzed the prevalence, incidence, and DALYs of NAFLD in the US between 1990 and 2019. We computed relative percentage changes, performed Joinpoint regression analyses of trends, and compared these between states and age groups (5-19, 20-55, and more than 55years old). In the United States, the prevalence of NAFLD increased more than the global average over the study period (+ 30.7% vs. + 24.5%), especially in the 5-19-year-old age group. Among all states, Kansas, Washington, and California had the highest increase in prevalence and the District of Columbia followed by Massachusetts and North Carolina had the lowest increase in prevalence. The increase in incidence was greater in the US than the global average (+ 37.18% vs. + 7.28%). West Virginia, Ohio, and Kentucky had the highest increase in incidence. The increase in DALYs was greater in the US compared to the global average (+ 57.15% vs. + 12.65%). Alaska, West Virginia, and Kentucky had the highest increase in DALYs. The increased incidence and DALYs were found in all states except in the District of Columbia. The prevalence of NAFLD in the US has increased more rapidly than the global average, especially in the pediatric population. South and Midwest states have the highest increase in prevalence, incidence, and DALYs of NAFLD. The District of Columbia was the only state that has decreased incidence and DALYs.

Use of Artificial Intelligence Tools for Diabetes Care: Protocol for Exploring Patient Attitude and Perspective

The prevalence of diabetes is still rising across the world. The high increase in incidence and economic load from diabetes leads to efforts to seek more effective ways to treat and care for diabetic patients. One of the ways is to explore the significant contribution of artificial intelligence (AI) in healthcare. AI has been defined as the ability of computers to perform tasks typically related to human intelligence and their applications are believed to be an essential part of healthcare services that could be embedded into several aspects of clinical diabetic care. However, there is still a lack of research exploring diabetic patients’ attitudes and perspectives toward AI applications. Thus, in this study, patients' attitudes and perspectives toward the use of artificial tools for diabetic care will be studied. It is important to understand the patients’ views because it will have a positive impact on how research is going to be conducted and to ensure that the work is relevant and useful and that any concerns can be addressed at the beginning. This paper aims to present the preliminary work for this study. A qualitative research design is chosen for this observational study where semi-structured interviews will be used as the data collection method. The participants will be the current patients within a government tertiary hospital located in the south of the royal town of Klang, Selangor, Malaysia. Prior to the study, the concepts of attitude, perspective, and related theories and models are examined. From the literature review, many factors and variables were discovered, and the conceptual framework is proposed as the foundation of this study. The conceptual framework will guide the data collection process whereby a qualitative thematic analysis approach will be employed for this study.

Management of bullous pemphigoid and mucous membrane pemphigoid

Bullous pemphigoid (BP) is the most common blistering autoimmune dermatosis and, as an age-associated disease, is also the bullous dermatosis with the highest increase in incidence in recent years due to demographic developments. Mucous membrane pemphigoid (MMP), which is less common, is aclinically and immunopathologically heterogeneous blistering autoimmune dermatosis characterized by blisters and erosions on mucous membranes. This work summarizes the manifold clinical characteristics of both diseases and provides an up-to-date overview of diagnostics and therapy of BP and SHP. Aselective literature search was carried out. While eczematous, urticarial, or bullous lesions on the integument are typical for BP, MMP is characterized by pronounced, erosive mucosal changes orally, ocularly, genitoanally, tracheally or esophageally and, at most, only minor skin involvement. For diagnosis, the combination of histology, direct immunofluorescence microscopy, and serological detection of autoantibodies against the hemidesmosomal proteins BP180 and BP230 and, in MMP, also against laminin 332 is important. New pathophysiological findings and therapeutics have recently significantly expanded the range of treatment options. Due to the comorbidities of the usually elderly BP patients and the often multiple affected mucous membranes in MMP, with the risk of developing irreversible complications such as strictures and synechiae, interdisciplinary diagnosis and therapy is often required.

The incidence and mortality of lung cancer in China: a trend analysis and comparison with G20 based on the Global Burden of Disease Study 2019.

Lung cancer is a significant health concern in China. There is limited available data of its burden and trends. This study aims to evaluate the trends of lung cancer across different age groups and genders in China and the Group of Twenty (G20) countries, explore the risk factors, and predict the future trends over a 20-year period. The data were obtained from the GBD study 2019. The number of cases, age standardized rate (ASR), and average annual percentage changes (AAPC) were used to estimate the trend in lung cancer by age, gender, region and risk factor. The trend of lung cancer was predicted by autoregressive integrated moving average (ARIMA) model by the "xtarimau" command. The joinpoint regression analysis was conducted to identify periods with the highest changes in incidence and mortality. Additionally, the relationship between AAPCs and socio-demographic index (SDI) was explored. From 1990 to 2019, both the incidence and mortality of lung cancer in China and G20 significantly increased, with China experiencing a higher rate of increase. The years with the highest increase in incidence of lung cancer in China were 1998-2004 and 2007-2010. Among the G20 countries, the AAPC in incidence and mortality of lung cancer in the Republic of Korea was the highest, followed closely by China. Although India exhibited similarities, its AAPC in lung cancer incidence and mortality rates was lower than that of China. The prediction showed that the incidence in China will continue to increase. In terms of risk factors, smoking was the leading attributable cause of mortality in all countries, followed by occupational risk and ambient particulate matter pollution. Notably, smoking in China exhibited the largest increase among the G20 countries, with ambient particulate matter pollution ranking second. Lung cancer is a serious public health concern in China, with smoking and environmental particulate pollution identified as the most important risk factors. The incidence and mortality rates are expected to continue to increase, which places higher demands on China's lung cancer prevention and control strategies. It is urgent to tailor intervention measures targeting smoking and environmental pollution to contain the burden of lung cancer.

Oligometastatic disease and visceral resections in advanced malignant melanoma: a propensity-matched analysis

PurposeMalignant melanoma is among the tumours with the highest increase in incidence of solid tumours in Germany. While most patients are diagnosed at an early stage and show a good prognosis, advanced stages of malignant melanoma are accompanied with a poor prognosis and limited treatment options. Comparable to other tumour entities, the resection of visceral metastases could lead to a better prognosis. Supplementary, the subgroup of oligometastatic patients might benefit from surgical therapy to a greater extent.MethodsThis retrospective study analysed 351 patients treated between 2006 and 2017 at the University Hospital of Cologne. A total of 121 patients showed visceral metastases, with which we compared patients with a diffuse tumour spread to patients in an oligometastatic state. Furthermore, we evaluated the effect of visceral resection of oligometastatic, malignant melanoma.ResultsOur analysis showed that patients with an oligometastatic malignant melanoma had a significantly better prognosis than patients with a diffuse pattern of metastases, if they showed visceral metastases. Furthermore, the resection of visceral metastases leads to a significant gain in median overall survival time (13.6 vs. 34.2 months) and in progression-free survival (9.6 vs. 3.8 months).ConclusionThe resection of visceral metastases is a rational treatment option in advanced malignant melanoma. Although our study is limited by a small cohort of patients (n = 18), we believe that the resection of visceral metastases will be fundamental in the treatment of malignant melanoma. In particular, patients in an oligometastatic stage could be an eligible group for surgical treatment.

Epidemiology of Achilles Tendon Rupture in South Korea: Claims Data of the National Health Insurance Service from 2009 to 2017

BackgroundThe incidence of Achilles tendon rupture and its trend has not been studied in Asia. The purpose of this nationwide study was to analyze the trend of incidence and surgical treatment of tendon ruptures in South Korea based on sex, age, and income level of patients, as well as seasonal variation.MethodsA descriptive epidemiologic study was performed based on the data collected retrospectively from the Korea National Health Insurance Service. Data of all outpatients and inpatients were collected from approximately 52 million residents of South Korea, primarily diagnosed with Achilles tendon rupture from 2009 to 2017.ResultsA total of 112,350 patients had Achilles tendon rupture, of which 44,248 patients underwent surgical treatment during the study period. The overall, age-specific, and sex-specific incidence of Achilles tendon rupture and surgical treatment showed an increasing trend. Patients in the age group of 41 to 50 years showed the highest increase in incidence. Regarding season, higher incidence was reported during spring and summer, whereas the lowest incidence was found in winter. Higher income level was associated with increased incidence of the condition.ConclusionsThe incidence of Achilles tendon rupture and surgical treatments increased rapidly in patients between 41 and 50 years of age. Patients in the higher income quintile groups experienced more Achilles tendon injury than those in lower income groups, and fewer ruptures were observed during winter.

The etiology of revision total hip arthroplasty: current trends in a retrospective survey of 3450 cases.

Over the last years, the design of implants, the surgical approaches, and diagnostic tools changed in primary and revision of total hip arthroplasty. A knowledge of the different causes for revision after total hip arthroplasty is essential to avoid complications and failures. The purpose of this study was to determine trends of the etiology of implant failures over the last years by analyzing indications of revision hip arthroplasty. All the patients who performed revision hip arthroplasties in our institution between 2001 and 2015 were reviewed retrospectively. Patient demographics, the indication for revision surgery as well as the procedure were assessed. Descriptive statistical analyses and association analyses were performed. Within our collective of 3450 revision hip arthroplasties, a total of 20 different indications were identified and categorized. Overall, 80.8% of the revisions were categorized as aseptic, 19.2% as septic implant failures. Some recently debated diagnoses like low-grade infection showed a high increase in incidence, whereas classic failure mechanisms like polyethylene wear showed a decrease over the time. In addition, the data revealed that cup loosening caused more revision surgeries than stem loosening. This study successfully updated the current knowledge of different failure mechanisms in revision hip arthroplasties. The data proved that cup loosening was the most common failure mechanism in older patients, while in young patients, septic complications showed a high incidence. Probably, due to improved diagnostic tools, the percentage of infection in revision hip arthroplasty increased over the years.

Trends of survival based on race and ethnicity in gastrointestinal tract neuroendocrine tumor.

607 Background: There is paucity of data about racial/ethnic disparities in gastrointestinal tract neuroendocrine tumors (GiNET). We aimed to study the race/ethnic differences in disease characteristics and survival in GiNET. Methods: We analyzed the SEER database to identify cases with non-pancreatic GiNET between 2004 and 2015. We evaluated trends in incidence and outcomes between Hispanic, non-Hispanic/non-Black (NH/NB) and non-Hispanic Black (NHB). Kaplan-Meier method and cox regression model were performed for overall survival (OS) after adjusting for stage, grade, gender, race/ethnicity, and surgery. Results: 25,826 cases were included, 12.7% were Hispanic, 18.5% NHB and 68.8% NH/NB; males comprised 46.8%, 50.5%, 41.9%, respectively (p &lt; 0.001). The overall incidence of GiNET increased two-folds in the ten years. The highest increase in incidence was observed in appendiceal NET followed by small intestine NET, and this increase was observed mostly among Hispanic population. NH/NB cases were older ( &gt; 65 years) (31.3% vs. 23.3% vs. 23.5%; p &lt; 0.001) and presented with metastatic disease (17.8% vs. 12.7%, 12.0%; p &lt; 0.001). On multivariate analysis Hispanic population had significantly better OS than NH/NB and NHB (HR: 1.25 95% CI: 1.14-1.37 and HR: 1.15 95% CI: 1.033-1.28, respectively). For stage-4 low- and intermediate-grade GiNET, OS was better if surgery was performed (p &lt; 0.001), and this trend was most pronounced among Hispanic as compared to NH/NB (HR 1.35, 95% CI 1.07-7.71). Conclusions: The incidence of GiNET had increased two-fold in the last ten years with the highest increase in Hispanic. However, Hispanic had significantly better overall survival than NH/NB and NHB population.[Table: see text]

Abstract 402: RNA-sequencing of plasma exosomes reveals specific transcriptomic profiles in patients with hepatocellular carcinoma

Abstract Hepatocellular carcinoma (HCC) is the tumor with the highest increase in incidence and mortality in the last 20 years. Exosomes are nano-sized particles loaded with nucleic acids and proteins involved in cell-to-cell communication. The aims of this study are: 1) to establish a method to isolate exosomes from plasma of HCC patients, and 2) to detect de-regulated transcripts in exosomes from HCC patients compared to controls. In this pilot study, we included 10 HCC patients and 5 controls at high-risk of HCC development (i.e. patients with cirrhosis and/or chronic hepatitis B). Plasma exosomes were isolated by differential ultracentrifugation. Presence of exosomes was confirmed by morphological assessment with electron microscopy, nanoparticle tracking analysis and immune-labeling of EV specific markers (CD9, CD63, CD81, and TSG101) with ExoView and Western Blotting. RNA from exosomes was extracted and quantified with Bioanalyzer. Library preparation was done with SMARTer smRNA-Seq kit and whole transcriptome sequencing was performed on an Illumina HiSeq2500 instrument. Differential gene expression was done with LIMMA and enrichment analyses (i.e., gene ontology) with Enrichr. HCC patients and controls were matched for age (median 67 vs. 63 yrs.), sex (70% vs. 67% males), and etiology (viral 70% vs. 67%). Sequencing reads obtained from exosomes mapped mRNA, lincRNA and small RNA, including miRNAs and Y-RNAs. Compartment ontology enrichment analysis of the top 250 expressed genes matched to exosomes and membrane-bounded vesicles (FDR&amp;lt;0.01). Genes from hepatic lineage were among the top expressed genes including ALB, BAAT, CRP, C3/5, FGA/B, CYP and APO family. This confirms the presence of liver-derived exosomes in human plasma. We identified 252 differentially expressed genes between HCC and controls (FDR&amp;lt;0.05). Among them, we found genes with known aberrant expression in HCC tissue samples such as ARF1 (Fold-change [FC]: 5 fold up-regulated), CDKN2A (FC:-3.2), H3F3A (FC:8) or TAGLN2 (FC:7). Among the 35 highest differentially expressed genes (FC&amp;gt;8) between HCC and controls, there was an enrichment in previously unreported Y-RNAs (37%, FDR&amp;lt;0.001) and microRNAs (11%, FDR&amp;lt;0.001). We conclude that whole transcriptomic analysis of plasma exosomes is feasible in patients with HCC. Our pilot study detects significant differences in the transcriptomic profiles of HCC patients compared to controls, including an enrichment of upregulated miRNAs and Y-RNAs. Citation Format: Johann von Felden, Amanda J. Craig, Mehmet Eren Ahsen, Ismail Labgaa, Delia D'Avola, Gabriela Hernandez Meza, Kimaada Allette, Navneet Dogra, Teresa Garcia Lezana, Parissa Tabrizian, Amon Asgharpour, Douglas Dieterich, Robert Sebra, Gustavo Stolovitzky, Myron Schwartz, Augusto Villanueva. RNA-sequencing of plasma exosomes reveals specific transcriptomic profiles in patients with hepatocellular carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 402.

Trends in Multiple Myeloma Incidence in the United States (US): Demographic and Geographic Considerations and Focus on Young Adults

Background: The incidence of multiple myeloma (MM) in the US is increasing among non-Hispanic (NH) White males and females as well as NH Black males (Costa LJ, Blood Advances 2017). However, more specific incidence studies accounting for geographic and age subgroups are limited. There is also a growing concern that incidence of many cancers is increasing in the younger population. Utilizing the Surveillance, Epidemiology, and End Results Program (SEER), we investigated the trends in MM incidence in the US according to demographic and geographic subgroups with a focus on the young adults.Methods: Incidence rates (case/100,0000) were calculated using SEER*Stat and 2000-2015 data from SEER-18 registries age-adjusted to the U.S. 2000 standard population. We calculated the annual percentage change (APC) of incidence rates according to age groups and stratified by sex, race, and registry. Age at diagnosis was analyzed in 10-year intervals starting at 20 years. All analyses used ICD-O-3 codes 9732/3 with microscopically confirmed MM.Results: There were 69,613 MM patients included in the analysis. The mean age at diagnosis was 68 years and decreased over time from 68.5 years in 2000 to 67.6 years in 2015. Men comprised 55.5% of the population. Patients <50 years constituted 7.9% of the population with 6.6% between 40-49 years. The incidence significantly (all p values <0.01) increased from 2000-2015 for the entire cohort (incidence 6.9-9.5; APC 1.1) and for males (8.6-9.5; 1.1) and females (5.7-6.3; 0.8). The highest increase in incidence among the age groups (Figure) was in 40-49 years (1.9-2.7; 2.1). When analyzing the trends for age groups stratified by sex, women ages 40-49 years had the highest increase in incidence (1.6-2.6; 2.4). The APCs of SEER-18 registries stratified by age and sex are reported in the Table. The highest APCs (>3.0) were observed in the registries of Atlanta, Greater Georgia, Hawaii, and New Jersey. When the SEER-18 registries were further stratified by race, white men ages 40-49 years in Seattle and New Jersey had APCs of 5.5 and 2.9 respectively, while Black women ages 40-49 years in Greater Georgia had an APC of 3.3. Only 3 groups of individuals had a significant decline in the incidence: Asian women ≥70 years in Los Angeles (APC -6.4), White women ≥70 years in Los Angeles (APC -1.9), and men 50-59 years in San Jose (APC -1.5).Conclusions: The overall incidence of MM is increasing in the US with the highest increment among young adults between the age groups 40-49 years. We observed geographic and demographic differences in the incidence rates, which may reflect genetic and environmental influences. Interestingly, a few geo-demographic subgroups had a decline in the incidence. Further research is needed to determine the reasons behind the observed trends. DisclosuresKapoor:Celgene: Research Funding; Takeda: Research Funding.

Increasing incidence and survival of head and neck cancers in Denmark: a nation-wide study from 1980 to 2014

Background The purpose of the study was to determine trends in age-adjusted incidence rates (AAIR) and survival probability in head and neck cancers (HNCs) in the Danish population from 1980 to 2014. Material and methods All patients registered with HNC in the nationwide Danish Cancer Registry from 1980 to 2014 were included. We evaluated the AAIR per 100,000 and the average annual percent change (AAPC). The relative survival probability at 5 years was calculated in relation to gender, anatomical location and histology, and we constructed age-period-cohort models of incidence. Results About 34,606 patients were included (64.7% men). The AAIR increased from 9.1 per 100,000 in 1980 to 17.4 per 100,000 in 2014 with an AAPC of 2.1%. The greatest incidence increase was observed in oropharyngeal cancer (AAPC: 5.4%) followed by hypopharyngeal cancer (AAPC: 4.2%). Adenocarcinomas had the highest AAPC (5.0%) followed by squamous cell carcinomas (AAPC: 2.0%). The AAPC was significantly higher in women (2.4%) compared with men (1.6%). For all HNC patients, the relative survival at 5 years rose significantly from 49.0% in 1980–1984 to 62.4% in 2010–2014. Women had a significantly higher survival than men with a relative survival of 61.7% compared to 50.0% in men. Laryngeal cancer had the best survival probability of cancers in the upper aerodigestive tract with hypopharyngeal cancer having the poorest survival. Conclusion This nation-wide study showed a significant rise in incidence of HNC for men and women along with a significant increase in relative survival. Oropharyngeal cancer had the highest increase in incidence followed by hypopharyngeal cancer which showed the poorest survival of HNCs.

Abstract 21273: Burden of Arrhythmias in Hypertrophic Obstructive Cardiomyopathy in United States From 2000 Through 2014: A National Population-Based Cohort Study

Background: Hypertrophic obstructive cardiomyopathy (HOCM) is the leading cause of sudden cardiac death (SCD) in young adults and ventricular arrhythmias are known to cause SCD in these high-risk patients. The risk of SCD increases with increasing age. This data is first of its kind to address the trends in the prevalence of arrhythmias in HOCM population. Methods: The study cohort was extracted from Nationwide inpatient sample (NIS) from 2000 to 2014. Appropriate international classification of diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes were used to diagnose HOCM (425.1 and 425.11) and arrhythmias (427.xx). P-values for trends were generated by Cochrane-Armitage test for categorical variables and simple linear regression for continuous variables. Results: We noted 49.13 % incidence of any arrhythmias in HOCM patients with a relative increase of 27.92% over study period (2000-2014). Atrial fibrillation was most prevalent arrhythmia in this patient population (33.39%).Highest increase in incidence over study period was observed in bundle branch blocks ( relative increase 189.64%), atrioventricular blocks ( relative increase 119.85%), premature atrial/ventricular complex ( relative increase 123.28%), atrial flutter ( relative increase 66.86%), ventricular tachycardia (relative increase 60.54%) and atrial fibrillation ( relative increase 24.31%). Conclusion: Patients with HOCM are at increased risk of arrhythmias. Even after improvement in the early diagnosis and treatment of these high-risk patients, the burden of arrhythmias i.e., AF, ventricular arrhythmias, premature arrhythmias and atrioventricular blocks has increased exponentially through 2000-2014. It was also accompanied by increase in-hospital mortality in HOCM population.

The World Incidence and Prevalence of Autoimmune Diseases is Increasing

Epidemiological data provide evidence of a steady rise in autoimmune disease throughout Westernized societies over the last decades. Multiple publications exist, describing past or actual incidences/prevalence of individual autoimmune diseases, however, long term studies on selected populations are scarce. Aims: to calculate the % increases per year of autoimmune diseases frequencies worldwide, analyze the differential increases per country and disease, and identify geoepidemiological trends. Methods: A systematic review was performed to identify incidence and prevalence of autoimmune diseases. 30 Studies from the last 30 years were identified using Medline, Google, and Cochrane Library databases. Only long-term regional or national follow-ups are reported. Results: The means ± s.d. of the net % increased /year incidence and prevalence of autoimmune diseases worldwide were 19.1±43.1 and 12.5±7.9, respectively. Rheumatic, endocrinological, gastrointestinal and neurological autoimmune diseases revealed the following annual % increases per year: 7.1, 6.3, 6.2, and 3.7, respectively. In all of these, differences between old vs new frequencies were highly significant (p< 0.0001). Comparing various autoimmune diseases, celiac disease increased the most and the highest increase in incidence, comparing old to new surveys is allocated to myasthenia gravis. Despite considerable variations between the countries, celiac, type 1 diabetes and myasthenia gravis frequencies increased the most in , and , respectively. Frequencies of the autoimmune diseases increased significantly in the West and North when compared to East and South, respectively. Conclusions: Despite multiple reports on autoimmune diseases frequencies, long-term longitudinal follow-ups are scarce. Incidences and prevalences have increased significantly over the last 30 years. Rheumatic, endocrinological and gastrointestinal autoimmune diseases in , , and increased the most. These observations point to a stronger influence of environmental factors as opposed to genetic factors on autoimmune disease development.

National and regional breast cancer incidence and mortality trends in Mexico 2001–2011: Analysis of a population-based database

IntroductionBreast cancer is the most common malignancy in Mexican women since 2006. However, due to a lack of cancer registries, data is scarce. We sought to describe breast cancer trends in Mexico using population-based data from a national database and to analyze geographical and age-related differences in incidence and mortality rates. MethodsAll incident breast cancer cases reported to the National Epidemiological Surveillance System and all breast cancer deaths registered by the National Institute of Statistics and Geography in Mexico from 2001 to 2011 were included. Incidence and mortality rates were calculated for each age group and for 3 geographic regions of the country. Joinpoint regression analysis was performed to examine trends in BC incidence and mortality. We estimated annual percentage change (APC) using weighted least squares log-linear regression. ResultsWe found an increase in the reported national incidence, with an APC of 5.9% (95% CI 4.1–7.7, p<0.05). Women aged 60–65 had the highest increase in incidence (APC 7.89%; 95% CI 5.5 −10.3, p<0.05). Reported incidence rates were significantly increased in the Center and in the South of the country, while in the North they remained stable. Mortality rates also showed a significant increase, with an APC of 0.4% (95% CI 0.1–0.7, p<0.05). Women 85 and older had the highest increase in mortality (APC 2.99%, 95% CI 1.9–4.1; p<0.05). ConclusionsThe reporting of breast cancer cases in Mexico had a continuous increase, which could reflect population aging, increased availability of screening, an improvement in the number of clinical facilities and better reporting of cases. Although an improvement in the detection of cases is the most likely explanation for our findings, our results point towards an epidemiological transition in Mexico and should help in guiding national policy in developing countries.

Sintomas que afetam a ingestão alimentar de pacientes com linfoma em quimioterapia ambulatorial

Lymphomas are a malignant neoplasm which arises in the lymph nodes, which are involved in fighting infection. This cancer had the highest increase in incidence among oncohematological diseases. The objective of the study was evaluate the pos-sible gastrointestinal symptoms presented by the patient during treatment and relates them to food intake and nutritional status. The subjective global assessment was performed; body mass index, arm muscle area and assessed food intake, as well as presence of gastrointestinal symptoms in patients with lymphoma undergoing outpatient chemotherapy. The sample consisted of 30 patients of the Oncology Clinic Erasto Gaertner Hospital of Parana service, between the months of May and June 2014, 33.3% with Hodgkin’s lymphoma and 66.7% with non-Hodgkin lymphoma. According to ASG 100% of patients were considered nourished, but 46.7% of patients had weight loss. According to the AMB, 57% of patients had some degree of malnutrition. In the BMI, 26.7% of adults were eutrophic, 30% were overweight, 13.3% were obese and none with malnutrition, in relation to the elderly 6.7% were underweight, 6.7% were eutrophic and 16.7 % overweight. There was a decrease in food intake by some patients after chemotherapy initiation, being nausea, dysgeusia, dry mouth and constipation the most frequent symptoms. Considering the gastrointestinal symptoms that interfere directly in the dietary pattern and weight loss caused by chemotherapy, the onco hematological patients should be considered at nutritional risk and receiving specialized nutritional monitoring to minimize its adverse side effects and improve their life quality.

Incidence and costs of bicycle-related traumatic brain injuries in the Netherlands

The main cause of death and serious disability in bicycle accidents is traumatic brain injury (TBI). The aim of this population-based study was to assess the incidence and costs of bicycle-related TBI across various age groups, and in comparison to all bicycle-related injuries, to identify main risk groups for the development of preventive strategies.Data from the National Injury Surveillance System and National Medical Registration were used for all patients with bicycle-related injuries and TBI who visited a Dutch emergency department (ED) between 1998 and 2012. Demographics and national, weighted estimates of injury mechanism, injury severity and costs were analysed per age group. Direct healthcare costs and indirect costs were determined using the incidence-based Dutch Burden of Injury Model.Between 1998 and 2012, the incidence of ED treatments due to bicycle-related TBI strongly increased with 54%, to 43 per 100,000 persons in 2012. However, the incidence of all bicycle-related injuries remained stable, from 444 in 1998 to 456/100,000 in 2012. Incidence of hospital admission increased in both TBI (92%) and all injuries from cycling (71%). Highest increase in incidence of both ED treatments and hospital admissions was seen in adults aged 55+. The injury rate of TBI per kilometre travelled increased (44%) except in children, but decreased (−4%) for all injuries, showing a strong decrease in children (−36%) but an increase in men aged 25+, and women aged 15+. Total costs of bicycle-related TBI were €74.5 million annually. Although bicycle-related TBI accounted for 9% of the incidence of all ED treatments due to cycling, it accounted for 18% of the total costs due to all bicycle-related injuries (€410.7 million). Children and adolescents (aged 0–24) had highest incidence of ED treatments due to bicycle-related injuries. Men in the working population (aged 15–64) had highest indirect costs following injuries from cycling, including TBI. Older cyclists (aged 55+) were identified as main risk group for TBI, as they had highest ED attendance, injury rate, injury severity, admission to hospital or intensive care unit, and costs.Incidence of ED treatments due to cycling are high and often involve TBI, imposing a high burden on individuals and society. Older cyclists aged 55+ were identified as main risk group for TBI to be targeted in preventive strategies, due to their high risk for (serious) injuries and ever-increasing share of ED visits and hospital admissions.

Update on the etiology of revision TKA — Evident trends in a retrospective survey of 1449 cases

BackgroundA working and complete knowledge of the different causes of dysfunction and pain after TKA is essential for the ability to correctly determine the cause of failure and to address this problem specifically.The purpose of this study was to update the etiology of implant failure. New diagnosis and current trends should be displayed. MethodsAll TKA revisions performed in our institution between 2001 and 2010 were reviewed retrospectively. Patient demographics and the precise indication for the surgery were documented. Descriptive statistical analyses and association analyses of both the diagnosis and patient demographics were performed. ResultsWithin our collective of 1449 revision TKA a total of 40 different pathologies leading to revision surgery were identified and categorized. Overall 68.5% of the revisions were categorized aseptic, 31.5% as septic implant failure. Some recently debated diagnoses like low-grade-infection showed a high increase in incidence whereas classic failure mechanisms like polyethylene wear showed a decrease over the time. ConclusionWe believe that this study successfully updates the current knowledge of different failure mechanisms in revision TKA, which have to be considered on dysfunction or pain after surgery. We were able to evaluate the clinical relevance of each pathology and could shift from implant related problems like wear to more surgical problems like instability and or malalignment over the last years. With a higher alertness to chronic low-grade-infections the incidence of infection is even increasing. Level of evidenceLevel II, economic and decision analysis.

Carcinome hépatocellulaire : une incidence croissante, une prise en charge « optimisée »

Hepatocellular carcinoma is the main type of primary liver cancer. It is a major complication of chronic liver diseases, mainly cirrhosis. High increase in incidence and mortality has been observed in industrialized countries for about 30 years, as well as major improvement in the understanding of carcinogenesis and diagnostic and therapeutic management of patients: ultrasonographic screening of patients with cirrhosis, noninvasive (probabilistic) diagnosis mainly based on imaging procedures, improvement of liver transplantation results, development of tumor destruction using percutaneous radiofrequency, and more recently slight but significant increase in survival in patients treated with sorafenib. Nevertheless, some progress is still needed in order to improve significantly the incidence and the mortality of patients with hepatocellular carcinoma: widespread and improvement of ultrasonographic screening in patients with cirrhosis, effective chemoprevention, expanded indications of liver transplantation, prevention and treatment of cancer recurrences after surgical resection or radiofrequency, and methodological improvement in assessment of new treatments.