Significant Increase In Incidence Research Articles

Induction of thyroid and liver tumors by chronic exposure to 2-methylimidazole in F344/N rats and B6C3F1 mice

2-Methylimidazole (2MI) has been identified as a by-product of fermentation and is detected in foods and mainstream and side-stream tobacco smoke. It is used in the manufacture of pharmaceuticals, photographic chemicals, dyes and pigments, agricultural chemicals, and rubber. Carcinogenicity studies of 2MI were conducted because of its high potential for human exposure and a lack of carcinogenicity data. Groups of male and female Fischer 344/N rats were fed diets containing 0, 300, 1,000, or 3,000 ppm (males) or 0, 1,000, 2,500, or 5,000 ppm (females) 2MI for 106 weeks and groups of male and female B6C3F1 mice were fed 0, 625, 1,250, or 2,500 ppm 2MI for 105 weeks. Animals in each group were sacrificed at 8 days, 14 weeks, and 6 months for determinations of serum thyroid hormone and liver enzyme levels and histopathological examinations and at 2 years for evaluations of neoplastic lesions. In rats, 2MI administration reduced serum thyroxine and triiodothyronine and increased thyroid stimulating hormone levels. 2MI administration also increased total hepatic UDP-glucuronosyltransferase levels. At 2 years, the incidences of thyroid follicular cell hyperplasia, adenoma or carcinoma (combined), as well as follicular mineralization were increased. The incidences of hepatocellular adenoma or carcinoma (combined) in the two highest dose groups of males and females were also increased. The incidences of mixed cell focus in males and females were also significantly increased. In mice, the incidences of thyroid follicular cell hypertrophy and hyperplasia were significantly increased in the high dose males and females. The incidence of thyroid follicular cell adenoma in the 2,500 ppm males was significantly greater than that in the control group. The incidences of hepatocellular adenoma or carcinoma (combined) were significantly increased in all exposed groups of males and in the 2,500 ppm females. Significant increases in incidences were also observed in spleen hematopoietic cell proliferation in both sexes and bone marrow hyperplasia, chronic active inflammation of the epididymis, sperm granuloma, and germinal epithelial atrophy of the testis in males. Under these experimental conditions, carcinogenic activity of 2MI was demonstrated in male and female rats and mice.

Trends in pancreatic cancer incidence in nine SEER Cancer Registries, 1973–2002

Background: The evolution of pancreatic cancer incidence in the last three decades in the United States remains unclear. This study was conducted to investigate this problem, using data from the nine registries of the Surveillance, Epidemiology, and End Results (SEER) Program.Patients and methods: The incidence data in 1973–2002 were age standardized to the 2000 USA standard population and analyzed by the joinpoint regression.Results: For the nine registries combined, pancreatic cancer incidence in men significantly decreased by 0.62% per year from 1973 to 2002. Incidence in women increased until 1984 and slowly declined thereafter. A rise in incidence, although not statistically significant, has been noted in young and middle-aged adults (<60 years) since 1994. Changes in incidence over time substantially differed among the nine SEER registries compared. Incidence decreased in most age-, sex-, and race-specific groups of the populations covered in the nine registries during the period examined. Conversely, a statistically significant increase in incidence was observed among women in Hawaii and Iowa and among old adults (≥60 years) in Seattle and Utah.Conclusions: Pancreatic cancer incidence significantly decreased from 1973 to 2002 in men and increased until 1984 and then declined slowly in women in the United States.

Life-span exposure to low doses of aspartame beginning during prenatal life increases cancer effects in rats.

BackgroundIn a previous study conducted at the Cesare Maltoni Cancer Research Center of the European Ramazzini Foundation (CMCRC/ERF), we demonstrated for the first time that aspartame (APM) is a multipotent carcinogenic agent when various doses are administered with feed to Sprague-Dawley rats from 8 weeks of age throughout the life span.ObjectiveThe aim of this second study is to better quantify the carcinogenic risk of APM, beginning treatment during fetal life.MethodsWe studied groups of 70–95 male and female Sprague-Dawley rats administered APM (2,000, 400, or 0 ppm) with feed from the 12th day of fetal life until natural death.ResultsOur results show a) a significant dose-related increase of malignant tumor–bearing animals in males (p < 0.01), particularly in the group treated with 2,000 ppm APM (p < 0.01); b) a significant increase in incidence of lymphomas/leukemias in males treated with 2,000 ppm (p < 0.05) and a significant dose-related increase in incidence of lymphomas/leukemias in females (p < 0.01), particularly in the 2,000-ppm group (p < 0.01); and c) a significant dose-related increase in incidence of mammary cancer in females (p < 0.05), particularly in the 2,000-ppm group (p < 0.05).ConclusionsThe results of this carcinogenicity bioassay confirm and reinforce the first experimental demonstration of APM’s multipotential carcinogenicity at a dose level close to the acceptable daily intake for humans. Furthermore, the study demonstrates that when life-span exposure to APM begins during fetal life, its carcinogenic effects are increased.

Lack of promoting effects of chronic exposure to 1.95‐GHz W‐CDMA signals for IMT‐2000 cellular system on development of N‐ethylnitrosourea‐induced central nervous system tumors in F344 rats

The present study was performed to evaluate effects of a 2-year exposure to an electromagnetic near-field (EMF) equivalent to that generated by cellular phones on tumor development in the central nervous system (CNS) of rats. For this purpose, pregnant F344 rats were given a single administration of N-ethylnitrosourea (ENU) on gestational day 18. A total of 500 pups were divided into five groups, each composed of 50 males and 50 females: Group 1, untreated controls; Group 2, ENU alone; Groups 3 to 5, ENU + EMF (sham exposure and two exposure levels). A 1.95-GHz wide-band code division multiple access (W-CDMA) signal, which is a feature of the International Mobile Telecommunication 2000 (IMT-2000) cellular system was employed for exposure of the rat head starting from 5 weeks of age, 90 min a day, 5 days a week, for 104 weeks. Brain average specific absorption rates (SARs) were designed to be .67 and 2.0 W/kg for low and high exposures, respectively. The incidence and numbers of brain tumors in female rats exposed to 1.95-GHz W-CDMA signals showed tendencies to increase but without statistical significance. Overall, no significant increase in incidences or numbers, either in the males or females, was detected in the EMF-exposed groups. In addition, no clear changes in tumor types in the brain were evident. Thus, under the present experimental conditions, exposure of heads of rats to 1.95-GHz W-CDMA signals for IMT-2000 for a 2-year period was not demonstrated to accelerate or otherwise affect ENU-initiated brain tumorigenesis.

Adenoviruses associated with acute gastroenteritis in hospitalized and community children up to 5 years old in Rio de Janeiro and Salvador, Brazil

Acute gastroenteritis is a major source of morbidity and mortality among young children in developed and developing countries. Human adenoviruses (HAdVs), and in particular species F, are related to childhood diarrhoea worldwide. This study presents the results obtained during an investigation of HAdVs causing acute gastroenteritis in children hospitalized in Rio de Janeiro, RJ, Brazil, from April 1996 to September 2003, as well as in children with diarrhoea living in the slums of Salvador, BA, Brazil, from October 2001 to September 2003. A total of 3060 stool samples was analysed by an enzyme immunoassay for rotavirus and adenovirus (EIARA) and 61 (2%) were found to be positive. HAdV presented with low prevalence throughout the year, with a slight but not significant increase in incidence in late summer and early autumn. Children up to 2 years of age were the most frequently affected (79% of all positive samples). All positive samples were analysed further by generic and species-specific HAdV PCR protocols, confirming 100% specificity of this rapid and inexpensive EIARA. Species F was the most prevalent (65%), despite the occurrence of species A (12%), C, D and co-infection F/D (5% each) and species B and co-infections F/A, F/C and B/D (2% each). In order to type the species F strains as HAdV-40 or -41, generic PCR and a HinfI restriction digest were performed. HAdV-40 and -41 were found to represent 62% (23/37) and 38% (14/37), respectively. These results demonstrated that a combination of generic and species-specific PCRs is useful and reliable for HAdV species and type identification directly from faecal specimens. The results confirmed the endemism of human adenoviruses, mainly species F, in children as aetiological agents of diarrhoea, although the limited sensitivity of EIARA as a screening method may have underestimated their prevalence.

Changes in the site distribution of malignant melanoma in South East Scotland (1979–2002)

Scottish Melanoma Group (SMG) data on 2790 melanoma (MM) cases in South East Scotland over a 24-year time period were analysed in four periods each of 6 years duration grouped into frequently exposed, intermittently exposed, and always covered sites. Incidence increased significantly over time with females having a higher incidence rate than males. In both sexes, the proportion of cases seen on the posterior trunk and arm increased significantly (P<0.001), but declines were seen in the proportion of leg tumours in males (P=0.09) and of head tumours in females (P=0.011). Although the proportion of cases decreased for certain sites, the actual MM incidence increased at all sites. A significant increase in incidence occurred at usually and always covered sites (P<0.001 and P<0.001, respectively) in females and at usually covered sites in males (P<0.001).

Hypothesis: hair cover can protect against invasive melanoma on the head and neck (Australia).

The anatomic distribution of cutaneous melanoma reflects people’s levels and patterns of sun exposure. While examining trends of incident invasive melanomas by site in recent decades in Australia we noted significant increases in incidence on the ears but not the face or any other site in women younger than 40 years, by 6% (95% confidence interval [CI] 2–10%) per year, and 40–59 years by 7% (95% CI 4–10%) per year. Men of the same age showed no corresponding changes in ear melanoma. However incidence rates of ear melanoma in general were fourfold higher in males than females in Australia. Further, using data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) Program, rates of invasive melanoma on the ear were found to be sevenfold higher in males than females in the US population in the same period. Higher rates of scalp and neck melanomas were also seen in men and women in both populations. We therefore speculated that the isolated rises of ear melanoma in younger women in Australia, and the higher overall rates of ear, scalp and neck melanoma in men compared with women, reflect differences in hair coverage. We tested the specific hypothesis that hair cover reduces sun exposure of the ears using experimental manikins and found that hair cover of the ear reduced solar ultraviolet-B exposure by 81% [SE ±8] compared with uncovered ears. We conclude that hair cover can protect against invasive melanoma on the ear and may similarly protect on the scalp and neck. When discretionary, hair may be an important additional factor to be considered for melanoma prevention.

Candidate Selection for Long-term Left Ventricular Assist Device Therapy for Refractory Heart Failure

The epidemic of heart failure has been widely reported.1–3 The reasons for its significant increase in incidence are multiple and include improved survival with current drug therapy for heart failure3–5 and the development and increased use of internal cardio-defibrillators (ICDs),6,7 especially in patients with ischemic heart disease and reduced ejection fraction. Other facts include all therapies that have been shown to be associated with significant reductions in mortality from acute coronary syndromes.

Medulloblastoma incidence has not changed over time: A CBTRUS study

9058 Background: Past studies of medulloblastoma (MB) present conflicting claims about declines and rises in MB incidence, possibly due to misclassification. By using a strict classification of the disease and a rigorous analysis of a data registry, we aimed to determine the incidence trends of MB over the last three decades. Methods: 441 MB patients diagnosed between 1985 and 2002 were identified from the Central Brain Tumor Registry of the United States (CBTRUS), a data set representing approximately 5% of the American population (6 registries). MB was strictly defined and non-cerebellar embryonal tumors (primitive neuro-ectodermal tumors [PNETs]) excluded, using histology and site codes. Multiplicative Poisson regression and joinpoint regression were performed (Joinpoint Regression Program, version 3.0, Statistical Research and Applications Branch, National Cancer Institute) to determine the estimated average annual percentage change (EAPC) and sharp (i.e., acute) changes in incidence, respectively. Results: A slight but nonsignificant (p=.18) increase in medulloblastoma was demonstrated (EAPC = 1.1), and no sharp changes in incidence were found (joinpoints = 0). The analysis was repeated with a less strict definition of MB (including non-cerebellar PNETs) and 559 patients were identified. Using this broader classification scheme, there was a statistically significant increase in incidence (p=.02, EAPC = 1.6), but no sharp changes in incidence (joinpoints = 0). Conclusions: MB incidence does not appear to have changed since the 1980s. “Medulloblastoma” incidence increased only when the diagnosis was not strictly defined and misclassified by including non-cerebellar PNETs in the analysis. The observed increase in the combined MB/PNET classification may relate to the PNET hypothesis–a proposal that all brain tumors of apparently undifferentiated neuroepithelial cells be considered a unique diagnostic group–popularized in the 1980s and early 1990s. No significant financial relationships to disclose.

Pontiac fever: an operational definition for epidemiological studies

BackgroundPontiac fever is usually described in epidemic settings. Detection of Pontiac fever is a marker of an environmental contamination by Legionella and should thereby call for prevention measures in order to prevent outbreak of Legionnaire's disease. The objective of this study is to propose an operational definition of Pontiac fever that is amenable to epidemiological surveillance and investigation in a non epidemic setting.MethodsA population of 560 elderly subjects residing in 25 nursing homes was followed during 4 months in order to assess the daily incidence of symptoms associated, in the literature, with Pontiac fever. The water and aerosol of one to 8 showers by nursing home were characterized combining conventional bacterial culture of Legionella and the Fluorescence In Situ Hybridization (FISH) technique that used oligonucleotides probes specific for Legionellaceae. A definition of Pontiac fever was devised based on clinical symptoms described in epidemic investigations and on their timing after the exposure event. The association between incidence of Pontiac fever and shower contamination levels was evaluated to test the relevance of this definition.ResultsThe proposed definition of Pontiac fever associated the following criteria: occurrence of at least one symptom among headache, myalgia, fever and shivers, possibly associated with other 'minor' symptoms, within three days after a shower contaminated by Legionella, during a maximum of 8 days (minimum 2 days). 23 such cases occurred during the study (incidence rate: 0.125 cases per person-year [95% CI: 0.122–0.127]). A concentration of Legionella in water equal to or greater than 104.L-1 (FISH method) was associated with a significant increase of incidence of Pontiac fever (p = 0.04).ConclusionOnce validated in other settings, the proposed definition of Pontiac fever might be used to develop epidemiological surveillance and help draw attention on sources of Legionella.

Incidence of oral and oropharyngeal cancer in United Kingdom (1990–1999)—recent trends and regional variation

This study aimed to determine whether the incidence of oral cancer is continuing to rise in the UK and if this varies geographically. A descriptive epidemiological study of oral cancer incidence in 12 UK cancer registries (1990-1999) was undertaken. Poisson regression models were employed to assess trends. There were 32,852 oral cancer cases registered (1990-1999). Statistically significant increases in incidence of 18% and 30% were seen in males and females respectively (p<0.01). The trend was observed in younger (<45 years) and older (45+ years) age groups (p<0.01) with 3.5% and 2.4% average annual increases respectively. These increases were consistent for the majority of regions in the older group. For the younger group the increases in incidence were more rapid and differed geographically. Incidence remains higher in men than women, in older compared with younger groups, and in northern regions. These findings provide evidence of a continuing increase in the burden of oral cancer across the UK.

Cancer in adolescents and young adults aged 15–24 years: A report from the North of England young person's malignant disease registry, UK

Descriptions of population-based data have rarely been published specifically for adolescents and young adults with cancer. Data on young adults (15-24 years) diagnosed with cancer in the North of England from 1968 to 1997 were obtained from the Northern Region Young Person's Malignant Disease Registry. Temporal changes in incidence and survival rates were investigated. There were 2,329 first cancers diagnosed over the study period (M:F 1.22:1). Overall age standardized incidence was 174 cases per million 15-24 years old, per year, 190 for males and 157 for females. The most common cancers in young adults were Hodgkin disease (19%), carcinomas (15%), central nervous system tumors (14%), germ cell tumors (13%), and leukemia (11%). Comparing incidence for 1968-1977 with 1988-1997 there were significant increases in the incidence of bone tumors (rate ratio 1.72, 95% CI 1.10-2.68), testicular tumors (rate ratio 1.64, 95% CI 1.16-2.32), thyroid cancer (rate ratio 2.63, 95% CI 1.37-5.02), and malignant melanoma (rate ratio 2.04, 95% CI 1.36-3.08). Survival rates improved significantly (P < 0.001) over the study period; 5-year survival rates over the three time periods 1968-1977, 1978-1987, 1988-1997 for all cancers were 45% (95% CI 41%-49%), 62% (95% CI 58%-65%), and 74% (95% CI 71%-77%) respectively. Survival rates improved and there were significant increases in incidence for specific cancers in young adults in the North of England. Further research is required to identify the reasons for changing incidence and to investigate the late effects of treatment among survivors.

The BLyS Survival Pathway in NHL-B Cells: Constitutive NF-kB and NFAT Lead to Activation.

B-cell non-Hodgkin's Lymphomas (NHL-B), neoplasms of the immune system have shown a significant increase in incidence in the USA over the last three decades. While the pathophysiology of the NHL-B is still unclear, the need to identify the relevant genes and critical signaling pathways, and their involvement in the disease processes in NHL-B have begun to be elucidated. Recently, B Lymphocyte Stimulator (BLyS) has been described as a relatively new member of the TNF ligand family, as a potent cell survival factor that is expressed in many hematopoietic cells, including neoplastic B cells. BLyS can bind to three receptors: TACI, BCMA, BAFF-R, and plays a critical role in B cell maturation, differentiation and proliferation. Relatively high levels of BLyS has been found in the serum of NHL-B patients as well as of the patients with autoimmune disease. The mechanisms of BLyS gene expression and regulation is still unclear, but we have recently found that BLyS is constitutively expressed in several NHL-B cell lines and patient tumor samples by RT-PCR, confocal microscopy, realtime PCR and flow cytometry (FCM). We detected high levels and differential expression of BLyS receptors (TACI, BCMA, BAFF-R) in several NHL-B cell lines by flow cytometry, RT-PCR and realtime PCR in both NHL-B cell lines and patient tumor samples. We have identified a single binding site for NF-kB and two binding sites for NFAT in the BLyS promoter. We also show in aggressive lymphoma B cells that constitutive NF-kB and NFAT binds to the BLyS promoter constitutively. Inhibiting NF-kB/NFAT activity levels, using the NF-kB inhibitors, BAY-11 or Velcade (PS-341), can decrease NF-kB binding activity in the BLyS promotor by EMSA. These inhibitors also decrease BLyS and BAFF-R mRNA and protein levels by realtime PCR and flow cytometry. Similarly, when NHL-B cells were transfected with dominant negative NFAT or NF-kB constructs, there is a 50% decrease in BLyS and BAFF-R expressions, demonstrating that both the ligand (BLyS) and the receptor (BAFF-R) expression are regulated by NFAT and NF-kB. Interestingly, follicular (low grade) lymphoma cells do not express constitutive NF-kB/NFAT activation, and barely detectable mRNA and protein levels of BlyS, but can be activated with exogenous CD154/anti IgM in vitro, activating NF-kB/NFAT and promoting binding to the BLyS promoter by EMSA. This results in a significant increase of BLyS protein level by flow cytometry. Our studies indicate that constitutive NF-kB and NFAT are critical transcriptional regulators of the BLyS survival pathway in malignant B cells that may provide a future therapeutic target in the aggressive NHL-B.

Lithotripter Shockwave-Induced Enhancement of Mouse Melanoma Lung Metastasis: Dependence on Cavitation Nucleation

To confirm a previous report of metastasis enhancement by lithotripter shockwaves (LSW) and to test the hypothesis that this effect is attributable to cavitation. The metastatic B16-D5 melanoma cell line was implanted on the hind legs of female C57/b16 mice 12 days before tumor treatment. The tumors were treated with 500 LSW in a waterbath arrangement. The effect of augmented cavitation nucleation was tested by intratumor injection of air bubbles or ultrasound contrast agent gas bodies (UCAGB). The primary tumor was surgically removed on day 1 after treatment. The six groups of mice were sham, LSW, sham + air bubbles, LSW + air bubbles, sham + UCAGB, and LSW + UCAGB. Data were collected for the 113 mice that survived at least 25 days. Lung evaluations were performed blind after 2 weeks of bleaching in Fekete's solution. The outcomes of the three sham groups were very similar and indicated that the simple injection of material into the tumor did not increase metastasis. In comparison with the pooled shams, both the LSW + air bubbles and LSW + UCAGB groups had statistically significant increases in metastasis counts. Only the LSW + UCAGB group had a significant increase in incidence of metastasis relative to the pooled shams. The LSW + UCAGB also had significantly reduced survival. Shockwaves can enhance metastasis from tumors, and this effect is attributable to cavitation.

Occurrence of multiple sclerosis in central Finland: a regional and temporal comparison during 30 years.

We estimated the prevalence and incidence of multiple sclerosis (MS) in central Finland up to 2000. Rates were compared with those in other areas in Finland. MS cases were identified in the hospital registry by ICD codes for demyelinating diseases from 1979 to 2000. Cases with definite MS were included. Incidence and prevalence were calculated with 95% CI and standardization was performed using direct method. In 1993 prevalence was 59/10(5) (n = 153). Incidence in 1979-93 was 3.8/10(5) person-years (n = 126). Rates are similar to average in areas with known rates of MS in Finland but substantially less than the over twofold MS risk in the neighbouring district Seinajoki. Extended follow-up to 2000 in central Finland showed increasing prevalence up to 105/10(5) (n = 277) and a significant increase in incidence 1994-98 up to 9.2/10(5) (n = 105). At the same time the diagnostic use of MRI increased up to 97%. Central Finland represents an average risk area of MS when compared with other areas of Finland but still a high risk in global comparison. The recent rapid increase in both prevalence and incidence is largely accounted for by increased use of MRI.

Chromosome and spindle configurations of human oocytes matured in vitro after vitrification at the germinal vesicle stage in stimulated cycle

Optimization of oocyte freezing system contributes to improving the efficacy of various infertility treatment program, such as oocyte banking and ovum donation. Selecting of proper oocyte cryopreservation method is a critical factor in development of effective banking system. In our previous study, human oocytes matured in vitro after slow freezing at the germinal vesicle stage displayed a significant increase in incidence of chromosomal and spindle abnormalities. When vitrification method using ethylene glycol (EG)-based cryoprotectants and electron microscopy (EM) grid were used on human oocytes, higher rate of post-thawed egg survival and subsequent embryo development were observed.

Population-based incidence and mortality cancer trends (1986–1997) from the network of Italian cancer registries

The objective of this study was to analyse incidence and mortality cancer trends in the Italian Network of Cancer Registries (about 8,000,000 inhabitants) during the period 1986-1997. Included were 525,645 newly diagnosed cancers and 269,902 cancer deaths (subjects > 14 years). Joinpoints (points in time where trend significantly changes from linearity) were found and estimated annual percentage changes (EAPC) used to summarize tendencies. Overall cancer incidence increased in both sexes and cancer mortality significantly decreased (since 1991 among men). Lung cancer showed significantly decreasing incidence (EAPC = -1.4%) and mortality (EAPC = -1.6%) among men and increasing trends among women. In women, breast cancer incidence significantly increased (EAPC= +1.7%) and mortality decreased since 1989 (EAPC= -2.0%). Stomach cancer incidence and mortality decreased in both sexes. Prostate incidence sharply increased since 1991 and mortality decreased. Colon cancer incidence increased and rectum mortality decreased significantly in both sexes. Significant increases in incidence were also found for kidney (up to 1991 among men), urinary bladder, skin epithelioma, melanoma, liver (up to 1993 among men), pancreas, mesothelioma, Kaposi's sarcoma (up to 1995 among men), testis, thyroid, non-Hodgkin's lymphomas and multiple myeloma. Mortality significantly decreased for cancers of the oral cavity and pharynx, oesophagus, liver (women), larynx (men), bone, cervix (since 1990), central nervous system, urinary bladder, thyroid, Hodgkin's lymphomas and leukaemias (men). Non-Hodgkin's lymphoma mortality increased in both sexes. In conclusion, most of the changes seen can be explained as the effect of changes in smoking habits and of the extension of secondary prevention activities. The Italian health care system will also have to cope with growing cancer diagnostic and therapeutic needs due to population ageing.

Continued increase in the incidence of childhood Type 1 diabetes in a population-based Australian sample (1985-2002).

Our aim was to determine the incidence of Type 1 diabetes in children who were 0 to 14 years of age in Western Australia from 1985 to 2002, and to analyse the trends in incidence rate over the same period. Primary case ascertainment was from a prospective population-based diabetes register that was established in 1987, and secondary case ascertainment was from the Western Australia Hospital Morbidity Data System. Denominator data were obtained from the Australian Bureau of Statistics. Poisson regression was used to analyse the incidence rates by calendar year, sex and age at diagnosis. There was a total of 1144 cases (560 boys, 584 girls). Using the capture-recapture method, case ascertainment was estimated to be 99.8% complete. The mean age standardised incidence from 1985 to 2002 was 16.5 per 100,000 person years (95% CI 14.7-18.2), ranging from 11.3 per 100,000 in 1985 to 23.2 per 100,000 in 2002. The incidence increased on average by 3.1% (95% CI 1.9%-4.2%) a year over the period ( p<0.001). No significant difference was found between boys and girls. A significant increase in incidence was found in all age groups, with no disproportionate increase found in the 0 to 4-year-olds. The incidence of childhood-onset Type 1 diabetes in Western Australia has increased significantly over the past 18 years and shows no signs of abating. In contrast to other studies, a higher rate of increase was not found in the youngest children.

Relationships Between the Deinstitutionalization of Healthcare for Patients with Mental Disorder, Substance Abuse, and Isolated Death

Isolated death (ID) (i.e., dying alone without anyone noticing for several days) has been suggested to be related to social isolation, mental disorder, and alcohol and/or drug abuse. A major transfer of patients with a mental disorder and/or alcohol and/or drug abuse from institutionalized care to treatment as outpatients has been enacted in Sweden during the past decade. On the basis of the assumption that such deinstitutionalization is likely to result in increased social isolation, our working hypothesis was that the incidence of ID among patients belonging to these categories has increased in Sweden. The present study involved all deaths subjected to a medicolegal examination in Stockholm County (with a population of approximately 1.9 million people) during the period 1992-2000. The pattern of ID (defined as cases involving a postmortem delay between death and discovery of at least 1 week), as well as the incidence of fatalities subjected to medicolegal examination with a record of mental disorder and/or alcohol and/or drug abuse was evaluated. Throughout this period, the proportion of the deceased with a record of a mental disorder was high among all the cases examined and higher still among the cases of ID, especially among those younger than 65 years of age. There was a rather limited increase in the incidence of ID and a much more pronounced increase in the number of former psychiatric patients whose deaths were subjected to medicolegal examination, but did not satisfy the criteria for ID. A record of alcohol and/or drug abuse was more common than a diagnosis of mental disorder among both the males and females who died at an age of less than 65, with a clear difference between the cases of ID and non-ID in the case of men. There was no significant increase in incidence over the course of this study. Thus, this study reveals a slight increase in the number of IDs and a more pronounced increase in the number of medicolegal examination of non-IDs of individuals with a record of a mental disorder.

Hip fracture incidence in central norway: a followup study.

Studies in the 1980s, including one from central Norway, in most cases showed that the incidence of hip fractures was increasing. In the 1990s, however, studies from Sweden and the United States indicated that the increase may have stopped. We report the current incidence of hip fractures in subjects in central Norway and compare it with that previously reported. The number of cervical and trochanteric fractures in a defined region of Central Norway in 1992 to 1993 and in 1997 to 1998 was found by a thorough search and collation of the hand written surgery reports, the reports from radiology departments, and hospital discharge reports. One thousand three hundred twelve hip fractures were sustained during 1997 to 1998, 10% more than in the preceding period. This was almost entirely attributable to aging of the population. In contrast to the highly statistically significant increase in the actual incidence of 2% per year previously reported between 1972 to 1973 and 1983 to 1984, there was no statistically significant increase in incidence between 1983 to 1984 and 1997 to 1998 (0.55% per year). The incidence of hip fractures was 18% higher in subjects in urban areas than in subjects in rural areas in 1992 to 1993, and 33% higher in 1997 to 1998. Whereas the proportion of trochanteric fractures was 32% in 1972 to 1973 and in 1983 to 1984, it increased to 44% in 1992 to 1993 and to 68% in 1997 to 1998. There has been an insignificant increase in hip fracture incidence since 1983 to 1984. The lower incidence of hip fractures in subjects in rural areas persists, and there has been a dramatic increase in the proportion of trochanteric fractures.