Trends In Annual Incidence Research Articles

The potential for organ donation in Iceland: A nationwide study of deaths in intensive care units.

The deceased organ donation rate in Iceland has been low compared with other Western countries. The aim of this study was to explore the potential for organ donation after brain death in Iceland. Observational cohort study of patients with catastrophic brain injury who died in intensive care units (ICUs) at hospitals in Iceland in 2003-2016. Medical records were retrospectively reviewed to identify potential donors (PDs), using the WHO Critical Pathway for Deceased Donation. Trends in annual incidence of PDs, conversion to actual donors, and family refusals were assessed. Among 1537 patients who died in the ICU, 125 (8.1%) were identified as PDs. Of 103 PDs who were declared brain dead, consent for organ donation was pursued in 84 cases and granted in 63. Fifty-six became actual donors. The annual donation rate averaged 13 per million population (pmp), but rose abruptly in the final 2years to 36 and 27 pmp, respectively. This was paralleled by an increase in annual incidence of PDs from an average of 28 pmp to 54 and 42 pmp, respectively. The donor conversion rate increased during the study period (P=.026). Twenty-three PDs (18%) were not pursued without an apparent reason. The donation rate increased markedly in the last 2years of the study period after remaining low for more than a decade. This change can largely be explained by a high incidence of PDs and a low family refusal rate. Missed donation opportunities suggest a potential to maintain a high donation rate in the future.

Incidence, Admission Rates, and Economic Burden of Adult Emergency Visits for Chronic Pancreatitis

Chronic pancreatitis (CP) is a common reason for emergency department (ED) visits, but little research has examined ED use by patients with CP. The Nationwide Emergency Department Sample (2006 to 2012) was interrogated to evaluate trends in adult ED visits for a primary diagnosis of CP (International Classification of Disease, 9th revision, Clinical Modification code: 577.1), the rates of subsequent hospital admission, and total charges. A survey logistic regression model was used to determine factors associated with hospitalization from the ED. We identified 253,753 ED visits with a primary diagnosis of CP. No significant trends in annual incidence were noted. However, the ED-to-hospitalization rates decreased by 3% per year (P<0.001) and mean ED charges after adjusting for inflation increased by 11.8% per year (P<0.001). Higher Charlson comorbidity index, current smoker status, alcohol use, and biliary-related CP were associated with hospitalization. In hospitalized patients, length of stay decreased by 2.2% per year (P=0.003) and inpatient charges increased by 2.9% per year (P=0.004). Patient characteristics associated with higher risk of hospitalization from the ED deserve further attention.

Prehospital characteristics, incidence trends, and outcome of emergency self-inflicted injury patients with gas substances: a population-based descriptive study in Osaka, Japan.

AimLittle is known about the detailed characteristics of patients using gas substances for self‐inflicted injury in prehospital settings. The aim of this study was to investigate the characteristics, incidence trends, and outcomes of patients who used gas substances for self‐inflicted injury in Osaka City, Japan, using ambulance records.MethodsThis was a retrospective observational study that used data from 2009 to 2015. We extracted details from ambulance records of self‐inflicted injury patients who used gas substances. The annual incidence of self‐inflicted injury by gas substance and age group and Poisson regression models were applied for calculating the annual incidence trend by type of gas substance. The main outcome was confirmed death at the scene, and we also calculated the crude odds ratios and 95% confidence intervals for each gas substance.ResultsDuring the study period, there were 324 self‐inflicted injury patients who used gas substances. The most commonly used gases were carbon monoxide (CO) (54.9%), followed by hydrogen sulfide (12.7%), helium (6.5%). The incidence of CO and hydrogen sulfide have subsequently decreased (P for trend = 0.023 and <0.001, respectively); however, the incidence of helium did not change during the study period (P for trend = 0.586). The mortality rate was highest in patients who used helium (66.7% [14/21]) and the crude odds ratio of helium was 3.857 (95% confidence interval, 1.267–11.745; P = 0.017) compared with hydrogen sulfide.ConclusionThis study revealed that the incidence of self‐inflicted injury with helium did not change and its proportion of death at the scene was high in Osaka City.

Cartilage Restoration Surgery: Incidence Rates, Complications, and Trends as Reported by the American Board of Orthopaedic Surgery Part II Candidates

To evaluate the current status of advanced cartilage restoration procedures among newly trained orthopaedic surgeons in the United States. The American Board of Orthopaedic Surgery database was queried to identify all advanced cartilage restoration procedure cases submitted by American Board of Orthopaedic Surgery part II board certification examination candidates from 2003 to 2015. All documented autologous chondrocyte implantation, autologous osteochondral transfer, osteochondral allograft transplantation, and marrow stimulation techniques (MSTs) procedures were analyzed. Analysis was performed to describe trends in annual incidence, types of complications, concomitant procedures, and geographical differences in incidence of advanced cartilage procedures. From 2003 to 2015, a total of 2,827 surgeons submitted 7,522 cartilage restoration procedures, with 7,060 cases documented as MST (80.01%). The number of cartilage cases decreased significantly from 2003 to in 2015 (P <.001), with MST having the largest decline (P < .001). The incidence of open osteochondral allograft transplantation (odds ratio= 1.35; P= .023) and open autologous osteochondral transfer (odds ratio= 0.84; P= .004) increased over the study period. Overall, the majority of patients (57.0%) were male; however, female patients were on average significantly older than male patients (P < .001). Cartilage procedures were performed concomitantly with a realignment osteotomy procedure in 1.7% of cases. The incidence of surgical complications increased throughout the study period from 2.9% in 2003 to 9.5% in 2015 (P<.001). Cartilage restoration procedures, specifically MSTs, are being decreasingly performed among recently trained orthopaedic surgeons. In contrast, complication rates have been increasing since 2003, demonstrating a possible paradigm shift toward more complex cartilage procedures, specifically osteochondral grafting procedures. This study demonstrates a significant decline in the use of MSTs by recently trained orthopaedic surgeons. In addition, an increase in several more complex cartilage restoration procedures was found. Taken in sum, these changes may reflect a shift in residency and fellowship training away from marrow stimulation procedures that elicit a fibrocartilage reparative tissue and toward more complex procedures that provide a more hyaline-like articular cartilage surface.

Health seeking behavior of patients in Muzaffarpur-TMRC Health and Demographic Surveillance Site may obstruct Kala-azar elimination in Bihar, India

Background: Muzaffarpur-TMRC Health and Demographic Surveillance System (HDSS) is a dedicated platform for visceral leishmaniasis (VL) research established in 2008 in Muzaffarpur district of Bihar state in India. In the 50 VL endemic villages of the HDSS, annual household surveys are conducted and all VL patients are registered and interviewed. We use the HDSS dataset to get more insight into the healthcare seeking behavior of VL patients. Methods & Materials: From the available data we extracted information on number and types of health providers consulted by VL patients, diagnosis and treatment prescribed; and individual and health system delay. We performed the trend analysis to study changes occurred in the health seeking behavior of the villagers over a period of 8 years. Results: Between March 2007 and July 2015, 332 VL cases were registered (185 men (56%) and 147 women (44%)). We observed declining trend in annual incidence (15 per 10000 in 2007 to 0.82 in 2014). Most patients (73%) first consulted unqualified providers; only 3% opted government hospitals. Mean patient delay was 7.3 days and on average each patient visited more than three health facilities before being diagnosed. These trends did not improve much over the study period. During the course of health seeking, only 17% of the time government hospitals were consulted. Mean total health system delay (constituted as diagnosis delay: 37.7 days + treatment delay 6.3 days) was 44 days. Patients (93.7%) were diagnosis by rK39 rapid test, Amphotericin-B (45.5%) and Miltefosine (23.5%) were the most common treatments while 19.3% received some combination therapy, 11.8% received abandoned antimonial treatment. Of 332 patients, though 35.5% were diagnosed at public hospitals, only 22.3% of them took final treatment there. Remaining patients moved to either NGOs (47%) or private qualified doctors (30.72%). Conclusion: Incidence of VL in the HDSS area sharply declined over the past 8 years. Patients usually present early but mostly to unqualified providers despite free diagnosis, treatment and wage loss compensation provided by public hospitals. They still incur alarmingly long health system's delays which increases risks for further transmission of infection.

Epidemiology of Robin sequence with cleft palate in the East of Scotland between 2004 and 2013.

Robin sequence (RS) is a congenital disorder characterized by cleft palate, micrognathia, and glossoptosis which can result in clinically significant upper airway obstruction (UAO). Historically, incidence of RS in the UK has been estimated as 1 in 8500 live births. Our study describes birth prevalence, clinical characteristics, and management of RS in the East of Scotland (EoS) region. Retrospective case note review of infants born in EoS from 2004 to 2013 with a clinical diagnosis of RS. Cases were identified by searching the regional cleft service patient database and review of Hospital Activity Statistics data. Regional live birth rate provided the denominator for incidence calculations. A total of 105 cases of RS were identified, giving a birth prevalence of 1:2685 live births. No trends in annual incidence were observed over the 10-year period. Intrauterine exposure to potentially teratogenic agents was identified in 17% cases, including Methadone in 8% cases. Signs of UAO were present in 93% of infants, 63% of whom required active airway management. Nasopharyngeal airway (NPA) was the most commonly used intervention (53% cases), whilst only 7% required surgical management. Infants with an underlying syndrome or additional anomalies (RS+) were significantly more likely to be admitted to a tertiary center and require surgical airway or feeding support compared to those with isolated RS. RS incidence in EoS is substantially higher than that reported within other populations, and than previously reported in the UK. A possible association with intrauterine Methadone exposure warrants further investigation.

Trends in the Surgical Management of Acromioclavicular Joint Arthritis Among Board-Eligible US Orthopaedic Surgeons

(1) Define the epidemiologic trend of distal clavicle excision (DCE) for acromioclavicular (AC) joint arthritis among board-eligible orthopaedic surgeons in the United States, (2) describe the rates and types of reported complications of open and arthroscopic DCE, and (3) evaluate the effect of fellowship training on preferred technique and reported complication rates. The American Board of Orthopaedic Surgery (ABOS) database was used to identify DCE cases submitted by ABOS Part II Board Certification examination candidates. Inclusion criteria were predetermined using a combination of ICD-9 and CPT codes. Cases were dichotomized into 2 groups: open or arthroscopic DCE. The 2 groups were then analyzed to determine trends in annual incidence, complication rates, and surgeon fellowship training. From April 2004 to September 2013, there were 3,229 open and 12,782 arthroscopic DCE procedures performed and submitted by ABOS Part II Board Eligible candidates. Overall, the annual incidence of open DCE decreased (78-37 cases per 10,000 submitted cases, P= .023). Although the annual number of arthroscopic DCE remained steady (1160-1125, P= .622), the percentage of DCE cases performed arthroscopically increased (65%-79%, P= .033). Surgeons without fellowship training were most likely to perform a DCE via an open approach (31%) whereas surgeons with sports medicine training were more likely to perform DCE arthroscopically compared with other fellowship groups (88%, P<.001). Open DCE was associated with a higher surgical complication rate overall when compared with arthroscopic DCE (9.4% vs 7.6%, respectively; P < .001). When compared with other fellowship-trained surgeons, sports medicine surgeons maintained a lower reported surgical complication rate whether performing open or arthroscopic DCE (5.5%, P= .027). In recent years, open management of AC joint arthritis has declined among newly trained, board-eligible orthopaedic surgeons, possibly because of an increased complication rate associated with open treatment. Fellowship training was significantly associated with the type of treatment (open vs arthroscopic) rendered and complication rates. Level IV, case series.

Increasing incidence of optic nerve hypoplasia/septo-optic dysplasia spectrum: Geographic clustering in Northern Canada.

Owing to the shared embryonic origin, defects in development of optic nerves are often seen in conjunction with defects affecting the surrounding brain and pituitary gland. Optic nerve hypoplasia (ONH) and septo-optic dysplasia (SOD) represent a clinical spectrum associated with visual, pituitary and severe central nervous system structural abnormalities (SODplus). Based on changing clinical patterns, our primary objective was to examine trends in annual incidence of ONH/SOD and geographical clustering in Manitoba. This was a retrospective 1996 to 2015 chart review with extraction of anthropometric measures, radiologic findings, parental characteristics, endocrinopathies and neurologic symptoms from all involved in care. Postal codes were used to assign map co-ordinates and identify relevant census-based deprivation indices. Ninety-three children were identified in our catchment area; Poisson regression confirmed a striking 1.11-fold annual increase (95% confidence interval 1.07 to 1.16) or ~800% over two decades. The annual incidence (averaged 2010 to 2014 chart data) reached 53.3 per 100,000, affecting 1 in 1875 live births. Most (~55%) had SODplus. Common presenting features were hypoglycemia, nystagmus, seizures and developmental delay; 40% had hormone deficiencies; 80% had reduced visual acuity, typically bilateral. Many were premature with young, primiparous mothers. Unhealthy maternal lifestyles and severe material deprivation were noted. There was disproportionate clustering in individuals from Northern Manitoba at three times the average provincial rate. We noted a dramatic rise in the annual incidence of ONH/SOD, which was strongly associated with poverty and northern communities. The pattern was consistent with environmental or nutritional etiologies. Many children were severely affected with increased morbidity and health care burdens.

Acute coronary syndrome in women: rising hospitalizations in middle-aged French women, 2004-14.

We aimed to analyse trends in annual incidence of hospitalized acute coronary syndrome (ACS) in France from 2004 to 2014. Primary diagnosis of ACS and subtypes on admissions were selected in national and exhaustive French Hospitalization Database from 2004 to 2014. Age-standardized rates were computed using standardization on the census of the 2010 European population and mean annual percent changes were estimated by using Poisson regression model. In 2014, 113 407 patients, 36 480 women (32.2%) and 76 927 men (67.8%) were hospitalized for ACS. Among women, the proportion aged under 65 years was 25.2% (n = 9206) and there was 34.4% of STEMI, 18.2% of NSTEMI and 47.4% of UA. From 2004 to 2014, the rates of age-standardized admissions for ACS in women less than 65 years old increased by 6.3%.This rise in ACS was driven by significant increases in STEMI (+21.7%) and NSTEMI (+53.7%). The largest increase in STEMI mean annual percent change was observed among women aged 45-54 years old (+3.6%/per year). After 65 years of age, significant decreases in all ACS types were observed. This nationwide study showed substantial rising trends in STEMI annual incidence, especially among younger women. This increase could be attributed to increase in smoking and obesity. Efforts to strengthen primary prevention of CVD in younger women is needed as the main risk factors are modifiable, and as there is a growing evidence of higher short-term mortality of CHD in women.

Epidemiologic characteristics and risk factors for congenital hypothyroidism from 1989 to 2014 in Beijing

To investigate the epidemiologic characteristics and risk factors for congenital hypothyroidism (CH) in Beijing between the years 1989 and 2014. Information on neonatal screening, and diagnoses and treatment of CH from 1989 to 2014 were obtained from the database of the Beijing Neonatal Screening Center. The screening parameter was thyroid-stimulating hormone (thyrotropin; TSH), which was measured by radioimmunoassay (RIA) from 1989 to 1995, enzyme-linked immunosorbent assay (ELISA) from 1996 to 2003, and time-resolved fluorescence immunoassay (DELFIA(®)) from 2004 to 2014. The cutoff value of each screening method was set as the international standard for the corresponding years (20 mIU/L from 1989 to 1995 and 10 mIU/L from 1996 to 2014). CH was diagnosed using "The Technical Specification of Diagnosis and Treatment of Phenylketonuria and Congenital Hypothyroidism" , published in 2010 by the Ministry of Health of the People's Republic of China. Data on live birth infants were obtained from Beijing obstetric quality reports. The incidence of CH using different screening methods was compared, and trends in annual incidence were analyzed. To exclude the influence of different screening methods, data from the years 2004 to 2014 were used to identify the risk factors for CH. Between 1989 and 2014, the incidence of CH in Beijing was 36.7 per 100 000 individuals, with permanent CH (PCH) and transient CH (TCH) having incidences of 16.4 per 100 000 and 15.9 per 100 000, respectively. The annual incidence of CH increased from 11.2 per 100 000 in 1989 to 51.0 per 100 000 in 2014 (χ(2)=119.02, P<0.001), with PCH increasing from 5.6 to 16.0 per 100 000 (χ(2)=34.38, P<0.001) and TCH increasing from 5.6 to 13.0 per 100 000 (χ(2)=26.93, P<0.001). Among the PCH cases, 70.44% (255/362) were thyroid dysgenesis or ectopic glands, while the other 29.56% (107/362) were dyshormonogenesis. Between 2004 and 2014, the incidence of CH in females (51.7/100 000) was higher than in males (37.0/100 000), and it was higher in post-term (334.5/100 000) and preterm births (77.8/100 000) than that in term births (41.4/100 000). It was also higher in the low birth weight (87.7/100 000) than the normal (42.4/100 000) and high birth weight (42.6/100 000) populations. Between 1989 and 2014, there was a tendency towards an increase in the overall incidence of CH, and the incidence of both PCH and TCH in Beijing. Female sex, preterm birth, older gestational age, low birth weight, and preterm birth were risk factors affecting the incidence of CH in Beijing.

Trends in Bone-Block Augmentation Among Recently Trained Orthopaedic Surgeons Treating Anterior Shoulder Instability.

Shoulder instability is a common entity requiring surgical stabilization. Although arthroscopic soft-tissue stabilization has been the most common surgical treatment, increased attention is now being paid to Latarjet coracoid transfers and bone-block augmentation, particularly with glenoid bone loss. The purpose of this work was to evaluate the current status of arthroscopic soft-tissue stabilization and bone-block augmentation stabilization techniques among newly trained orthopaedic surgeons in the United States. The American Board of Orthopaedic Surgery (ABOS) database was utilized to identify shoulder instability cases submitted by ABOS Part-II Board Certification examination candidates. Cases were dichotomized into two groups: isolated soft-tissue stabilizations and bone-block augmentation procedures, including coracoid transfer. The two groups were then analyzed to determine trends in annual incidence, complication rates, types of complications, concomitant procedures, surgeon fellowship training, and geographic region of practice. From 2004 to 2013, 6,854 surgeons submitted 7,587 shoulder instability surgical cases that met all inclusion criteria. Of these, 7,515 (99.1%) were isolated soft-tissue stabilizations, and 72 (0.95%) were bone-block glenoid augmentations. Surgeons with sports medicine fellowship training performed 61.85% of isolated soft-tissue stabilization procedures and 58.33% of bone-block stabilization procedures. The percentage of stabilization cases that utilized bone-block augmentation increased tenfold from 0.14% to 1.4% (p = 0.029) during the study period. The overall annual incidence of isolated soft-tissue stabilizations (p = 0.037) and bone-block procedures (p = 0.016) increased from 2004 to 2013. Although the complication rate of the bone-block procedures remained steady (mean rate, 20.8%; p = 0.932), the isolated soft-tissue stabilization complication rate rose from 4.9% to 9.0% (mean rate, 5.4%; p = 0.003). A trend exists toward increased utilization of bone-block stabilization for the treatment of shoulder instability among recently trained orthopaedic surgeons. Complication rates remained relatively high (20.8%) for these procedures, but did not increase as was seen with the isolated soft-tissue stabilizations. Residency and fellowship programs should continue to focus on methods to optimize training for these procedures. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Increasing Incidence of Optic Nerve Hypoplasia/ Septo-Optic Dysplasia Spectrum: Geographic Clustering in Northern Canada

Abstract BACKGROUND: Since optic nerves and pituitary gland are embryologi-cally related, optic nerve hypoplasia (ONH) and septo-optic dysplasia (SOD) represent a clinical spectrum associated with visual impairment, pituitary deficiencies, and severe CNS structural malformations(SODplus). ONH is a leading cause of pediatric blindness in North America; genetic mutations are rarely observed. We recently perceived an increase in the number of children with SOD in our clinic. Similarly, several studies have reported a rise in the incidence of ONH/SOD in other jurisdictions. OBJECTIVES: Our primary objectives were to examine trends in annual incidence in Manitoba and geographical clustering in our catchment area ofManitoba, NW Ontario and Nunavut. DESIGN/METHODS: This was a retrospective 1996-2015 chart review from all medical services (Neurology, Ophthalmology, Endocrinology, Genetics) caring for these children to extract information pertaining to anthropometric measures, radiologic findings, parental characteristics, endocrinopathies, and neurologic symptoms. Postal codes were used to assign map co-ordinates and census-based material and social deprivation indices. Numbers of children from Manitoba only were used to calculate annual incidence. From 2010-2014, a Quality Assurance (QA) sub-study identified all pediatric radiology reports containing the words 'optic nerve'; the additional cases of ONH/SOD children not identified by chart review were used to better define the true incidence in Manitoba. RESULTS: Ninety-three children were identified in our catchment area by chart review; Poisson regression confirmed a striking 1.11-fold annual increase (95%CI=1.07-1.16) or ~800% over two decades. The annual incidence (averaged 2010-2014) reached 53.3 per 100,000 affecting 1 in 1875 live births (chartdata). Including children identified by QA sub-study, the incidence rose to 113.3 per 100,000 live births in Manitoba. These are much higher than previously reported. Most children (~60%) had SODplus. Common presenting or follow-upfeatures were hypoglyce-mia, nystagmus, seizures, and developmental delay (50%); 40% had hormone deficiencies; 80% (75/93) had reduced visual acuity, typically bilateral. Many childrenwere born prematurelywith young (mean 21y: IQR 19-26y), primiparous mothers. Unhealthy maternal lifestyles and severe material deprivation were noted. There wasdisproportionate clustering in Northern Manitoba (3 times the average provincial rate) and in Nunavut. CONCLUSION: We noted a dramatic rise in the annual incidence of ONH/SOD in Manitoba, NW Ontario and Nunavut, which is much higher than previous reports. This disorderwas strongly associated with poverty in northern communities. The temporal picture was consistent with environmental, nutritional, or toxic etiologies. About half of the children were severely affected with increased morbidity and health care burdens.

Temporal Trends in Outcomes after Out-of-Hospital Cardiac Arrests Witnessed by Emergency Medical Services in Japan: A Population-Based Study

Objective: Survival after out-of-hospital cardiac arrests (OHCA) witnessed by emergency medical service (EMS) personnel has been insufficiently understood. The aim of this study was to evaluate temporal trends in survival after EMS-witnessed OHCAs in Japan. Methods: A nationwide, population-based, observational cohort study of consecutive adult OHCA patients with emergency responder resuscitation attempts from January 2005 to December 2012 in Japan. We assessed the trends in annual incidence, characteristics, and outcomes of OHCA patients witnessed by EMS personnel. Multiple logistic regression analysis was used to assess factors that were potentially associated with neurologically favorable outcome defined as cerebral performance category scale 1or 2. Results: During the study period, a total of 66,760 EMS-witnessed OHCAs were documented. The annual incidence rates per 100,000 persons of EMS-witnessed OHCA patients increased from 4.6 (n = 7219) in 2005 to 4.9 (n = 9256) in 2012 (p for trend = 0.035). The proportion of one-month survival with neurologically favorable outcome improved from 5.9% in 2005 to 8.6% in 2012 (p for trend < 0.001), and the proportion increased from 22.1% in 2005 to 30.2% in 2012 in cases with shockable rhythm (p for trend < 0.001). In a multivariate analysis, adults, male gender, shockable rhythm, presumed cardiac origin, and year were associated with a better neurological outcome. Conclusions: In this population, the proportion of one-month survival with neurologically favorable outcome among OHCA patients witnessed by EMS personnel significantly improved during the study period.

Worldwide Inverse Association between Gastric Cancer and Esophageal Adenocarcinoma Suggesting a Common Environmental Factor Exerting Opposing Effects.

The incidence of esophageal adenocarcinoma (EAC) is increasing while adenocarcinoma of the stomach is decreasing. We have investigated whether the incidences of these two cancers and their time trends might be inversely related pointing to a common environmental factor exerting opposite effects on these cancers. For cross-sectional analyses data were abstracted from "Cancer Incidence in Five Continents" (CI5) Volume X and GLOBOCAN 2012. Relevant ICD-10 codes were used to locate esophageal and gastric cancers anatomically, and ICD-O codes for the histological diagnosis of EAC. For longitudinal analyses, age standardized rates (ASRs) of EAC and total gastric cancer (TGC) were extracted from CI5C-Plus. Estimated (2012) ASRs were available for 51 countries and these showed significant negative correlations between EAC and both TGC (males: correlation coefficient (CC)=-0.38, P=0.006, females: CC=-0.41, P=0.003) and non-cardia gastric cancer rates (males: CC=-0.41, P=0.003 and females: CC=-0.43, P=0.005). Annual incidence trends were analyzed for 38 populations through 1989-2007 and showed significant decreases for TGC in 89% and increases for EAC in 66% of these, with no population showing a fall in the latter. Significant negative correlation between the incidence trends of the two cancers was observed in 27 of the 38 populations over the 19-50 years of available paired data. Super-imposition of the longitudinal and cross-sectional data indicated that populations with a current high incidence of EAC and low incidence of gastric cancer had previously resembled countries with a high incidence of gastric cancer and low incidence of EAC. The negative association between gastric cancer and EAC in both current incidences and time trends is consistent with a common environmental factor predisposing to one and protecting from the other.

6: Towards Pulse Oximetry Screening in Ontario, Canada: What is the Burden of Missed Critical Congenital Heart Disease?

Pulse oximetry screening (POS) for critical congenital heart disease (CCHD) in newborns is gaining acceptance in clinical practice. The geographical setting of Ontario in relation to its vast yet sparsely populated regions presents unique challenges with regards to POS implementation. Evaluate the incidence of missed CCHD cases and the trends over time in Ontario, Canada over 10 years as a first step towards consideration of POS. Data from multiple, linked, administrative health and demographic datasets were used to determine the annual incidence of total and missed cases of CCHD in Ontario from 2002–11, along with baseline demographics including designated level of birth hospital. Patients discharged home prior to diagnosis of CCHD were considered to have “missed CCHD” and were further subcategorized into “definitely missed” [1 of 9 pre-determined severest CCHDs and re-admission within 30 days or death] and “possibly missed” [1 of 6 less severe CCHDs requiring readmission in first year of life resulting in either cardiac intervention or death]. Annual trends in incidence of missed CCHD were evaluated during study period. Of 1,343,850 total births in Ontario during the study period, 2787 (0.21%) had a diagnosis of CCHD and 438 (15.7%) cases of CCHD were missed. Of these 438 patients, 66 were definitely and 372 were possibly missed CCHD cases and the proportion delivered in hospitals without neonatal intensive care capability was 77.3% and 82.5%, respectively. There was no discernible change in the incidence of missed CCHD cases over the ten year period. Despite a low overall incidence of CCHD, a significant proportion of CCHD cases were not diagnosed prior to discharge home, and the vast majority were delivered in non-tertiary hospitals. Further research is required to evaluate the logistical and economic impact of POS implementation in Ontario in light of these data.

The Descriptive Epidemiology of Yersiniosis: A Multistate Study, 2005–2011

Yersiniosis, a foodborne infection of zoonotic origin caused by the bacteria Yersinia enterocolitica and Yersinia pseudotuberculosis, is a reportable disease in 38 states. Both sporadic and foodborne outbreaks of yersiniosis have been reported in the U.S., with annual occurrence of an estimated 98,000 episodes of illness, 533 hospitalizations, and 29 deaths. We analyzed surveillance data from nine non-FoodNet-participating U.S. states during the period 2005-2011 to describe the epidemiology of this disease. As part of a passive surveillance system, laboratory-confirmed cases of yersiniosis were reported to state health departments in Arizona, Illinois, Michigan, Missouri, Nebraska, North Carolina, South Carolina, Washington, and Wisconsin. We calculated overall, age-, and race-specific annual incidence rates per 100,000 population using 2010 Census data as the denominator. We used Poisson regression to examine seasonal variation and annual incidence trends by race, age group, and overall. The average annual incidence of yersiniosis was 0.16 cases per 100,000 population during 2005-2011. We observed a statistically significant decreasing annual trend of yersiniosis incidence among African Americans <5 years of age (p<0.01), whereas white people aged 19-64 years (p=0.08) and Hispanic people (p=0.05) had an overall increasing annual incidence of yersiniosis. We observed higher incidence during October-December (p<0.01) and January-March (p=0.03) quarters among African Americans, whereas white people had a higher incidence during April-June (p=0.05). This multistate analysis revealed differences in the epidemiology of yersiniosis by race/ethnicity that may be useful for future research and prevention efforts. While this study was consistent with the FoodNet report in recognizing the high and declining incidence among African American children and winter seasonality among African Americans, our study also identified April-June seasonality among the white population.

Trends in the incidence and management of acute myocardial infarction from 1999 to 2008: get with the guidelines performance measures in Taiwan.

BackgroundThe American Heart Association Get With the Guidelines (GWTG) program has improved care quality of acute myocardial infarction (AMI) with important implications for other countries in the world. This study evaluated the incidence and care of AMI in Taiwan and assessed the compliance of GWTG in Taiwan.Methods and ResultsWe used the Taiwan National Health Insurance Research Database (1999–2008) to identify hospitalized patients ≥18 years of age presenting with AMI. The temporal trends of annual incidence and care quality of AMI were evaluated. The age‐adjusted incidence of AMI (/100 000 person‐years) increased from 28.0 in 1999 to 44.4 in 2008 (P<0.001). The use of guideline‐based medications for AMI was evaluated. The use of dual antiplatelet therapy (DAPT) increased from 65% in 2004 to 83.9% in 2008 (P<0.001). Angiotensin‐converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) was used in 72.6% in 2004 and 71.7% in 2008 (P=NS) and β‐blocker was used in 60% in 2004 and 59.7% in 2008 (P=NS). Statin use increased from 32.1% to 50.1% from 2004 to 2008 (P<0.001). The in‐hospital mortality decreased from 15.9% in 1999 to 12.3% in 2008 (P<0.0001). Multivariable analysis showed that DAPT, ACE inhibitor/ARB, β‐blocker, and statin use during hospitalization were all associated with reduced in‐hospital mortality in our AMI patients.ConclusionsAMI incidence was increasing, but the guideline‐based medications for AMI were underutilized in Taiwan. Quality improvement programs, such as GWTG, should be promoted to improve AMI care and outcomes in Taiwan.

Cholera Surveillance in Uganda: An Analysis of Notifications for the Years 2007–2011

Cholera outbreaks have occurred periodically in Uganda since 1971. The country has experienced intervals of sporadic cases and localized outbreaks, occasionally resulting in prolonged widespread epidemics. Cholera surveillance data reported to the Uganda Ministry of Health from 2007 through 2011 were reviewed to determine trends in annual incidence and case fatality rate. Demographic characteristics of cholera cases were analyzed from the national line list for 2011. Cases were analyzed by district and month of report to understand the geographic distribution and identify any seasonal patterns of disease occurrence. From 2007 through 2011, Uganda registered a total of 7615 cholera cases with 181 deaths (case fatality rate = 2.4%). The absolute number of cases and incidence per 100 000 varied from year to year with the highest incidence occurring in 2008 following heavy rainfall and flooding in eastern Uganda. For 2011, cholera cases occurred in 1.6 times more males than females. The geographical areas affected by the outbreaks shifted each year, with the exception of a few endemic districts. No clear seasonal trends in cholera occurrence were identified for this time period. We observed an overall decline in cases reported during the 5 years under review. During this period, concerted efforts were made by the Ugandan government and development partners to educate communities on proper sanitation and hygiene and provide safe water and timely treatment. Mechanisms to ensure timely and complete cholera surveillance data are reported to the national level should continue to be strengthened.

Trends in annual incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection in HIV-infected and HIV-uninfected patients.

We describe trends in incidence rates of methicillin-resistant Staphylococcus aureus (MRSA) in HIV-infected and HIV-uninfected patients enrolled in a large northern California Health Plan, and the ratio of MRSA to methicillin-susceptible S. aureus (MSSA) case counts. Between 1995 and 2010, 1549 MRSA infections were diagnosed in 14060 HIV-infected patients (11·0%) compared to 89546 MRSA infections in 6597396 HIV-uninfected patients (1·4%) (P = 0·00). A steady rise in MRSA infection rates began in 1995 in HIV-uninfected patients, peaking at 396·5 infections/100000 person-years in 2007. A more rapid rise in MRSA infection rates occurred in the HIV-infected group after 2000, peaking at 3592·8 infections/100000 in 2005. A declining trend in MRSA rates may have begun in 2008-2009. Comparing the ratio of MRSA to MSSA case counts, we observed that HIV-infected patients shouldered a greater burden of MRSA infection during most years of study follow-up compared to HIV-uninfected patients.

Childhood epilepsy recorded in primary care in the UK

ObjectiveTo examine temporal trends in the incidence of epilepsy recorded in UK primary care and to evaluate the impact of recent efforts to improve the specificity of diagnosis in children.DesignBirth...