Updated Incidence Research Articles

Estimates of the annual direct medical costs of the prevention and treatment of disease associated with human papillomavirus in the United States

Estimates of the direct medical costs attributable to human papillomavirus (HPV) can help to quantify the economic burden of HPV and to illustrate the potential benefits of HPV vaccination. The purpose of this report was to update the estimated annual direct medical costs of the prevention and treatment of HPV-associated disease in the United States, for all HPV types. We included the costs of cervical cancer screening and follow-up and the treatment costs of the following HPV-associated health outcomes: cervical cancer, other anogenital cancers (anal, vaginal, vulvar and penile), oropharyngeal cancer, genital warts, and recurrent respiratory papillomatosis (RRP). We obtained updated incidence and cost estimates from the literature. The overall annual direct medical cost burden of preventing and treating HPV-associated disease was estimated to be $8.0 billion (2010 U.S. dollars). Of this total cost, about $6.6 billion (82.3%) was for routine cervical cancer screening and follow-up, $1.0 billion (12.0%) was for cancer (including $0.4 billion for cervical cancer and $0.3 billion for oropharyngeal cancer), $0.3 billion (3.6%) was for genital warts, and $0.2 billion (2.1%) was for RRP.

Exposure to o-Toluidine, Aniline, and Nitrobenzene in a Rubber Chemical Manufacturing Plant: A Retrospective Exposure Assessment Update

The National Institute for Occupational Safety and Health previously conducted a retrospective cancer incidence and mortality study of workers employed at a rubber chemical manufacturing plant. Compared with New York State incidence, the bladder cancer risk was 6.5 times higher for workers considered to have definite exposure to ortho-toluidine and aniline, and 4 times higher for workers with possible exposure. Exposure characterization in the original study utilized a surrogate measure based only on departments in which each worker was ever employed. As part of an update of that study, some departments in the three original exposure groups were reclassified based on a follow-up site visit; interviews with employees, management, and union representatives; and review of records including exposure data. An additional evaluation of department-job combinations, rather than only departments, was used to stratify exposure into four categories. An approximate rank of “relative” exposure level for each department-job-year combination was also assigned using a ranking scale of 0 to 10. The ranks were supported by quantitative exposure levels and by professional judgment. The numerical ranking scale was applied to each worker by multiplying the exposure rank by duration for each job held based on comprehensive individual work histories. The cumulative rank scores for this cohort ranged from 0 to 300 unit-years. The medians of the cumulative rank scores for the exposure categories showed very good agreement with increasing exposure classifications (e.g., 0.72, 4.6, 11, 14 unit-years for the four exposure categories). Workers’ breathing zone air sampling data collected at this plant from 1976–2004 were well below published occupational exposure limits for these chemicals, but additional cases of bladder cancer have been reported. The exposure assessment revisions and rank estimates will be used to analyze the updated bladder cancer incidence data.

P-0168 Epidemiology of Gallbladder Cancer in Algeria

ABSTRACT Introduction Gallbladder cancer incidence is higher in women than in men in most areas of the world. It is a relatively rare neoplasm, Diagnosis is generally made when the cancer is already in advanced stages, and prognosis for survival is less than 5 years in 90% of cases. This study was designed to provide up-dated incidence figures for Gallbladder cancer in Setif at the period 1986-2008 adjusting for the effect of age, sex, and period of diagnosis and the geographical distribution. These datas are compared with standardized rates of Cancer Registries in Five Continents. Methods Cancer registry represents a data source. Cancer morphology and topography are coded in accordance of the international classification of diseases for oncology manual (ICD-O, the third edition). Results In Setif, Algeria, gallbladder cancer ranked third in the female population with the standardized incidence rates 8.1 /100.000 persons year for representing 8.9 % of all cases among women. The Gallbladder cancer touch the young woman from the age of 35 years to increase gradually with the age and reach a maximum in 70-74 years then the incidence increases quickly from 85 years with a median age at 62 years old. Conclusion Gallbladder cancer is an important public health problem in Algeria. Incidence and mortality have been declining in Algeria the last few decades, mainly due to the increasing frequency of cholecystectomy. More than 50% of new cases are the young women whose age is inferior at 50 years. It represents the second cause of mortality at women in Algeria it accounts 6000 deaths each year.

Updated fracture incidence rates for the Italian version of FRAX®

In order to update data underlying the Italian version of FRAX, we computed the national hip fracture incidence in Italy from hospitalization records for the year 2008. Mortality data and 10-year probabilities of major osteoporotic fractures were also updated. This revision will improve FRAX accuracy and reliability. The original Italian version of FRAX® was based on five regional estimates of hip fracture risk undertaken up to 20 years previously. Our objective was to update hip fracture rates for the model with more recently derived data from the whole Italian population and more recent data on mortality. We analyzed the Italian national hospitalization database for the year 2008 in order to compute age- and sex-specific hip fracture incidence rates. Re-hospitalisations of the same patients within 1 year were excluded from the analysis. Hip fracture incidence rates were computed for the age range of 40-100 years, whereas the original FRAX model lacked data on the youngest and oldest age groups. In addition, we used the national mortality data for the same year 2008 to update the model. Ten-year fracture probabilities were re-calculated on the basis of the new fracture incidence rates. The new hip fracture age- and sex-specific incidence rates were close to those used in the original FRAX tool, although some significant differences (not exceeding 25-30 %) were found for men aged 65-75 years and women under 55 years of age. In general, the revision resulted in decreased estimated 10-year probabilities in the younger age groups, whilst those in the older age groups were slightly increased. The Italian version of FRAX has been updated using the new fracture incidence rates. The impact of these revisions on FRAX is likely to increase the accuracy and reliability of FRAX in estimating 10-year fracture probabilities.

Updated Incidence of Progressive Multifocal Leukoencephalopathy in Natalizumab-Treated Multiple Sclerosis Patients Stratified by Established Risk Factors (S41.001)

Objective: To quantify progressive multifocal leukoencephalopathy (PML) risk in multiple sclerosis (MS) patients considering or receiving natalizumab using three risk factors: anti-JC virus (JCV) antibody positive serostatus, prior immunosuppressant use, and natalizumab treatment duration. Background PML, an opportunistic brain infection caused by JCV, occurs primarily in patients who are immunocompromised or have received immunomodulatory therapies, such as natalizumab. Anti-JCV antibody positive status, prior immunosuppressant use, and natalizumab treatment duration are PML risk factors in natalizumab-treated patients. Design/Methods: Data from natalizumab postmarketing sources and clinical studies were used to estimate PML incidence in natalizumab-treated MS patients by anti-JCV antibody status (positive or negative), prior immunosuppressant use (yes or no), and duration of natalizumab treatment (1–24 or 25–48 months). Results: As of September 2011, 159 PML cases were confirmed among 92,105 patients exposed to natalizumab in the postmarketing setting. PML risk was lowest in anti-JCV antibody negative patients (estimated at ≤0.10 per 1000 [95%CI:0–0.56] or ≤0.17 per 1000 [95%CI:0.00–0.94], assuming one hypothetical PML case testing anti-JCV antibody negative prior to diagnosis, and exposures ≥1 natalizumab dose or ≥18 natalizumab doses, respectively). PML risk was highest in patients with all three risk factors, anti-JCV antibody positive status, prior immunosuppressant use, and 25–48 months of natalizumab treatment (9.8 per 1000; 95%CI:7.0–13.4). Conclusions: This analysis, representing approximately 178,000 patient-years of natalizumab experience, demonstrates that discrete MS subpopulations can be identified at greater or lesser PML risk based upon the presence or absence of risk factors using an algorithm capable of discerning an approximate 100-fold difference in risk between the highest and lowest risk groups. The use of anti-JCV antibody status in this quantitative algorithm marks the first use of a safety biomarker for risk stratification to inform treatment decisions in MS. Studies are ongoing to further characterize the PML risks presented in this analysis. Supported by: Biogen Idec Inc. and Elan Pharmaceuticals, Inc. Disclosure: Dr. Bloomgren has received personal compensation for activities with Biogen Idec as an employee. Dr. Richman has received personal compensation for activities with Biogen Idec as employees.Dr. Richman holds stock and/or options in Biogen Idec, which sponsored research in which Dr. Richman was involved as an investigator. Dr. Hotermans has received personal compensation for activities with Biogen Idec as an employee.Dr. Hotermans holds stock and/or stock options in Biogen Idec which sponsored research in which Dr. Hotermans was involved as an investigator. Dr. Subramanyam has received personal compensation for activities with Biogen Idec as an employee. Dr. Subramanyam holds stock and/or stock options in Biogen Idec. Dr. Natarajan has received personal compensation for activities with Biogen Idec as an employee. Dr. Lee has received personal compensation for activities with Biogen Idec as an employee. Dr. Plavina has received personal compensation for activities with Biogen Idec as an employee.Dr. Plavina holds stock and/or stock options in Biogen Idec which sponsored research in which Dr. Plavina was involved as an investigator. Dr. Scanlon has received personal compensation for activities with Biogen Idec as an employee. Dr. Sandrock has received personal compensation for activities with Biogen Idec as an employee. Dr. Sandrock holds stock and/or stock options in Biogen Idec. Dr. Bozic has received personal compensation for activities with Biogen Idec. Dr. Bozic holds stock and/or stock options in Biogen Idec, which sponsored research in which Dr. Bozic was involved as an investigator. Dr. Bozic holds stock and/or stock options in Biogen Idec.

Tu1287 Factors Associated With 30-Day Readmissions in Patients With Inflammatory Bowel Disease (IBD): A Case-Control Study

Background and aims: The epidemiology of inflammatory bowel disease (IBD) is changing. In Europe, recent incidence and prevalence rates are lacking. The primary objective of this study is to update incidence and prevalence figures in a large well-phenotyped populationbased IBD cohort.Methods: All IBD patients living in the adherence area of 2 non-academic hospitals between 20042010 were identified. Patients were searched in 3 independent hospital databases case finding sources. 1378 Possible IBD cases were scrutinized, IBD diagnosis was based on established clinical, endoscopic and pathologic criteria. Location and behaviour of IBD was reported according to the Montreal classification. Results: 768 IBD patients were included. 255 (33.2%) patients were diagnosed with Crohn's disease (CD), 432 (56.3%) with ulcerative colitis (UC) and 81 (10.5%) with IBD-Unspecified (IBDU). The male-female ratio of IBD was 1:1.3 (P<0.001). The mean incidence for IBD was 28.0 per 100,000 inhabitants per year; 7.4 for CD, 17.4 for UC and 3.3 for IBD-U. The point prevalence on 01-01-2009 was 345.7 per 100,000 inhabitants; 113.3 for CD, 194.8 for UC and 37.6 for IBD-U. A peak in the mean age-specific incidence for CD was found at the age of 2125 years. For UC 3 peaks were found at the age of 2125, 5155, and 6165 years. In CD, 64 patients (25%) had ileitis without colitis, 91 patients (35.7%) had a colitis, 86 patients (33.7%) had an ileocolitis. 14 Patients (5.5%) had upper GI involvement. Nonstricturing, nonpenetrating behaviour of CD was found in 139 patients (54.5%), stricturing, nonpenetrating was found in 59 (23.1%) patients, penetrating was found in 53 (20.8%) patients. 118 UC patients (27.3%) had a proctitis, 189 patients (43.8%) a left-sided colitis and 124 patients (28.7%) a pancolitis. Male patients had a more extensive UC than female patients (P= 0.003). Conclusion: The population based incidence for IBD was: 28.0 per 100,000 inhabitants per year, with a point prevalence of 345.7 per 100,000 inhabitants. In UC, male patients have a more extensive colitis than female patients.

Self-guiding of a high velocity pilotless aircraft on the terminal flight leg in atmosphere

An algorithm for self-guiding of a high velocity aircraft with high aerodynamic quality on the terminal flight leg in the atmosphere is proposed. This algorithm provides guiding to a given spatial domain with required high accuracy and the conditions of approaching this domain in the case of uncertain aerodynamic characteristics of the aircraft and the action of a wide spectrum of uncontrollable factors of different physical nature. The algorithm consists in the formation of an updated incident trajectory using the data of a multispectral observation system. The results of simulation of the process of terminal guiding of a high velocity aircraft using the proposed algorithm in different conditions are presented; these results prove the possibility of achieving high terminal accuracy and weak sensitivity of the algorithm to the action of uncontrollable factors.

SP1-110 Lung cancer incidence and trends in Setif, Algeria between 1986 and 2008

BackgroundLung cancer is the most frequent malignant neoplasm among men in most countries and represents the most important cause of cancer death worldwide, it accounts for an estimated 960 000...

Sudden Cardiac Death in Athletes: Is Universal ECG Screening Plausible?

Abstract This article does not have abstract.

Abstract 3717: Evaluation and comparison of breast cancer risk prediction models for Hispanic and non-Hispanic white women in the Women's Health Initiative

Abstract Introduction: The National Cancer Institute (NCI) Breast Cancer Risk Assessment Tool (BCRAT) has not been previously validated for use in Hispanic women. We evaluated and compared BCRAT risk projections for Hispanic and non-Hispanic White (NHW) participants in the Women's Health Initiative (WHI). Methods: We used data on 6,248 Hispanic and 127,426 NHW post-menopausal WHI participants aged 50 years and older. Absolute risks of developing invasive breast cancer over the WHI main and extension studies were calculated using the BCRAT and an updated BCRAT using 1993-2007 SEER breast cancer incidence rates. We assessed model calibration by the ratio of observed to expected number of breast cancers (O/E ratio) and discriminatory accuracy with the concordance statistic (c-statistic). Results: In the WHI main study, the BCRAT underestimated the number of breast cancers in Hispanics (O/E ratio=1.18, 95% CI = 0.99, 1.40) and NHWs (O/E ratio=1.18, 95% CI = 1.14, 1.21). The updated BCRAT was well calibrated for Hispanics (O/E ratio=1.08, 95% CI = 0.91, 1.28) and NHWs (O/E ratio=0.98, 95% CI = 0.96, 1.01). The c-statistic was 0.629 (95% CI = 0.582, 0.676) for Hispanics and 0.575 (95%CI = 0.566, 0.583] for NHWs. In the WHI extension study, where women reported being screened less frequently, BCRAT overestimated risk in both Hispanics and NHWs. Conclusion: Underestimation of breast cancer risk by the BCRAT in Hispanic and NHW women was corrected by using updated SEER breast cancer incidence rates. Recalibrating the BCRAT with current SEER incidence rates and racial/ethnic specific relative risk estimates may improve the predictive accuracy for Hispanic women. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3717. doi:10.1158/1538-7445.AM2011-3717

Nutrient Intake and Anemia Risk in the Women's Health Initiative Observational Study

Background Nutrient-related anemia among postmenopausal women is preventable; recent data on prevalence are limited. Objective To investigate the association between nutrient intakes and anemia prevalence, in relation to both incidence and persistence, in a longitudinal sample of postmenopausal women. We hypothesized that anemia prevalence, incidence, and persistence would be greater among women reporting lower intake of vitamin B-12, folate, and iron. Design Prospective cohort analysis. Participants/setting The observational cohort of the Women's Health Initiative, including 93,676 postmenopausal women, aged 50 to 79 years, who were recruited across the United States at 40 clinical study sites. Women were enrolled between 1993 and 1998; data collection for these analyses continued through 2000. Main outcome measures Anemia was defined as a blood hemoglobin concentration of <12.0 g/dL (120.0 g/L). Persistent anemia was defined as anemia present at each measurement time point. Diet was assessed by food frequency questionnaire for iron, folate, B-12, red meat, and cold breakfast cereal; inadequacies were based on dietary reference intakes for women older than age 50 years. Statistical analysis Descriptive statistics (mean±standard deviation) were used to characterize the population demographics, anemia rates, and diet. Unconditional logistic regression was used to investigate associations between diet and incident and persistent anemia. Associations are presented as odds ratio and 95% confidence intervals. Results Anemia was identified in 3,979 (5.5%) of the cohort. Inadequate intakes of multiple anemia-associated nutrients were less frequent in non-Hispanic whites (7.4%) than other race/ethnic groups (inadequacies demonstrated in 14.6% to 16.3% of the sample). Age, body mass index, and smoking were associated with anemia. Women with anemia reported lower intakes of energy, protein, folate, vitamin B-12, iron, vitamin C, and red meat. Multiple (more than a single nutrient) dietary deficiencies were associated with a 21% greater risk of persistent anemia (odds ratio 1.21, 95% confidence interval 1.05 to 1.41) and three deficiencies resulted in a 44% increase in risk for persistent anemia (odds ratio 1.44, 95% confidence interval 1.20 to 1.73). Conclusions Inadequate nutrient intake, a modifiable condition, is associated with greater risk for anemia in postmenopausal women participating in the Observational Study of the Women's Health Initiative. Efforts to identify and update incidence estimates for anemia-associated nutrient deficiencies in aging women should be undertaken.

Incidence of Vaginal Cuff Dehiscence after Different Modes of Hysterectomy: A Follow-Up Study to a Single Institution's Experience

Study Objective: To update the incidence of vaginal cuff dehiscence after varying modes of hysterectomy, as well as to identify surgical and patient characteristics associated with cuff dehiscence.Design: Retrospective review.Setting: Large, urban, university teaching hospital.Patients: All women who underwent hysterectomy and had a vaginal cuff dehiscence repair from January 2006 until December 2009 at Magee-Womens Hospital (MWH) were analyzed, compared and combined with the prior data set (from 2000-2005) for a 10-year analysis.Intervention: Repair of vaginal cuff dehiscence.Tabled 1Incidence of vaginal cuff dehiscence (#dehiscences/#total hysterectomies)2000-20052006-20092000-2009All total hysts0.13 (9/6720)0.39 (19/4910)0.24 (28/11,630)TAH0.00 (0/4506)0.38 (11/2886)0.15 (11/7392)TVH0.06 (1/1617)0.11 (1/917)0.08 (2/2534)LH1.34 (8/597)0.63 (7/1107)0.88 (15/1704)Breakdown of LH2004-20052006-20092004-2009 LAVH0.00 (0/131)0.46 (2/432)0.36 (2/563) TLH4.08 (8/196)0.75 (5/668)1.50 (13/864) RLH0.00 (0/0)0.00 (0/7)0.00 (0/7)Note: LAVH and TLH were analyzed separately from 2004-2009; TAH=Total Abdominal Hysterectomy, TVH=Total Vaginal Hysterectomy, LH=Laparoscopic Hysterectomy, LAVH=Laparoscopic-Assisted Vaginal Hysterectomy, TLH=Total Laparoscopic Hysterectomy, RLH=Robotic-Assisted Laparoscopic Hysterectomy Open table in a new tab Conclusion: This study is the first to provide an updated incidence of vaginal cuff dehiscence after varying modes of hysterectomy. While TLH has historically been reported to have an increased risk of dehiscence, our updated analysis suggests the incidence of cuff dehiscence after TLH is not nearly as high as previously published. Study Objective: To update the incidence of vaginal cuff dehiscence after varying modes of hysterectomy, as well as to identify surgical and patient characteristics associated with cuff dehiscence. Design: Retrospective review. Setting: Large, urban, university teaching hospital. Patients: All women who underwent hysterectomy and had a vaginal cuff dehiscence repair from January 2006 until December 2009 at Magee-Womens Hospital (MWH) were analyzed, compared and combined with the prior data set (from 2000-2005) for a 10-year analysis. Intervention: Repair of vaginal cuff dehiscence. Note: LAVH and TLH were analyzed separately from 2004-2009; TAH=Total Abdominal Hysterectomy, TVH=Total Vaginal Hysterectomy, LH=Laparoscopic Hysterectomy, LAVH=Laparoscopic-Assisted Vaginal Hysterectomy, TLH=Total Laparoscopic Hysterectomy, RLH=Robotic-Assisted Laparoscopic Hysterectomy Conclusion: This study is the first to provide an updated incidence of vaginal cuff dehiscence after varying modes of hysterectomy. While TLH has historically been reported to have an increased risk of dehiscence, our updated analysis suggests the incidence of cuff dehiscence after TLH is not nearly as high as previously published.

The moderate decrease in invasive cervical cancer incidence rates in Spain (1980–2004): limited success of opportunistic screening?

Background: Despite its low incidence, invasive cervical cancer (ICC) is still a public health concern in Spain, due to its being perceived as an avoidable neoplasm. Social changes in recent decades may have increased the risk of ICC among Spanish females. This study sought to update incidence trends in Spanish registries.Patients and methods: We studied the ICC incidence time trend over the period 1980–2004 using data from 13 Spanish population-based cancer registries, analysing all cases and the two main histological types, i.e. squamous cell carcinoma (SCC) and adenocarcinoma (AC). Change-point Poisson regression models were fitted for all women and for the following three age groups: 25–44, 45–64 and ≥65 years. Age–period–cohort models were used to study cohort and period effect.Results: ICC incidence showed a moderate decrease (annual percentage change: –0.9%; 95% CI –1.3% to –0.5%). Whereas rates among younger women rose sharply by 5.5% until 1990, when they began to descend by 1.2% annually, among women aged ≥45 years they declined by 1.5% per annum. In the last decade of the study period, divergent trends were found for SCC and AC, i.e. downward versus upward, respectively. Risk increased with birth cohort after 1940–45 but the period effect showed opposite trends for the two histological types.Conclusion: Cervical cancer incidence rates have decreased moderately in Spain, a trend consistent with the preventive effect of widespread opportunistic screening.

Traumatic Facial Nerve Palsy in Newborns: Is It Always Iatrogenic?

We sought to report an updated incidence, risk factors, and outcome of traumatic facial palsy (TFP) in newborn infants born at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. We performed a 12-year retrospective study at KAMC. The records of infants with the diagnosis of TFP during the study period were reviewed and compared with 148 healthy term infants born during the same study period. Among 83,067 infants delivered between January 1994 and December 2005, 29 infants were diagnosed with TFP for an incidence of 0.03%. Forceps delivery and maternal primiparity were the only significant risk factors for TFP. Only 7 (24.1%) of these infants were delivered by cesarean section. The other 22 cases of TFP (75.9%) were delivered without any forceps application. Almost all infants (93%) with TFP had spontaneous recovery within 2 months. Only one child suffered from permanent facial weakness when he was last examined at the age of 12 years. Although forceps delivery was considered the most significant risk factor, currently most of the cases occur spontaneously without forceps application. The majority of infants with TFP will recover spontaneously within the first 2 months of life.

Highway traffic incident detection based on BPNN

Because traffic incident is the main cause of traffic congestion in Highway, traffic incident detection plays an important role in ITS. Based on the professional software VISSIM, we performed an experiment on incident caused by traffic jam to obtain the original simulated data. We offered a way to deal and analyse the traffic prameters, then an updated automatic traffic incident detection method was proposed based on BP neural network. Simulation result shows that the new method has many advantages such as higher detection rate, lower false alarm rate and shorter mean detection time.

The effects of a FRAX® revision for the USA

A revision (version 3.0) of the fracture risk assessment tool (FRAX) is developed based on an update of epidemiological information for the USA. With the revised tool, there were strong correlations (r > 0.99) between versions 2.0 and 3.0 for FRAX estimates of fracture probability, but the revised models gave lower probability estimates. The aim of this study was to determine the effects of a revision of the epidemiological data used to compute fracture probabilities in the USA with FRAX. Models were constructed to compute fracture probabilities based on updated fracture incidence and mortality rates in the USA. The models comprised the ten-year probability of hip fracture and the ten-year probability of a major osteoporotic fracture, both including femoral neck bone mineral density (BMD). For each model, fracture and death hazards were computed as continuous functions. The effect of the revised rates on fracture probability was examined by piecewise linear regression using multiple combinations of clinical risk factors and BMD. At all ages, there was a strong correlation (r > 0.99) between version 2.0 and revised FRAX estimates of fracture probability. For a major osteoporotic fracture, the revised model gave lower median probabilities by 13% to 24% in men, depending on age, and by 19% to 24% in women. For hip fracture probability, the revised model gave lower median fracture probabilities by 40% and 27% at the ages of 50 and 60 years in men and by 43% and 30%, respectively, in women. At the ages of 70 years and older the revised model gave similar hip fracture probabilities as version 2.0 in both men and women. The revised FRAX model for the USA (version 3.0) does not alter the ranking of fracture probabilities but provides lower probability estimates than version 2.0, particularly, in younger women and men.

Updated fracture incidence rates for the US version of FRAX.

SummaryOn the basis of updated fracture and mortality data, we recommend that the base population values used in the US version of FRAX® be revised. The impact of suggested changes is likely to be a lowering of 10-year fracture probabilities.IntroductionEvaluation of results produced by the US version of FRAX® indicates that this tool overestimates the likelihood of major osteoporotic fracture. In an attempt to correct this, we updated underlying fracture and mortality rates for the model.MethodsWe used US hospital discharge data from 2006 to calculate annual age- and sex-specific hip fracture rates and age-specific ratios to estimate clinical vertebral fracture rates. To estimate the incidence of any one of four major osteoporotic fractures, we first summed these newly derived hip and vertebral fracture estimates with Olmsted County, MN, wrist and upper humerus fracture rates, and then applied 10–20% discounts for overlap.ResultsCompared with rates used in the current FRAX® tool, 2006 hip fracture rates are about 16% lower, with greatest reductions observed among those below age 65 years; major osteoporotic fracture rates are about one quarter lower, with similar reductions across all ages.ConclusionsWe recommend revising the US-FRAX by updating current base population values for hip fracture and major osteoporotic fracture. The impact of these revisions on FRAX® is likely to be lowering of 10-year fracture probabilities, but more precise estimates of the impact of these changes will be available after these new rates are incorporated into the FRAX® tool.

Drug-induced liver injury: what was new in 2008?

Background: Given the number of publications appearing annually regarding drug-induced liver injury (DILI), there remains a need to concisely summarize each year's new crop of case series and reports as well as the advances in mechanisms of liver injury and in the field of pharmacogenomics relating to DILI. Objective: To present an up-to-date review of the past year's most important clinical studies and reports of DILI, placing them into context of previous publications. Methods: A Medline search was conducted of all manuscripts appearing in the fields “hepatotoxicity” and “drug-induced liver injury” during the calendar year 2008. The most clinically relevant English language case reports and studies exploring mechanisms and risk factors for DILI were then chosen for review, and supplemented with older literature where appropriate. Conclusions: As in past years, 2008 was replete with publications dealing with virtually all facets of DILI, including updated incidence and prevalence data, as well as the latest information regarding mechanisms of liver injury. Data from the first 300 patients in the National Institute of Health-sponsored DILI Network registry of > 100 non-acetaminophen causes were presented. Antimicrobials and CNS drugs were responsible for > 60% of cases, with herbals and dietary supplements being increasingly reported. Identification of genetic predispositions to DILI is coming of age with the FDA calling for the testing of human leukocyte antigen B*5701 before the use of abacavir to reduce the risk of hypersensitivity reactions. Several groups emphasized the pitfalls in utilizing Roussel Uclaf Causality Assessment Method and other causality assessment methodologies, and an updated review appeared on the use of potentially hepatotoxic medications in patients with underlying liver disease.

Recent patterns in gastric cancer: A global overview

Until the mid-1990s, gastric cancer has been the first cause of cancer death worldwide, although rates had been declining for several decades and gastric cancer has become a relatively rare cancer in North America and in most Northern and Western Europe, but not in Eastern Europe, Russia and selected areas of Central and South America or East Asia. We analyzed gastric cancer mortality in Europe and other areas of the world from 1980 to 2005 using joinpoint regression analysis, and provided updated site-specific incidence rates from 51 selected registries. Over the last decade, the annual percent change (APC) in mortality rate was around -3, -4% for the major European countries. The APC were similar for the Republic of Korea (APC = -4.3%), Australia (-3.7%), the USA (-3.6%), Japan (-3.5%), Ukraine (-3%) and the Russian Federation (-2.8%). In Latin America, the decline was less marked, but constant with APC around -1.6% in Chile and Brazil, -2.3% in Argentina and Mexico and -2.6% in Colombia. Cancers in the fundus and pylorus are more common in high incidence and mortality areas and have been declining more than cardia gastric cancer. Steady downward trends persist in gastric cancer mortality worldwide even in middle aged population, and hence further appreciable declines are likely in the near future.

Assessment of Climate– Coccidioidomycosis Model

Understanding the predictive relationships between climate variability and coccidioidomycosis is of great importance for the development of an effective public health decision-support system. Preliminary regression-based climate modeling studies have shown that about 80% of the variance in seasonal coccidioidomycosis incidence for southern Arizona can be explained by precipitation and dust-related climate scenarios prior to and concurrent with outbreaks. In earlier studies, precipitation during the normally arid foresummer 1.5-2 years prior to the season of exposure was found to be the dominant predictor. Here, the sensitivity of the seasonal modeling approach is examined as it relates to data quality control (QC), data trends, and exposure adjustment methodologies. Sensitivity analysis is based on both the original period of record, 1992-2003, and updated coccidioidomycosis incidence and climate data extending the period of record through 2005. Results indicate that models using case-level data exposure adjustment do not suffer significantly if individual case report data are used "as is." Results also show that the overall increasing trend in incidence is beyond explanation through climate variability alone. However, results also confirm that climate accounts for much of the coccidioidomycosis incidence variability about the trend from 1992 to 2005. These strongly significant relationships between climate conditions and coccidioidomycosis incidence obtained through regression modeling further support the dual "grow and blow" hypothesis for climate-related coccidioidomycosis incidence risk.