Monthly variation in diagnosis of acute lymphoblastic leukemia and survival outcome in children and adults: 15-year trends at a single center

ABSTRACT Background: The date of acute lymphoblastic leukemia (ALL) diagnosis has been studied regarding potential etiologic roles with contrasting results and the issue remains controversial. The principal aim of this study was to analyze monthly variation of ALL diagnosis in a large homogenous Hispanic Latin American cohort over 15 years; its association with survival rates was also assessed. Methods: Clinical files and electronic records of 501 consecutive patients of all ages with ALL in northeastern Mexico over the years of 2004-2018 were scrutinized. Patients were divided into children <18 and adults >18 years. The Chi-square heterogeneity analysis was used to test for non-uniform variation. The Poisson regression analysis was used to fit sinusoidal (harmonic) models to the data, using the month of diagnosis as a covariate in a separate model. Results: During the study period 363 children (72.5%) and 138 adults (27.5%) (p < 0.001) were diagnosed with ALL. Heterogeneity across the months of diagnosis was confirmed (p = 0.019) and the Poisson regression analysis confirmed a significant monthly variation (p < 0.001) (95% CI, 3.024-3.745), a higher annual peak being observed in the month of March (p = 0.002), followed by a second peak in October (p = 0.026). The five-year OS for children was 68.2% (95% CI, 67.64-68.74) and for adults, 43.7% (95% CI, 42.67-44.71) (p < 0.001). No significant association between the month of diagnosis and OS was found (p = 0.789). Conclusion: The monthly variation of ALL diagnosis was documented; these results confirm the heterogeneous behavior of the disease and appear to be consistent with an interplay of environmental and biologic factors. Further studies are needed to examine putative candidate agents.

Análise de efeito idade-período-coorte na mortalidade por doenças cerebrovasculares em Maceió e Florianópolis / Analysis of age-period-cohort effect on mortality due to cerebrovascular diseases in Maceió and Florianópolis, Brazil

Resumo Introdução A doença cerebrovascular (DCBV) é a segunda principal causa de morte no mundo e no Brasil. Objetivo Avaliar as tendências da mortalidade por DCBV em duas cidades brasileiras (Maceió e Florianópolis) com diferenças socioeconômicas extremas, entre 1981 e 2015, estimando os efeitos idade, período e coorte. Método Estudo de séries temporais da mortalidade por DCBV em indivíduos com ≥ 40 anos, empregando a ferramenta Web tool. Resultados A mortalidade por DCBV diminuiu com o tempo, aumentou com a idade e foi menor para gerações mais novas. O efeito foi igual para ambos os sexos. Houve diminuição da mortalidade nas duas cidades, mas a diferença foi grande e a mortalidade continua alta em Maceió. Com base na amplitude dos efeitos estimados, foi possível verificar que o efeito de coorte foi o termo mais significativo para explicar a variabilidade temporal das taxas de mortalidade por DCBV no período. Conclusão A comparação da tendência temporal nas duas cidades mostrou a importância da melhora das condições de vida, do acesso a serviços de saúde para prevenção e controle dos fatores de risco, assim como assistência hospitalar aos casos para diminuirmos a mortalidade por DCBV em todo o território nacional.

Abstract Background Cerebrovascular disease (CBVD) is the second leading cause of death in the world and Brazil. Objective To evaluate trends in mortality from CBVD in two Brazilian cities (Maceió and Florianópolis) with extreme socioeconomic differences, between 1981 and 2016, estimating the age, cohort effect. Method Study of CBVD mortality time series in individuals aged ≥40 years, using the Age, Period, Cohort (APC) analysis and the Web tool. Results CBVD mortality decreased with time, increased with age and was lower for younger generations. The effect was the same for both sexes. There was a decrease in mortality in both cities, but the difference was large, and mortality remains high in Maceió. Based on the amplitude of the estimated effects, it was possible to verify that the cohort effect was the most significant term to explain the temporal variability of mortality rates due to CVD in the period. Conclusion The comparison of the time trend in the two cities showed the importance of improving living conditions, access to health services for the prevention and control of risk factors, as well as hospital care for cases to reduce mortality from CVD nationwide.

HIV incidence estimates by sex and age group in the population aged 15 years or over, Brazil, 1986-2018

Abstract INTRODUCTION HIV incidence estimates are essential to monitor the progress of prevention and control interventions. METHODS Data collected by Brazilian surveillance systems were used to derive HIV incidence estimates by age group (15-24; 25+) and sex from 1986 to 2018. This study used a back-calculation method based on the first CD4 count among treatment-naïve cases. Incidence estimates for the population aged 15 years or over were compared to Global Burden of Disease Study (GBD) estimates from 2000 to 2018. RESULTS Among young men (15-24 years), HIV incidence increased from 6,400 (95% CI: 4,900-8,400), in 2000, to 12,800 (95% CI: 10,800-15,900), in 2015, reaching incidence rates higher than 70/100,000 inhabitants and an annual growth rate of 3.7%. Among young women, HIV incidence decreased from 5,000 (95% CI: 4,200-6,100) to 3,200 (95% CI: 3,000-3,700). Men aged ≥25 years and both female groups showed significant annual decreases in incidence rates from 2000 to 2018. In 2018, the estimated number of new infections was 48,500 (95% CI: 45300-57500), 34,800 (95% CI: 32800-41500) men, 13,600 (95% CI: 12,500-16,000) women. Improvements in the time from infection to diagnosis and in the proportion of cases receiving antiretroviral therapy immediately after diagnosis were found for all groups. Comparison with GBD estimates shows similar rates for men with overlapping confidence intervals. Among women, differences are higher mainly in more recent years. CONCLUSIONS The results indicate that efforts to control the HIV epidemic are having an impact. However, there is an urgent need to address the vulnerability of young men.

Chagas disease-related mortality in Colombia from 1979 to 2018: temporal and spatial trends

Abstract INTRODUCTIOn: Studies on Chagas disease-related mortality assist in decision-making in health policies. We analyzed the epidemiological characteristics, temporal trends, and regional differences in Chagas disease-related mortality in Colombia from 1979 to 2018. METHODS: A time-series study was conducted using death records and population data from the National Administrative Department of Statistics, using categorizations from the International Classification of Disease (ICD)-9 and ICD-10 systems. All deaths with Chagas disease as an underlying or associated cause of death were included. Crude and age-sex standardized mortality rates per 100,000 inhabitants and the annual percent change (APC) were calculated. RESULTS: Of the 7,287,461 deaths recorded in Colombia during 1979-2018, 3,276 (0.04%) deaths were related to Chagas disease-2,827 (86.3%) as an underlying cause and 449 (13.7%) as an associated cause. The average annual age-sex standardized mortality rate was 0.211 (95% confidence interval [CI]: 0.170-0.252) deaths/100,000 inhabitants, with a significant upward trend (APC = 6.60%; 95% CI: 5.9-7.3). The highest Chagas disease-related death rates were in males (0.284 deaths/100,000 inhabitants), those ≥65 years old (1.296 deaths/100,000 inhabitants), and residents of the Orinoco region (1.809 deaths/100,000 inhabitants). There was a significant increase in mortality in the Orinoco (APC = 8.28%; 95% CI: 6.4-10.2), Caribbean (APC = 5.06%; 95% CI: 3.6-6.5), and Andean (APC = 4.63%; 95% CI: 3.9-5.3) regions. CONCLUSIONS: Chagas disease remains a major public health issue in Colombia with high mortality rates in older age groups, a wide geographic distribution, regional differences, and the potential to increase.

Decline in the Incidence of All-Cause and Alzheimer's Disease Dementia: a 12-Year-Later Rural Cohort Study in Korea

BACKGROUND: There has been no study on the time trends of dementia incidence in Korea. We report the 5-year incidence and its correlates of all-cause and Alzheimer's disease (AD) dementia, and compared our results with those of a 12-year-prior cohort study conducted in the same area. METHODS: A total of 751 community-dwelling older adults were followed up for a mean duration of 5.4 years. The age-, gender-, and educational attainment-specific incidence of all-cause and AD dementia were reported as cases per 1,000 person-years. We performed univariate and multivariate cox proportional hazard regression analyses to determine whether baseline sociodemographic, lifestyle, and clinical variables were associated with the risk of all-cause and AD dementia. A 12-year-prior cohort study was used for descriptive comparison to indicate the time trends of dementia incidence. RESULTS: The incidence rates were 16.2 and 13.0 cases per 1,000 person-years for all-cause and AD dementia, respectively. The baseline diagnosis of mild cognitive impairment increased the 5-year incidence of all-cause dementia by more than 4-fold. Old age and low baseline global cognitive function were noted as risk factors for both all-cause and AD dementia. CONCLUSION: Upon comparing the results with those from the earlier cohort study in Yeoncheon, the incidence of all-cause and AD dementia decreased by approximately 40% over 12 years; it has been mainly driven by the increase in the educational level of older adults. The declining time trends of incidence should be taken into account for estimating the future prevalence of dementia in Korea.

Time trends in prevalence of anaemia in pregnancy

Background & objectives: The prevalence of anaemia in pregnancy in India is among the highest in the world. In the last two decades, several national surveys have estimated haemoglobin levels in pregnant women. In this study, data from these surveys were analyzed to find out changes, if any, in prevalence of anaemia in pregnancy. Methods: National and State-level estimates on the prevalence of anaemia were tabulated from the reports of the National Family Health Survey (NFHS) 2, NFHS 3, Fact Sheets of NFHS 4 and District Level Household Survey (DLHS) 2. Unit level data from DLHS 4 and Annual Health Survey Clinical Anthropometric and Biochemical component (AHS CAB) were obtained and State level prevalence of different grades of anaemia was estimated. Time trends in the prevalence of anaemia and different grades of anaemia were assessed from these surveys. Results: NFHS 2, 3 and 4 reported relatively lower prevalence of anaemia as compared to DLHS and AHS CAB. There was not much change in the prevalence or severity of anaemia between NFHS 2, 3 and 4. There was substantial reduction in the prevalence and severity of anaemia in all States except Uttarakhand between DLHS 2 and 4 and DLHS 2 and AHS CAB. Interpretation & conclusions: There was a reduction in the prevalence and severity of anaemia in the last 15 years. The two-pronged strategy of increasing iron intake (dietary diversification and use of iron-fortified iodized salt) in all the population and testing, and detecting and treating pregnant women with anaemia will accelerate the pace of reduction in anaemia.

Incidence and mortality analysis of lung cancer among residents in Qidong City of Jiangsu Province from 1993 to 2012 / 中国肿瘤临床

Objective:To determine the prevalence, disease burden, and possible causes of lung cancer. Population-based lung cancer registration data collected from 1993 to 2012 were used to analyze the lung cancer epidemic status in Qidong City. Methods:Joinpoint regression was used to calculate the trend of incidence and mortality for lung cancer. Age-period-cohort model was used to assess the effects of age and exposure on the incidence and mortality rates. Results:Upward trends were observed both for the incidence and mortality rates of lung cancer. The risk of incidence and mortality increased with age. According to the cohort effect, the risk of lung cancer increased with recent birth dates. Women had higher risk than men. Conclusion:The incidence and mortality rates of pulmo-nary neoplasms have annually increased, and the exposure to risk factors for lung cancer gradually increases. Among the community population in Qidong City, people over 70 years belong to the high-risk groups.

Incidence of epithelial ovarian cancer according to histologic subtypes in Korea, 1999 to 2012 / 부인종양

OBJECTIVE: To investigate trends in the incidence of epithelial ovarian cancer (EOC), according to histologic subtypes, in Korean women between 1999 and 2012. METHODS: Data from the Korea Central Cancer Registry recorded between 1999 and 2012 were evaluated. The incidences of EOC histologic subtypes were counted. Age-standardized incidence rates (ASRs) and annual percentage changes (APCs) in incidence rates were calculated. Patient data were divided into three groups based on age (59 years), and age-specific incidence rates were compared. RESULTS: Overall, the incidence of EOC has increased. Annual EOC cases increased from 922 in 1999 to 1,775 in 2012. In 1999, the ASR was 3.52 per 100,000 and increased to 4.79 per 100,000 in 2012 (APC, 2.53%; p<0.001). The ASRs in 2012 and APCs between 1999 and 2012 for the four major histologic subtypes were as follows (in order of incidence): serous carcinoma (ASR, 2.32 per 100,000; APC, 4.34%; p<0.001), mucinous carcinoma (ASR, 0.73 per 100,000; APC, -1.05%; p=0.131), endometrioid carcinoma (ASR, 0.51 per 100,000; APC, 1.48%; p=0.032), and clear cell carcinoma (ASR, 0.50 per 100,000; APC, 8.13%; p<0.001). In the sub-analyses based on age, clear cell carcinoma was confirmed as the histologic subtype whose incidence had increased the most since 1999. CONCLUSION: The incidence of EOC is increasing in Korea. Among the histologic subtypes, the incidence of clear cell carcinoma has increased markedly across all age groups since 1999.

An Unexpected Increase in Adult Appendicitis in England (2000/01 to 2012/13): Could Cytomegalovirus (CMV) be Risk Factor?

Aims: To study the trends in admission for diseases of the appendix and to attempt to present a potential basis for the observed (complex) age-dependent trends and etiologies. Study Design: Longitudinal study of admissions relating to the appendix with analysis by age and gender. Place and Duration of Study: Admissions for diseases affecting the appendix for the residents of England over the period 2000/01 to 2012/13. Methodology: Retrospective application of age-standardized admission rates based on 2012/13 as the base year to determine what proportion of the increase in admissions is due to demography or to non-demographic forces. Synthesis of available literature covering diseases of the appendix to propose possible causes for the increase in admissions. Results: Based on admissions in 2012/13 diseases of the appendix cost the NHS in England around £107 million per annum (roughly £2 per head of population per annum). Admission rates peak at age 17 but have been increasing over the past 14 years in adults but not children. The rate of increase escalates with age and is more rapid in females. The trend for females shows far higher volatility than that for males and both show some degree of cyclic behavior. Depending on age, demographic change can only explain between 20% and 40% of the long-term increase. Social and health service factors are unlikely to explain this gap. Conclusion: An immune/infectious basis for increasing admission rates appears most likely. A possible role for the immune modulating herpes virus, cytomegalovirus (CMV), is discussed in the context of a potential linkage between infection with multiple agents (called the infectious burden) and the development of multiple morbidity. Both of which increase with age and are amenable to manipulation by CMV. The suggested mechanism may also provide insight into why the rates for admission of certain medical diagnoses are increasing far faster than due to demographic change.

Age-Period-Cohort Analysis of Thyroid Cancer Incidence in Korea / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: South Korea has the highest incidence rate of thyroid cancer in the world, and the incidence rate continues to increase. The aim of this study was to determine the age-period-cohort effects on the incidence of thyroid cancer in Korea. MATERIALS AND METHODS: Using the Korean National Cancer registry database, age-standardized incidence rates and annual percent changes (APCs) in thyroid cancer according to sex and histologic type were analyzed between 1997 and 2011. Age-period-cohort models were applied using an intrinsic estimator method according to sex. RESULTS: In both men and women, the incidence of thyroid cancer showed a sharp increase from 1997 through 2011. Among the histologic types, papillary carcinoma showed the greatest increase, with APCs of 25.1% (95% confidence interval [CI], 22.7% to 27.5%) in men and 23.7% (95% CI, 21.9% to 25.5%) in women, whereas anaplastic carcinoma did not show a significant increase in either sex. An increase in overall thyroid cancer incidence over time was observed in all birth cohorts. An age-period-cohort model indicated a steeply increasing period effect, which increased prominently from 1997 to 2011 in both men and women. The age effect showed an inverted U-shaped trend. The cohort effect tended to show a slight increase or remain constant from 1952 to 1977, followed by a decrease. CONCLUSION: The period effect can explain the sharp increase in thyroid cancer incidence, strongly suggesting the role of thyroid screening.

The case-case-time-control study design / 中华流行病学杂志

Although the ‘self-matched case-only studies' (such as the case-cross-over or self-controlled case-series method) can control the time-invariant confounders (measured or unmeasured) through design of the study,however,they can not control those confounders that vary with time.A bidirectional case-crossover design can be used to adjust the exposure-time trends.In the areas of pharmaco-epidemiology,illness often influence the future use of medications,making a bidirectional study design problematic.Suissa' s case-time-control design combines the case-crossover and the case-control design which could adjust for exposure-trend bias,but the control group may reintroduce selection bias,if the matching does not go well.We propose a "case-case-time-control" design which is an extension of the case-time-control design.However,rather than using a sample of external controls,we choose those future cases as controls for current cases to counter the bias that arising from temporal trends caused by exposure to the target of interest.In the end of this article we will discuss the strength and limitations of this design based on an applied example.

Trends in gynecologic cancer mortality in East Asian regions / 부인종양

OBJECTIVE: To evaluate uterine and ovarian cancer mortality trends in East Asian countries. METHODS: For three Asian countries and one region (Japan, Korea, Singapore, and Hong Kong), we extracted number of deaths for each year from the World Health Organization (WHO) mortality database, focusing on women > or =20 years old. The WHO population data were used to estimate person-years at risk for women. The annual age-standardized, truncated rates were evaluated for four age groups. We also compared age-specific mortality rates during three calendar periods (1979 to 1988, 1989 to 1998, and 1999 to 2010). Joinpoint regression was used to determine secular trends in mortality. To obtain cervical and uterine corpus cancer mortality rates in Korea, we re-allocated the cases with uterine cancer of unspecified subsite according to the proportion in the National Cancer Incidence Databases. RESULTS: Overall, uterine cancer mortality has decreased in each of the Asian regions. In Korea, corrected cervical cancer mortality has declined since 1993, at an annual percentage change (APC) of -4.8% (95% confidence interval [CI], -5.3 to -4.4). On the other hand, corrected uterine corpus cancer mortality has abruptly increased since 1995 (APC, 6.7; 95% CI, 5.4 to 8.0). Ovarian cancer mortality was stable, except in Korea, where mortality rates steadily increased at an APC of 6.2% (95% CI, 3.4 to 9.0) during 1995 to 2000, and subsequently stabilized. CONCLUSION: Although uterine cancer mortality rates are declining in East Asia, additional effort is warranted to reduce the burden of gynecologic cancer in the future, through the implementation of early detection programs and the use of optimal therapeutic strategies.

Epidemiological trends of RF/RHD in school children of Shimla in north India.

Background & objectives: There are no active surveillance studies reported from South East Asian Region to document the impact of change in socio-economic state on the prevalence of rheumatic fever/rheumatic heart disease (RF/RHD) in children. Therefore, we conducted a study to determine the epidemiological trends of RF/RHD in school children of Shimla city and adjoining suburbs in north India and its association with change in socio-economic status. Methods : Active surveillance studies were conducted in 2007-2008 in urban and rural areas of Shimla, and 15145 school children, aged 5-15 yr were included and identical screening methodology as used in earlier similar survey conducted in 1992-1993 was used. The study samples were selected from schools of Shimla city and adjoining rural areas by multistage stratified cluster sampling method in both survey studies. After a relevant history and clinical examination by trained doctor, echocardiographic evaluation of suspected cases was done. An updated Jones (1992) criterion was used to diagnose cases of acute rheumatic fever (ARF) and identical 2D-morphological and Doppler criteria were used to diagnose RHD in both the survey studies. The socio-economic and healthcare transitions of study area were assessed during the study interval period. Results: Time trends of prevalence of RF/RHD revealed about five-fold decline from 2.98/1000 (95% C.I. 2.24-3.72/1000) in 1992-1993 to 0.59/1000 (95% C.I. 0.22-0.96/1000) in 2007-2008. (P<0.0001). While the prevalence of ARF and RHD with recurrence of activity was 0.176/1000 and 0.53/1000, respectively in 1992-1993, no case of RF was recorded in 2007-2008 study. Prevalence of RF/RHD was about two- fold higher in rural school children than urban school children in both the survey studies (4.42/1000 vs. 2.12/1000) and (0.88/1000 vs. 0.41/1000), respectively. The indices of socio-economic development revealed substantial improvement during this interim period. Interpretation & conclusions: The prevalence of RF/RHD has declined by five-fold over last 15 yr and appears to be largely contributed by improvement in socio-economic status and healthcare delivery systems. However, the role of change in the rheumatogenic characteristics of the streptococcal stains in the study area over a period of time in decline of RF/RHD cannot be ruled out. Policy interventions to improve living standards, existing healthcare facilities and awareness can go a long way in reducing the morbidity and mortality burden of RF/RHD in developing countries.

Trends in prostate cancer incidence and mortality in a mid-sized Northeastern Brazilian city / Tendências temporais de incidência e mortalidade por câncer de próstata em uma cidade de médio porte do nordeste brasileiro

OBJECTIVE: International data have reported prostate cancer as the most frequent among men, and the third highest in mortality. A rise in incidence has been observed in the course of recent decades, probably influenced by early detection, mainly in asymptomatic men, through regular screening with prostate-specific antigen (PSA) testing. The purpose of this study was to contribute to information on trends in prostate cancer incidence and mortality using population-based data. METHODS: This was an exploratory ecological study of time trends, aiming at describing changes in prostate cancer incidence and mortality in Aracaju, Sergipe, Brazil, from 1996 to 2006. Rates were calculated from data of the Registro de Câncer de Base Populacional de Aracaju. Trends were calculated using the Joinpoint Regression Program. RESULTS: For the study period, 1,490 incident cases and 334 deaths were included. Incident cases were more common after 50 years of age, and deaths after 55 years. Age-standardized incidence rates of 46.6 and 50.0/100,000 were observed in the early years of the series, and then progressively increased, with rates higher than 100.0/100,000 in later years. For mortality, age-standardized rates varied from 21.6 and 16.6/100,000 to 24.1 and 28.9/100,000 in later years. Joinpoint analysis identified one joinpoint for the incidence series, resulting in two trends, the first with annual percent change of 34% and the second with 5.8%; for the mortality series no joinpoint was identified, and the annual percent change was 2.1%. CONCLUSION: There was a sharp increase in incidence rates during the study period, probably due to screening. Mortality rates had a small upward trend, and did not show major changes during the study period.

OBJETIVO: Dados internacionais apontaram o câncer de próstata como o mais incidente e o terceiro em mortalidade entre os homens. O aumento da incidência tem sido observado nas últimas décadas, provavelmente por causa da detecção precoce, principalmente em homens assintomáticos, através do rastreamento regular com dosagem do antígeno prostático específico (PSA). O objetivo do estudo foi contribuir com as informações sobre as tendências de incidência e mortalidade por câncer de próstata a partir de extratos populacionais. MÉTODOS: Tratou-se de um estudo ecológico exploratório de tendências temporais, visando descrever as mudanças de incidência e mortalidade por câncer de próstata em Aracaju, SE, Brasil, no período de 1996 a 2006. As taxas foram calculadas a partir dos dados do Registro de Câncer de Base Populacional de Aracaju e as tendências temporais foram determinadas pelo Joinpoint Regression Program. RESULTADOS: No período do estudo, 1490 casos incidentes e 334 mortes foram incluídos. Os casos incidentes foram mais frequentes a partir de 50 anos de idade e as mortes a partir de 55 anos. Taxas padronizadas de incidência de 46,6 e 50,0/100.000 foram observadas nos primeiros anos da série, e um aumento progressivo acima de 100,0/100.000 foi observado nos últimos anos. Para a mortalidade, as taxas padronizadas variaram de 21,6 e 16,6/100.000 para 24,1 e 28,9/100.000. A análise do Joinpoint identificou duas tendências para a incidência, a primeira com percentual de mudança de 34,0% e a segunda com percentual de 5,8%; para a mortalidade, a análise resultou em uma tendência com percentual de 2,1%. CONCLUSÃO: Houve um grande aumento nas taxas de incidência, provavelmente devida ao rastreamento, durante o período de estudo. A mortalidade, entretanto, mesmo com uma pequena tendência de aumento, não apresentou grandes mudanças no tempo estudado.

Peptic ulcer disease in India - A 16 year trend analysis.

Background and Aim: The incidence of peptic ulcer disease has steadily declined throughout the world. The influence of seasonal changes on the incidence of peptic ulcer disease is not well established. The aim of the study was to identify the changing trends in the occurrence of peptic ulcer disease from a tertiary referral center in south India and to study the seasonal variation in the occurrence of peptic ulcer. Methods: Retrospective analysis of the endoscopic records between the years 1989 to 2004. Results: There was a significant decrease in the endoscopic diagnosis of duodenal and gastric ulcers (DU and GU) over the years. Both duodenal and gastric ulcers were more common in men than women. Over the years, there was a steady increase in the proportion of women affected with both DU and GU. A steady increase in the mean age of endoscopic diagnosis of GU and DU was seen over the years. The adjusted seasonal index revealed an increase in the endoscopic diagnosis of GU and DU in the months October – March. Conclusion: The endoscopic diagnosis of DU and GU has shown a decreasing trend over the past 16 years. The adjusted seasonal index has shown an increasing trend between the months of October- March.

Tendência temporal do trabalho infantil no Brasil, 1992-2006. / Time trend of child labor in Brazil, 1992-2006.

Objetivo: analisar a tendência do trabalho infantil no Brasil e por Estados brasileiros, no período de 1992 a 2006. Métodos: foram utilizados dados secundários obtidos pela Pesquisa Nacional por Amostras de Domicílios (PNAD/IBGE). A população referida pela PNAD para o cálculo da taxa de trabalho infantil é a população com idade entre 10 e 14 anos. As taxas foram calculadas estratificando-se a população por raça. Para a análise de tendência, utilizou-se a técnica de regressão polinomial. Resultados: observou-se que a taxa de trabalho infantil reduziu-se no Brasil, em cerca de 37%. Ainda, com relação à raça, a prevalência de trabalho infantil é, em sua maioria, maior entre os pretos e pardos, com diferenças de até 214%. Contudo, as taxas vêm caindo, sobretudo nas áreas metropolitanas da região Nordeste, e entre a população definida como ?preta?. Discussão: o estudo mostra que o trabalho infantil ainda é importante como resultado de condições sociais adversas. Além disso, a disparidade das taxas entre raças ratifica o contraste presente nas agendas de discussão sobre desigualdade social, embora haja diferença na distribuição racial entre os Estados.

Objective: to analyze the trend of the child labor in Brazil and in Brazilian states, between 1992 and 2006. Methods: secondary data obtained from the National Research for Samples of Domiciles from Brazilian Institute of Geography and Statistics (PNAD/IBGE, acronyms in Portuguese) was used. The population related for the PNAD for child labor is the population with age between 10 and 14 years. The rates were calculated stratifying population by race. Polynomial regression models were used for the trend analysis. Results: we observed that child labor rate reduced about 37% in Brazil. Besides, with regard to the race, the prevalence of child labor is, in its majority, greatest between the blacks and medium browns, with differences of up to 214%. However, the rates come falling, overall in the metropolitan areas of the Northeast region, and between blacks. Discussion: this study showed that child labor is still important as resulted of adverse social conditions. Moreover, the disparity of the rates between races ratifies the present contrast in agendas on social inequality, even so has difference in the racial distribution between the states.

Time trends on the prevalence of cancer during 1970 - 2005 in Shandong province / 中华流行病学杂志

Objective To analyze time trend of cancer during 1970-2005 in Shandong province so as to develop strategies for control and prevention of cancer at the community level. Methods Data was from 4 retrospective surveys regarding all causes of death during 1970-- 1974, 1985-1989, 1990- 1992 and 2004-2005, in Shandong province. Other than one set of data collected in 1985-1989 by Shandong province itself, the other 3 set of data were from the national surveys, in which the survey-point sampling of choice was based on data of 1970-1974 for assessing its representativeness. The observing indices would include standardized mortality and mortality. A join-point regression model was used to analyze the changing rate of tumor. Results The mortality rate of the entire tumor increased 143.15 percent in 2005 than in 1970. The changing slope of standardized rate of all tumors in the regression model showed that the inter-annual growth rate were 0.54 and 1.24 percent from 1970 to 1984 and from 1985 to 1992. The rate of increase since 1992 had been 0.18 percent. During 2004-2005, the main malignant cancers were lung, stomach, liver, esophageal, coiorectal, leukemia, breast and cervical cancer, in order. Lung cancer rose from the 4th ranking to the first while cervical cancer dropped from the fifth ranking to the 8th place. Esophageal cancer and cervical cancer were decreased annually while gastric cancer was increased in the early days but decreased later on. The rest of the cancers were on the rise year by year. Rates of lung and breast cancers were higher while gastric and esophageal cancers were lower seen in the urban than in rural areas. Conclusion In Shandong province, a marked increase was seen in the mortality rate of tumors in the past 35 years. Evidence showed that the spectrum of death among main malignant tumors had changed which might provide a scientific basis for the development of a community-based prevention and control program on cancer.

Diferenças de gênero na tendência de mortalidade por câncer de pulmão nas macrorregiões brasileiras / Gender differences in lung cancer mortality trends in Brazilian macro regions

O câncer de pulmão é a primeira causa de óbito por câncer entre homens e a segunda entre mulheres no Brasil. Em países desenvolvidos, a mortalidade por este tipo de câncer vem declinando entre homens, mas não entre as mulheres. Este estudo analisou as tendências de mortalidade por câncer de pulmão no Brasil para homens e mulheres durante o período de 1979 a 2003 em todo o país e nas cinco macrorregiões. Foram calculadas taxas de mortalidade padronizadas por idade e específicas para os grupos etários de 40-59 e 60 anos e mais. As variações percentuais anuais estimadas (Estimated Annual Percent Change - EAPC) foram avaliadas para os períodos: 1979-1987, 1988-1995, 1996-2003. A mortalidade por câncer de pulmão em todo o período (1979-2003) aumentou em 29 por cento entre homens e em 86 por cento entre mulheres. Desagregando-se os dados, observou-se uma tendência inversa evidente na região Sudeste entre 1996 e 2003 para o grupo etário mais jovem com diminuição para homens (EAPC = - 2,1) e aumento para mulheres (EAPC = 3,2). Merece destaque a grande variação positiva nas tendências para mulheres na região Norte e Nordeste a partir de 1988 nos dois grupos etários estudados. Os resultados reforçam a necessidade de dar continuidade às ações de controle do tabagismo para os homens e de aperfeiçoar as estratégias voltadas para as mulheres.

Evalúan las variaciones producidas durante 27 años en la hospitalización de niños asmáticos / Hospitalizations for childhood asthma in athens, greece from 1978 to 2005

Antecedentes: Las tendencias en las tasas de ingresos por asma entre los niños han mostrado distintos patrones en diferentes países en las últimas décadas. Nosotros llevamos a cabo este estudio para determinar las tendencias temporales en los ingresos y reingresos por asma de niños en el área metropolitana de Atenas, Grecia, durante el período de 1978 a 2005. Materiales, métodos y resultados: Se obtuvieron datos de registros hospitalarios de los tres principales hospitales de niños de Atenas de 1978 a 2005. Se incluyeron niños que ingresaron con diagnóstico de asma, bronquitis asmática o bronquitis con sibilancias. Se observó un aumento paralelo y continuo en las tasas de ingresos y reingresos por asma en el área de Atenas durante toda la década de 1980 seguido por una estabilización durante los últimos años de los ’90 y un regreso impresionante a las tasas de comienzos de la década de 1980 durante el período 2001-2005. Existe una variabilidad estacional constante, y se presentan una relativa humedad y presión atmosférica como las variables meteorológicas más importantes,y el dióxido de azufre, el humo negro y el monóxido de carbono son los principales contaminantes ambientales implicados en los ingresos por asma entre los niños pequeños. Conclusión: Los ingresos y reingresos por asma entre los niños de Atenas mostraron una elevación brusca durante la década de 1980, una estabilización hacia fines de la década de 1990 y una disminución hasta las tasas de comienzos de la década de 1980 durante el último período.

Background: Trends in rates of asthma admissions amongchildren have shown a variety of patterns in differentcountries in the last decades. We undertook the presentstudy to determine the time trends in asthma admissionsand readmissions of children in metropolitan Athens area,Greece, during the 1978-2005 period. Material, methodsand results: Data were obtained from hospital registriesof the three main children’s hospitals in Athens from 1978to 2005. Children admitted with the diagnoses of asthma,asthmatic bronchitis or wheezy bronchitis were included.A continuous parallel increase in asthma admission andreadmission rates in the greater Athens area throughoutthe 1980s followed by stabilization during the late 1990sand an impressive comeback to the rates of early eightiesduring the 2001-2005 period was observed. A constantseasonal variability does exist, with relative humidity andatmospheric pressure appearing to be the most importantmeteorological variables, and sulphur dioxide, blacksmoke and carbon monoxide the main ambient airpollutants implicated in asthma admissions amongyounger children. Conclusion: Asthma admissions amongchildren and readmissions in Athens showed a sharp riseduring the 1980s, stabilization during the late 1990s anda decrease to the rates of the early eighties during thelast period.