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Public Health Burden (public + health_burden)

Distribution by Scientific Domains

Medical Sciences	75%

Selected Abstracts

Trends in Pediatric Melanoma Mortality in the United States, 1968 through 2004

DERMATOLOGIC SURGERY, Issue 2 2008
KEVAN G. LEWIS MD
BACKGROUND AND OBJECTIVE Mortality from melanoma in children is a poorly understood and controversial problem in dermatology. There is paucity of research into this important public health dilemma. The purpose of this study was to characterize pediatric melanoma mortality in the United States and to evaluate trends over time. METHODS AND MATERIALS Deaths were derived from a database of more than 75 million records of the U.S. Center for National Health Statistics based on routine death certification. Information on age, race, gender, and geographic location was available for years 1968 through 2004. RESULTS During the 37-year period, there were 643 deaths attributed to melanoma in children under 20 years of age in the United States, an average of 18 per year. The overall age-adjusted mortality rate for melanoma in children was 2.25 deaths per year (per 10 million at-risk individuals). Mortality rates were strongly associated with age. In the oldest age group (age 15,19 years) the mortality rate was approximately an order of magnitude 8,18 times higher compared to younger age groups. Mortality among males was 25% higher than females. Mortality rates for white children were more than twice as high as black children. Overall mortality from melanoma in children declined steadily from 1968 to 2004. The highest mortality rates were observed in Idaho, Nevada, Arizona, and New Mexico. CONCLUSIONS Although mortality from melanoma among children in the United State is low, the magnitude of the public health burden from this preventable cause of death is substantial. In contrast to results of studies suggesting that the incidence of melanoma may be rising in children and adolescents, the data suggest that mortality in these groups may be falling. Additional study is warranted to further characterize and ultimately reduce mortality from childhood melanoma. [source]

Addressing insulin resistance in Type 1 diabetes

DIABETIC MEDICINE, Issue 9 2008
T. T. L. Pang
Abstract Type 1 diabetes is recognised to include an element of insulin resistance. Insulin resistance is an independent risk factor for the development of macro- and microvascular complications of Type 1 diabetes and may also contribute to the development of the disease. This understanding comes at a time when the incidence of Type 1 diabetes appears to be rising and the public health burden from its vascular complications is high. A variety of safe and efficacious manoeuvres are available to redress insulin resistance in Type 2 diabetes. So far however, clinical trials addressing insulin resistance in Type 1 diabetes have been small with only short periods of follow-up. Regardless, these trials have yielded promising results. This review examines the evidence for insulin resistance in the pathophysiology of Type 1 diabetes and its complications, the problems associated with its measurement, and summarizes the trials aimed at reducing insulin resistance in Type 1 diabetes. This includes a meta-analysis of controlled trials of adjuvant metformin in Type 1 diabetes. [source]

The evolutionary ecology of Plasmodium

ECOLOGY LETTERS, Issue 9 2003
R. E. L. Paul
Abstract Plasmodium, the aetiological agent of malaria, imposes a substantial public health burden on human society and one that is likely to deteriorate. Hitherto, the recent Darwinian medicine movement has promoted the important role evolutionary biology can play in issues of public health. Recasting the malaria parasite two-host life cycle within an evolutionary framework has generated considerable insight into how the parasite has adapted to life within both vertebrate and insect hosts. Coupled with the rapid advances in the molecular basis to host,parasite interactions, exploration of the evolutionary ecology of Plasmodium will enable identification of key steps in the life cycle and highlight fruitful avenues of research for developing malaria control strategies. In addition, elucidating the extent to which Plasmodium can respond to short- and long-term changes in selection pressures, i.e. its adaptive capacity, is even more crucial in predicting how the burden of malaria will alter with our rapidly evolving ecology. [source]

Dementia incidence continues to increase with age in the oldest old: The 90+ study

ANNALS OF NEUROLOGY, Issue 1 2010
María M. Corrada ScD
Objective The oldest old are the fastest growing segment of the US population, and accurate estimates of dementia incidence in this group are crucial for healthcare planning. Although dementia incidence doubles every 5 years from ages 65 to 90 years, it is unknown if this exponential increase continues past age 90 years. Here, we estimate age- and sex-specific incidence rates of all-cause dementia in people aged 90 years and older, including estimates for centenarians. Methods Participants are from The 90+ Study, a population-based longitudinal study of aging and dementia. Three hundred thirty nondemented participants aged 90 years and older at baseline were followed between January 2003 and December 2007. Age- and sex-specific incidence rates of all-cause dementia were estimated by person-years analysis. Results The overall incidence rate of all-cause dementia was 18.2% (95% confidence interval [CI], 15.3,21.5) per year and was similar for men and women (risk ratio, 0.94; 95% CI, 0.65,1.37). Rates increased exponentially with age from 12.7% per year in the 90,94-year age group, to 21.2% per year in the 95,99-year age group, to 40.7% per year in the 100+-year age group. The doubling time based on a Poisson regression was 5.5 years. Interpretation Incidence of all-cause dementia is very high in people aged 90 years and older and continues to increase exponentially with age in both men and women. Projections of the number of people with dementia should incorporate this continuing increase of dementia incidence after age 90 years. Our results foretell the growing public health burden of dementia in an increasingly aging population. ANN NEUROL 2010;67:114,121 [source]