Global Incidence and mortality of oesophageal cancer and their correlation with socioeconomic indicators temporal patterns and trends in 41 countries.

Oesophageal cancers (adenocarcinomas [AC] and squamous cell carcinomas [SCC]) are characterized by high incidence/mortality in many countries. We aimed to delineate its global incidence and mortality, and studied whether socioeconomic development and its incidence rate were correlated. The age-standardized rates (ASRs) of incidence and mortality of this medical condition in 2012 for 184 nations from the GLOBOCAN database; national databases capturing incidence rates, and the WHO mortality database were examined. Their correlations with two indicators of socioeconomic development were evaluated. Joinpoint regression analysis was used to generate trends. The ratio between the ASR of AC and SCC was strongly correlated with HDI (r = 0.535 [men]; r = 0.661 [women]) and GDP (r = 0.594 [men]; r = 0.550 [women], both p < 0.001). Countries that reported the largest reduction in incidence in male included Poland (Average Annual Percent Change [AAPC] = -7.1, 95%C.I. = -12,-1.9) and Singapore (AAPC = -5.8, 95%C.I. = -9.5,-1.9), whereas for women the greatest decline was seen in Singapore (AAPC = -12.3, 95%C.I. = -17.3,-6.9) and China (AAPC = -5.6, 95%C.I. = -7.6,-3.4). The Philippines (AAPC = 4.3, 95%C.I. = 2,6.6) and Bulgaria (AAPC = 2.8, 95%C.I. = 0.5,5.1) had a significant mortality increase in men; whilst Columbia (AAPC = -6.1, 95%C.I. = -7.5,-4.6) and Slovenia (AAPC = -4.6, 95%C.I. = -7.9,-1.3) reported mortality decline in women. These findings inform individuals at increased risk for primary prevention.

The global epidemiology of bladder cancer: a joinpoint regression analysis of its incidence and mortality trends and projection.

We tested the hypotheses that the global incidence of bladder cancer was increasing but its mortality was reducing and its incidence was positively correlated with country-specific socioeconomic development. We retrieved data on age-standardized incidence and mortality rates/100,000 from the GLOBOCAN database in 2012. Temporal patterns were examined for 39 countries from the Cancer Incidence in Five Continents volumes I-X and other national registries. We evaluated the correlation between the incidence/mortality rates and Human Development Index (HDI)/ logarithmic values of Gross Domestic Product per capita (GDP). The average annual percent change of the incidence and mortality rates in the most recent 10 years was examined by joinpoint regression analysis. The highest incidence rates were observed in Southern Europe, Western Europe and North America. The mortality rates were the highest in Western Asia and Northern Africa. The incidence was positively correlated with HDI (r = 0.66 [men]; r = 0.50 [women]) and to a lesser extent logarithmic values of GDP per capita (r = 0.60 [men]; r = 0.50 [women], all p < 0.01). Many European countries experienced incidence rise. A substantial mortality reduction was observed in most countries, yet increases in mortality rates were observed in the Philippines and Iceland. These findings identified countries where more preventive actions are required.

Incidence and mortality of kidney cancer: temporal patterns and global trends in 39 countries.

We tested the hypotheses that kidney cancer incidence was increasing globally whilst its mortality was reducing; and its incidence was positively correlated with country-specific socioeconomic development. The incidence and mortality figures of each country were projected to 2030. Data on age-standardized incidence/mortality rates were retrieved from the GLOBOCAN in 2012. Temporal patterns were examined for 39 countries from the Cancer Incidence in Five Continents volumes I-X and other national registries. We evaluated the correlation between the incidence/mortality rates and Human Development Index (HDI)/Gross Domestic Product (GDP]). The average annual percent change of its incidence and mortality in the most recent 10 years was obtained from joinpoint regression. The highest incidence rates were observed in Eastern Europe and North America, while its mortality rates were the highest in European countries. Incidence was positively correlated with HDI and GDP per capita. Many countries experienced incidence rise over the most recent 10 years, and a substantial reduction in mortality rates was observed for a significant number of countries, yet increases in mortality rates were observed in Eastern Europe. By 2030, Brazil and Ecuador may have the greatest rise in incidence both in men and women, which requires urgent need for planning healthcare resources.

International incidence and mortality trends of liver cancer: a global profile.

We examined the global incidence and mortality rates of liver cancer, and evaluated the association between incidence/mortality and socioeconomic development (Human Development Index [HDI] and Gross Domestic Product [GDP]) using linear regression analysis. The average annual percent change (AAPC) of the trends was evaluated from join-point regression analysis. The global incidence of liver cancer varied widely by nine-fold, and was negatively correlated with HDI (men: r = -0.232, p = 0.003; women: r = -0.369, p < 0.001) and GDP per capita (men: r = -0.164, p = 0.036; women: r = -0.212, p = 0.007). Its mortality showed a similarly negative correlation with both indices. The greatest incidence rise in men was observed in Poland (AAPC = 17.5, 95% C.I. = 5.6, 30.9) and Brazil (AAPC = 13.2, 95% C.I. = 5.9, 21.0), whereas Germany (AAPC = 6.6, 95% C.I = 2.0, 11.5) and Norway (AAPC = 6.5, 95% C.I. = 3.2, 10.0) had the greatest increase in women. The mortality rates paralleled the incidence rates in most countries. For mortality, Malta (AAPC = 11.5, 95% C.I. = 3.9, 19.8), Australia (AAPC = 6.8, 95% C.I. = 2.2, 11.5) and Norway (APCC = 5.6, 95% C.I. = 2.8, 8.5) reported the biggest increase among men; whilst Australia (AAPC = 13.4, 95% C.I. = 7.8, 19.4) and Singapore (AAPC = 7.7, 95% C.I. = 4.1, 11.5) showed the most prominent rise among women. These epidemiological data identified countries with potentially increasing trends of liver cancer for preventive actions.

The effectiveness of Dietary Approaches to Stop Hypertension (DASH) counselling on estimated 10-year cardiovascular risk among patients with newly diagnosed grade 1 hypertension: A randomised clinical trial.

BACKGROUND: The Dietary Approaches to Stop Hypertension (DASH) has been shown to lower blood pressure in the West. However, the real-life impact of DASH on reducing cardiovascular (CV) risk in routine clinical setting has not been studied. METHODS: A parallel-group, open-labelled, physician-blinded, randomised controlled trial was conducted in January-June 2013 and followed up for 6- and 12-months in primary care settings in Hong Kong. Patients newly diagnosed with grade 1 hypertension (aged 40-70years) who had no concomitant medical conditions requiring dietary modifications were consecutively recruited. Subjects were randomised to standard education (usual care) (n=275), or usual care plus dietitian-delivered DASH-based dietary counselling in a single one-to-one session (intervention) (n=281). Primary outcomes were the changes in estimated 10-year CV risk. RESULTS: Outcome data were available for 504 (90.6%) and 485 (87.2%) patients at 6 and 12months, respectively. There was no difference in the reduction of 10-year CV risk between the two groups at 6months (-0.13%, 95% confidence interval [95% CI] -0.50% to 0.23%, p=0.477) and 12months (-0.08%, 95% CI -0.33% to 0.18%, p=0.568). Multivariate regression analyses showed that male subjects, younger patients, current smokers, subjects with lower educational level, and those who dined out for main meals for ≥4 times in a typical week were significantly associated with no improvements in CV risk. CONCLUSIONS: The findings may not support automatic referral of newly diagnosed grade 1 hypertensive patients for further one-to-one dietitian counselling on top of primary care physician's usual care. Patients with those risk factors identified should receive more clinical attention to reduce their CV risk. CLINICAL TRIAL REGISTRATION: ChiCTR-TRC-13003014 (http://www.chictr.org.cn/enindex.aspx).

The adoption of the Reference Framework for diabetes care among primary care physicians in primary care settings: A cross-sectional study.

The prevalence of diabetes mellitus has been increasing both globally and locally. Primary care physicians (PCPs) are in a privileged position to provide first contact and continuing care for diabetic patients. A territory-wide Reference Framework for Diabetes Care for Adults has been released by the Hong Kong Primary Care Office in 2010, with the aim to further enhance evidence-based and high quality care for diabetes in the primary care setting through wide adoption of the Reference Framework.A valid questionnaire survey was conducted among PCPs to evaluate the levels of, and the factors associated with, their adoption of the Reference Framework.A total of 414 completed surveys were received with the response rate of 13.0%. The average adoption score was 3.29 (SD 0.51) out of 4. Approximately 70% of PCPs highly adopted the Reference Framework in their routine practice. Binary logistic regression analysis showed that the PCPs perceptions on the inclusion of sufficient local information (adjusted odds ratio [aOR] = 4.748, 95%CI 1.597-14.115, P = 0.005) and reduction of professional autonomy of PCPs (aOR = 1.859, 95%CI 1.013-3.411, P = 0.045) were more likely to influence their adoption level of the Reference Framework for diabetes care in daily practices.The overall level of guideline adoption was found to be relatively high among PCPs for adult diabetes in primary care settings. The adoption barriers identified in this study should be addressed in the continuous updating of the Reference Framework. Strategies need to be considered to enhance the guideline adoption and implementation capacity.

Global Incidence and Mortality for Prostate Cancer: Analysis of Temporal Patterns and Trends in 36 Countries.

BACKGROUND: Prostate cancer (PCa) is a leading cause of mortality and morbidity globally, but its specific geographic patterns and temporal trends are under-researched. OBJECTIVE: To test the hypotheses that PCa incidence is higher and PCa mortality is lower in countries with higher socioeconomic development, and that temporal trends for PCa incidence have increased while mortality has decreased over time. DESIGN, SETTING, AND PARTICIPANTS: Data on age-standardized incidence and mortality rates in 2012 were retrieved from the GLOBOCAN database. Temporal patterns were assessed for 36 countries using data obtained from Cancer incidence in five continents volumes I-X and the World Health Organization mortality database. Correlations between incidence or mortality rates and socioeconomic indicators (human development index [HDI] and gross domestic product [GDP]) were evaluated. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The average annual percent change in PCa incidence and mortality in the most recent 10 yr according to join-point regression. RESULTS AND LIMITATIONS: Reported PCa incidence rates varied more than 25-fold worldwide in 2012, with the highest incidence rates observed in Micronesia/Polynesia, the USA, and European countries. Mortality rates paralleled the incidence rates except for Africa, where PCa mortality rates were the highest. Countries with higher HDI (r=0.58) and per capita GDP (r=0.62) reported greater incidence rates. According to the most recent 10-yr temporal data available, most countries experienced increases in incidence, with sharp rises in incidence rates in Asia and Northern and Western Europe. A substantial reduction in mortality rates was reported in most countries, except in some Asian countries and Eastern Europe, where mortality increased. Data in regional registries could be underestimated. CONCLUSIONS: PCa incidence has increased while PCa mortality has decreased in most countries. The reported incidence was higher in countries with higher socioeconomic development. PATIENT SUMMARY: The incidence of prostate cancer has shown high variations geographically and over time, with smaller variations in mortality.

Hydrologic transport of fecal bacteria attenuated by flue gas desulfurization gypsum.

Flue gas desulfurization (FGD) gypsum is a byproduct of coal-fired power plants. Its application to agricultural fields may increase water infiltration, reduce soil erosion, and decrease nutrient losses from applications of animal manures. It may also reduce fecal bacterial contamination of surface waters. We tested the hypothesis that FGD gypsum applications would decrease the load of and the fecal indicator bacterium from poultry litter applications. Two rainfall simulation experiments were undertaken: one in spring 2009 and one in spring 2011. Six treatments consisted of four rates of FGD gypsum (0, 2.2, 4.5, and 9.0 Mg ha) with poultry litter (13.5 Mg ha and two controls) in a randomized, complete-block design with three replications. Each replicate 4- × 6-m plot contained a single 1- × 2-m subplot that was delineated by metal plates and a flume that captured total overland flow or runoff. Rainfall was applied at ∼64 mm h. Volume of overland runoff was measured and subsampled for analysis every 10 min for 1 h. Flow-weighted concentrations, total loads, and soil concentrations of were determined. was not detected in runoff. No significant differences between treatments were observed for the 2009 rainfall simulation. However, after 3 yr of FGD gypsum applications, the highest rate of FGD gypsum resulted in decreased flow-weighted concentrations and total loads of . Flue gas desulfurization gypsum applications may be a management practice that reduces microbial contamination of surface waters from manure applied to agricultural fields in the southeastern United States.

Influence of aeration implements, phosphorus fertilizers, and soil taxa on phosphorus losses from grasslands.

Attenuation of rainfall within the solum may help to move contaminants and nutrients into the soil to be better sequestered or utilized by crops. Surface application of phosphorus (P) amendments to grasslands may lead to elevated concentrations of P in surface runoff and eutrophication of surface waters. Aeration of grasslands has been proposed as a treatment to reduce losses of applied P. Here, results from two small-plot aeration studies and two field-scale, paired-watershed studies are supplemented with previously unpublished soil P data and synthesized. The overall objective of these studies was to determine the impact of aeration on soil P, runoff volume, and runoff P losses from mixed tall fescue [Lolium arundinaceum (Schreb.) Darbysh.]-bermudagrass (Cynodon dactylon L.) grasslands fertilized with P. Small-scale rainfall simulations were conducted on two soil taxa using three types of aeration implements: spikes, disks, and cores. The-field scale study was conducted on four soil taxa with slit and knife aeration. Small-plot studies showed that core aeration reduced loads of total P and dissolved reactive P (DRP) in runoff from plots fertilized with broiler litter and that aeration was effective in reducing P export when it increased soil P in the upper 5 cm. In the field-scale study, slit aeration reduced DRP losses by 35% in fields with well-drained soils but not in poorly drained soils. Flow-weighted concentrations of DRP in aerated fields were related to water-soluble P applied in amendments and soil test P in the upper 5 cm. These studies show that the overall effectiveness of mechanical soil aeration on runoff volume and P losses is controlled by the interaction of soil characteristics such as internal drainage and compaction, soil P, type of surface-applied manure, and type of aeration implement.

Impact of water troughs on cattle use of riparian zones in the Georgia Piedmont in the United States.

Cattle use of riparian areas may lead to stream water contamination with nutrients, pathogens, and sediments. Providing alternative water away from the stream may reduce the amount of time cattle spend near streams and therefore reduce contamination. We conducted this study to 1) evaluate the effect of providing water troughs outside of the riparian zones on the amount of time cattle spend in riparian zones, and 2) evaluate if environmental factors such as temperature and humidity affect the impact of water trough availability on the amount of time cattle spend within riparian and nonriparian locations. Global positioning system (GPS) collars were used to document cow locations every 5 min in 2 mixed tall fescue/common bermuda-grass pastures of the Georgia Piedmont in the United States. We found that when the temperature and humidity index (THI) ranged between 62 and 72, providing cattle with water troughs outside of riparian zones tended to decrease time cattle spent in riparian zones by 63% (52 min x d(-1); P = 0.11). When THI ranged between 72 and 84, nonriparian water availability did not have a significant impact on the amount of time cattle spent in the riparian zone or in riparian shade. These results suggest that water troughs placed away from unfenced streams may improve water quality by reducing the amount of time cattle spend in riparian zones when environmental conditions as evaluated by THI are not stressful.

Variable rainfall intensity and tillage effects on runoff, sediment, and carbon losses from a loamy sand under simulated rainfall.

The low-carbon, intensively cropped Coastal Plain soils of Georgia are susceptible to runoff, soil loss, and drought. Reduced tillage systems offer the best management tool for sustained row crop production. Understanding runoff, sediment, and chemical losses from conventional and reduced tillage systems is expected to improve if the effect of a variable rainfall intensity storm was quantified. Our objective was to quantify and compare effects of a constant (Ic) intensity pattern and a more realistic, observed, variable (Iv) rainfall intensity pattern on runoff (R), sediment (E), and carbon losses (C) from a Tifton loamy sand cropped to conventional-till (CT) and strip-till (ST) cotton (Gossypium hirsutum L.). Four treatments were evaluated: CT-Ic, CT-Iv, ST-Ic, and ST-Iv, each replicated three times. Field plots (n=12), each 2 by 3 m, were established on each treatment. Each 6-m2 field plot received simulated rainfall at a constant (57 mm h(-1)) or variable rainfall intensity pattern for 70 min (12-run ave.=1402 mL; CV=3%). The Iv pattern represented the most frequent occurring intensity pattern for spring storms in the region. Compared with CT, ST decreased R by 2.5-fold, E by 3.5-fold, and C by 7-fold. Maximum runoff values for Iv events were 1.6-fold higher than those for Ic events and occurred 38 min earlier. Values for Etot and Ctot for Iv events were 19-36% and 1.5-fold higher than corresponding values for Ic events. Values for Emax and Cmax for Iv events were 3-fold and 4-fold higher than corresponding values for Ic events. Carbon enrichment ratios (CER) were or=1.0 for CT plots (except for first 20 min). Maximum CER for CT-Ic, CT-Iv, ST-Ic, and ST-Iv were 2.0, 2.2, 1.0, and 1.2, respectively. Transport of sediment, carbon, and agrichemicals would be better understood if variable rainfall intensity patterns derived from natural rainfall were used in rainfall simulations to evaluate their fate and transport from CT and ST systems.

Aerating grasslands: effects on runoff and phosphorus losses from applied broiler litter.

Aeration has been promoted as improving infiltration of rainfall and extending grass or forage productivity, but research on the impact of this practice on P losses from grasslands has had mixed results. We designed a study to determine at the field scale, using a paired watershed approach, the impact of slit aeration on runoff volume and P losses in runoff from fescue (Festuca arundinacea Schreb.)/bermudagrass (Cynodon dactylon L.) hay fields fertilized with broiler litter. Three pairs of 0.8-ha fields, each with similar soils (Typic Kanhapludults, Aquic Hapludults, and Aquultic Hapludalfs), were fertilized with broiler litter and monitored under similar management from 1995 through 1998, then one field in each pair received aeration treatment from 2001 through 2003. In the field with mostly well-drained soils, grassland aeration reduced surface runoff volume and mass losses of dissolved reactive P (DRP) in runoff by approximately 35%. In contrast, when poorly drained soils dominated, grassland aeration increased runoff volume (4.8 mm/runoff event) and mass losses of DRP and total P (0.25 kg TP ha-1 per runoff event). This implies that aeration of well-drained soils in the top poultry-producing counties of Georgia (0.2 million ha) could decrease dissolved phosphorus losses by more than 500 Mg P each year. This is not the case if soils are poorly drained.

Phosphorus, sediment, and Escherichia coli loads in unfenced streams of the Georgia Piedmont, USA.

Contamination of unfenced streams with P, sediments, and pathogenic bacteria from cattle (Bos taurus) activity may be affected by the availability of shade and alternative water sources. The objectives of this study were to evaluate water quality in two streams draining tall fescue (Festuca arundinacea Schreb.)-common bermudagrass (Cynodon dactylon L.) pastures with different shade distribution, and to quantify the effects of alternative water sources on stream water quality. For 3 yr, loads of dissolved reactive phosphorus (DRP), total phosphorus (TP), and total suspended solids (TSS) were measured during storm flow, and loads of DRP, TP, TSS, and Escherichia coli were measured every 14 d during base flow. We also used GPS collars to determine amount of time cattle spent in riparian areas. Our results showed that cattle-grazed pastures with unfenced streams contributed significant loads of DRP, TP, TSS, and E. coli to surface waters (p < 0.01). Time spent by cattle in riparian areas as well as storm flow loads of DRP, TP, and TSS were larger (p < 0.08) in the pasture with the smaller amount of nonriparian shade. Water trough availability decreased base flow loads of TSS and E. coli in both streams, and decreased time cattle spent in riparian areas in the pasture with the smaller amount of nonriparian shade (p < 0.08). Our results indicate that possible BMPs to reduce contamination from cattle-grazed pastures would be to develop or encourage nonriparian shade and to provide cattle with alternative water sources away from the stream.

Distribution of inorganic nitrogen and phosphorus concentrations in stream flow of two Southern Piedmont watersheds.

Innate distributions or variability of nutrient concentrations within the fluvial system must be better understood to establish nutrient guidelines that are applicable and to discern which areas or landscape positions within the watershed are more vulnerable to nutrient losses. This work was conducted to (1) determine the system-wide spatial distribution of N and P concentrations in biweekly stream samples from two Southern Piedmont watersheds, and (2) determine the relationship between N and P concentrations in biweekly samples and watershed morphological features. From December 1998 through December 2000 samples were collected biweekly from 17 sampling sites located on Rose Creek and from 18 sampling sites located on Greenbrier Creek. The samples were analyzed for ammonium (NH4), nitrate (NO3), and dissolved reactive phosphorus (DRP) concentrations. We found that spatial autocorrelation of nitrate concentrations was evident and that some spatial autocorrelation of DRP concentrations was also present. We further found that the fluvial network morphological feature, drainage density, explained part of the spatial autocorrelation found for nitrate but did not for DRP. These results indicate that innate variability of nutrient concentrations within streams exists and suggest that decision makers should begin to consider location within the watershed when making nutrient management guidelines and decisions.

The Scottish multi-centre prospective study of bronchoscopy for bronchial carcinoma and suggested audit standards.

Fibre-optic bronchoscopy is widely used to diagnose bronchial carcinoma. There is considerable variation in techniques for patient sedation, methods of obtaining samples and histopathological yield. We wished to examine variations in practice in different centres throughout Scotland and derive realistic audit standards for best clinical practice from these results. Diagnostic bronchoscopies from five centres were included. Patient details, grade of individual performing the test, endobronchial abnormalities, specimens taken and the histocytological yield were recorded. A patient satisfaction questionnaire was completed. One thousand eight hundred and two bronchoscopies were performed to look for bronchial carcinoma. Sedation and anaesthesia techniques varied considerably between centres. There were marked differences in patient satisfaction between centres. Nearly twice as many females as males would prefer not to have bronchoscopy repeated. Six hundred and fifty-eight carcinomas were confirmed by histocytology. Yield was unaffected by the grade of doctor performing bronchoscopy. Improving yield may be achieved by increasing the number of sampling techniques employed and changing the order in which specimens are taken (biopsies first and washings last). Eighty-seven percent of endoscopically visible tumours were confirmed histocytologically. There was a considerable variation in histological spectra between centres that may relate to differences in pathological interpretation rather than actual differences in case mix. Suggested audit standards are discussed. This study demonstrates the variety of techniques and also the levels of histocytological yield and patient satisfaction that can be achieved. Provisional standards of practice for this procedure have been agreed with a view to auditing performance against these. It is hoped that centres will adopt the methods that are shown to achieve the highest standards.

Development of a humidifier for patient ventilation using a semi-permeable tube to minimize system condensate.

Condensation in the external airways of patient ventilation systems using conventional warm-water humidifiers increases the risk of bacterial contamination. Condensate formation can be reduced by heating the external airway and reducing the length of tubing between the patient and humidifier. The method described incorporates the humidifying element within the interconnecting tubing itself. Air is supplied through two semi-permeable tubes, of polytetrafluoroethylene, which are encased in an outer shell. A warm-water jacket is maintained in the shell; this is the source of heat and water vapour which diffuses through the semi-permeable tube wall and into the patient's air supply. An evaluation of performance and an initial clinical trial are reported.