Incidence of invasive anal cancer in Singapore, 1968–2012, by gender and histology.

<p>Incidence trends are based on incidence rates for 5-year time periods that were age-adjusted to the WHO standard population. Annual percent change (APC) was calculated using Joinpoint regression analysis. APC = annual percent change. An asterisk (*) indicates an APC value that is statistically significant at p≤0.05. Abbreviations: SCC = squamous cell carcinoma, non-SCC = non-squamous cell carcinoma</p

Incidence of invasive cervical cancer in Singapore, 1968–2012, by ethnicity.

<p>Incidence trends are based on incidence rates for 5-year time periods that were age-adjusted to the WHO standard population. Annual percent change (APC) was calculated using Joinpoint regression analysis. APC = annual percent change. An asterisk (*) indicates an APC value that is statistically significant at p≤0.05.</p

Incidence of oropharyngeal and non-oropharyngeal head and neck squamous cell carcinomas in Singapore 1968–2012, by gender.

<p>Incidence trends are based on incidence rates for 5-year time periods that were age-adjusted to the WHO standard population. Annual percent change (APC) was calculated using Joinpoint regression analysis. APC = annual percent change. An asterisk (*) indicates an APC value that is statistically significant at p≤0.05. Abbreviations: OPSCC = oropharyngeal squamous cell carcinoma; non-OP HNC = non-oropharyngeal head and neck squamous cell carcinoma</p

Age-standardized incidence rates (ASR) per 100,000 person years for each cancer, by gender and ethnicity, from 1968 to 2012 in Singapore.

<p>Age-standardized incidence rates (ASR) per 100,000 person years for each cancer, by gender and ethnicity, from 1968 to 2012 in Singapore.</p

Trends in crude cancer incidence over time, by type and gender, from 1968 to 2012 in Singapore^a.

<p>Trends in crude cancer incidence over time, by type and gender, from 1968 to 2012 in Singapore<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0146185#t001fn001" target="_blank">^a</a>.</p

Risk of Community-Acquired Pneumonia with Outpatient Proton-Pump Inhibitor Therapy: A Systematic Review and Meta-Analysis

<div><p>Background</p><p>Proton-pump inhibitors (PPIs) are among the most frequently prescribed medications. Community-acquired pneumonia (CAP) is a common cause of morbidity, mortality and healthcare spending. Some studies suggest an increased risk of CAP among PPI users. We conducted a systematic review and meta-analysis to determine the association between outpatient PPI therapy and risk of CAP in adults.</p><p>Methods</p><p>We conducted systematic searches of MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Scopus and Web of Science on February 3, 2014. Case-control studies, case-crossover, cohort studies and randomized controlled trials reporting outpatient PPI exposure and CAP diagnosis for patients ≥18 years old were eligible. Our primary outcome was the association between CAP and PPI therapy. A secondary outcome examined the risk of hospitalization for CAP and subgroup analyses evaluated the association between PPI use and CAP among patients of different age groups, by different PPI doses, and by different durations of PPI therapy.</p><p>Results</p><p>Systematic review of 33 studies was performed, of which 26 studies were included in the meta-analysis. These 26 studies included 226,769 cases of CAP among 6,351,656 participants. We observed a pooled risk of CAP with ambulatory PPI therapy of 1.49 (95% CI 1.16, 1.92; I2 99.2%). This risk was increased during the first month of therapy (OR 2.10; 95% CI 1.39, 3.16), regardless of PPI dose or patient age. PPI therapy also increased risk for hospitalization for CAP (OR 1.61; 95% CI: 1.12, 2.31).</p><p>Discussion</p><p>Outpatient PPI use is associated with a 1.5-fold increased risk of CAP, with the highest risk within the first 30 days after initiation of therapy. Providers should be aware of this risk when considering PPI use, especially in cases where alternative regimens may be available or the benefits of PPI use are uncertain.</p></div

Summary Forest Plot of Overall Risk of Community-Acquired Pneumonia with Outpatient Proton Pump Inhibitor Use, subdivided by study design and effect estimate.

<p>Solid diamond represents effect estimate. Shaded box size is proportional to the weight of the study in the meta-analysis. Confidence intervals are denoted by horizontal lines, with arrows where confidence interval extends beyond figure. Vertical dashed line represents the null effect. The open diamond is centered at the summary effect estimate and proportional to the confidence interval.</p

Qualitative analysis of 32 Studies under Systematic Review.

<p>Qualitative analysis of 32 Studies under Systematic Review.</p

Flow Diagram of Study Selection, adapted from PRISMA Group 2009 Flow Diagram.

<p>Studies could be excluded for more than one reason, therefore the sum of exclusion reasons exceeds total studies. Examples of studies lacking extractable data included abstracts without full results (such as abstracts reporting an odds ratio without exposure or outcome definitions) or papers summarizing outcomes qualitatively in the text (such as manuscripts reporting adverse event categories that grouped pneumonia among other events).</p

Summary of Subgroup Analyses.

<p>Summary of Subgroup Analyses.</p