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Background Frailty Index (FI) reflects health, functioning and well-being of older people. It is valuable to compare how frailty has changed over time in ageing cohorts. This study aims to examine trends in frailty among 75–95-year-old men and women over three decades. Methods The Helsinki Ageing Study started in 1989 and includes repeated cross-sectional postal surveys every 10 years examining community-dwelling cohorts of older people (75, 80, 85, 90 and 95 years). FI comprises the same 36 items in each cohort. Results The mean FI was 0.22 (SD 0.12), 0.25 (SD 0.15), 0.26 (SD 0.15) and 0.23 (SD 0.15) in 1989, 1999, 2009 and 2019, respectively (P for linearity for crude values.11). Adjusted for age and sex, the four cohorts differed in their frailty the 2019 cohort having the lowest FI. This sex-adjusted difference was seen among 75-, 80-, 85- and 90-year-olds but not among 95-year-olds. FI decreased more among men than women (P for cohort <.001, P for sex <.01, P for interaction =.19). Conclusions The prevalence of frailty among community-dwelling individuals aged 75, 80, 85 and 90 years—but not among those aged 95 years—has significantly decreased over the last decades. This positive trend may have important implications for health policies in societies with increasing longevity. [ABSTRACT FROM AUTHOR]

Introduction: Significant changes in the nutrition and physical fitness of children and adolescents have been observed in many countries around the world. The purpose of this study is to determine the changes in the prevalence of underweight, normal BMI, and overweight, as well as in the physical fitness of girls and boys from eastern Poland. Materials and methods: The study was conducted over the years 2006–2021. BMI was calculated, and physical fitness was assessed using the EUROFIT test. The results were statistically analyzed. Results: Minor changes in underweight were observed, and even a re-duction in its prevalence among girls was noted. However, a significant increase in the frequency of overweight was identified. Meanwhile, a decrease in the level of physical fitness in both girls and boys was recorded. These changes, however, were not uniform across all fitness abilities. Conclusions: The systematic decline in physical fitness among the examined girls and boys, particularly in cardiovascular-respiratory endurance, underscores the necessity for continued regular monitoring of the health of children and adolescents. [ABSTRACT FROM AUTHOR]

Reduced age-specific mortality and increased muscle strength and walking speed of current older adults may have altered the relationships between these factors as more people may be above the reserve capacity threshold. We compared the cross-sectional associations between muscle strength and walking speed, and the associations of muscle strength and walking speed with five-year mortality between two population-based cohorts of 75- and 80-year-old people born 28 years apart. Maximal isometric grip and knee extension strength and walking speed were measured in 2017–2018 (n = 726). Mortality was ascertained from registers. The associations were compared with data of same-aged people studied in 1989–1990 with identical protocols (n = 500). The knee extension strength-walking speed relationship showed plateauing at higher strength levels among the later-born men, whereas the earlier-born men and women of both cohorts with lower strength levels were on the linear part of the curve. In the later-born women with lower five-year mortality rate (1.16 vs. 5.88 per 100 person-years), the association between grip strength and mortality was markedly different from the earlier cohort (HR 1.13 [95% CI 0.47–2.70] vs. 0.57 [0.37–0.86]). For knee extension strength and walking speed, the mortality hazards were similar between the cohorts, although statistically non-significant in the later-born women. In men, the later-born cohort showed similar associations as observed in the earlier-born cohort despite having lower mortality rate (2.93 vs. 6.44). Current older adults have more functional reserve that will likely help them to maintain walking ability for longer while also contributing to better survival. [ABSTRACT FROM AUTHOR]

This study examined secular trends in Russian adolescent mental health, the specific effects of the COVID‐19 pandemic, and associations with country‐level indicators. A cross‐sectional survey of 12,882 adolescents aged 11–18 years was carried out between 1999 and 2021 using the Strengths and Difficulties Questionnaire. The results showed an incline in girls' internalizing problems with a two‐fold increase in the gender gap. There was a decline in girls' prosocial behavior and an incline in peer problems, with decreasing gender differences. Conduct problems showed a reversal of gender differences. Changes during the pandemic were not greater than over‐time changes, with the exception of inclines in hyperactivity‐inattention in both genders. Time trends in adolescent mental health were associated with over‐time changes in national indicators of wealth and gender equality. The findings provide a strong basis for further research into the determinants of gender differences in adolescent mental health and for gender‐specific interventions. [ABSTRACT FROM AUTHOR]

Objectives: To examine birth cohort differences in depressive symptoms and life satisfaction in older men and women and the mechanisms underpinning the possible cohort differences. Methods: Two independent cohorts of Finnish men and women aged 75 and 80 were assessed in 1989–1990 (n = 617) and 2017–2018 (n = 794). They reported their depressive symptoms (CES-D), current life satisfaction, and evaluation of life until now. Results: The later-born cohort reported fewer depressive symptoms (8.6 ± 7.1 vs. 13.9 ± 8.3) and the differences were similar for the subdomains of depressive symptoms. The later-born cohort was more often mostly satisfied with life until now (90 vs. 70%) but not with the current life than the earlier-born cohort. Better self-rated health and education of the later-born cohort partly explain the cohort differences. Discussion: Older people in Finland report fewer depressive symptoms and they are more satisfied with their past life compared to their counterparts assessed 28 years ago. [ABSTRACT FROM AUTHOR]

This investigation aimed to describe the current physical fitness (PF) status of Portuguese youth, compare secular trends from 2008 and 2018, and establish updated age‐ and sex‐specific percentile values for distinct PF tests. In 2008 and 2018, 22 048 and 8960 children and adolescents (10–18 years) were included in two national cross‐sectional investigations. PF was evaluated using the FITESCOLA® battery tests and the handgrip strength test. Independent sample t‐tests and chi‐squared tests were used to model the results. Weight smoothed percentile values were calculated using Cole's Lambda‐Mu‐Sigma (LMS) method. All analyses were weighted according to age, sex, and geographic region. In 2018, boys surpassed girls in the 20‐m shuttle run, curl‐ups, push‐ups, standing long, and vertical jump tests, while girls performed better in the sit‐and‐reach (p < 0.05). The percentage of boys and girls meeting the healthy zone in the 20‐min shuttle run test did not differ between 2008 and 2018 (p ≥ 0.05). In boys, a higher percentage fell in the healthy zone for the curl‐up and push‐up tests in 2018 compared to 2008 (85.8% vs. 83.4%, and 57.8% vs. 53.8%; p < 0.05). Girls improved their flexibility component (sit‐and‐reach test), with a higher percentage meeting the healthy zone in 2018 (32.6% vs. 36.9%; p < 0.05); an opposite trend was seen for boys (65.5% vs. 50.1%; p < 0.05). The present investigation provides new and updated PF percentile curves for Portuguese youth, which can be used as a general overview of the current PF state among the Portuguese young population. [ABSTRACT FROM AUTHOR]

Background: Since 2014, there has been increasing public outreach effort regarding isolated/idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) in Montreal. Objective: To assess if, over time, milder iRBD cases are presenting earlier. Methods: Disease‐free survival was compared in two iRBD recruitment epochs: 2004 to 2013 ("earlier") versus 2014to 2022 ("later") and by referral type ("self‐referral" vs. "conventional‐referral") in three large centers. Results: In Montreal, among 209 subjects followed prospectively, shorter time to phenoconversion was observed in the earlier epoch (5‐year phenoconversion = 42% earlier vs. 23% later); diagnosis before 2014 had a 1.8‐fold phenoconversion hazard. However, no difference was observed in 248 subjects from Barcelona and 166 from Innsbruck. Analysis of Montreal data found that increased survival in the later epoch was driven by an increasing number of self‐referrals, who phenoconverted at 1/3 the rate of physician‐referred subjects. Conclusions: Increased patient awareness of iRBD results in earlier presentation to clinical attention, with a longer time to phenoconversion. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether the Cayo Santiago, Puerto Rico (Latitude: 18.1564°N; temperature range 19°C to 32°C) rhesus macaque population has acclimated to their tropical island conditions since arriving from Lucknow, India (Latitude: 26.8470°N; temperature range 8°C to 41°C) in 1938. Materials and Methods: Using the derived skeletal collection, measurements were taken of long bone lengths, diaphyseal circumference, and body weight using 635 (237 males and 398 females) skeletally mature individuals. Measurements sampled colony members born over a 51‐year time span at Cayo Santiago, from 1951 to 2002. Results: Results demonstrated that body weights and diaphyseal circumferences significantly declined in both males and females. Long bone lengths relative to body weight and diaphyseal circumference also increased in females. Whereas body weight, long bone length and diaphyseal circumference declined at near parallel rates in males. Discussion: The population has acclimated to homogenous, tropical, conditions of the Caribbean island since their arrival over 80 years ago. Trends in both sexes aligned with Bergmann's rule, though females displayed a greater decline in body weight, as well as greater affinity with Allen's rule, than did males. Buffering effects related to male competition may be responsible for this discrepancy. Overall, the Cayo Santiago populations, as shown over a significant period (1951–2002) of their history, have acclimated to their island conditions by decreasing in size and altering body proportions. [ABSTRACT FROM AUTHOR]

The present study was conducted to determine whether the problem characteristics of U.S. students school-identified with emotional disturbance (ED) have changed over two decades. We used data from a teacher rating instrument designed to measure the five problem characteristics of ED, as stated in its Individuals with Disabilities Education Act (IDEA) definition. These data were collected in the process of norming the instrument for 1998 and again for 2020. Comparison of the 1998 and 2020 students school-identified with ED showed that the 1998 group had significantly more problematic functioning on two characteristics, namely, Relationship Problems and Inappropriate Behavior, but no more problematic differences on Inability to Learn, Unhappiness or Depression, and Physical Symptoms or Fears. In addition, analyses of selected items gave more context to the main results. Study limitations, future research, and implications are discussed. [ABSTRACT FROM AUTHOR]

Simple Summary: Oral cancer (OC) is prevalent cancer worldwide, with varying incidence rates in different regions. To analyze the secular trend of the incidence of OC in Taiwan, this study used data from the national cancer registry database between 1980 and 2019. The study used the age-period-cohort model and average annual percentage change (AAPC) to examine the characteristic of incidence. The study also used Spearman's correlation to determine the correlation between age-standard incidence rates (ASR) of OC and related risk factors. Results indicated that ASR of OC increased in men and women from 1980–1984 to 2015–2019. The age-period-cohort model revealed a peak incidence rate in the 1975 cohort in men, followed by a declining trend. The study found a correlation between the incidence of OC and changes in cigarette and alcohol consumption and the production of betel quid. Therefore, the study recommends avoiding these risk factors to prevent OC. Oral cancer (OC) is one of the most common cancers worldwide, and its incidence has regional differences. In this study, the cancer registry database obtained from 1980 to 2019 was used to analyze the characteristic of incidence of OC by average annual percentage change (AAPC) and an age–period–cohort model. Spearman's correlation was used to analyze the relationship between the age-standard incidence rates (ASR) of OC and related risk factors. Our results showed that the ASR of OC increased from 4.19 to 27.19 per 100,000 population with an AAPC of 5.1% (95% CI = 3.9–6.3, p value < 0.001) in men and from 1.16 to 2.8 per 100,000 population with an AAPC of 3.1% (95% CI = 2.6–3.6, p value < 0.001) in women between 1980–1984 and 2015–2019. The age–period–cohort model reported a trend of rising then declining for the rate ratio in men, with peaks occurring in the 1975 cohort, with a rate ratio of 6.80. The trend of incidence of oral cancer was related to changes in the consumption of cigarettes and alcohol and production of betel quid, with r values of 0.952, 0.979 and 0.963, respectively (all p values < 0.001). We strongly suggest avoiding these risk factors in order to prevent OC. [ABSTRACT FROM AUTHOR]

Levels of emotional and behavioral problems in children and adolescents demonstrate secular changes over time, warranting ongoing investigation. Prior studies examining secular trends in a range of such problems have been conducted in the U.S. and internationally. Research in this area generally has not fully considered the school setting. This study compared emotional and behavioral problems across two cohorts of students in the U.S. assessed over a 22-year time period as part of measurement development efforts for the Scales for Assessing Emotional Disturbance Rating Scale (SAED-RSRS; Epstein et al., 2020). Specifically, analyses drew from data collected via teacher report on matched cohorts of students for the 1998 (data collected from 1996 to 1997; n = 1,148) and 2020 (data collected from 2016 to 2018; n = 1,148) editions of the SAED-RS. After establishing measurement invariance across cohorts and testing for gender differences, structural equation modeling revealed statistically significant cohort mean differences on two of the five factors of the SAED-RS, suggesting increases over time in Inability to Learn (β = 0.09, p =.024) and Physical Symptoms and Fears (β = 0.14, p =.005) that were comparable for girls and boys. There were no statistically significant differences on the remaining factors: Relationship Problems, Inappropriate Behavior, and Unhappiness/Depression. Supplemental item-level tests revealed differences on 8 of the 39 SAED-RS items. Findings suggest increases in specific problem areas that could benefit from ongoing monitoring and targeted interventions to support contemporary students. [ABSTRACT FROM AUTHOR]

Limited data are available on the impact of the coronavirus disease (COVID‐19) pandemic on encephalitis. Therefore, we evaluated trends in encephalitis in South Korea between 2010 and 2021 using data from the National Health Insurance Service. During the pandemic (February 2020 to 2021), the monthly incidence of encephalitis declined by 0.027 per 100 000 population (95% confidence interval [CI]: −0.055 to 0.001, p = 0.062) compared to that before the pandemic. In subgroup analysis, the estimated coefficient for level change during the pandemic in the 0–4 and 5–9 years age groups were −2.050 (95% CI: −2.972 to −1.128, p < 0.001) and −0.813 (95% CI: −1.399 to −0.227, p = 0.008), respectively. The annual incidence of encephalitis during the pandemic period significantly decreased in the 0–4 and 5–9 years age groups (incidence rate ratio: 0.34 [p = 0.007] and 0.28 [p = 0.024], respectively). The intensive care unit admission rate (39.1% vs. 58.9%, p < 0.001) and cases of death (8.9% vs. 11.1%, p < 0.001) decreased significantly during the pandemic compared to the prepandemic. During the pandemic, the incidence of encephalitis decreased markedly in South Korea, particularly in children aged ≤9 years. In addition, there were changes in the clinical outcome of encephalitis during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

During armed conflict, the non-combative population, and particularly children, are susceptible to the effects of conflict from a variety of perspectives; psychological stress, loss of food and resources, loss of accommodation, occupation, income, death of family members, etc. The Lancet recently published a special issue entitled 'Maternal and child health and armed conflict' concluding that the ways in which health can be affected by conflict are protean but systematic evidence is sparse, whatever evidence exists is localised and of low to moderate quality, and that data on adolescents are sparse to non-existent. Whilst this may be true of the challenging environments of conflicts in developing countries, historically recent conflicts in Europe provide an alternative viewpoint that is frequently aired in the Auxological literature but is virtually unknown and/or unrecognised in health settings. The current paper summarises three previously published studies based on repeated cross-sectional child growth surveys in London, Oslo, and Stuttgart covering the years of the Second World War. Taken together these studies provide extensive evidence of the response of children to armed conflict in the context of secular tends in growth of children living in industrialised nations during the twentieth century. The conclusions to all three studies may be summarised, with regard to children in industrialised nations, as: (1) armed conflict adversely affects human growth and health, (2) armed conflict affects all age groups but adolescents more so, (3) all age groups recover from poor growth as conditions improve in relation to post-war health and welfare programmes, (4) pre-war differences in size between SES groups diminish during post-war recovery when accompanied by nutritional, welfare and reconstruction programmes. [ABSTRACT FROM AUTHOR]

Summary: International variations in osteoporosis and fracture rates have been reported, with temporal trends differing between populations. We observed higher BMD and lower fracture prevalence in a recently recruited cohort compared to that of a cohort recruited 20 years ago, even after adjusting for multiple covariates. Purpose: We explored sex-specific differences in femoral neck bone mineral density (FN-BMD) and in prevalent major osteoporotic fractures (MOF) using two Canadian cohorts recruited 20 years apart. Methods: We included men and women aged 50–85 years from the Canadian Multicentre Osteoporosis Study (CaMos, N = 6,479; 1995–1997) and the Canadian Longitudinal Study on Aging (CLSA, N = 19,534; 2012–2015). We created regression models to compare FN-BMD and fracture risk between cohorts, adjusting for important covariates. Among participants with prevalent MOF, we compared anti-osteoporosis medication use. Results: Mean (SD) age in CaMos (65.4 years [8.6]) was higher than in CLSA (63.8 years [9.1]). CaMos participants had lower mean body mass index and higher prevalence of smoking (p < 0.001). Adjusted linear regression models (estimates [95%CI]) demonstrated lower FN-BMD in CaMos women (− 0.017 g/cm2 [− 0.021; − 0.014]) and men (− 0.006 g/cm2 [− 0.011; 0.000]), while adjusted odds ratios (95%CI) for prevalent MOF were higher in CaMos women (1.99 [1.71; 2.30]) and men (2.33 [1.82; 3.00]) compared to CLSA. In women with prevalent MOF, menopausal hormone therapy use was similar in both cohorts (43.3% vs 37.9%, p = 0.076), but supplements (32.0% vs 48.3%, p < 0.001) and bisphosphonate use (5.8% vs 17.3%, p < 0.001) were lower in CaMos. The proportion of men with MOF who received bisphosphonates was below 10% in both cohorts. Conclusion: Higher BMD and lower fracture prevalence were noted in the more recently recruited CLSA cohort compared to CaMos, even after adjusting for multiple covariates. We noted an increase in bisphosphonate use in the recent cohort, but it remained very low in men. [ABSTRACT FROM AUTHOR]

Changes in physical activity levels and increases in screen time across different cohorts may affect young children's motor skill development (MSD). This study examined cohort differences in MSD in China. Four-year-olds living in Shanghai and in Guizhou province were assessed, in individual sessions, in 2013 (n = 230) and in 2017 (n = 446). Controlling for age, parental education, gender, height, weight, and overall development, children's MSD scores were significantly lower in 2017 than in 2013 in both Shanghai and Guizhou. Parental education moderated these differences. Declines in MSD scores may be due to increased screen time, higher levels of air pollution, and decreased access to safe, outdoor spaces. The overall decline in motor skills across both regions suggests that appropriate and timely interventions are needed to support young Chinese children's MSD. [ABSTRACT FROM AUTHOR]

Secular trends in puberty refer to the changes observed over time in the onset and progression of puberty in populations. One of the most notable secular trends in recent years it is the declining age of puberty timing. The secular trend in early breast development (thelarche) refers to the observed phenomenon of girls entering puberty at progressively younger ages over successive generations. The aim of this study is to assess the breast development stages among girls, comparing four ethnicities in the northwestern part of North Macedonia. Material and methods: An assessment of breast development stages was conducted, which included the cross-sectional study evaluation of 480 sampled girls aged 6-13 years from four different ethnicities. Breast development was assessed using Tanner and Whitehouse method which categorizes breast development into five stages (B1 to B5) based on specific physical characteristics. Results: The prevalence of breast development stages according to age shows that B2 increased gradually from 2.6% at 6+ years to 8.0% at 7+, 13.5% at 8+, and 30.6% at 9+. The highest prevalence was observed at 10+ years with 43.1% and at 11+ years with 25.8%. The mean age of reaching breast development stage B2 in the entire sample of girls was 9.38 +/- 1.3 years. Among the four ethnicities, the lowest average age was observed among Roma girls (9.11 +/- 1.19 years), followed by Turkish girls (9.13 +/- 0.63 years), Macedonian girls (9.41 +/- 1.22 years), and Albanian girls (9.43 +/- 1.44 years). Conclusion: At our study the prevalence of stage B2 breast development at 6 and 7 years, is worth emphasizing because the occurrence of secondary sexual characteristics before the age of 8 may indicate a possible sign of early onset of puberty. Early thelarche, occurring before the age of 8, has become a topic of interest due to its potential psychological, social, and long-term health implications. [ABSTRACT FROM AUTHOR]

The goal of the study was to identify secular trends in dental service delivery between dental therapists and dentists in the Yukon-Kuskokwim Delta region of Southwest Alaska, the first area of the United States to authorize dental therapy practice. Electronic health record transactions from the Yukon-Kuskokwim Health Corporation from 2006 through 2015 (n = 27,459) were analyzed. Five types of dental services were identified using Current Dental Terminology procedure codes: diagnostic, preventive, restorative, endodontic, and oral surgery. Main outcomes were percentages of services provided by dental therapists compared with dentists and population-level preventive oral health care. The overall number of diagnostic, preventive, and restorative services in the Yukon-Kuskokwim Delta increased. For diagnostic services, there was a 3.5% annual decrease observed for dentists and a 4.1% annual increase for dental therapists (P <.001). Similar trends were observed for restorative services. For preventive services, there was no change for dentists (P =.89) and a 4.8% annual increase for dental therapists (P <.001). Dental therapists were more likely than dentists to provide preventive care at the population level. Dental therapists have made substantial contributions to the delivery of dental services in Alaska Native communities, particularly for population-based preventive care. The study's findings indicate that there is a role for dental therapy practice in addressing poor access to oral health care in underserved communities. [ABSTRACT FROM AUTHOR]

Context: Sleep quality has been related to the risk of diabetes; however, little is known about the prevalence of diabetes in the United States according to the levels of sleep quality. Objective: To examine the joint secular trends of the overall sleep quality and diabetes among US adults from 2005-2006 to 2017-2018. Methods: Seven cycles of cross-sectional National Health and Nutrition Examination Survey (NHANES) data between 2005-2006 and 2017-2018 were included. Nonpregnant adults aged 20 years or older were eligible for the study. A healthy sleep score was calculated to represent overall sleep quality. The prevalence of diabetes was estimated and mean levels of fasting plasma glucose (FPG), glycated hemoglobin, and insulin resistance were calculated. Results: Both the estimated age-standardized prevalence of diabetes and changing trend in prevalence of diabetes varied by the overall sleep quality groups. The highest prevalence of diabetes was consistently observed in the low sleep quality group in each cycle, in which a significantly increasing trend was also noted across cycles (P for trend = .004). In contrast, the lowest prevalence of diabetes was consistently observed in the high sleep quality group in each cycle, in which no increasing trend over time was observed (P for trend = .346). Conclusions: Overall sleep quality decreased significantly between 2005-2006 and 2017-2018 among US adults. The estimated prevalence of diabetes and related measures only increased in participants with low or medium overall sleep quality but remained stable in participants with high sleep quality. [ABSTRACT FROM AUTHOR]

Background: The number of dementia patients is increasing worldwide, especially in Japan, which has the world's highest ageing population. The increase in the number of older people with dementia is a medical and socioeconomic problem that needs to be prevented, but the actual situation is still not fully understood. Methods: Four cross‐sectional studies on dementia were conducted in 1997, 2004, 2012, and 2016 for complete enumeration of all residents aged 65 years and older. We examined the secular trends in the prevalence of all‐cause dementia, Alzheimer's disease (AD), vascular dementia (VaD), and other/unclassified dementia. Results: The age‐standardised prevalence of all‐cause dementia significantly increased (4.5% in 1997, 5.7% in 2004, 5.3% in 2012, 9.5% in 2016; P for trend <0.05). Similar trends were observed for AD (1.7%, 3.0%, 2.5% and 4.9%, respectively; P for trend <0.05) and other/unclassified dementia (0.8%, 1.0%, 1.0% and 2.2%, respectively; P for trend <0.05), whereas no significant change in VaD was seen (2.1%, 1.8%, 1.8%, 2.4%, respectively; P for trend = 0.77). The crude prevalence of all‐cause dementia and AD increased from 1997 to 2016 among participants aged 75–79 years and ≥85 years (all P for trend <0.05). Similar trends were observed for other/unclassified dementia among participants aged ≥80 years (all P for trend <0.05), but not in VaD. Conclusions: The prevalence of dementia has increased beyond the ageing of the population, suggesting that factors in addition to ageing are involved in the increase in the number of older people with dementia. To control the increase in the number of older people with dementia, elucidation of secular trends in the incidence, mortality, and prognosis of dementia as well as the factors that promote and protect against dementia, and development of preventive strategies are necessary. [ABSTRACT FROM AUTHOR]

Background: Although numerous studies have reported a decrease in dementia risk in the last two decades, it is unclear whether dementia-free cognitive function is also changing across generations.Objective: The objective was to systematically evaluate the published data on generational differences in cognitive function in the older population.Methods: Searches were performed on PubMed, Embase, and PsychInfo for articles published in English before 28 June 2021. Included studies were from population-based samples that reported generational differences in cognition in individuals without dementia, aged ≥60 years.Results: 28,101 studies were identified and 15 selected covering the period from 1971 to 2015: including studies from China, Europe, and the USA. The results show generally consistent findings of improvements or stability in dementia free cognitive function in later versus earlier born generations, but not for all cognitive domains. Prevalence of mild cognitive impairment and cognitive impairment no dementia has remained stable in the USA, UK, and China over the last two decades.Results: Prevalence of vascular related mild cognitive impairment has increased in China. Improvements in cognition may only partially be explained by increased educational attainment across generations.Conclusion: This review provides evidence for generational effects in dementia-free cognitive function, predominately stability or improvements in performance, in later compared to earlier born individuals across different world regions. There is an urgent need to determine the factors driving such changes and whether they are being experienced in all world regions, particularly low- and middle-income countries where the burden of cognitive impairment is greatest and rising. [ABSTRACT FROM AUTHOR]

Malocclusion is a well‐known phenomenon since antiquity. Previous studies found an increase in malocclusion in the modern population. This study was undertaken to assess the frequency and severity of malocclusions in a sample of ancient skulls and to compare these findings with a modern sample, using the same examination protocol. The archaeological sample comprised 63 skulls from Dor, northern Israel, dated to the 16th–19th centuries. Skull examination was performed in maximal occlusion by using a clinically based approach. The modern sample comprised a random, ethnicity‐matched group of 340 school students, aged 11–16 years, who underwent a clinical orthodontic examination. The following parameters were recorded for both groups: Angle's classification, overjet, overbite, crowding, spacing, midlines, and crossbite. Descriptive statistics was obtained for all the parameters examined, and the results were compared between the groups. Differences were considered significant at p < 0.05. The frequency of the occlusal relationships according to Angle's classification in the two groups was different, although the difference did not reach statistical significance (p = 0.471). However, the main difference between the two groups was recorded in Angle's Class I malocclusion, which was remarkably more prevalent in the modern population, and in a higher prevalence of normal occlusion in the archaeological group. The distribution of malocclusion severity was significantly different in the two groups (p < 0.01). Frequency of crowding in the maxilla (33.9% vs. 15.4%) and mandible (55.3% vs. 29.6%) was significantly higher in the modern group (p < 0.01). The frequency of open bite was higher in the archaeological group (p < 0.01). The secular trend observed in this study could be attributed to poor oral health and inadequate food supply in the past, as well as changes in food processing over the years. [ABSTRACT FROM AUTHOR]

Rationale: The population of patients with pulmonary arterial hypertension (PAH) has evolved over time from predominantly young White women to an older, more racially diverse and obese population. Whether these changes are reflected in clinical trials is not known. Objectives: To determine secular and regional trends among PAH trial participants. Methods: We performed a pooled cohort analysis using harmonized data from phase III clinical trials of PAH therapies submitted to the U.S. Food and Drug Administration. We used mixed-effects linear and logistic regression to assess regional differences in participant age, sex, body habitus, and hemodynamics over time. Results: A total of 6,599 participants were enrolled in 18 trials between 1998 and 2013; 78% were female. The mean age of participants in North America, Europe, and Latin America at the time of study start increased by 2.09 (95% confidence interval [CI], 0.67-3.51), 1.62 (95% CI, 0.24-3.00), and 4.75 (95% CI, 2.29-7.21) years per 5 years, respectively (P = 0.01). Body mass index at the time of study start increased by 0.72 kg/m2 per 5 years (95% CI, 0.44-0.99; P < 0.001) across all regions. Eighty-five percent of participants in early studies were non-Hispanic White, but this decreased over time to 70%. Ninety-seven percent of Asians and 74% of Hispanics in the sample were recruited from Asia and Latin America. Conclusions: Patients enrolled in more recent PAH therapy trials are older and more obese, mirroring the changing epidemiology of observational cohorts. However, these trends varied by geographic region. PAH cohorts remain predominantly female, presenting challenges for generalizability to male patients. Although the proportion of non-White participants increased over time, this was primarily through recruitment in Asia and Latin America. [ABSTRACT FROM AUTHOR]

Summary: This was a retrospective observational study to determine the secular trends in osteoporosis hip fractures in Brazil from 2004 to 2013. The fracture rates were stable for both sexes, and there was not a secular trend. Fractures were predominant in the South and Southeast Regions. The hip fracture rate was lower in this study than in other studies. These regional differences may be considered in the FRAX Brazil calibration. Purpose: Hip fractures are well-known osteoporotic fractures with high mortality and morbidity. Epidemiological studies in Brazil on hip fractures are scarce, and the great majority have been performed in small populations from a few cities. None of these studies has analyzed the long-term hip fracture secular trends, which are important data for the promotion of public health actions. Methods: This was a retrospective observational study with a secular trend analysis in patients over 50 years old who were admitted to the Brazilian Public Health System from 2004 to 2013. We collected hospitalization data according to the ICD-10 for low-trauma hip fractures. The fracture rate was calculated when the patients were stratified by sex, age, and geographic region, and linear regression analysis was performed to evaluate the secular trends. Results: The hip fracture rate per 100,000 inhabitants was 59.69; the rate was 74.72 in females and 42.95 in males. The fracture rates were higher in the South and Southeast Regions and steadily increased with age, and the average ratio of women-to-men was 1.74. No secular trend was detected in the overall population. Surprisingly, the secular trend only increased in the South region from 2004 to 2013, and the secular trends were stable in the other regions. Conclusion: Although the secular trend was similar to some worldwide studies, the hip fracture rate was lower than that previously observed in regional studies in Brazil. These regional differences may be considered in the FRAX Brazil calibration. [ABSTRACT FROM AUTHOR]

Introduction: A previous review study showed the trends of declining age- and sex-adjusted incidence of hip fractures in almost all the countries, except Austria and Japan, in the most recent of the periods studied. However, the expansion of devices for diagnosis and drugs for fracture prevention in Japan was roughly the same as in the other countries. This study aimed to conduct a comprehensive systematic review and meta-analyses of incidence rates (IRs) of osteoporotic fractures reported over 30-years in multiple communities in Japan and to evaluate secular trends. Materials and Methods: We searched MEDLINE for observational studies reporting IRs of osteoporotic fractures in the general population. Additional studies were identified by hand searches of reference lists of published studies. Two reviewers and 1 expert independently assessed study eligibility. Pooled analyses of IRs were conducted by a random-effect model. Data from 3 periods (1985–1999, 2000–2009, and from 2010) were compared. Results: Of 47 eligible studies, 21 with IRs or information enabling recalculation of IRs in the population aged 50 years and older were included. IRs of hip fractures per 100,000 person-years significantly increased over time in men: 1985–1999, 0.79 (95% CI 0.71–0.87); 2000–2009, 1.18 (95% CI 1.09–1.28); and 2010 onwards, 1.31 (95% CI 1.17–1.45). They also significantly increased in women: 2.23 (95% CI 1.89–2.58); 3.99 (95% CI 3.70–4.28); and 4.39 (95% CI 4.00–4.78), respectively. Conclusion: IRs of hip fractures continuously increased in the past 30-years in men and women despite improved the diagnosis, treatment, and care. Such data from Japan, a leading aging society, provide important information for other countries. [ABSTRACT FROM AUTHOR]

Over the past few decades, more studies have suggested that the age at menarche (AAM) has continued to decline. However, the AAM for women in resource-constrained areas is not clear. Moreover, the association between the Chinese famine and AAM is still unclear in rural regions. The study aimed to investigate the secular trends of AAM for women born between 1935 and 2000 and to further explore the effect of famine on AAM in rural China. The study included 23,444 women participants from the baseline study of the Henan Rural Cohort study. Changing AAM over time was analysed using linear regressions. Multinomial logistic regression was conducted to analyse the association between famine exposure and AAM subgroups. The age-standardised mean AAM was 14.74 years. The average AAM declined from 16.98 years for those born in 1935 to 13.87 years for those born in 2000, a decline of 0.077 years per 1 year and 0.729 years per decade. Compared to the reference group, women exposed to famine during foetal, early childhood, middle childhood, and late childhood were 1.376 (95% CI = 1.071–1.769), 1.848 (95% CI = 1.512–2.259), 2.084 (95% CI = 1.725–2.518), and 2.146 (95% CI = 1.788–2.576) times more likely to be ≥18 years AAM than women unexposed to famine, respectively. AAM showed a decreasing trend in rural China. Furthermore, both foetal and childhood famine exposure, especially in late childhood, were positively associated with increased AAM compared to unexposed famine. [ABSTRACT FROM AUTHOR]

Background: Research suggests that incident dementia is decreasing, yet research on secular trends of prodromal dementia such as mild cognitive impairment (MCI) is lacking. Methods: To determine change of MCI prevalence over time and potential explanatory factors, four baseline samples (years 2001-2020) of Swedish participants (n = 3910) aged 60 and 81 at examination were compared. Results: An overall drop of 9 to 10 percentage points inMCI prevalence between 2001 and 2020 was observed, with lower odds ratios (OR) forMCI in the latest birth cohorts compared to earliest (e.g., ORs for 60-year-olds in latest born = 0.53; 95% confidence interval [CI] 0.37-0.76). Adjustments for sociodemographic (e.g., education), lifestyle, vascular and metabolic health and depression could not fully explain the observedMCI decline (e.g., 60-year-olds, OR = 0.59; 95% CI 0.40-0.88). Discussion: Studies like this are imperative as even a slight postponement in the onset of dementia could have a substantial impact on future public health burden. [ABSTRACT FROM AUTHOR]

With unprecedented increases, mortality trends in the United States have received significant attention in recent years. To date, research on this topic has emphasized specific causes of death and proximal behavioral or physiological determinants. In this commentary, I consider novel contributions of Zheng and Echave (Am J Epidemiol. 2021;190(11):2242–2255) in examining trends in mental health, health behaviors, and physiological dysregulation. I then discuss broader developments in related research and make a case for: 1) not allowing recent health trends among Whites to overshadow the urgent work that needs to be done to mitigate persistent racial inequities, 2) further investigation of what accounts for increases in income inequality and its life-span health consequences, and 3) broadening the scope of mechanisms considered to include underdiscussed topics such as the role of increases in social media use or environmental toxicant exposures. Underlying several potential explanations for observed trends in health and mortality is the fact that substantial change has occurred on multiple fronts in US society and that policy responses to these changes have been insufficient. An enhanced emphasis on innovative population health research will be essential to provide the evidence base needed for policy makers to rise to these urgent challenges. [ABSTRACT FROM AUTHOR]

Understanding the changing health consequences of childhood socioeconomic disadvantage (SED) is highly relevant to policy debates on inequality and national and state goals to improve population health. However, changes in the strength of association between childhood SED and adult health over historic time are largely unexamined in the United States. The present study begins to address this knowledge gap. Data were from 2 national samples of adults collected in 1995 (n  = 7,108) and 2012 (n  = 3,577) as part of the Midlife in the United States study. Three measures of childhood SED (parents' occupational prestige, childhood poverty exposure, and parents' education) were combined into an aggregate index and examined separately. The association between childhood SED (aggregate index) and 5 health outcomes (body mass index, waist circumference, chronic conditions, functional limitations, and self-rated health) was stronger in the 2012 sample than the 1995 sample, with the magnitude of associations being approximately twice as large in the more recent sample. Results persisted after adjusting for age, sex, race, marital status, and number of children, and were similar across all 3 measures of childhood SED. The findings suggest that the socioeconomic circumstances of childhood might have become a stronger predictor of adult health in recent decades. [ABSTRACT FROM AUTHOR]

Background: Previous epidemiological studies have indicated the seasonal variability of serum lipid levels. However, little research has explicitly examined the separate secular and seasonal trends of dyslipidemia. The present study aimed to identify secular and seasonal trends for the prevalence of dyslipidemia and the 4 clinical classifications among the urban Chinese population by time series decomposition. Methods: A total of 306,335 participants with metabolic-related indicators from January 2011 to December 2017 were recruited based on routine health check-up systems. Multivariate direct standardization was used to eliminate uneven distributions of the age, sex, and BMI of participants over time. Seasonal and trend decomposition using LOESS (STL decomposition) was performed to break dyslipidemia prevalence down into trend component, seasonal component and remainder component. Results: A total of 21.52 % of participants were diagnosed with dyslipidemia, and significant differences in dyslipidemia and the 4 clinical classifications were observed by sex (P <0.001). The secular trends of dyslipidemia prevalence fluctuated in 2011–2017 with the lowest point in September 2016. The dyslipidemia prevalence from January to March and May to July was higher than the annual average (λ = 1.00, 1.16, 1.06, 1.01, 1.02, 1.03), with the highest point in February. Different seasonal trends were observed among the 4 clinical classifications. Compared to females, a higher point was observed among males in February, which was similar to participants aged < 55 years (vs. ≥ 55 years) and participants with a BMI ≤ 23.9 (vs. BMI > 23.9). Conclusions: There were significant secular and seasonal features for dyslipidemia prevalence among the urban Chinese population. Different seasonal trends were found in the 4 clinical classifications of dyslipidemia. Precautionary measures should be implemented to control elevated dyslipidemia prevalence in specific seasons, especially in the winter and during traditional holidays. [ABSTRACT FROM AUTHOR]

Objective: This study examines secular changes in diet-related greenhouse gas emissions (GHGE) in younger and older Swedish adults, since the turn of this century.Design: Two cross-sectional health examination surveys were conducted in 2001-2004 (T1) and 2014-2018 (T2). At both times, an eighty-six-item FFQ was embedded in the survey. From the food frequencies and age-standardised portion sizes, GHGE estimates (kg CO2e/year) were calculated. GHGE was modelled as a function of time period and covariates, for five distinct age groups.Setting: The municipality of Gothenburg, in western Sweden.Participants: Women and men aged 25-34, 35-44, 45-54, 55-64 and 65-75 years were randomly selected from the population registry and recruited for examinations. After exclusion of participants with incomplete dietary data, the analytic sample consisted of 2569 individuals at T1 and 2119 at T2.Results: Lower dietary GHGE scores were observed at T2 compared with T1, in each age group, adjusting for sex, BMI and education. The largest differences in GHGE were observed in the youngest age group (approximately 30 % reduction). Decreasing trends in GHGE from animal-based foods were observed at all ages and were accompanied by smaller increases from plant-based sources in younger groups only. At all ages, GHGE from discretionary foods decreased, and prevalence of overweight remained stable.Conclusions: Optimal dietary trends should support both human health and planetary health. Our results suggest that Swedish adults have moved in this direction, e.g. through less intake of red meat products and stable weight status. [ABSTRACT FROM AUTHOR]

Background: Whether increased life expectancy is accompanied by increased functional capacity in older people at specific ages is unclear. We compared similar validated measures of maximal physical performance in 2 population-based older cohorts born and assessed 28 years apart.Method: Participants in the first cohort were born in 1910 and 1914 and were assessed at age 75 and 80 years, respectively (N = 500, participation rate 77%). Participants in the second cohort were born in 1938 or 1939 and 1942 or 1943 and were assessed at age 75 and 80 years, respectively (N = 726, participation rate 40%). Participants were recruited using a population register and all community-dwelling persons in the target area were eligible. Both cohorts were interviewed at home and were examined at the research center with identical protocols. Maximal walking speed, maximal isometric grip and knee extension strength, forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were assessed. Data on non-participation were systematically collected.Results: Walking speed was on average 0.2-0.4 m/s faster in the later than earlier cohort. In grip strength, the improvements were 5%-25%, and in knee extension strength 20%-47%. In FVC, the improvements were 14-21% and in FEV1, 0-14%.Conclusions: The later cohort showed markedly and meaningfully higher results in the maximal functional capacity tests, suggesting that currently 75- and 80-year-old people in Finland are living to older ages nowadays with better physical functioning. [ABSTRACT FROM AUTHOR]

Background: Temporal trends in clinical composition and outcome in dilated cardiomyopathy (DCM) are largely unknown, despite considerable advances in heart failure management. We set out to study clinical characteristics and prognosis over time in DCM in Sweden during 2003-2015.Methods: DCM patients (n = 7873) from the Swedish Heart Failure Registry were divided into three calendar periods of inclusion, 2003-2007 (Period 1, n = 2029), 2008-2011 (Period 2, n = 3363), 2012-2015 (Period 3, n = 2481). The primary outcome was the composite of all-cause death, transplantation and hospitalization during 1 year after inclusion into the registry.Results: Over the three calendar periods patients were older (p = 0.022), the proportion of females increased (mean 22.5%, 26.4%, 27.6%, p = 0.0001), left ventricular ejection fraction was higher (p = 0.0014), and symptoms by New York Heart Association less severe (p < 0.0001). Device (implantable cardioverter defibrillator and/or cardiac resynchronization) therapy increased by 30% over time (mean 11.6%, 12.3%, 15.1%, p < 0.0001). The event rates for mortality, and hospitalization were consistently decreasing over calendar periods (p < 0.0001 for all), whereas transplantation rate was stable. More advanced physical symptoms correlated with an increased risk of a composite outcome over time (p = 0.0043).Conclusions: From 2003 until 2015, we observed declining mortality and hospitalizations in DCM, paralleled by a continuous change in both demographic profile and therapy in the DCM population in Sweden, towards a less affected phenotype. [ABSTRACT FROM AUTHOR]

Objectives: Increasing life expectancy and decreasing mortality in patients with HIV infection are well documented. However, details of how many of the years of healthy life are damaged by HIV infection vs. good health have not been understood. We conducted this study to provide a comprehensive assessment of the levels and trends of the global burden, as measured by disability-adjusted life years (DALYs), of HIV infection.Methods: Data on HIV-related DALY were obtained from the Global Burden of Disease Study 2019. The absolute numbers and age-standardised rates of DALYs due to HIV were reported between 1990 and 2019. Estimated annual percentage changes in age-standardised rates by sex, region and nation were calculated to quantify the temporal trends in HIV burden.Results: Global HIV infection caused 47.63 million DALYs in 2019, presenting a 1.28-fold increase from 1990 to 2019. In 2019, years of life lost contributed to most of the total DALYs, but the increases in HIV-related years lived with disability have outpaced increases in years of life lost. The age-standardised rates of HIV-related DALYs in 2019 decreased as the sociodemographic indexes increased. The highest age-standardised rates were observed in sub-Saharan Africa, and the greatest increments over time were detected in Oceania.Conclusions: Globally, HIV continues to cause enormous healthy life loss. The first and foremost strategy for controlling the HIV burden is still the reduction of premature deaths, and much effort needs to be exerted to mitigate the harm of comorbidities. [ABSTRACT FROM AUTHOR]

Objectives: To study the prevalence of frailty and its relationship to mortality in cohorts born before and after the Second World War using three different frailty measures. Methods: Cross-sectional data from two cohorts born in 1935 (n=593) and 1945 (n=714) were studied for frailty at the mean age of 70.7 (SD 1.8) years. Frailty was measured using the Frailty Phenotype (FP), the Frail Scale (FS) and the 74-item Frailty Index (FI>0.21 denoted frailty). Information on socioeconomic factors was obtained via a study questionnaire and the data on mortality were obtained from the Population Information System. Results: The prevalence of frailty by FI was more common in the older 1935 cohort than in the 1945 cohort (p<0.001). The percentage of robust subjects was higher in both sexes in the 1945 cohort using both FI and FS. After adjusting for sociodemographic factors, the difference in the prevalence of frailty between the cohorts remained significant in women only (OR 1.9 (95% CI 1.3–2.9), p=0.001). The FI classified people as frail more often (30.2% in the 1935 cohort and 17.5% in the 1945 cohort) than the FS (13.1% and 8.8%) or FP (1.8% and 1.6%). Low financial satisfaction was associated significantly with frailty in both sexes. Low level of education was associated with frailty in women and being unmarried or divorced in men. Frailty was associated to increased mortality using all frailty definitions in the 1935 cohort with a longer follow-up time. Conclusions: Improved living conditions and health care may have resulted in the lower prevalence of frailty in the 1945 cohort. The present study further strengthens the association between frailty and mortality & poor economic status and frailty. Frailty definitions are in need of further study. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore whether trends in the pattern of income inequality over the past 40 years apply equally to working and retirement age households in the UK, and if so, why this might be so. Design/methodology/approach: Drawing on data from the Office of National Statistics, various indices of income inequality have been calculated among retired and working-age households for the period 1977–2017. Findings: Despite a broadly similar trend towards increasing inequality during the 1980s and into the 1990s among both types of household, income inequality among UK retired households has always remained below than that of working-age households. For retired and working-age households alike, the fortunes of those in the upper half of the income distribution have seen themselves do better. Despite the temporal contiguity, different explanations for both sets of inequalities seem to be required, and likely different strategies needed to ameliorate their more negative effects. Originality/value: Few studies have conducted comparisons of inequality between retirement and working-age households over four decades in any country. The present study's long view suggests that factors creating inequality in the upper half of the income distribution may differ in both their cause and impact, compared with inequalities in the lower half. Arguably, the greatest need is to improve access to benefits for those retired householders at the bottom of the income distribution. [ABSTRACT FROM AUTHOR]

Dementia is the major predictor of death in old age. The aim of this paper was to determine whether 8-year mortality among 85-year olds with and without dementia, and if the contribution of dementia to mortality relative to other common diseases has changed. We used two population-based cohorts of 85-year-olds (N = 1065), born in 1901–02 and 1923–24, which were examined with identical methods in 1986–87 and 2008–2010 and followed for 8-year mortality according to data from the Swedish Tax Agency. Dementia was diagnosed according to DSM-III-R. Other diseases were diagnosed based on self-reports, close informant interviews, somatic examinations, and the Swedish National In-patient Register. Compared to cohort 1901–02, cohort 1923–24 had a lower 8-year mortality both among those with (HR 0.7; 95% CI 0.5–0.99) and without dementia (HR 0.7; 95% CI 0.5–0.9). Dementia was associated with increased mortality in both cohorts (cohort 1901–02, HR 2.6; 95% CI 2.0–3.2, cohort 1923–24, HR 2.8; 95% CI 2.3–3.5), and remained the major predictor of death, with a population attributable risk of 31.7% in 1986–87 and 27.7% in 2008–10. Dementia remained the most important predictor of death in both cohorts. The relative risk for mortality with dementia did not change between cohorts, despite a decreased mortality rate in the population. [ABSTRACT FROM AUTHOR]

Background: Beginning in 2019, stepped-wedge designs (SWDs) were being used in the investigation of interventions to reduce opioid-related deaths in communities across the United States. However, these interventions are competing with external factors such as newly initiated public policies limiting opioid prescriptions, media awareness campaigns, and the COVID-19 pandemic. Furthermore, control communities may prematurely adopt components of the intervention as they become available. The presence of time-varying external factors that impact study outcomes is a well-known limitation of SWDs; common approaches to adjusting for them make use of a mixed effects modeling framework. However, these models have several shortcomings when external factors differentially impact intervention and control clusters.Methods: We discuss limitations of commonly used mixed effects models in the context of proposed SWDs to investigate interventions intended to reduce opioid-related mortality, and propose extensions of these models to address these limitations. We conduct an extensive simulation study of anticipated data from SWD trials targeting the current opioid epidemic in order to examine the performance of these models in the presence of external factors. We consider confounding by time, premature adoption of intervention components, and time-varying effect modification- in which external factors differentially impact intervention and control clusters.Results: In the presence of confounding by time, commonly used mixed effects models yield unbiased intervention effect estimates, but can have inflated Type 1 error and result in under coverage of confidence intervals. These models yield biased intervention effect estimates when premature intervention adoption or effect modification are present. In such scenarios, models incorporating fixed intervention-by-time interactions with an unstructured covariance for intervention-by-cluster-by-time random effects result in unbiased intervention effect estimates, reach nominal confidence interval coverage, and preserve Type 1 error.Conclusions: Mixed effects models can adjust for different combinations of external factors through correct specification of fixed and random time effects. Since model choice has considerable impact on validity of results and study power, careful consideration must be given to how these external factors impact study endpoints and what estimands are most appropriate in the presence of such factors. [ABSTRACT FROM AUTHOR]

Background: The incidence of preterm birth (PTB, < 37 weeks of gestation) has been increasing in China and many other countries in recent years. However, the causes of the increase were not well understood. The current study aims to examine the contribution of maternal age, period of delivery, and maternal birth cohorts to long-term trends in preterm birth in Guangzhou, China.Methods: In a retrospective population-based study, data were obtained from 2,535,000 singleton live births with 20-43 gestational weeks from 2001 to 2016 and recorded in the Guangzhou Perinatal Health Care and Delivery Surveillance System, in China. The age-period-cohort models were applied to investigate the temporal changes in incidences of PTB, stratified by parity.Results: The incidence of preterm birth steadily increased from 5.1% in 2001 to 5.9% in 2016, with larger rise in primiparous mothers (from 5.0 to 5.9%) compared to multiparous mothers (from 5.6 to 5.9%). A J-shaped and a V-shaped relationship were found between maternal age and PTB among primiparous and multiparous mothers, respectively. A linear cohort effect was found among primiparous mothers with the lowest risk of PTB [risk ratio (RR) = 0.81, 95% confidence interval (CI): 0.74 to 0.89] in 1961 and the highest risk (RR = 1.06, 95% CI: 1.00 to 1.13) in 1997 compared to the mothers born in 1981. An inverse U-shaped association between maternal birth cohort and PTB was found in multiparous mothers. There were weak decreasing period effects on the trend of overall PTB among multiparous mothers and on the trend of extremely (< 27 weeks) or very (28-31 weeks) PTB among both parity groups during the period of 2001-2012.Conclusions: Our findings showed the PTB incidences had been increasing in the past 16 years in Guangzhou, China and both maternal age and cohort effects contributed to these trends. Further studies are recommended on the impact of altered maternal age and parity on premature births and corresponding public education and public health policies. [ABSTRACT FROM AUTHOR]

Background: Sepsis is one of the leading causes of death worldwide. The associated incidence, mortality and trends do not differ greatly between documented reports. The purpose of this study was to provide an in-depth description of patients with sepsis and septic shock hospitalized in France from 2010 to 2015 and to explore the temporal trends of their clinical characteristics, costs and outcomes. Methods: Retrospective cohort study of the French hospital administrative database in which organ failure therapies and severity scores are systematically registered. All patients admitted between 2010 and 2015 for sepsis and septic shock as defined by an ICD-10 code for infection, and for organ failure or the use of organ failure supplementation were included. Incidence, outcomes and trends were analyzed. Subgroup analyses based on several coding strategies and adjusted for severity scores were performed. Results: A total of 737,147 patients with sepsis and 492,902 patients with septic shock were included. From 2010 to 2015, the incidence of sepsis and septic shock increased, respectively, from 206 to 243 and from 135 to 171 cases per 100,000 population. Case fatality remained at 34% for sepsis, but decreased from 46 to 44% for septic shock. Median hospital stay costs amounted to €11,400 (IQR: 5036; 24,364) for patients with sepsis and €16,439 (IQR: 7339; 29,360) for patients with septic shock. After adjustment for case-mix and illness severity, the risk of death was stable for sepsis (0.08% [− 0.04; 0.20] per year), but decreased for sepsis patients admitted to the intensive care unit and for cases of septic shock (− 0.33%[ − 0.40; − 0.27] per year). Conclusions: Sepsis is common, frequently fatal and expensive to treat. Its incidence has increased. Case fatality has decreased in most severely affected patients, owing partly to general improvements in care. [ABSTRACT FROM AUTHOR]

Background: Fall-induced injuries in older adults are a major public health challenge.Methods: We determined the current trends in the number and age-adjusted incidence of fall-induced severe cervical spine injuries among older adults in Finland by taking into account all persons 50 years of age or older who were admitted to Finnish hospitals for primary treatment of these injuries between 1970 and 2017. Similar patients aged 20-49 years served as a reference group.Results: The annual number of fall-induced severe cervical spine injuries among older Finnish adults rose steeply during the follow-up, from 59 in 1970 to 502 in 2017. The age-adjusted incidence of injury (per 100,000 persons) was higher in men than women throughout this period and showed a clear increase from 1970 to 2017: from 8.4 to 25.0 in men, and from 2.8 to 13.9 in women. In both sexes, the increase was most prominent in the oldest age group, persons aged 80 years or older. In the reference group, the injury incidence declined by time.Conclusions: The number and incidence of fall-induced severe cervical spine injuries among older Finns showed a sharp rise between 1970 and 2017. An increase in the average risk of serious falls may partly explain the phenomenon. Effective fall and injury prevention measures are urgently needed since further aging of the population is likely to aggravate the problem in the near future. [ABSTRACT FROM AUTHOR]

Timing of puberty and adult height have opposing secular trends yet are positively associated in individuals. We demonstrate this using data from a single sample and discuss possible statistical and epidemiological reasons behind it. The sample comprised 365 females from Fels Longitudinal Study born 1929–1992. We used Super-Imposition by Translation and Rotation (SITAR) to estimate individual age at peak height velocity (PHV) and PHV from serial height data (8149 observations between 5 and 24 years). General linear regression was used to investigate the association between height and age at PHV, and secular trends in height, age at PHV and PHV. Although adult height increased 0.42 (95% CI: 0.08, 0.77) cm per decade, and age at PHV decreased 1.14 (−3.74, 1.45) weeks per decade, adult height increased by 2.44 (1.78, 3.10) cm per year higher age at PHV. We found tentative evidence of the positive association between age at PHV and adult height strengthened 0.25 (−0.09, 0.59) cm each decade. Secular trends in related variables may differ if the between-individual and between-cohort associations are different. To understand if a secular trend in one variable has contributed to a trend in another, each needs to be modelled over time, together with the changing association between them. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES Over the past decade, feeding tube use in nursing home residents with advanced dementia has declined by 50% among white and black patients. Little is known about whether a similar reduction has occurred in other invasive interventions, such as mechanical ventilation. DESIGN Retrospective cohort study. SETTING Acute‐care hospitals in the United States. PARTICIPANTS Medicare beneficiaries with advanced dementia who previously resided in a nursing home and were hospitalized between 2001 and 2014 with pneumonia and/or septicemia and of either black or white race. MEASUREMENT Invasive mechanical ventilation (IMV), as identified by International Classification of Diseases (ICD) procedure codes. Two multivariable logistic regression models examined the association between race and the likelihood of receiving IMV, adjusting for patients' demographics, physical function, and comorbidities. A hospital fixed‐effects model examined the association of race within a hospital, whereas a random‐effects logistic model was used to estimate the between‐hospital variation in the probability of receiving IMV and examine the overall association of race and use of IMV. RESULTS: Between 2001 and 2014, 289,017 patients with advanced dementia were hospitalized for pneumonia or septicemia. Use of IMV increased from 3.7% to 12.1% in white patients and from 8.6% to 21.8% in blacks. Among those ventilated, 1‐year mortality rates remained high, at 82.7% for whites and 84.2% for blacks dying in 2013. Compared with whites, blacks had a higher odds of receiving IMV in the fixed‐effects (within‐hospital) model (adjusted odds ratio (AOR) = 1.34; 95% confidence interval (CI) = 1.29–1.39) and in the random‐effects (between‐hospital) model (AOR = 1.46; 95% CI = 1.40–1.51). CONCLUSION: IMV use in patients with advanced dementia has increased substantially, with black patients having a larger increase than whites, based, in part, on the hospitals where black patients receive care. [ABSTRACT FROM AUTHOR]

OBJECTIVES Hospitalists are increasingly the attending physician for hospitalized patients, and the scheduling of their shifts can affect patient continuity. For dementia patients, the impact is unknown. DESIGN Longitudinal study using physician billing claims between 2000 and 2014 to examine the association of continuity of care with the insertion of a feeding tube (FT). SETTING US hospitals. PARTICIPANTS Between 2000 and 2014, 166,056 hospitalizations of patients with a prior nursing home stay, advanced cognitive impairment, and impairments in four or more activities of daily living (mean age = 84.2 years; 30.4% male; 81.0% white). MEASUREMENTS Continuity of care measured at the hospital level with the Sequential Continuity Index (SECON; range = 0 to 100; higher score indicates higher continuity). RESULTS: Rates of a hospitalist acting as the attending physician increased from 9.6% in 2000 to 22.6% in 2010, whereas a primary care physician with a predominant outpatient focus acting as the attending physician decreased from 50.3% in 2000 to 12.6% in 2014. Post‐2010, a mixture of physician specialties increased from 55.5% to 66.4% with a reduction in hospitalists from 22.6% (2010) to 14.1% (2013). Continuity of care decreased over time with SECON dropping from 63.0 to 43.5. Adjusting for patient baseline risk factors, a nonlinear association was observed between SECON and FT insertion. Using cubic splines in the multivariate logistics regression model, the risk of FT insertion in hospitals where the SECON score dropped from 82 to 23 had an adjusted risk ratio (ARR) of FT insertion of 1.48 (95% confidence interval [CI] = 1.34‐1.63); hospitals in which SECON dropped from 51 to 23 had an ARR of FT insertion of 1.38 (95% CI = 1.27‐1.50). CONCLUSION: Hospitalized dementia patients in hospitals in which continuity of care was lower had higher rates of FT insertions. Newer models of care are needed to enhance care continuity and thus ensure treatment consistent with likely outcomes of care and goals of care. J Am Geriatr Soc 68:1852‐1856, 2020. [ABSTRACT FROM AUTHOR]

Aim: To present specific reference values for cardiorespiratory fitness (CRF) in children with obesity and to analyse secular trends of CRF in the studied population.Methods: Cardiorespiratory fitness, the maximal oxygen uptake (VO2 max), was estimated with the Åstrand-Rhyming submaximal bicycle test, in 705 Swedish children (356 girls, 8-20 years) with obesity according to the International Obesity Task Force (IOTF). Data were collected from 1999 to 2013. Secular trends, analysed with multiple linear regression, were adjusted for age, height and body mass index standard deviation score (BMI SDS).Results: All children had low CRF compared with normal weight standards but there was a marked variability of CRF in children with obesity, which was possible to quantify with the developed obesity specific CRF reference values. The mean value of absolute VO2 max (L/min) increased with age and relative VO2 max (mL/kg/min) decreased with age in both boys and girls. There was a negative secular trend in both sexes (P < .001).Conclusion: These are the first obesity specific reference values of CRF in children enabling clinical evaluation in childhood obesity treatment. Cardiorespiratory fitness in children with obesity has declined the last decades, indicating that also within this vulnerable group physical activity has gone down. [ABSTRACT FROM AUTHOR]

Purpose: The most common sites of low-energy trauma fractures are the femur, vertebra, humerus, and forearm. Ankle fractures have significant morbidity and high costs for surgical procedure. Forearm fractures are common nonvertebral fractures. Forearm fractures are classified as fragility fractures and predictive for fractures at other sites, although do not allow osteoporosis diagnosis. It is controversial whether ankle fractures are osteoporosis fractures. Methods: Retrospective observational study, with secular trend analysis, in patients over 50 years old admitted in the Brazilian Public Health System, from 2004 to 2013. We collected hospitalization data according to the ICD-10 for low-trauma ankle and forearm fractures. Fracture rate was calculated according to gender, age, and geographic region, performed linear regression analysis, and estimated fracture rates for 2030. Comparison of ankle and forearm rates was also performed, grouping them in 3-year block. ANOVA test was used to compare each block. Results: Ankle fracture rate was 21.39 fractures per 100,000 inhabitants, 23.98 in females and 18.49 in males. Fracture rates were higher in the South and Southeast regions. In absolute numbers, although ankle fracture rate increased with age, there was a significant decrease in the population over 80 years old. Data showed stabilization in ankle fractures from 2004 to 2013, in women and men. In 3-year block analysis, men had higher ankle fracture rates than forearm. However, in women, forearm rates were higher than ankle. Conclusion: Our data suggest that ankle fractures in men would be considered as a sentinel fracture with a similar clinical impact of forearm fracture. [ABSTRACT FROM AUTHOR]

Introduction: Physical fitness is strongly related to health and may offer valuable information about public health. We investigated trends in physical fitness, leisure‐time physical activity (LTPA), and anthropometry of young healthy adult Finnish men in representative population‐based samples between 2003 and 2015. Methods: Three independent cross‐sectional samples of 18‐ to 35‐year‐old Finnish men were assessed in 2003 (n = 889), 2008 (n = 803), and 2015 (n = 690). Cardiorespiratory (VO2max) and muscular fitness (1‐minute sit‐ups and push‐ups), body mass, and height were measured. Self‐reported LTPA was assessed. Results: After adjusting for age, education, and smoking, cardiorespiratory fitness was higher in 2003 (mean: 43.5, 95%CI: 42.9‐44.1 mL/kg/min) compared to 2008 (41.3, 95%CI: 40.7‐41.9 mL/kg/min) and 2015 (40.6, 95%CI: 40.0‐41.2 mL/kg/min) (P <.001), whereas no difference was observed between 2008 and 2015. The lowest values in muscular fitness were observed in 2003, while no clear trends were further noticed. The adjusted BMI was higher in 2008 (25.1, 95%CI: 24.9‐25.4) and 2015 (25.3, 95%CI: 25.3, 95%CI: 25.0‐25.6) compared to 2003 (24.5, 95%CI: 24.3‐24.8) (P <.005). In 2015, a higher proportion of individuals exercised at least four times per week compared to 2003 and 2008 (P <.05). Conclusion: The decrease in cardiorespiratory fitness that took place between 2003 and 2008 plateaued after 2008. The plateau is in accordance with the previously observed trend of 5‐10 years younger Finnish men. Moreover, muscular fitness was for the most part higher in 2008 and 2015 compared to 2003. Efforts directed to promote regular physical activity and improve physical fitness are needed. [ABSTRACT FROM AUTHOR]

Background: Several studies from the US and Europe have shown a population-level decline in serum testosterone in men from 1970's to early 2000's. However, to the best of our knowledge, no study examining population-level decline in testosterone has been published in more recent years. The study objective was therefore to examine secular trends in testosterone levels among Israeli men in the first and second decades of the twenty-first century, Methods: All incident total testosterone performed between1/2006 and 3/2019 among 102,334 male members of a large health organization. Results: A significant (p < 0.001) and prominent trend of age-independent decline in the testosterone levels was recorded during the study period for most age groups. Conclusions: There was a highly significant age-independent decline in total testosterone in the first and second decades of the twenty-first century. The decline was unlikely to be explained by increasing rates of obesity. [ABSTRACT FROM AUTHOR]

Background: The mean age at menarche remains poorly documented in Africa. Aim: To document levels, trends, and determinants of mean age at menarche in selected African populations. Subjects and methods: The World Fertility Surveys recorded the age at menarche in 12 African countries. These surveys were conducted from 1977 to 1983 and were based on large representative samples of national populations. Demographic and Health Surveys provided trends in adult height for the same cohorts. Results: The mean age at menarche was higher in sub-Saharan Africa (14.5 years) than in North-Africa (13.5 years). Age at menarche was declining significantly in all sub-Saharan African countries, but only in one North-African country. The speed of decline in sub-Saharan Africa averaged 0.47 years for a 30-year period, comparable to the speed of decline in Europe. Sub-Saharan African countries with higher increase in female adult height also had larger declines in mean age at menarche. In multivariate analysis, trends in age at menarche were correlated with trends in adult height and child survival. Conclusion: In sub-Saharan Africa, age at menarche was undergoing a transition similar to that of European countries in the nineteenth century and was associated with improving health of young women. North-African countries were more advanced. [ABSTRACT FROM AUTHOR]

Background & Aims: Trends in long‐term mortality rates for viral hepatitis in East and Southeast Asia have been rarely reported. The aim of our study was to explore the long‐term trends in viral hepatitis mortality rates in East and Southeast Asian countries between 1987 and 2015 and provide predictions of mortality to 2030. Methods: We obtained viral hepatitis mortality data from the WHO Mortality Database for six East and Southeast Asian countries between 1987 and 2015. We produced choropleth maps of viral hepatitis mortality rates in 1987 and 2015 in East and Southeast Asia to illustrate geographic variations. We made predictions of mortality rates for each included country until the year 2030 using a series of joinpoint models. Results: Viral hepatitis mortality rates declined in China (the average annual percent change (AAPC) = −5.1%, 95% CI: −7.5, −2.6), Singapore (AAPC = −5.4%, 95% CI: −7.5, −3.2), and the Philippines (AAPC = −3.4%, 95% CI: −4.9, −1.8). In contrast, Japan, the Republic of Korea, and Malaysia have experienced increasing trends in mortality rates, followed by decreasing trends. Our predictions indicate that all countries will experience slight to moderate downward trends until 2030. Conclusion: Favourable decreasing trends have been noted in East and Southeast Asian countries, which may not only inform the control and management of viral hepatitis in this region but also guide the prevention of viral hepatitis deaths in another region with a similar viral hepatitis epidemic. [ABSTRACT FROM AUTHOR]

Country‐specific hip fracture incidence rates (IRs) and longevity allow the Fracture Risk Assessment Tool (FRAX) to be adapted to individual countries. Secular trends can affect tool calibration. Data on hip fracture IRs in the Middle East is scarce, and long‐term secular trend studies are nonexistent. Using the Ministry of Public Health hip fracture registry, we calculated age‐ and sex‐specific hip fracture IRs in Lebanon, from 2006 to 2017, among individuals aged ≥50 years. We used Kendall's tau‐b (τb) test to determine the correlation between time and hip fracture IRs, and calculated both the annual % change in IRs and the % change in IR compared to the baseline period (2006 to 2008). The registry recorded 6985 hip fractures, 74% at the femoral neck, 23% intertrochanteric, and 3% subtrochanteric. Men constituted 32% of the population, and were significantly younger than women (76.5 ± 11.0 years versus 77.7 ± 10.3 years; p < 0.001). Annual overall IRs, per 100,000, ranged from 126.6 in 2014 to 213.2 in 2017 in women, and 61.4 in 2015 to 111.7 in 2017 in men. The average women to men IR ratio was 1.8 (range, 1.5 to 2.1). IRs steadily increased with age, and IR ratios increased in parallel in both sexes, with a steeper and earlier rise (by 5 years) in women. Data showed a consistent decline in hip fracture IRs starting in 2006 in women, and in 2009 in men. There was a significant negative correlation between time (2006 to 2014) and hip fracture IRs in women (τb = −0.611, p = 0.022) but not in men (τb = −0.444, p = 0.095). The steady decrease in IRs reversed after 2015 in both sexes. This long‐term data on secular trends in the Middle East is novel and consistent with worldwide changes in hip fracture rates. The impact of such changes on national FRAX‐derived estimates is unclear, should be assessed, and may necessitate an update in the FRAX Lebanon calculator. © 2019 American Society for Bone and Mineral Research. [ABSTRACT FROM AUTHOR]