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Throughout the 20 century, in developed countries there has been a secular trend toward earlier menarche. Over the past 2 decades, however, there has been an apparent stabilization in the average age of menarche age in most Western countries.The objective of this study was to analyze the mean age of menarche in a cohort of Italian girls, to analyze the mean age of breast button appearance (B2), and to correlate the B2 developmental stage and age at menarche with the most important clinical and auxological parameters.We retrospectively evaluated the data of 1458 Italian girls born between 1995 and 2003. We collected the main auxological and clinical parameters, including age at B2, age at menarche, height, weight, and body mass index (BMI) at B2 and menarche and, when possible, adult/near adult height.The mean age of B2 was 10.16 ± 1.00 years, significantly earlier than previously reported for Italian girls (P.05); the mean age of menarche was 12.07 ± 0.99 years, also significantly earlier than previously reported (P.0001). Age at B2 and menarche inversely correlated with BMI standard deviation score (SDS) (P.0001). The mean adult/near adult height of the girls in the study cohort was not statistically different from previously reported data for Italian women.Our results suggest a new trend for an earlier appearance of thelarche and menarche in Italian girls. Our data confirm a significant relationship between BMI and age of B2 and menarche. The girls' final height seems to be in line with average height for the Italian female population.

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.

Introduction Interventions to deal with the COVID-19 pandemic may impact the burden of other respiratory diseases. The aim of this study is to analyze the impact of non-pharmacological initiatives (NPI) against COVID-19 on the number of hospitalizations due to pediatric acute respiratory illnesses (ARIs). Material and methods This is a retrospective analysis of pediatric hospitalizations in Porto Alegre, Brazil. We analyzed the monthly incidence of hospital admissions from 2018 to 2020 due to ARIs included in the study. The time series was divided into the period before introducing NPI (2018 and 2019), and the period when NPI were running (2020). We compared means between the years with Student’s t-test. The Dickey-Fuller test was used for secular trend analysis. For seasonality, Fischer’s G test was performed. Dynamic linear univariate and multivariate models were used to estimate the association between the predictors (the introduction of NPI, secular trend, and seasonality) and outcome (the incidence of ARI admissions). For the statistical analysis, the cut-off probability for rejecting the null hypothesis was defined as Results From 2018 to 2020, 10,109 hospital admissions were due to the respiratory causes included in this study. There was a significant decrease in 2020 in the mean incidence of the ARIs studied compared with 2018 and 2019. The number of hospitalizations due to respiratory diseases in children decreased by 64% for asthma and 93% for bronchiolitis. A secular trend of monthly admissions rates due to ARIs was only observed in the laryngotracheitis data (p = 0.485), but seasonality was detected in all analyses. According to the univariate and multivariate analysis, the introduction of NPI was associated with a decrease in the incidence of ARI admissions. Conclusion There was a significant reduction in hospital admissions due to ARIs in children. Our data suggest a significant impact of NPI on reducing the spread of viruses associated with ARIs in children. These results support respiratory illness prevention strategies.

Background The effectiveness of lockdowns in mitigating the spread of COVID-19 has been the subject of intense debate. Data on the relationship between public health restrictions, mobility, and pandemic growth has so far been conflicting. Objective We assessed the relationship between public health restriction tiers, mobility, and COVID-19 spread in five contiguous public health units (PHUs) in the Greater Toronto Area (GTA) in Ontario, Canada. Methods Weekly effective reproduction number (Rt) was calculated based on daily cases in each of the five GTA public health units between March 1, 2020, and March 19, 2021. A global mobility index (GMI) for each PHU was calculated using Google Mobility data. Segmented regressions were used to assess changes in the behaviour of Rt over time. We calculated Pearson correlation coefficients between GMI and Rt for each PHU and mobility regression coefficients for each mobility variable, accounting for time lag of 0, 7, and 14 days. Results In all PHUs except Toronto, the most rapid decline in Rt occurred in the first 2 weeks of the first province-wide lockdown, and this was followed by a slight trend to increased Rt as restrictions decreased. This trend reversed in all PHUs between September 6th and October 10th after which Rt decreased slightly over time without respect to public health restriction tier. GMI began to increase in the first wave even before restrictions were decreased. This secular trend to increased mobility continued into the summer, driven by increased mobility to recreational spaces. The decline in GMI as restrictions were reintroduced coincides with decreasing mobility to parks after September. During the first wave, the correlation coefficients between global mobility and Rt were significant (p t. In the second wave, this relationship was attenuated, and was only significant in Toronto and Durham at 14 days after lockdown. Conclusions The association between mobility and COVID-19 spread was stronger in the first wave than the second wave. Public health restriction tiers did not alter the existing secular trend toward decreasing Rt over time.

BACKGROUND AND AIMS The uptake of antiviral treatment for patients with chronic hepatitis B (CHB) has been suboptimal. We aimed to determine the secular trend of treatment uptake in the territory-wide CHB cohort in Hong Kong from 2000 to 2017 and the factors for no treatment despite fulfilling treatment criteria. METHODS Chronic hepatitis B patients under public clinics and hospitals were identified through electronic medical records. The treatment indications were defined according to the Asian-Pacific guidelines published at the time of patients' first appearance in four periods: 2000-2004, 2005-2009, 2010-2013, and 2014-2017. RESULTS There were 135 395 CHB patients were included; 1493/12472 (12.0%), 7416/43426 (17.1%), 10 129/46559 (21.8%), 8051/32 938 (24.4%) patients fulfilled treatment criteria in the four periods, respectively. The treatment uptake rate increased with time: 35.1%, 43.4%, 60.2%, and 68.6% respectively. High fibrosis indices (APRI, FIB-4, and Forns indices) appeared to be the main factors for treatment indication in non-cirrhotic patients, with over 90% fulfilling treatment criteria due to high fibrosis indices alone. Of those fulfilling treatment criteria by high fibrosis indices, less than 60% of patients (25.2%, 36.1%, 46.0%, and 58.9%, respectively) had antiviral treatment initiated. Normal platelet count (odds ratio 0.42, P

Objective:To examine secular trends and sociodemographic determinants of thinness, overweight and obesity among Malaysian children and adolescents from 2006 to 2015.Design:We used cross-sectional data from the National Health and Morbidity Surveys 2006, 2011 and 2015. Individuals were classified into pre- (6–9 years), early (10–13 years) and mid- (14–17 years) adolescence. BMI status was determined according to the International Obesity Task Force (IOTF) and WHO criteria, using measured height and weight. We analysed trends using log-binomial regression, by sex-age groups, stratified by sociodemographic factors (ethnicity, residential area, household size and household income), and accounting for the complex survey design. Associations between sociodemographic factors and prevalence of thinness and overweight (obesity included) in 2015 were assessed using log-Poisson regression.Setting:Nationwide population-based surveys, Malaysia.Participants:Eligible 6–17-year-olds from urban and rural residential areas (n 28 094).Results:The prevalence of thinness decreased from 2006 to 2015 (IOTF: boys from 22 % to 18 %, girls from 23 % to 19 %; WHO: boys from 9 % to 7 %, girls from 8 % to 6 %), while the prevalence of overweight increased (IOTF: boys from 20 % to 26 %, girls from 19 % to 24 %; WHO: boys from 25 % to 31 %, girls from 22 % to 27 %). These changes were statistically significant in most sex-age groups. Thinness and overweight co-existed in all sociodemographic subgroups, with variation in the prevalence estimates, but similar secular changes in most subgroups.Conclusions:Malaysia is facing a double burden of malnutrition at population level with a secular increase in overweight and obesity and a gradual decrease in thinness among 6–17-year-olds from varying sociodemographic backgrounds.

We investigated the secular trends of the incidence and hospitalization cost of hip fracture in Tangshan, China. The incidence of hip fracture and the hospitalization cost were both increasing during the observation period. The present study aimed to determine sex-, age-, and fracture type-specific incidence and annual changes in hip fractures in Tangshan, China, between 2007 and 2018. We analyzed annual hip fracture incidence using urban hospital data during 2007–2018 and calculated incidence rate/100,000 person years in each age group and sex. We assessed annual changes in incidence among people aged >60 years using linear-by-linear association tests and evaluated hospitalization costs with the Kruskal–Wallis test. During the study period, we observed an increasing proportion of hip fractures in people >60 years old from 14.2 to 22.79%. Crude hip fracture incidence increased markedly from 140.87 to 306.56/100,000 in women (p 60 years. Type-specific analysis indicated significantly increased trends in incidence of cervical and trochanteric fractures among women and cervical fracture among men (p < 0.01). In people aged 36–60 years, the trend of hip fracture increased significantly in both sexes. The total and cervical-to-trochanteric ratio in men increased, with significant upward trends (p < 0.01). The proportion of cervical fracture was higher than that for trochanteric fracture in women, with stable levels from 2007 to 2018. Hospitalization costs for cervical and trochanteric fractures increased by 51.91% and 53.20%, respectively, during 2011–2018. Tangshan will have an increasing burden on health care resources attributable to a considerable rise in hip fracture incidence and the older population. Further investigation of risk factors and subsequent implementation of effective measures to prevent hip fracture are needed.

This study estimates the prevalence of natural and surgical menopause among Indian women aged 30 to 49 years, examines the secular trend in prevalence, and identifies different correlates of menopa...

Low physical fitness has been found to be associated with many chronic diseases and medical conditions. Knowledge of secular trends in physical fitness is important to initiate countermeasures for addressing negative trends. The aim of this study was to analyze secular trends in health-related muscular fitness in Slovenian children and adolescents between 1983 and 2014. Data were collected as part of "The Analysis of Children's Development in Slovenia (ACDSi)" study in 1983, 1993/94, 2003/04, and 2013/14. Anthropometry (body weight, height, BMI, and triceps skinfold) and muscular fitness (standing long jump, bent-arm hang, and sit-ups 60 s test) of 18730 (9168 female) students from primary and secondary schools were recorded. The secular trend was analyzed considering anthropometry. The results showed that anthropometric measures had an increasing trend and overall muscular fitness had a decreasing trend. Leg muscle power decreased over the decades in all age groups (relative difference between -1.5% and -2.6%), being more pronounced in boys. Arm muscle strength decreased in two younger age groups (range -21.1% to -42.7%, 6-10, and 11-14 years), but not in the oldest group (15-19 years), where the increase occurred in both genders (0.4% to 9.3%). In terms of decades, the largest negative changes (-30.1%) occurred from 1993/94 to 2003/04 and the smallest changes (-4.2%) from 2003/04 to 2013/14. The overall trend in repetitive core strength surprisingly increased (1.1% to 18.3%). There is a need to promote healthy lifestyles, raise parental awareness and use all government resources to redirect the negative trend in physical fitness.

Introduction: Health of the residents of the territories adjacent to the space launches have been shown to be inferior to the national average. However, the data from the Altai region are scarce. Aim: To assess health status of the residents of the territories of the Altai region adjacent to the areas of falling of separating parts of launch vehicles Methods: All residents of the affected territories were examined by medical teams in 1999 (n = 1 929), 2005 (n = 1 213), 2010 (n = 1 016) and 2015 (n = 843). Overall prevalence rates class-specific rates per 1000 population were calculated. Secular trends were analyzed and comparisons with the reference population were performed. Results: The overall prevalence decreased from 4 400,5 - 4 406,5 % in 1999 to 3 932,7 - 3 941,5 % in 2015 (p < 0.001) with no clear trend. In 1999, the main contributors to the overall burden of diseases were diseases of the endocrine system (1 072,2 - 1 075,0 %), diseases of the circulatory system (526,9 - 572,1 %), diseases of the eye and its appendages (390,8 - 435,6 %), and diseases of the respiratory system - 318,0 - 361,2 %. In 2015, the most prevalent illnesses were diseases of the circulatory system (743,4 - 801,0 %), diseases of the respiratory system (668,3 - 731,5 %), diseases of the endocrine system (636,6 - 701,4 %), and diseases of the eye and its appendages (452,0 - 520,8 %). Residents of the study group had greater overall prevalence of diseases (3 932,7 - 3,941,5 %) than the reference (2 539,3 - 2,539,5 %), p < 0.001. The same was observed for the most classes of diseases. Conclusions: The overall prevalence of diseases among the residents of the territories adjacent to the areas of falling of separating parts of launch vehicles significantly decreased from 2015 to 1999 with no obvious linear trend. Women had poorer health than men. The overall prevalence of diseases and the prevalence of the most classes of diseases in the study group is significantly higher than in the reference population.

The purpose of the present study was to analyze the secular trends in anthropometric characteristics and health-related physical fitness (i.e., flexibility, muscular strength and speed/agility) in Macedonian children between 2012 and 2019. Materials and methods. We analyzed the secular trends in anthropometric characteristics and health-related physical fitness in Macedonian children between 2012 and 2019. Two representative population studies were conducted 7 years apart in children (6-10 years) from Skopje (Mаcedonia). Both studies used the same anthropometric measures and tests to assess physical fitness: height, weight, body mass index, body fat percentage, muscle mass percentage, sit and reach, handgrip strength, standing long jump, 30 sec sit ups, and 4 × 10 m shuttle run. Result. The boys and girls measured in 2019 had significantly better performance in the sit and reach (Cohen’s d ~0.4 and ~0.5, respectively), 30 sec sit ups (Cohen’s d ~0.3 and ~0.2, respectively), and 4 × 10 m shuttle run (Cohen’s d ~0.7 and ~0.8, respectively) tests compared to those measured in 2012–2013. Levels of the standing long jump were significantly lower in 2019 in boys and girls (Cohen’s d ~0.6 for both). Conclusions. Based on the results of the study, it can be concluded that Macedonian children measured in 2019 have higher levels of flexibility, abdominal muscle strength and coordination, speed and agility, but lower levels of explosive force of the lower limbs than their counterparts measured. 7 years ago, no statistically significant differences were found in anthropometric measures and measures of body weight.

Aims To investigate secular trends in severe periodontitis incidence, prevalence and disability-adjusted life year (DALY) rates in China, India, Japan, South Korea and Thailand from 1990 to 2017. Materials and methods Data were obtained from the "Global Burden of Disease Study" 2017. The annual percentage change and average annual percentage change were calculated using Joinpoint regression analysis. The independent age, period and cohort effects were estimated by age-period-cohort analysis. Results From 1990 to 2017, the overall age-standardized incidence, prevalence and DALY rates increased in China, Japan and India, while decreasing in South Korea and Thailand. The highest incidence, prevalence and DALY rates were in India. By APC analysis, the age effect presented increase in 20-59 years in China, Japan and South Korea, 20-54 years in India and 20-64 years in Thailand; the period effect showed progressive increases in five countries, with the most significant increase shown in China; the cohort effect showed monotonic decreases with birth cohort in five countries. Conclusions Severe periodontitis poses a serious burden in Asian countries, especially China and India. We suggest raising people's awareness of periodontal health and providing professional interventions in these countries, especially for high-risk groups, such as younger people aged ≤65 years.

Summary In this study, we found that regional disparity in incidence of hip fractures has converged. Also, annual hip fracture risk ratios between genders have systematically diminished over time. Introduction Several studies have reported secular trends in hip fracture incidence, but knowledge about the possible causes is limited. We studied potential explanations by examining spatio-temporal epidemiology of the fractures and estimating relative risks between genders. Methods This observational study was based on all inpatient hospital discharges in 1972–2018 in Finland. We divided the data by gender, 5-year age groups and Finnish sub-regions and estimated gender and age standardized spatio-temporal rates of hip fractures by using a Bayesian age-period-cohort model. Results In 1972, women’s hip fracture incidence was 1.2–1.3 times higher in western and coastal Finland compared to eastern and inland areas. Also, women had approximately 1.7 times higher average risk to get a hip fracture compared to men. Today, the hip fracture differences between the areas have converged to insignificant and the relative risk between genders has diminished to 1.2. Age-specific relative risks indicate greater hip fracture risk for younger men and older women, and the women’s risk increases beyond the risk of men at age 65 which is ten years later than in the beginning of the study period. Conclusion Incidence of hip fracture has converged significantly between regions and genders. Especially factors related with socioeconomic development and increased frailty and longevity seem to be important. The hip fracture incidence rate ratio between women and men has systematically decreased in time, and more attention should be paid to hip fracture risk in men in the future. Supplementary Information The online version contains supplementary material available at 10.1007/s00198-021-05906-6.

Pubertal BMI change is an independent risk marker of cardiovascular mortality/morbidity. Previous studies demonstrated a secular trend of increased childhood BMI but it is unknown if there is a concomitant secular trend regarding pubertal BMI change. The aim of this study was to describe the trend in pubertal BMI change. We collected heights and weights before and after puberty from school health records and military conscript records for boys born every five years during 1946–1991 (n = 3650, total cohort) and calculated pubertal BMI change (young adult BMI at 20 years of age minus childhood BMI at 8 years of age) for all study participants. A secular trend of increasing pubertal BMI change during the study period was observed. The increase in pubertal BMI change (0.27 kg/m2 per decade [0.22; 0.32]) explained 54% of the secular trend of increasing young adult BMI (0.50 kg/m2 per decade [0.43; 0.57]). We made the novel observation that there is a secular trend of increasing pubertal BMI change. We propose that the secular trend of increasing pubertal BMI change might contribute more than the secular trend of increasing childhood BMI to the adverse cardiovascular health consequences associated with the ongoing obesity epidemic.

Background Smoking, obesity and alcohol abuse greatly affect mortality and exhibit a distinct time dynamic, with their prevalence and associated mortality rates increasing and (eventually) declining over time. Their combined impact on secular trends in life expectancy is unknown but is relevant for understanding these trends. We therefore estimate the combined impact of smoking, obesity and alcohol on life-expectancy trends in Europe. Methods We used estimated national age-specific smoking-, obesity- and alcohol-attributable mortality fractions for 30 European countries by sex, 1990–2014, which we aggregated multiplicatively to obtain lifestyle-attributable mortality. We estimated potential gains in life expectancy by eliminating lifestyle-attributable mortality and compared past trends in life expectancy at birth (e0) with and without lifestyle-attributable mortality. We examined all countries combined, by region and individually. Results Among men, the combined impact of smoking, obesity and alcohol on e0 declined from 6.6 years in 1990 to 5.8 years in 2014, mainly due to declining smoking-attributable mortality. Among women, the combined impact increased from 1.9 to 2.3 years due to mortality increases in all three lifestyle-related factors. The observed increase in e0 over the 1990–2014 period was 5.0 years for men and 4.0 years for women. After excluding lifestyle-attributable mortality, this increase would have been 4.2–4.3 years for both men and women. Conclusion Without the combined impact of smoking, obesity and alcohol, the increase over time in life expectancy at birth would have been smaller among men but larger among women, resulting in a stable increase in e0, parallel for men and women.

Introduction: Despite changes in prenatal diagnostic methods and perceptions regarding the prognosis of and treatment options for patients with trisomy 18 syndrome, data on the secular changes in patient survival are limited. This study aimed to investigate the survival pattern for such patients. Methods: To investigate the general patient survival patterns, we used data from the vital statistics database of deaths in Japan from 1975 to 2016. We described demographic factors, such as sex, gestational age at delivery, and surgical history, for patients whose primary cause of death was trisomy 18 syndrome. Results: The proportions of deaths within 24 h of birth (4.0% in 1975–1980 to 21.9% in 2011–2016) and at age ≥1 year (8.9% in 1975–1980 to 17.7% in 2011–2016) increased. The median survival time was higher for females, infants born after 37 weeks of gestation, and those who received surgical intervention. The median survival time tripled among patients who received surgical intervention (61.5 days in 1995–2005 to 182.5 days in 2006–2016), and the proportion of such patients increased (from 3.8% in 1995 to 24.1% of the entire affected population in 2016). Discussion/Conclusion: In Japan, the median survival time of infants with trisomy 18 increased over time, and the proportion of death within 24 h and at ≥1 year increased. Greater acknowledgement of the possible benefits of surgical intervention likely led to the increased provision of interventions and contributed to the increased survival time.

Introduction: Secular changes in hip fracture incidence have been reported in the last few decades in Japan, but whether long-term bone mineral density (BMD) is also changing is unclear. This study aimed to determine whether BMD of Japanese women has changed over time. Methods: Subjects were 10,649 adult women who underwent BMD measurement in a health check-up population in Niigata, Japan, between 1995 and 2013. BMD of the distal, non-dominant forearm was measured by dual-energy X-ray absorptiometry. Demographic information and BMI were also obtained. Secular trends were determined by linear regression analysis. Results: BMD of subjects in their 40’s decreased significantly in the age-adjusted model (P for trend=0.0162), but not in the age- and BMI-adjusted model (P for trend=0.2171). BMD of subjects in their 50’s decreased marginally in the age-adjusted model (P for trend=0.0535), but not in the age- and BMI-adjusted model (P for trend=0.6601). BMDs of subjects in their 30’s and 60’s did not significantly change, while BMIs of subjects in their 40’s-60’s decreased significantly. Conclusions: A secular decrease in BMD, partly attributed to decreases in BMI, was observed in middle-aged Japanese women from 1995 to 2013. Measures to help maintain suitable BMI will be necessary to prevent a decrease in BMD among women.

Background: Various studies have indicated that the prognosis of leukemia has been improved in recent years, but the secular trends of incidence and long-term survival of all leukemia have not been thoroughly examined. Methods: We estimated the leukemia incidence and 5-year survival rate along with the temporal trends by sex, race, age, and subtype in the United States over the past four decades using Surveillance, Epidemiology, and End Results (SEER) database. Results: The overall incidence of leukemia steadily increased from 12.39/100 000 in 1975 to 14.65/100 000 in 2011, and then began to decline in recent years (13.73/100 000 in 2017), with average annual percent changes (APC) of 0.350 (P

Background Life expectancy in Japan has increased dramatically and is one of the longest in the world. However, the changes in lifespan in Japanese individuals with congenital diseases remain unknown. We investigated secular changes in the lifespan of people with Down syndrome over the last 20 years. Methods We observed secular trends in the number of stillbirths, deaths and the mortality rates at ages 20, 40, and 60 among all deaths registered with Down syndrome as the cause of death (ICD10 code: Q90) in the Japan national death registry database between 1995 and 2016. Changes in the median age at death between 1995-2005 and 2006-2016 were investigated based on sex and history of surgery. Results We identified 240 stillbirths and 1,099 deaths in this period. The annual number of stillbirths and deaths above the age of 1 year increased, whereas the number of deaths below 1 year did not change. The proportional mortality indicator at ages 20, 40, and 60 increased from 21.7%, 11.7%, and 1.7% in 1995 to 69.9%, 66.7%, and 36.6% in 2016, respectively. The median age at death was higher in females, individuals without a surgical history, and deaths occurring in 2006-2016. The median age at death increased over the period in those without a surgical history. Conclusions The age at death among people with Down syndrome has increased over the last 20 years, with currently 1 in 3 persons living over 60 years, necessitating adequate social welfare services in this aging population.

Objectives The prevalence of general overweight and obesity defined by body mass index criteria has greatly increased in Chinese children and adolescents in recent decades. However, few studies have considered the trend in abdominal obesity in Chinese children and adolescents. This study aimed to examine the secular trends in waist circumference (WC), waist-to-height ratio (WHtR) and the prevalence of abdominal obesity among Chinese children and adolescents aged 6–17 years from 1993 to 2015. Methods A total of 11,985 children and adolescents aged 6–17 years participated in the China Health and Nutrition Survey, a continuous cross-sectional survey, conducted from 1993 to 2015. Abdominal obesity was defined as WC≥age- and sex-specific 90th percentile based on the reference from Chinese children and adolescents or WHtR≥0.50. Results After adjustment for age, sex and region, mean WC increased from 60.27 cm in 1993 to 64.31 cm in 2015 (p for trend Conclusions The prevalence of abdominal obesity among Chinese children and adolescents aged 6–17 years has increased between 1993 and 2015.

Aim: We aimed to examine the distribution and secular changes of conscript body height in the geographic network of Norway since 1878 and to study its association with the degree of urbanization, and population density. Material and methods: Data on body height of Norwegian military conscripts were provided by the Statistics Norway Department (SSB). The sample comprised eight cohorts with the following measurement years: 1st 1877, 1878 and 1880, 2nd 1895-1897, 3rd 1915-1917, 4th 1935-1937, 5th 1955-1957, 6th 1975-1977, 7th 1995-1997, and 8th 2009-2011. For determining neighborhood correlations, a network was created consisting of neighboring counties, sharing a common border. Results: Average body height of Norwegian men increased by 10.9 cm between 1878 and 2010, but this trend was heterogeneous. Some counties increased by more than 1 cm per decade (Finmark) others by only 7 mm per decade (Sor-Trondelag). Urban counties and counties with higher population density showed stronger height trends than rural counties. The largest spread in body height between the various counties was observed in 1936 when for the first time people living in the more urban counties got taller than rural people. The height advantage of urban counties however, disappeared after 1996. At this time, also the secular trend in height had come to a halt. The secular trend in height had become obvious after the dissolution of the union between Norway and Sweden in 1905 and World War I, and was strongest between 1936 and 1956. During this period maximum between-county heterogeneity in height existed with body height differences of more than 6 cm between the tallest and the shortest county. The end of this period was characterized by social democratic reforms that flattened the income distribution, eliminated poverty, and ensured social services after World War II. Conclusion: The temporal coincidence between the trends in height, the degree of urbanization and the onset of the political transition of Norway from a Swedish province into an independent democratic wealthy modern European state after World War I and particularly after World War II, and the abatement of this trend after this period of transition had stabilized, suggest social and political components interfering with the regulation of physical growth in humans.

To investigate the prevalence and background of children with medical complexity (CMC) and its secular trend in Japan.CMC were defined as patients under the age of 20 years requiring medical care and devices. The patients were enrolled using the national health insurance claims data of three hospitals and two rehabilitation centers in Tottori Prefecture. The study period was divided into three periods: Period 1, 2007-2010; Period 2, 2011-2014; and Period 3, 2015-2018.A total of 378 CMC were enrolled. The prevalence of CMC was 1.88 per 1000 population among subjects aged20 years in 2018, and it increased by approximately 1.9 times during the study period. The number of CMC who presented with severe motor and intellectual disabilities did not change from Period 1 to Period 3. Meanwhile, the number of CMC who had relatively preserved motor and intellectual abilities increased from 58 to 98. The proportion of CMC who required respiratory management and oxygen therapy increased by 1.3 and 1.8 times, respectively. By contrast, the proportion of CMC who need tube feeding decreased significantly between periods 1 and 3 (P 0.05).The prevalence of CMC increased almost twice during the 12-year study period; however, the increase in the number of patients with relatively preserved motor and intellectual abilities was pronounced. This study showed that the need for medical care and devices differed based on the underlying disorders and severity of CMC; therefore, individualized medical, welfare, and administrative services and education about the various types of CMC must be provided.

Background Influenza infection is often measured by a fourfold antibody titer increase over an influenza season (ie seroconversion). However, this approach may fail when influenza seasons are less distinct as it does not account for transient effects from recent infections. Here, we present a method to determine seroconversion for non‐paired sera, adjusting for changes in individuals’ antibody titers to influenza due to the transient impact of recent exposures, varied sampling times, and laboratory processes. Methods We applied our method using data for five H3N2 strains collected from 942 individuals, aged 2‐90 years, during the first two study visits of the Fluscape cohort study (2009‐2012) in Guangzhou, China. Results After adjustment, apparent seroconversion rates for non‐circulating strains decreased while we observed a 20% increase in seroconversion rates to recently circulating strains. When examining seroconversion to the most recently circulating strain (A/Brisbane/20/2007) in our study, participants aged under 18, and over 64 had the highest seroconversion rates compared to other age groups. Conclusions Our results highlight the need for improved methods when using antibody titers as an endpoint in settings where there is no clear influenza “off” season. Methods, like those presented here, that use titers from circulating and non‐circulating strains may be key.

IntroductionAnalyses of secular trends in work-related fatal injury in New Zealand have previously only considered the total working population, potentially hiding trends for important subgroups of workers. This paper examines trends in work-related fatalities in worker subgroups between 2005 and 2014 to indicate where workplace safety action should be prioritised.MethodsA dataset of fatally injured workers was created; all persons aged 15–84 years, fatally injured in the period 2005–2014, were identified from mortality records, linked to coronial records which were then reviewed for work relatedness. Poisson regression modelling was used to estimate annual percentage change in rates by age, sex, ethnicity, employment status, industry and occupation.ResultsOverall, worker fatalities decreased by 2.4% (95% CI 0.0% to 4.6%) annually; an average reduction of 18 deaths per year from baseline (2005). Significant declines in annual rates were observed for younger workers (15–29 and 30–49 years), indigenous Māori, those in the public administration and service sector, and those in community and personal service occupations. Increases in annual rates occurred for workers in agriculture and forestry and fisheries sectors and for labourers. Rates of worker deaths in work-traffic settings declined faster than in workplace settings.DiscussionAlthough overall age-standardised rates of work-related fatal injury have been declining, these trends were variable. Sources of injury risk in identifiable subgroups with increases in annual rates need to be urgently addressed. This study demonstrates the need for regular, detailed examination of the secular trends to identify those subgroups of workers requiring further workplace safety attention.

PURPOSE: Racial/ethnic minorities experience greater job loss than whites during periods of economic downturn and after a cancer diagnosis. Therefore, race/ethnicity-matched controls are needed to distinguish the impact of illness on job loss from secular trends. METHODS: Surveys were administered during and 4 months post-completion of breast cancer treatment. Patients were pre-diagnosis employed women aged 18–64, undergoing treatment for stage I-III breast cancer, who spoke English, Chinese, Korean, or Spanish. Each patient was asked to: 1) nominate peers who were surveyed in a corresponding timeframe (active controls), 2) report a friend’s work status at baseline and follow-up (passive controls). Both types of controls were healthy, employed at baseline, and shared the nominating patient’s race/ethnicity, language, and age. The primary outcome was number of evaluable patient-control pairs by type of control. A patient-control pair was evaluable if work status at follow-up was reported for both individuals. RESULTS: Of 180 patients, 25% had evaluable active controls (45 patient-control pairs); 84% had evaluable passive controls (151 patient-control pairs). Although patients with controls differed from those without controls under each strategy, there was no difference in the percentage of controls who were working at follow-up (96% of active controls; 91% of passive controls). However, only 65% of patients were working at follow-up. CONCLUSIONS: The majority of patients had evaluable passive controls. There was no significant difference in outcome between controls ascertained through either method. IMPLICATIONS FOR CANCER SURVIVORS: Passive controls are a low-cost, higher-yield option to control for secular trends in racially/ethnically diverse samples.

The most commonly used methods for bone age (BA) reading were described in the Caucasian population decades ago. However, there are secular trends in skeletal maturation and different BA patterns between ethnic groups. Automated BA reading makes updating references easier and more precise than human reading. The objective of the present study was to present automated BA reference curves according to chronological age and gender in the Mexican population and compare the maturation tempo with that of other populations.The study included 923 healthy participants aged 5 to 18 years between 2017 and 2018. A hand radio-graph was analyzed using BoneXpert software to obtain the automated BA reading according to Greulich and Pyle (GP) and Tanner-Whitehouse 2 (TW2) references. We constructed reference curves using the average difference between the BA and chronological age according to sex and age.The GP and TW2 automated reference curves showed that Mexican boys exhibit delays in BA during middle childhood by 0.5 to 0.7 (95% confidence intervallsqb;CI], -0.9 to -0.2) years; however, they demonstrate an advanced BA of up to 1.1 (95% CI, 0.8 to 1.4) years at the end of puberty. Mexican girls exhibited a delay in BA by 0.3 to 0.6 (95% CI, -0.9 to -0.1) years before puberty and an advanced BA of up to 0.9 (95% CI, 0.7 to 1.2) years at the end of puberty.Mexican children aged10 years exhibited a delay in skeletal maturity, followed by an advanced BA by approximately 1 year at the end of puberty. This may affect the estimation of growth potential in this population.

The age at menarche is changing together with the development of society. The intensities of secular trends vary in different countries, regions or even towns and villages. Therefore, the objective of the paper was to assess the changes of the menarcheal age of girls in groups defined by different levels of parental education and the number of children in a family as well as the general index of socioeconomic status. The paper utilises the results of research conducted in the years 1985–1986, 2005–2006 and 2015–2016, covering 11 671 girls aged 10–16 from eastern provinces of Poland. Information about the date of birth, the date of the first period, place of residence, fathers’ and mothers’ education and the number of children in a family was collected. Research material was divided into groups stratified by mother’s education, father’s education, number of children in a family, size of place of residence and the general index of socioeconomic status (SES) was calculated. The results were processed statistically using one-way analysis of variance (ANOVA) and the Newman-Keuls method. In all the assessed groups of girls the acceleration of maturation has been observed. Greater socio-economic differences of the menarcheal age of the respondents were observed in the years 1986–2006, whereas in the years 2006–2016 the differences were smaller. During the assessed period of 30 years, the most intensive acceleration in menarche was observed in the lowest social strata, i.e. in the daughters of parents with primary or vocational education, in those from the largest families and in those who were included in the group with the lowest SES point values. The lowest acceleration in the described indicator of development was found in girls from families with one or two children, whose parents had higher education degrees and the highest SES values. The assessed schoolgirls still demonstrate the existence of social gradients in the menarcheal age but the gradients are smaller than 30 years ago.

Aim To assess secular trend and changes in social inequalities of children's height across nearly 50 years, when vast socio-political changes took place in Poland. Methods Data on schoolchildren aged 7-18 years were collected in 1966, 1978, 1988 and 2012 in Poland. Height was standardised for age using the LMS method. Socio-economic status (SES) was based on 4 factors: urbanisation level, mother's and father's education, and family size (number of children). Statistics included 2-way ANOVA with post hoc Tukey's test and effect size calculations. Results Positive secular trend in height was observed across all years. All analysed SES factors had significant effect on height which differed depending on SES category and year of Survey. Differences in height between extreme categories of SES factors decreased gradually, starting from 1978. However, only general SES in girls and urbanisation level in both sexes became insignificant in 2012. Conclusion Improvement of living conditions across nearly 50 years was reflected in the secular trend in children's height. Despite this improvement, however, the biological effects of social inequalities, visible in differences in height, to some extent, are still present in Poland.

We aimed to describe trends in rates of hospitalisation for lower extremity amputation (LEA) and 1 year mortality rates after LEA in people with diabetes in Hong Kong between 2001 and 2016.The Hong Kong Diabetes Surveillance Database is a territory-wide population-based diabetes cohort (N = 770,078) identified from the Hong Kong Hospital Authority electronic medical system. We identified LEA events using ICD-9 procedure codes and 1 year mortality after LEA from linkage to the Hong Kong Death Registry. Joinpoint regression models were used to describe the trends.Between 2001 and 2016, 6113 hospitalisations for LEAs in men and 4149 in women were recorded in the Hong Kong Diabetes Surveillance Database. The rates of minor LEAs declined by 48.6% (average annual per cent change [AAPC]: -3.8; 95% CI -5.7, -1.9) in men and by 59.5% (AAPC: -6.3; 95% CI -10.6, -1.8) in women. The rates of major LEAs declined by 77.9% (AAPC: -8.0; 95% CI -9.6, -6.5) in men and by 79.3% (AAPC: -10.4; 95% CI -13.1, -7.6) in women. The cumulative 1 year mortality rates after minor and major LEAs were 18.5% and 41.8% in men, and 21.3% and 42.0% in women, respectively, for the whole period. No change was detected in 1 year mortality rates during the surveillance in both sexes.Although hospitalisation rates for LEAs have declined overall in people with diabetes, there were no improvements in 1 year mortality rates after LEA. Continuous efforts are needed to further prevent LEAs and improve the survival rate of people undergoing LEAs. Graphical abstract.

The median artery has been considered as an embryonic structure, which normally regresses around the 8th week of gestation. However, various prevalences have been reported in adults since the 18th century. Furthermore, in a study by Henneberg and George (1995; Am J Phys Anthropol 96, 329–334), has suggested that increasing prevalence of the median artery during the 20th century was a ‘possible secular trend’. The present study, conducted nearly a quarter of a century later, is a continuation of that study. A total of 26 median arteries were found in 78 upper limbs obtained from Australians aged 51 to 101 years, who died in the period 2015–2016, a prevalence rate of 33.3%. Analysis of the literature showed that the presence of the median artery has been significantly increasing (p = .001) over time, from approximately 10% in people born in the mid‐1880s to approximately 30% by the end of the 20th century. The significance of the prevalence increased to a p value

INTRODUCTION Secular trends of dementia prevalence and incidence have rarely been studied in the Chinese population. METHODS We examined the changes in dementia prevalence and incidence by comparing data from Shanghai Epidemiological Survey of Dementia and Alzheimer's disease (SESD) and Shanghai Aging Study (SAS) conducted two decades apart. FINDINGS The dementia prevalence and incidence in total participants in SAS were higher than that in SESD (prevalence: 6.44% vs 2.30%, P

Background Hypertension is one of the most prevalent non-communicable diseases (NCDs). However, unbalanced regional development and different research designs lead to greater heterogeneity of hypertension data in China, and lack of a summary of long-term variation trends. The aim was to estimate the pooled prevalence of hypertension and to describe the secular trend in hypertension. Methods Literatures, related to the prevalence of hypertension among Chinese adults, were searched through both English and Chinese databases. The pooled prevalence was estimated with random effects. Subgroup analysis and meta-regression was conducted to address heterogeneity. Continuous fractional polynomial regression model and compound model were used to estimate the trend of hypertension prevalence with time. Results A total of 18 studies were included and the whole population was 9, 191, 121. The pooled prevalence of hypertension among Chinese adults was 24.3% (95% CI: 18.8-29.8%), increasing from the west to the east. Hypertension was more common in male than in female (27.8% vs. 25.1%) and in urban population than in rural population (27.0% vs. 26.0%). The annual increase of prevalence was about 0.29% nonlinearly before 2004 and maintained approximately 2.45% per year between 2004 and 2010. After a significant decline in 2011, there was a slight incline. Conclusions The prevalence of hypertension in Chinese adults has been increasing, indicating that more efforts should be strengthened for hypertension management in China.

Purpose We use data from California, where 13% of US births occur, to address two questions arising from efforts in the first decade of this century to avoid stillbirths before 25 6/7 weeks of gestation (i.e., in the periviable period). First, did stillbirths decline in the first decade of this century? Second, if stillbirths did decline, did periviable live births increase simultaneously? Answering these questions is important given that periviable infants represent less than 1% of live births but account for roughly 40% of infant mortality and 20% of hospital-based obstetric costs in the United States. Methods We constructed 240 monthly conception cohorts, starting with that conceived in January 1991, from 9,880,536 singleton pregnancies that reached the 20 0/7 week of gestation. We used time-series design and Box-Jenkins methods that address confounding by autocorrelation, including secular trends and seasonality to answer our questions. Results We detected a downward shift in stillbirths in April 2007 that coincided with an upward shift in periviable live births. Conclusions Our findings imply that, since 2007, fewer Californians than expected from history and from the size of conception cohorts reaching 20 0/7 weeks of gestation have had to contend with the sequelae of stillbirths, but more than expected likely have had to contend with those of periviable births.

This study aimed to assess the impact of the 2017 American College of Cardiology and American Heart Association (ACC/AHA) guideline and the 2018 Chinese hypertension guidelines on the different secular trends for hypertension prevalence. A total of 82 665 eligible individuals aged ≥20 years were selected from nine cross‐sectional study periods (1991‐2015) from the China Health and Nutrition Survey (CHNS). Over the 24‐year period, the long‐term trend for the prevalence of the 2017 ACC/AHA‐defined age‐adjusted hypertension showed an increase from 32.2% (95% confidence interval (CI): 31.0%‐33.3%) in 1991 to 60.0% (95% CI: 58.6%‐61.3%) in 2015 (P trend

ObjectiveTo evaluate a comprehensive tobacco control policy package on hospital admissions for acute myocardial infarction (AMI) and stroke in a global city.DesignInterrupted time series study.SettingBeijing, China.Population31 707 AMI and 128 116 stroke hospital admissions recorded by the Beijing Medical Claim Data for Employees in 17.7 million residents from January 2013 to June 2017.InterventionThe policy package including all components of MPOWER has been implemented since June 2015.Main outcome measuresThe immediate change of AMI and stroke hospital admissions and the annual change in the secular trend.ResultsThere was a secular increase trend for the crude hospital admission rates of AMI and stroke during the observational period. After implementation of the policy, immediate reductions were observed in the hospital admissions for both AMI (−5.4%, 95% CI −10.0% to −0.5%) and stroke (−5.6%, 95% CI −7.8% to −3.3%). In addition, the secular increase trend for stroke was slowed down by −15.3% (95% CI −16.7% to −13.9%) annually. Compared with the hypothetical scenario where the policy had not taken place, an estimated 18 137 (26.7%) stroke hospital admissions had been averted during the 25 months of postpolicy period.ConclusionsThe results indicated significant health benefits on cardiovascular morbidity after the Beijing tobacco control policy package, which highlighted the importance for a comprehensive tobacco control policy at the national level in China. Similar tobacco control policy which consists of all components of MPOWER is urgently needed in other areas, especially in settings with high tobacco consumption, to achieve greater public health gains.

According to many scholars of public opinion, most of the fast-growing divides between Democrats and Republicans over the last few decades have taken place on moral issues. We find that the process...

Background A declining trend in mean cholesterol levels and smoking has been observed in high-income western countries during the last few decades, whereas obesity rates have increased. Simultaneously, mortality from coronary heart disease has decreased. The aim of the present study was to determine whether the trends in cardiovascular risk factors have continued in successive cohorts of middle-aged women over a period of 34 years. Methods Six population-based, cross-sectional samples of women (n = 2294) mean age: 49.8 years (range: 45–54), living in Gothenburg, Sweden, were investigated between 1980 and 2014. Results Body mass index (BMI) increased over time, with a mean BMI of 24.7 kg/m2 in 1980 to 25.7 kg/m2 in 2013–2014, corresponding to a weight gain of 4.5 kg, together with an increase in the proportion of obese individuals (BMI ≥ 30 kg/m2) from 10.4 to 16.6% (p = 0.0012). The proportion of smokers and women with hypertension decreased from 34.5 to 12.8% (p = 0.0006) and from 37.7 to 24.5% (p p p Conclusion The trend towards increasing obesity, more leisure-time physical activity and less smoking remains, while the decrease in serum cholesterol appears to have abated.

The prevalence of hepatitis C virus (HCV) infection in Taiwan was approximately 4% a decade ago, much higher than the worldwide average. This study aimed to assess the HCV burden among 4 million voluntary blood donors after 2 decades of prevention and treatment policies. We retrieved screening results for anti‐HCV and HCV RNA from the Database for Evaluating Voluntary Taiwanese Eligible Donors. First‐time blood donors who donated blood after 1999 and repeat donors who donated blood more than once between 2013 and 2017 were included to estimate HCV prevalence and incidence, respectively. The Cox proportional hazards model was used to estimate hazard ratios. Geographic variation in HCV prevalence and incidence in 364 townships was also analyzed. The prevalence study included 3,656,598 first‐time donors. The overall crude prevalence of anti‐HCV decreased from 15.5 to 4.5 per 1,000 donors between 1999 and 2017. Younger birth cohorts had a significantly lower prevalence of anti‐HCV. The majority of townships (64.3%) in Taiwan showed a significantly decreased prevalence. The incidence study included 1,393,014 repeat donors followed for 3,436,607 person‐years. Ninety‐eight donors seroconverted to HCV RNA positivity, resulting in an HCV incidence of 2.9 per 100,000 person‐years. Donors living in townships where HCV RNA prevalence was greater than 2 per 1,000 had at least 2.5‐fold greater risk of new HCV infection. Conclusion: HCV prevalence in Taiwanese first‐time blood donors decreased by 71% in the last 2 decades. However, townships with higher HCV prevalence also showed higher HCV incidence and require more active intervention., HCV prevalence and incidence were estimated among four million blood donors in Taiwan. The overall crude prevalence of anti‐HCV decreased by 71% during 1999‐2017, and incidence of HCV RNA was as low as 2.85 per 100,000 in recent years. This successful control may be due to the overall improvements in medical resources, practices, and health education.

Background Many previous studies reported secular trend of lung cancer incidence and mortality, but little is known about the possible reasons for these trends. Methods Data were obtained from Shanghai Cancer Registry. Age‐standardized rates were calculated and average annual percent changes (AAPCs) were evaluated by Joinpoint regression. Age, period, and birth cohort effects were assessed by age‐period‐cohort models. Results From 1973 to 2010, compared with long‐time slowly increasing trend in women, male lung cancer incidence had significantly decreased between 2001 and 2009. After that lung cancer incidence rising sharply in women (AAPC = 14.13%, 95%CI: 2.68%‐26.86%, P = .016) and similar rising trends without statistical significance in men (AAPC = 2.96, 95%CI: −2.47%‐8.69%, P = .281) between 2010 and 2014. Age‐period cohort model showed the different patterns of period effects for lung cancer incidence between men and women. The period effects for lung cancer incidence showed rising effect for women, whereas there was decline effect for lung cancer incidence for men. On the other hand, the model showed a significant period effect in both genders with a similar fashion in mortality, yielding steady falling trends during the entire study period. Conclusions The distinctive patterns of lung cancer incidence between men and women may be attributable to significant period effects, which reflected the changes in public health policies or diagnostic practices and highlighted the urgent of continued monitoring of gender‐specific risk factors for lung cancer incidence., This study found that distinctive patterns of lung cancer incidence between male and female may be attributable to significant period effects, which reflect the effectiveness of primary prevention measures and highlighted the urgent of continued monitoring of gender‐specific risk factors for lung cancer incidence.

Background: Violence is a challenging modern epidemic worldwide. Less evidence is available on the populations most affected by violence in recent decades. The aim of the study was to ecologically investigate temporal trends of the global burden of violence according to gender, age group, and socio-demographic development. Methods: Data on the age- and gender-specific rates of country-level disability adjusted life years (DALYs) attributable to different types of violence i.e. interpersonal violence (IV), and collective violence (CV) and legal interventions were retrieved from online database provided by the global burden of diseases project. Countries were categorized according to their socio-demographic index (SDI). Incidence rate ratio (IRR) per one year was estimated according to age groups, genders and SDI categories applying Poisson regression modeling. Results: The highest decrease of the DALYs attributable to IV was observed for the under-five-years age group and then for 5–14-years in both genders, globally. Considering the CV, estimated IRRs were significant only for the under-five-years age group, which was at 1.30 (95% CI: 1.20, 1.40, per 10 years) for girls and 1.29 (95% CI: 1.21, 1.39, per 10 years) for boys. Conclusion: The rate of DALYs due to IV has been more decreasing among women and children during the recent decades. By the next 10 years, the attributed DALYs to CV would increase up to 120%. Children, adolescents and women are highly affected by CV in countries with middle-low and middle social development in the recent decades.

Over the previous decades, the prevalence of pediatric obesity has been increased in Korea as well as worldwide. Pediatric obesity is associated with comorbidities in childhood and adulthood. We reviewed the prevalence of pediatric obesity using data from the National School Health Examination (NSHE) and the Korea National Health and Nutrition Examination Survey (KNHANES). Obesity was defined as a body mass index (BMI) ≥25 kg/m2; BMI ≥95th percentile for the corresponding sex and age in the 2007 growth charts for the NSHE; or BMI ≥95th percentile for the corresponding sex and age in the 2017 growth charts for the KNHANES. There was a slight discrepancy in the prevalence of obesity depending on the data source. The prevalence of obesity increased from 8.7% in 2007 to 15.0% in 2017 in the NSHE (in children aged 6–18 years) and from 8.6% in 2001 to 9.8% in 2017 in the KNHANES (in children aged 2–18 years). The increase in the prevalence of obesity was higher in boys and high school students. Accurate epidemiologic data analyzed using the new 2017 growth charts are essential in developing strategies for controlling obesity. Efforts to collect more reliable nationally representative data, including longitudinal studies, are warranted.

The aim of this study was to investigate inter-generational changes in selected mid-upper-arm measurements of boys from Kolkata, India. The analysis was based on the anthropometric measurements of two cohorts of Bengali boys aged 7–16 from middle-class families, in 1982–83 and 2005–11. The two cohorts were compared in terms of their mid-upper-arm circumference (MUAC) and mid-upper-arm area (MUAA), mid-upper-arm muscle area (MUAMA), mid-upper-arm fat area (MUAFA) and Arm Fat Index (AFI). The significances of the differences were determined using two-way ANOVA. All features differed significantly between the examined cohorts and all showed a general positive secular trend. In most cases, the biggest differences were noted for 14- and 16-year olds and the smallest for the youngest boys. The contemporary boys seemed to have more favourable overall developmental conditions, probably related to socioeconomic progress in India over recent decades.

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 Astrand-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

Background All life on earth has adapted to the effects of changing seasons. The general and ESKD populations exhibit seasonal rhythms in physiology and outcomes. The ESKD population also shows secular trends over calendar time that can convolute the influences of seasonal variations. We conducted an analysis that simultaneously considered both seasonality and calendar time to isolate these trends for cardiovascular, nutrition, and inflammation markers. Methods We used data from adult patients on hemodialysis (HD) in the United States from 2010 through 2014. An additive model accounted for variations over both calendar time and time on dialysis. Calendar time trends were decomposed into seasonal and secular trends. Bootstrap procedures and likelihood ratio methods tested if seasonal and secular variations exist. Results We analyzed data from 354,176 patients on HD at 2436 clinics. Patients were 59±15 years old, 57% were men, and 61% had diabetes. Isolated average secular trends showed decreases in pre-HD systolic BP (pre-SBP) of 2.6 mm Hg (95% CI, 2.4 to 2.8) and interdialytic weight gain (IDWG) of 0.35 kg (95% CI, 0.33 to 0.36) yet increases in post-HD weight of 2.76 kg (95% CI, 2.58 to 2.97). We found independent seasonal variations of 3.3 mm Hg (95% CI, 3.1 to 3.5) for pre-SBP, 0.19 kg (95% CI, 0.17 to 0.20) for IDWG, and 0.62 kg (95% CI, 0.46 to 0.79) for post-HD weight as well as 0.12 L (95% CI, 0.11 to 0.14) for ultrafiltration volume, 0.41 ml/kg per hour (95% CI, 0.37 to 0.45) for ultrafiltration rates, and 3.30 (95% CI, 2.90 to 3.77) hospital days per patient year, which were higher in winter versus summer. Conclusions Patients on HD show marked seasonal variability of key indicators. Secular trends indicate decreasing BP and IDWG and increasing post-HD weight. These methods will be of importance for independently determining seasonal and secular trends in future assessments of population health.

Most public companies incorporate in Delaware. Is this because they prefer its legal system or are they simply following a trend? Using the incorporation histories of over 22,000 public companies from 1930 to 2010, I show that firms are more influenced by changes in each other's decisions than by changes in the law. The analysis exploits an unexpected legal shock that increased Delaware's long run share from 30 to 74 percent. I attribute most of this change to a cascading effect in which the decisions of past firms successively influence future cohorts. Delaware firms also enjoyed abnormal returns precisely during those years in which the Delaware network grew most. I conclude that network effects dominate secular trends in corporate governance.

Summary Background/Objectives The aims were to study the presence of a secular trend in (a) age at peak height velocity (PHV), (b) velocity at PHV, and (c) duration of skeletal maturation in relation to PHV. Material/Method Two groups of children: 100 children (63 boys, 37 girls) born between 1969–1973 and 71 children (49 boys, 22 girls) born between 1996 and 2000, were compared. Age and velocity at PHV were measured on individual growth velocity curves. Skeletal maturation stages were assessed on hand-wrist radiographs, and duration from the skeletal maturation stages to PHV was determined. Results Age at PHV occurred significantly earlier (0.47 years, CI 95% 0.19–0.76, P < 0.001), and velocity at PHV was significantly higher (0.68 cm/year, CI 95% 1.47–2.06, P < 0.003) in children born 1996–2000 compared to 1969–1973. No significant difference in duration of skeletal maturation was seen between the groups. Skeletal maturation stages occurred significantly in the following order before PHV for both genders: PP2= 2.18 years (P = 0.002), MP3= 1.60 year (P = 0.008), S 1.07 year (P = 0.003), and MP3cap 0.38 year (P = 0.037). Limitations Most radiographs were taken before PHV, the duration thus mainly reflects the early event of pubertal growth spurt. Conclusion A secular trend was evident: significantly decreased age at PHV and significantly increased velocity at PHV. No evidence of a secular trend regarding duration of the skeletal maturation in relation to PHV was found. Due to the declining age at PHV, the skeletal maturation stages occurred earlier in relation to chronological age.

Significant political and economic transformations took place on the territory of contemporary Russia in the first part of the 20th century. We hypothesized that they would have affected male growth curve negatively. To test this idea, the dataset was collected to present the graph, which illustrates the changes in male body height during the 20th century. We searched for bibliographic sources with information about body height of men and women born during the 20th century, with full description of measurement methodology, sample design and significant geographical distribution of the dataset covering more than 15 territories of the country – cities or regions. Such criteria were met only for men. We found only 8 sources that could be considered reliable in the research. The observed graph confirms positive changes in male body height on the territory of the European part of contemporary Russia: for those, who were born in 1900‘s it was 166.1 cm, in 1920s – 166.5 cm, in 1940s – 171 cm, in 1960s – 174.8 cm and in 1980s the indicator reached 176.1 cm. No significant negative changes in this indicator have been found during the studied period. The primary hypothesis that political and socio-economic transformations affect male growth curve negatively was confirmed only partly. We concluded that unfavorable political and socio-economic events (such as revolutions, World War I and World War II, purges and famines) influenced the pace of body height increase in men. While the main period of secular trend was fixed in the first decades of the 20th century in Germany, Netherlands and France, in this part of Russia it occurred later, in 1930–1960s. However, the total increase in male height was very similar for all mentioned territories (9–11 cm) during 1900–1980’s.

What is already known about this topic? The incidence of female lung cancer in China has been rising, whereas the incidence ratio among men and women is declining. The rising trend of female lung cancer is a prominent public health concern for China. What is added by this report? The joint secular trends distribution of the incidence, mortality, and years of life lost (YLLs) due to premature death of lung cancer in Chinese women demonstrated a certain regionality, which implied the risk factors for female lung cancer in China might be different by region. Common determinant risk factors may exist in regions sharing the same joint secular trends. What are the implications for public health practice? The secular trends and the regional pattern of the trends of female lung cancer in China suggested that the prevention and control of female lung cancer should be implemented with targeted regional interventions.

Background Current trends in serum lipid levels among children are likely to be important predictors of future cardiovascular disease prevalence. However, no studies have examined trends in low-density lipoprotein cholesterol (LDL-C) levels in Japanese children. Methods We investigated trends in LDL-C levels from 2008 through 2017 and HDL-C levels from 2007 through 2017 in a population of 10- and 13-year-old children in Fukuroi City, Japan. We analyzed 17,838 children, accounting for 93.8% of all fifth and eighth graders in the entire city. Adverse lipid levels were defined as follows: 130 mg/dL or higher for LDL-C, and lower than 40 mg/dL for HDL-C. The Jonckheere-Terpstra and Cochran-Armitage tests were used to evaluate secular trends in mean serum lipid levels and prevalence of dyslipidemia, respectively. Results There were no significant trends in BMI during the study period. In children aged 10 years, serum levels of LDL-C and HDL-C showed significant positive associations with calendar year during the study period for both sexes. A significant increase in HDL-C levels was observed in girls aged 13 years. On the other hand, no significant trends were observed in the prevalence of high LDL-C or low HDL-C regardless of sex or age, while the prevalence of high non-HDL-C showed a significant increase in boys. Conclusions In the Fukuroi population, serum levels of LDL-C and HDL-C slightly increased in both boys and girls aged 10 years, and HDL-C levels slightly increased in girls aged 13 years, during the past decade.

Objective To evaluate secular trends in 10-year risk of incident cerebrovascular accidents (CVA), in incident RA relative to the general population. Methods We conducted a retrospective study of a population-based incident cohort with RA onset from 1997 to 2004 in British Columbia, Canada, with matched general population controls (2:1), using administrative health data. RA and general population cohorts were divided according to year of RA onset, defined according to the first RA visit of the case definition. Incident CVA was defined as the first CVA occurring within 10 years from the first RA visit. Secular trend was assessed using delayed-entry Cox models with a two-way interaction term between the year of RA onset and indicator of RA vs general population. Linear, quadratic and spline functions of year of RA onset were compared with assess non-linear effects. The model with the lowest Akaike Information Criterion was selected. Results Overall, 23 545 RA and 47 090 general population experienced 658 and 1220 incident CVAs, respectively. A spline Cox model with a knot at year of onset 1999 was selected. A significant decline in risk of CVA was observed in individuals with RA onset after 1999 [0.90 (0.86, 0.95); P = 0.0001]. The change in CVA risk over time differed significantly in RA with onset from 1999 onwards compared with the general population (P-value of interaction term = 0.03), but not before 1999 (P = 0.06). Conclusion Our findings suggest that people with RA onset from 1999 onwards, had a significantly greater decline in 10-year risk of CVA compared with the general population.