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ABSTRACT Objective Methods Results Conclusions We aim (1) to examine secular trends in height, weight, and waist circumference (WC) among Peruvian children and adolescents living in the city of Junín and (2) to compare their growth status with the World Health Organization (WHO) and US Centers for Disease Control and Prevention (CDC) reference data.The sample included 2874 Peruvians (n = 1681 in the 2009 cohort and n = 1193 in the 2019 cohort) aged 6–16 years from the district of Junín (4107 m of altitude). Height, weight, and WC were measured using standardized protocols. Within each sex, a two‐way between‐subjects analysis of variance—age, and cohort as main factors and age‐by‐cohort as the interaction—was used to test for differences in height, weight, and WC. STATA 17 software was used in all statistical analyses.Height revealed a positive secular trend among girls, aged 6–11 years, and among boys up to 14 years of age. Similar positive secular trends in weight and WC were found across all age groups in both boys and girls. Compared to North American peers, children in the 2009 cohort were shorter, lighter, and had a smaller WC. For weight and WC, the 2019 cohort overlapped the 50th percentile across all age groups (except for 16‐year‐old girls).Both boys' and girls' height, weight, and WC showed positive secular trends between 2009 and 2019, with statistically significant differences varying across age groups. Peruvian youth of both sexes were shorter and lighter than their North American peers. [ABSTRACT FROM AUTHOR]

ABSTRACT Concerns related to school are consistently ranked as among the greatest stressors in the lives of adolescents. Research from varying contexts report rising rates of school‐related stress among students, but we currently lack knowledge on what drives these trends. The aim of this study is to investigate the predictors of temporal trends in school‐related stress in Swedish students between 2003 and 2020. To this end, repeated surveys of 9807 Swedish students aged 16 years are analysed using Blinder‐Oaxaca decomposition techniques. The results show that the rise in school‐related stress was primarily due to growing schoolwork difficulties and social exclusion among students, indicating possibly adverse consequences of a large‐scale educational reform as well as of the COVID‐19 pandemic. In addition, rising academic aspirations contributed to the increase, in line with arguments concerning the increasing weight attached to educational success among adolescents in the ‘schooled society’. [ABSTRACT FROM AUTHOR]

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]

Nitrogen dioxide (NO2) plays a pivotal role in the production of secondary pollutants, most importantly ozone (O3) and particulate matter. Regulatory controls have greatly reduced NO2 in cities, where most of the surface monitoring occurs, but the change in rural environments is less certain. Here, we present summertime (June-September) spatio-temporal patterns of NO2 concentrations using satellite and ground observations across California from 2009-2020, quantifying the differences in NO2 trends for five distinct land cover classes: urban, forests, croplands, scrublands (shrublands, savannas, and grasslands), and barren (minimally vegetated) lands. Over urban environments, NO2 columns exhibited continued but weakening downward trends (−3.7 ± 0.3%a−1), which agree fairly well with contemporaneous trends estimated from the surface air quality network (−4.5 ± 0.5%a−1). In rural (i.e., non-urban) parts of the state, however, secular trends are insignificant (0.0-0.4 ± 0.4%a−1) or in the case of remote forests are rapidly on the rise (+4.2 ± 1.2%a−1). Sorting the NO2 columns by air temperature and soil moisture reveals relationships that are commensurate with extant parameterizations but do indicate a stronger temperature dependence. We further find that rapidly rising temperatures and, to a lesser extent, decreasing precipitation in response to climate change are acting to increase soil NO x emissions, explaining about one-third of the observed NO2 rise in non-urban regions across California. Finally, we show that these trends, or their absence, can be attributed predominantly to the dramatic rise in wildfire frequency, especially since the turn of the 21st century.

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]

BackgroundLeukemia imposes a large healthcare burden both in China and the United States (US). The disease burden differs greatly between the two countries, but related research is limited. We explored the differences in leukemia incidence and mortality between China and the US.MethodsData on leukemia in China and the US from 1990 to 2021 were collected from the Global Burden of Disease 2021 database. Incidence and mortality were used to estimate the disease burden, and joinpoint regression was performed to compare their secular trends. We used an age-period-cohort model to analyze the effects of age, period, and birth cohort and project future trends in the next 15 years.ResultsIn 2021, the age-standardized incidence rate (ASIR) and the age-standardized death rate (ASDR) of leukemia were lower in China than in the US. However, the incidence and mortality of acute lymphoblastic leukemia (ALL) was considerably higher in China. In the past decades, the ASIR showed decreased tendency in the US, while ASIR showed stable in China. The ASDR tended to decrease in both countries from 1990 to 2021. Males have higher rates of incidence and mortality than females in two countries. The age effects showed that children and older individuals have higher RRs for incidence and mortality in China, while the RRs for incidence and mortality in the US particularly increased in the older population. The disease burden of leukemia in children is obviously greater in China. The ASIRs and ASDRs of leukemia will continue to decline in the next 15 years in China and the US, with the US experiencing a more obvious downtrend.ConclusionsOver the past decades, the ASDRs in two countries both tended to decrease. And compared to the US, China had lower leukemia incidence and mortality, However, the ASIRs in China tended toward stable, which it was showed downtrend in the US. Children have obviously greater RRs for incidence and mortality in China. The incidence and mortality will decrease continuously in two countries. Effective intervention measures are needed to reduce the burden of leukemia.

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]

School stress is widespread among students’ worldwide, impacting academic success and mental health. Most research focuses on average stress levels but lacks insights into temporal trends and inequalities. Using repeated longitudinal survey data on 33,000 students in Swedish compulsory school from the Evaluation Through Follow-up (ETF) study, we investigate temporal trends in stress across three cohorts of students (born 1992, 1998, and 2004), with a focus on inequalities by school year, sex, socio-economic status, migration background, school grades, and school difficulties. The results show that (1) stress increased more in year 6 than in year 9 in recent cohorts; (2) stress increased more for girls than for boys; and (3) low school grades and school difficulties have become stronger risk factors for stress. We discuss the findings in the context of recent educational reforms and broader societal trends concerning the role of education for young people’s prospects in life. [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]

IntroductionHistorically, secular and seasonal trend analyses have been examined using self-report measures of intake. Rarely are objective measures and known determinants of dietary intake used in these analyses. Our objective was to quantify the seasonal and secular differences in an objective ad libitum intake paradigm while considering the contribution of determinants, such as fat-free mass (FFM) index and spontaneous physical activity (SPA) limited to the restricted space of a whole-room calorimeter.MethodsFor this study, recruitment of N = 292 healthy, diabetes free, adults occurred from 1999 to 2020. Assessment during their 10-day stay included body composition (by DXA), SPA (by an approximately 24-h stay in whole-room calorimetry), and ad libitum intake (by a vending machine for 3 days). This secondary analysis used general linear models (GLM) to investigate secular and seasonal differences while adjusting for sex, age, FFM index, FM (fat mass) index, SPA, and race/ethnicity.ResultsFFM index and SPA were positively associated with all intake measures (p < 0.05). In all adjusted seasonal models, season did not affect intake. Adjusted secular trends models (kcals/year) demonstrated a decrease in total kcals (β = −55), intake as percent weight maintaining energy needs (β = −2), protein kcals (β = −10), fat kcals (β = −27), and carbohydrates kcals (β = −22) (all p < 0.05). After further adjustment for SPA, significance remained in all intake measures (p < 0.05). Secular trends in body composition revealed no changes in weight, BMI, and percent body fat (all p > 0.20).DiscussionOur results indicate that over time, ad libitum intake decreased in this controlled research setting and remained significant even after accounting for positive determinants of intake. A significant ad libitum decrease, coupled with no change in body composition, may highlight a participant bias toward calorie restriction in a controlled setting over time and deserves further investigation.

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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]

Individual development and aging are shaped by historical changes in sociocultural contexts. Studies indicate that later-born cohorts experience improvements in well-being in the young–old. However, whether this historical trend holds in the old–old remains unknown. Using longitudinal data of Japanese older adults, we examined birth cohort differences in trajectories of well-being as measured by life satisfaction. Data were derived from a nationally representative study conducted from 1987 to 2012. We compared earlier- and later-born cohorts over 10 years in two age groups: the young–old (n = 1,195 per cohort; age 63–74; years of birth: 1913–1924 and 1925–1936) and the old–old (n = 436 per cohort; age 75–86; years of birth: 1901–1912 and 1913–1924). To control for covariates, we used case-matched cohorts based on age and sex. Growth curve models were employed to estimate age-related changes in life satisfaction by age group. At age 75 years, life satisfaction was higher in the later-born cohort than in the earlier-born cohort across age groups. Cohort differences in the rate of change in life satisfaction were absent among the young–old. Among the old–old, the later-born cohort showed steeper declines than the earlier-born cohort. Socioeconomic, social, and health resources did not fully explain the cohort differences in both age groups. Our results suggest that historical improvements in well-being in the young–old do not persist into the old–old. Societal advancements may enable later-born cohorts to survive with limited resources. Public Significance Statement: Historical changes can influence how individuals develop and grow older. This study examined how age-related changes in positive attitudes toward life differ between birth cohorts. Later-born Japanese people perceived better levels of life satisfaction until the mid-70s but experienced greater declines in their late 70–80s than earlier-born individuals. Later-born cohorts may be more likely to survive in adverse circumstances because of societal advancements, such as medical technology. [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]

In this paper we analyse the impact of different living conditions on the length of the femur, as a proxy for stature, of three Mediterranean samples with known historical contexts, and assess sex differentials in femur length changes. The first collection analysed is composed of 18th century plague victims who had suffered several previous starvation episodes. The second collection, from the 19th century, lived through comparatively better times. The third is from the 20th century, when living conditions were better than during the two previous centuries. We compared the femur lengths of females and males between the three collections using Mann-Whitney-Wilcoxon statistical tests. The median value of male femur lengths increased over time, as expected. However, the median values of the female sample decreased in the 19th century, while the differences between the 18th and the 20th centuries samples were not statistically significant. The samples from the 18th and 20th centuries are reliable sources, but for the 19th century collection, we have assumed a possible bias in the socio-economic representativeness of the female sample. While different trends in sexual dimorphism in stature have been observed in other studies, the non-significant difference between female femur length from the 18th and the 20th centuries is unexpected, given improvements in living conditions.

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]

Background 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. Methods 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. Conclusions 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.

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]

To evaluate the secular trends of sleep-wake patterns of Hong Kong preschool children. Kindergartens from the four geographical regions of Hong Kong were randomly invited to take part in a sleep survey in 2012 and again in 2018. The parent-completed questionnaire provided information on socioeconomic status (SES), children's, and parental sleep-wake patterns. Secular trends and risk factors associated with short sleep duration in preschoolers were explored. A sample of 5048 preschool children was included in the secular comparison, with 2306 and 2742 from the 2012 and 2018 surveys, respectively. A higher percentage of children in 2018 (41.1% vs 26.7%, p < 0.001) did not achieve the recommended sleep duration. During the survey years, sleep duration decreased by 13 ([95%CI: 18.5 to −8.1]) and 18 min ([95%CI: 23.6 to −12.2]) on weekdays and weekends, respectively. The overall trend of nap decrease was not significant. Sleep onset latency significantly increased on both weekdays (6 min [95%CI: 3.5 to 8.5]) and weekends (7 min [95%CI: 4.7 to 9.9]). Children's sleep duration was positively correlated with parental sleep duration with a correlation coefficient ranging from 0.16 to 0.27 (p < 0.001). A significant proportion of Hong Kong preschool children did not achieve the recommended amount of sleep. A downward secular trend in sleep duration was observed during the survey period. Public health measures to improve sleep duration in preschool children should be a high priority. • A downward secular trend in sleep duration is observed in Hong Kong preschoolers. • Parental sleep duration is also significantly shorter during the survey period. • Bedtime access to electronic media devices is a risk factor for reduced sleep duration. [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]

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]

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]

BackgroundAn accurate assessment of current trends in cardiovascular risks could inform public health policy. This study aims to determine 20-year trends in the prevalence of elevated cardiovascular risk and its risk factors' control among US adults.MethodsIn this serial cross-sectional analysis of 23,594 adults, aged 40–79 years, without clinical atherosclerotic cardiovascular disease (ASCVD) in the National Health and Nutrition Examination Survey from 2001 to 2020, we calculated the prevalence of elevated cardiovascular risk (10-year ASCVD risk ≥ 7.5%) for all participants and subgroups with their risk factors controlled for diabetes, hypertension, or dyslipidemia.ResultsThe age- and sex-adjusted prevalence of elevated cardiovascular risk slightly decreased from 41.5% (95% CI, 39.7–43.3%) in 2001–2004 to 38.6% (95% CI, 36.1–41.1%) in 2017–2020 (P for trend = 0.169) while the respective sex-adjusted prevalence significantly increased from 34.4% (95% CI, 32.8–36.0%) to 39.5% (95% CI, 37.0–42.0%; P for trend

BackgroundMost studies have focused on overweight/obesity and its secular trend, with insufficient studies on the factors influencing thinness and trends recently. To examine the trends of prevalence and sociodemographic determinants of thinness, overweight, and obesity among Chinese children and adolescents aged 7 to 18 years from 2010 to 2018.MethodsThis study was based on cross-sectional data of 11,234 children and adolescents aged 7 to 18 years from the Chinese Family Panel Studies (CFPS) in 2010, 2014, and 2018, including anthropometric and sociodemographic characteristics variables. The nutritional status of each individual was determined according to China and WHO criteria. The demographic characteristics of different subgroups were tested by chi-square, and log-binomial regression was used to analyze the trend of prevalence and the relationship between sociodemographic characteristics and different nutritional statuses.ResultsAfter adjusting for age, from 2010 to 2018, the overall prevalence of thinness decreased, and the prevalence of overweight increased in Chinese children and adolescents. The overall prevalence of obesity declined in boys and increased in girls, but in adolescents aged 16–18 years, it increased significantly. Log-binomial regression analysis showed that among all subjects, time (years), 16–18 years were negatively associated with thinness, while 13–15 years, walking to school, large family size, and paternal age at childbirth older than 30 years old were positively associated with thinness; 10–12/13–15/16–18 years, boarding at school, medium and large family sizes, and mother's education at junior middle school/junior high school and above were negatively associated with overweight/obesity, while time (years), boys were positively associated with overweight/obesity in the multivariate model by adjusting for the statistically significant factors (all p < 0.05).ConclusionChinese children and adolescents are facing a double burden of malnutrition. Future public health policies and interventions should prioritize high-risk groups specifically young age groups, boys, larger family sizes and so on.

IntroductionEnvironmental changes, including globalization, urbanization, social and cultural changes in society, and exposure to modern digital technology undoubtedly have an impact on children’s activity and lifestyle behavior. In fact, marked reductions in children’s physical activity levels have been reported over the years and sedentary behavior has increased around the world. The question arises whether these environmental changes had an impact on general motor performance in children and adolescents. The study aimed to investigate secular trends of motor performance in Swiss children and adolescents, aged between 7 and 18 years, over a period of 35 years from 1983 to 2018.MethodsLongitudinal data on the five motor components of the Zurich Neuromotor Assessment (ZNA) – pure motor (PM), fine motor (FM), dynamic balance (DB), static balance (SB), and contralateral associated movements (CAM) – were pooled with cross-sectional data on PM and FM from eight ZNA studies between 1983 and 2018. Regression models were used to estimate the effect of the year of birth on motor performance and body mass index (BMI) measurements. Models were adjusted for age, sex, and socioeconomic status.ResultsThe secular trend estimates in standard deviation scores (SDS) per 10 years were − 0.06 [−0.33; 0.22, 95% Confidence Interval] for PM, −0.11 [−0.41; 0.20] for FM, −0.38 [−0.66; −0.09] for DB (−0.42 when controlled for BMI), −0.21 [−0.47; 0.06] for SB, and − 0.01 [−0.32; 0.31] for CAM. The mean change in BMI data was positive with 0.30 SDS [0.07; 0.53] over 10 years.DiscussionDespite substantial societal changes since the 1980s, motor performance has remained relatively stable across generations. No secular trend was found in FM, PM, SB, and CAM over a period of 35 years. A secular trend in DB was present independent of the secular trend in body mass index.

BackgroundStudies of secular trends in mental unhealth indicate that adolescents in the Nordic countries, especially girls, have an increased reported prevalence of mental health problems the last decades. This increase needs to be seen in the light of the adolescents' assessments of their perceived overall health.ObjectiveTo investigate whether a person-centered approach to research can enhance understanding of changes over time in the distribution of mental health problems among Swedish adolescents.MethodA dual-factor approach was used to study changes over time in mental health profiles among nationally representative 15-year-old adolescent samples from Sweden. Cluster analyses of subjective health symptoms (psychological and somatic) and perceived overall health from the Swedish Health Behavior in School-aged Children (HBSC) surveys of 2002, 2006, 2010, 2014, and 2018 were used to identify these mental health profiles (n = 9,007).ResultsFour mental health profiles were identified by a cluster analysis which combined all five data collections—Perceived good health, Perceived poor health, High psychosomatic symptoms, and Poor mental health. There were no significant differences in the distributions of these four mental health profiles between the survey years 2002 and 2010, but substantial changes took place between 2010 and 2018. Here, particularly the High psychosomatic symptoms profile increased among both boys and girls. The Perceived good health profile decreased among both boys and girls, and the Perceived poor health profile decreased among girls. The profile involving the most pronounced mental health problems, the Poor mental health profile (perceived poor health, high psychosomatic problems), was stable from 2002 to 2018 among both boys and girls.ConclusionThe study shows the added value of using person-centered analyses to describe differences in mental health indicators between cohorts of adolescents over longer periods of time. In contrast to the long-term increase in mental health problems seen in many countries, this Swedish study did not find an increase among young persons, both boys and girls, with the poorest mental health, the Poor mental health profile. Rather, the most substantial increase over the survey years, predominantly between 2010 and 2018, was found among the 15-year-olds with High psychosomatic symptoms only.

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]

Although the construct of social maladjustment has been used for the last six decades, relatively little research has addressed secular trends in socially maladjusted behaviors over time, and even fewer studies have addressed trends for students identified with emotional disturbance (ED). The purpose of this study was to use two nationally representative cross-sectional cohorts, one sampled in 1998 (n = 1,509) and one sampled in 2020 (n = 1,513), to examine long-term trends in the socially maladjusted behaviors of students with ED and their peers without disabilities. Results indicated that (a) socially maladjusted behaviors were significantly lower for the 2020 cohort compared with 1998 cohort, (b) the decrease from 1998 to 2020 was significantly more pronounced for students with ED compared with peers without disabilities, and (c) only adolescent students demonstrated significant decreases in socially maladjusted behaviors. Potential explanations, limitations of the study, and implications for schools are discussed. [ABSTRACT FROM AUTHOR]

Background 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. Aim 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. Subjects and methods 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. Results 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. Conclusion 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.

BackgroundIn the context of concerns regarding the cardiorespiratory fitness (CRF) of youth populations, the aims of this study were: (1) to update reference values for the VO2max for school-aged Canadians and (2) to document secular trends in CRF after a 35-year interval.MethodsBetween September 2014 and April 2017, the CRF of 3725 students (53.2% boys; 6.0 to 17.9 yrs) was determined using the 20-m shuttle run test. The sample was collected in 36 different schools from six cities of Québec (Canada).ResultsMedian values of VO2max decreased with age in both sexes (p ≤ 0.05). By the age of 10, more than 20% of boys showed VO2max values below the recommended value (42 ml·kg−1·min−1). At the age of 17, that proportion reached 56.8%. A similar proportion of 12 yrs girls (20%) were under the recommended minimal value (37 ml·kg−1·min−1) and that value reached 69.9% at the age of 17. Compared to 1982, the VO2max at age 17 has declined by 18% for boys and 12% for girls. The situation is worse in terms of functional capacity (number of stages completed) with an overall decrease of more than 30%.ConclusionThis study demonstrates that, compared to data obtained using the same methodology 35 years ago, the CRF and functional capacity of children and adolescents has declined to levels that should raise concerns from a public health perspective. Thus, the development of strategies to promote a physically active lifestyle in youth is more relevant than ever.

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]

Purpose: We compared the vision and hearing of older men and women born 28 years apart. In addition, we explored factors explaining the possible cohort differences., Methods: Two independent cohorts of 75- and 80-year-old men and women were assessed as a part of the Evergreen study in 1989-1990 (n = 500) and the Evergreen II study in 2017-2018 (n = 726). Studies were conducted with similar protocols, and differences between cohorts were compared for distance visual acuity and hearing acuity. We also studied whether educational level and health factors (i.e. total cholesterol, blood pressure, BMI, and smoking status) underlie the possible cohort differences. Independent samples t-test, Pearson chi-squared test, and linear regression analyses were used as statistical analyses., Results: Across age and sex groups, the later-born cohort had better visual acuity and a lower prevalence of visual impairment compared to the earlier-born cohort. In hearing, 75-year-old men in the later-born cohort had better hearing acuity, with average hearing level at 32 dB compared to 36 dB in the earlier-born cohort, and 80-year-old men had a lower prevalence of moderate or worse hearing loss (74 % vs. 54 %) than men in the earlier-born cohort. Similar differences were not observed for women. The cohort differences in distance visual acuity and hearing acuity attenuated when adjusting for education level., Conclusions: Today older adults retain better vision longer than before, but cohort differences in hearing are less obvious. Differences between cohorts may be partly due to advances in education., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objectives: The primary objective of this study was to examine the secular trends of cervical, ovarian, and corpus uteri neoplasm in Wales, UK, over the period from 2002 to 2021. We aimed to identify changes in the incidence and mortality rates of these cancers to inform future healthcare policies and cancer prevention programs., Methods: We sourced incidence data from 2002 to 2019 and mortality data from 2002 to 2021 from the Welsh Cancer Intelligence and Surveillance Unit. The data were analysed using Joinpoint regression to compute the average annual percentage change (AAPC) in age-standardized incidence rates (ASIR) and mortality rates (ASMR) per 100,000 population for each type of cancer., Results: The results showed that the ASIR for cervical cancer remained stable between 2002 and 2019 (AAPC = -0.5; 95 %CI = -1.4-0.4). However, the ASMR significantly declined from 4.88 in 2002-3.03 in 2021 (AAPC = -2.3; 95 %CI = -3.4 to -1.1). The ASIR for ovarian cancer significantly decreased from 27.39 in 2002-17.87 in 2019 (AAPC = -2.6; 95 %CI = -3.0 to -2.1), and the ASMR showed a statistically significant decreasing trend from 15.92 in 2002-11.2 in 2021 (AAPC = -1.7; 95 %CI = -2.5 to -0.9). In contrast, the ASIR for corpus uteri neoplasm significantly increased from 22.24 in 2002-30.41 in 2019 (AAPC = 2.2; 95 %CI = 1.2-3.4), and ASMR also showed a statistically significant increasing trend from 3.27 in 2002-6.42 in 2021 (AAPC = 3.8; 95 %CI = 2.3-5.3)., Conclusions: The study concludes that while the incidence and mortality rates for cervical and ovarian cancers in Wales have significantly decreased, corpus uteri neoplasm rates have increased during the study period. These findings underscore the need for continued efforts to improve early detection and treatment strategies, including national screening programs and public health initiatives, to mitigate the burden of these cancers., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Leukemia imposes a large healthcare burden both in China and the United States (US). The disease burden differs greatly between the two countries, but related research is limited. We explored the differences in leukemia incidence and mortality between China and the US., Methods: Data on leukemia in China and the US from 1990 to 2021 were collected from the Global Burden of Disease 2021 database. Incidence and mortality were used to estimate the disease burden, and joinpoint regression was performed to compare their secular trends. We used an age-period-cohort model to analyze the effects of age, period, and birth cohort and project future trends in the next 15 years., Results: In 2021, the age-standardized incidence rate (ASIR) and the age-standardized death rate (ASDR) of leukemia were lower in China than in the US. However, the incidence and mortality of acute lymphoblastic leukemia (ALL) was considerably higher in China. In the past decades, the ASIR showed decreased tendency in the US, while ASIR showed stable in China. The ASDR tended to decrease in both countries from 1990 to 2021. Males have higher rates of incidence and mortality than females in two countries. The age effects showed that children and older individuals have higher RRs for incidence and mortality in China, while the RRs for incidence and mortality in the US particularly increased in the older population. The disease burden of leukemia in children is obviously greater in China. The ASIRs and ASDRs of leukemia will continue to decline in the next 15 years in China and the US, with the US experiencing a more obvious downtrend., Conclusions: Over the past decades, the ASDRs in two countries both tended to decrease. And compared to the US, China had lower leukemia incidence and mortality, However, the ASIRs in China tended toward stable, which it was showed downtrend in the US. Children have obviously greater RRs for incidence and mortality in China. The incidence and mortality will decrease continuously in two countries. Effective intervention measures are needed to reduce the burden of leukemia., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ge, Zhang, Zhang, Feng, Yang, Tong, Zheng and Tan.)

Abstract 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 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.

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]

Objectives: Analyze secular trends of preeclampsia in Norway based on risk factors.Study Design: Population-based cohort study of 1,153,227 women using data from Medical Birth Registry of Norway from 1999 to 2018. Aggregated data from Norwegian Prescription Database from 2004 to 2018 were used. Main exposure variable was time period. Descriptive statistics identified the prevalence of preeclampsia, labor induction and aspirin use. Multiple logistic regression analysis was performed to estimate the risk of preeclampsia during the time periods.Main Outcome Measures: Preeclampsia.Results: Overall preeclampsia prevalence decreased from 4.3% in 1999-2002 to 2.7% in 2015-2018. A reduction was observed in all subgroups of women with known risk factors (age, nulliparity, diabetes, chronic hypertension, assisted reproduction, twin pregnancy). Adjusted risk of preeclampsia was reduced by 44% from 1999-2002 to 2015-2018 (aOR = 0.56, 95%CI 0.54, 0.58), while the net prevalence of gestational hypertension remained stable over the study period. Labor induction increased 104%. Aspirin prescriptions increased among fertile women in the general Norwegian population.Conclusions: Preeclampsia prevalence and risk were reduced regardless of risk factors and despite an increased proportion of high-risk parturients (advanced age, lower parity, use of assisted reproduction). A corresponding increase in aspirin prescriptions among fertile women and an overall increase in labor inductions were also observed, suggesting that clinical interventions may partly explain the observed reduction in preeclampsia prevalence. Lower average blood pressure and improved health in the population may also explain some of the reduction. [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]

Abstract 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

ObjectivesTo quantify the burden and variation trends of cancers in children under 5 years at the global, regional, and national levels from 1990 to 2019.MethodsEpidemiological data for children under 5 years who were diagnosed with any one childhood cancer were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) from 1990 to 2019. The outcomes were the absolute numbers and rates of incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) for different types of cancer.ResultsIn 2019, 8,774,979.1 incident cases (95% uncertainty interval [UI]: 6,243,599.2 to11,737,568.5) and 8,956,583.8 (6,446,323.9 to 12,364,520.8) prevalent cases of cancer in children under 5 years were identified worldwide; these cancers resulted in 44,451.6 (36,198.7 to 53,905.9) deaths and 3,918,014.8 (3,196,454.9 to 4,751,304.2) DALYs. From 1990 to 2019, although the numbers of incident and prevalent cases only decreased by −4.6% (−7.0 to −2.2) and −8.3% (−12.6 to −3.4), respectively, the numbers of deaths and DALYs clearly declined by −47.8% (−60.7 to −26.4) and −47.7% (−60.7 to −26.2), respectively. In 2019, the middle sociodemographic index (SDI) regions had the highest incidence and prevalence, whereas the low SDI regions had the most mortality and DALYs. Although all of the SDI regions displayed a steady drop in deaths and DALYs between 1990 and 2019, the low-middle and low SDI regions showed increasing trends of incidence and prevalence. Leukemia remained the most common cancer globally in 2019. From 1990 to 2019, the burdens of leukemia, liver cancer, and Hodgkin's lymphoma declined, whereas the incidence and prevalence of other cancers grew, particularly testicular cancer.ConclusionsThe global childhood cancer burden in young children has been steadily decreasing over the past three decades. However, the burdens and other characteristics have varied across different regions and types of cancers. This highlights the need to reorient current treatment strategies and establish effective prevention methods to reduce the global burden of childhood cancer.

Abstract 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.