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Introduction: Given the expected increase in the number of patients with osteoporosis and fragility fractures it is important to have concise information on trends in prescription rates of anti-osteoporosis drugs (AOD)., Methods: We undertook a retrospective observational study using the UK Clinical Practice Research Datalink (CPRD) in the UK between 1990 and 2012 in subjects 50years or older, stratified by age, sex, geographic region and ethnicity. Yearly prescription incidence rates of any AOD and of each specific AOD were calculated as the number of patients first prescribed these AODs per 10,000person-years (py)., Results: In women, yearly rates of first prescription of any AOD increased from 1990 to 2006 (from 2.3 to 169.7 per 10,000py), followed by a plateau and a 12% decrease in the last three years. In men, a less steep increase from 1990 to 2007 (from 1.4 to 45.3 per 10,000py) was followed by a plateau from 2008 onwards. Yearly rates of first prescription of any AOD increased up to the age of 85-89years (248.9 per 10,000py in women and 119.3 in men). There were marked differences between ethnic groups and regions. Bisphosphonates were the most frequently prescribed AODs: etidronate till 2000, and then subsequently alendronate., Conclusion: We have demonstrated marked secular changes in rates of anti-osteoporosis drug prescription over the last two decades. The plateau (and decrease amongst women) in rates in recent years, set against an ever ageing population, is worrying, suggesting that the well-documented care gap in osteoporosis treatment persists. The differences in prescription rates by geographic location and ethnicity raise intriguing questions in relation to underlying fracture rates, provision of care and health behaviour., Summary: We studied the prescription incidence of anti-osteoporosis drugs (AOD) from 1990 to 2012 in the UK CPRD. Overall AOD prescription incidence showed a strong increase from 1990 to 2006, followed by a plateau in both sexes and a decrease amongst women in the last three years., Competing Interests: R.Y. van der Velde, C. E. Wyers, E. Teesselink, P. P. M. M. Geusens, J. P. W van den Bergh, F. de Vries, C. Cooper, N. C. Harvey, T. P. van Staa report no conflicts of interest., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Although the prevalence of a body mass index [BMI (in kg/m 2 )] ≥30 has tripled among US adults since the 1960s, BMI is only moderately correlated with body fatness. Because skinfolds can more accurately estimate body fatness than can BMI, it is possible that skinfolds could be useful in monitoring secular trends in body fatness., Objective: We examined whether there were similar secular trends for skinfolds (triceps and subscapular), BMI, and waist circumference between US adults., Design: This study was an analysis of 45,754 adults who participated in the NHANES from 1988-1994 through 2009-2010. Approximately 19% of the subjects were missing ≥1 skinfold-thickness measurement. These missing values were imputed from other characteristics., Results: Trends in mean levels and in the prevalence of high levels of the 4 body size measures were fairly similar between men, with mean levels increasing by ≥5% from 1988-1994 through 2009-2010. Slightly larger increases were seen in women for BMI and waist circumference (7-8%), but trends in skinfolds were markedly different. The mean triceps skinfold, for example, increased by 2 mm through 2003-2004, but subsequently decreased so that the mean in 2009-2010 did not differ from that in 1988-1994. Compared with obese women in 1988-1994, the mean BMI of obese women in 2009-2010 was 1 higher, but mean levels of both skinfolds were 5-10% lower., Conclusions: Although there were fairly similar trends in levels of BMI, waist circumference, and skinfold thicknesses in men in the United States from 1988-1994 through 2009-2010, there were substantial differences in women. Our results indicate that it is unlikely that skinfold thicknesses could be used to monitor trends in obesity., (© 2017 American Society for Nutrition.)

Background: The aim was to describe secular trends in leisure time physical activity (LTPA) and work related physical activity (WPA) from 1979 to 2008. Additionally, we explored potential cross-sectional and longitudinal correlates of LTPA and WPA., Methods: Data are collected from 34,898 individuals (49.7% men) aged >20 years who participated in at least one Tromsø Study survey between 1979 and 2008. In each survey, the participants completed a self-administered questionnaire and underwent physical examinations. LTPA and WPA were assessed by the validated "Saltin-Grimby" 4-scale questions. Potential correlates of LTPA and WPA (sex, age, body mass index (BMI), education, smoking, self-reported cardiovascular disease, self-perceived health, and employment status) were tested using ordinal logistic regression., Results: The age-adjusted prevalence of participants being inactive in leisure time remained relatively stable around 20% from 1979 to 2008 (range 19.9-23.6%). The age-adjusted prevalence of moderate-vigorous LTPA decreased from 23.2% in 1979-80 to 16.0% in 2001, thereafter the prevalence increased to 24.3% in 2007-08 (P <0.05). The age-adjusted prevalence of being mostly sedentary at work increased gradually from 35.5% in 1979-80 to 53.4% in 2007-08 (P <0.05). Sex, age, education, and smoking were identified as cross-sectional correlates of LTPA and WPA (P <0.05). Men had higher odds of engaging in LTPA than women (adjusted OR 1.52 [95% CI 1.39-1.67] in 2007-08), whereas the association between sex and WPA shifted over time. High education level, not being a smoker, and high WPA were associated with high LTPA, whereas low education level, being a smoker, and high levels of LTPA were associated with high WPA (P <0.05). In general, odds of engaging in LTPA and WPA decreased with age (P <0.05). Individuals with healthy BMI had higher odds of being in a higher LTPA level than those who were underweight and obese (P <0.05). Longitudinal analyses identified sex, age, education, smoking, WPA, and LTPA measured in 1979-80 as determinants of LTPA in 2007-08., Conclusions: In Norwegian adults, the proportion of sedentary WPA increased from 1979 to 2008, whereas the proportion of inactive LTPA remained stable. Being female, older, smoker, obese or underweight, and low education level were associated with low LTPA levels.

Objective: To explore the influence of secular trends in body height and weight on the prevalence of overweight and obesity among Chinese children and adolescents., Methods: The data were obtained from five cross-sectional Chinese National Surveys on Students' Constitution and Health. Overweight/obesity was defined as BMI-for-age Z-score of per the Wold Health Organization (WHO) reference values. Body height and weight for each sex and age were standardized to those reported in 1985 (standardized height: SHY; standardized weight: SWY) and for each sex and year at age 7 (standardized height: SHA; standardized weight: SWA) using the Z-score method., Results: The prevalence of overweight/obesity in Chinese children was 20.2% among boys and 10.7% among girls in 2010 and increased continuously from 1985 to 2010. Among boys and girls of normal weight, SHY and SHA were significantly greater than SWY and SWA, respectively (P < 0.001). Among boys and girls with overweight/obesity, SHY was significantly lower than SWY (P < 0.001), and showed an obvious decreasing trend after age 12. SHA was lower than SWA among overweight boys aged 7-8 years and girls aged 7-9 years. SHY/SHW and SHA/SWA among normal-weight groups were greater than among overweight and obese groups (P < 0.001)., Conclusion: The continuous increase in the prevalence of overweight/obesity among Chinese children may be related to a rapid increase in body weight before age 9 and lack of secular increase in body height after age 12., (Copyright © 2016 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.)

Background: Evaluation of mortality trends in dialysis patients is important for improving their prognoses. The present study aimed to examine temporal trends in deaths (all-cause, cardiovascular, noncardiovascular and the five leading causes) among Japanese dialysis patients., Methods: Mortality data were extracted from the Japanese Society of Dialysis Therapy registry. Age-standardized mortality rates were calculated by direct standardization against the 2013 dialysis population. The average annual percentage of change (APC) and the corresponding 95% confidence interval (CI) were computed for trends using joinpoint regression analysis., Results: A total of 469 324 deaths occurred, of which 25.9% were from cardiac failure, 17.5% from infectious disease, 10.2% from cerebrovascular disorders, 8.6% from malignant tumors and 5.6% from cardiac infarction. The joinpoint trend for all-cause mortality decreased significantly, by -3.7% (95% CI -4.2 to -3.2) per year from 1988 through 2000, then decreased more gradually, by -1.4% (95% CI -1.7 to -1.2) per year during 2000-13. The improved mortality rates were mainly due to decreased deaths from cardiovascular disease, with mortality rates due to noncardiovascular disease outnumbering those of cardiovascular disease in the last decade. Among the top five causes of death, cardiac failure has shown a marked decrease in mortality rate. However, the rates due to infectious disease have remained stable during the study period [APC 0.1 (95% CI -0.2-0.3)]., Conclusions: Significant progress has been made, particularly with regard to the decrease in age-standardized mortality rates. The risk of cardiovascular death has decreased, while the risk of death from infection has remained unchanged for 25 years., (© The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)

Background: Secular trends in height reported from developing countries are few and scarce., Objective: To assess secular trends in linear growth in boys and girls from birth to 18 years of life in rural households of India based on periodical cross-sectional surveys conducted over a period of 35 years., Materials and Methods: The present study uses data from baseline and final surveys of National Nutrition Monitoring Bureau from 1975 to 1979 (N = 6043) to 2012 to 2013 (N = 11 910) on anthropometry from birth to 18 years from 7 states in households of rural India., Results: The overall improvement in 18+ boys and girls was 3.1 and 1.0 cm, respectively, over a period of 35 years. The increments in height of 18+ were highest for both boys (7.4 cm) and girls (4.8 cm) in the state of Kerala followed by Tamil Nadu (boys, 7.3 cm and girls, 3.8 cm). Under-5 stunting rates reduced from 82% in the baseline survey to 45.7% in the final survey at 1.35% per year in the pooled states and was similar in both boys and girls. The recovery in stunting was highest in Tamil Nadu (1.63% per year) followed by Kerala (1.46% per year)., Conclusion: The pattern of secular trends in height in rural India seen over 3 decades was strikingly similar to that of developed countries. The phenomenal improvement in linear growth in Kerala and Tamil Nadu in children younger than 5 years and adolescents suggests that growth potential for Indians is similar to that of developed countries.

There is increasing evidence that environmental factors in early life predict later health. The early adiposity rebound recorded in most obese subjects suggests that factors promoting body fat development have operated in the first years of life. Birth weight, growth velocity and body mass index (BMI) trajectories seem to be highly sensitive to the environmental conditions present during pregnancy and in early life ("The first 1000 days"). Particularly, nutritional exposure can have a long-term effect on health in adulthood. The high protein-low fat diet often recorded in young children may have contributed to the rapid rise of childhood obesity prevalence during the last decades. Metabolic programming by early nutrition could explain the development of later obesity and adult diseases.

Background: Prescription drugs are a central component of healthcare worldwide. We investigated changes in drug-prescribing patterns over time in the general population., Methods: Secular trends were analyzed using 1999-2012 prescription data from The Health Improvement Network. Prevalence of receipt of medication prescriptions was computed by age, sex, and therapeutic category for each calendar year. Spearman correlations were computed to assess change over time., Results: Between 1999 and 2012, the percentage of the population that received at least one medication prescription increased from 64.5% to 69.2% (rho = 0.96, p < 0.001). The percentage of patients receiving prescriptions for one to four unique agents declined from 45.6% to 42.1% (Spearman's rho = -0.98, p < 0.001). Meanwhile, the percentage receiving five to nine and 10 or more unique agents increased from 14.1% to 17.5% (rho = 0.996, p < 0.001) and 4.7% to 9.6% (rho = 1.000, p < 0.001) respectively. Largest increases were seen in use of drugs for gastrointestinal disease among women and cardiovascular disease among men. In 2012, the most commonly used agents were for infection or nervous system drugs, with 32.0% and 28.9% of patients receiving at least one prescription, respectively., Conclusions: Nearly 70% of the United Kingdom population has received prescriptions for one or more medication with increasing proportions receiving prescriptions for five or more. The high rates of medication use increase the complexity and cost of healthcare. These data can be used for public health planning and to design pharmacoepidemiology and comparative effectiveness studies. Copyright © 2015 John Wiley & Sons, Ltd., (Copyright © 2015 John Wiley & Sons, Ltd.)

Background: The study assessed birth trends per decade in offspring of females with inflammatory joint diseases (IJD) compared with women without IJD., Methods: This retrospective cohort study is based on data from the Medical Birth Registry of Norway from 1967 to 2009. We investigated singleton births in females with IJD (n = 7502) and compared with births from the general population (n = 2 437 110). Four periods were examined: 1967-79, 1980-89, 1990-99 and 2000-09. In the logistic regression analysis adjustments were made for maternal age at delivery and birth order. Odds ratios were obtained for the associations between IJD and birth outcome for each period., Results: Females with IJD had in average 65 deliveries / year (0.08 % of all births) in the 1970ies and 274 deliveries / year (0.5 % of all births) from 2000 to 2009. Adjusted Odds ratios (aOR) for newborns small for gestational age were 1.5 (95 % CI 1.2, 1.9) in the earliest and 1.1 (95 % CI 0.9, 1.2) in the last period. Correspondingly, for birth weight < 2500 grams aOR decreased from 1.4 (95 % CI 1.0, 1.9) to 1.1 (95 % CI 0.9, 1.4). For preterm birth aOR was 1.1 (95 % CI 0.8, 1.5) in the first and 1.3 (95 % CI (1.1, 1.5) in the last period., Conclusion: An increasing number of births among females with IJD were observed in the study period. Birth weights of newborns of IJD women approached to birth weights in the general population, but preterm birth remained a problem.

Purpose: To provide an up-to-date estimate on the changing prevalence of stroke survivors, and examines the geographic and socioeconomic variations in low and middle-income countries (LMICs)., Methods: We searched MEDLINE, EMBASE, SCOPUS and Web of Science databases and systematically reviewed articles reporting stroke prevalence and risk factors from inception to July 2015. Pooled prevalence estimates and secular trends based on random-effects models were conducted across LMICs, World Bank regions and income groups., Results: Overall, 101 eligible community-based studies were included in the meta-analysis. The pooled crude prevalence of stroke survivors was highest in Latin America and Caribbean (21.2 per 1000, 95% CI 13.7 to 30.29) but lowest in sub-Saharan Africa (3.5 per 1000, 95% CI 1.9 to 5.7). Steepest increase in stroke prevalence occurred in low-income countries, increasing by 14.3% annually while the lowest increase occurred in lower-middle income countries (6% annually), and for every 10years increase in participants' mean age, the prevalence of stroke survivors increases by 62% (95% CI 6% to 147%)., Conclusion: The prevalence estimates of stroke survivors are significantly different across LMICs in both magnitude and secular trend. Improved stroke surveillance and care, as well as better management of the underlying risk factors, primarily undetected or uncontrolled high blood pressure (HBP) are needed., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: Few studies on spatial patterns or secular trends in human leishmanias have been conducted in Morocco. This study aimed to examine spatial patterns and trends associated with the human leishmaniasis incidence rate (HLIR) at the province/prefecture level between 2003 and 2013 in Morocco., Methods: Only the available published country data on the HLIR between 2003 and 2013, from the open access files of the Ministry of Health, were used. Secular trends were examined using Kendall's rank correlation. An exploratory spatial data analysis was also conducted to examine the spatial autocorrelation (Global Moran's I and local indicator of spatial association [LISA]), and spatial diffusion at the province/prefecture level. The influence of various covariates (poverty rate, vulnerability rate, population density, and urbanization) on the HLIR was tested via spatial regression (ordinary least squares regression)., Results: At the country level, no secular variation was observed. Poisson annual incidence rate estimates were 13 per 100 000 population (95 % CI = 12.9-13.1) for cutaneous leishmaniasis (CL) and 0.4 per 100 000 population (95 % CI = 0.4-0.5) for visceral leishmaniasis (VL). The available data on HLIR were based on combined CL and VL cases, however, as the CL cases totally outnumbered the VL ones, HLIR may be considered as CL incidence rate. At the provincial level, a secular increase in the incidence rate was observed in Al Hoceima (P = 0.008), Taounate (P = 0.04), Larache (P = 0.002), Tétouan (P = 0.0003), Khenifra (P = 0.008), Meknes (P = 0.03), and El Kelaa (P = 0.0007), whereas a secular decrease was observed only in the Chichaoua province (P = 0.006). Even though increased or decreased rate was evident in these provinces, none of them showed clustering of leishmaniasis incidence. Significant spatial clusters of high leishmaniasis incidence were located in the northeastern part of Morocco, while spatial clusters of low leishmaniasis incidence were seen in some northwestern and southern parts of Morocco; there was spatial randomness in the remaining parts of the country. Significant clustering was seen from 2005 to 2013, during which time the Errachidia province was a permanent 'hot spot'. Global Moran's I increased from 0.2844 (P = 0.006) in 2005 to 0.5886 (P = 0.001) in 2011, and decreased to 0.2491 (P = 0.004) in 2013. It was found that only poverty had an effect on the HLIR (P = 0.0003), contributing only 23 % to this (Adjusted R-squared = 0.226)., Conclusion: Localities showing either secular increase in human leishmaniasis or significant clustering have been identified, which may guide decision-making as to where to appropriately allocate funding and implement control measures. Researchers are also urged to undertake further studies focusing on these localities.

Background: The incidence of childhood epilepsy has changed during the past decades, but it is unclear whether it increased or decreased., Methods: Changes in drug-treated childhood epilepsy between 1968 and 2012 were evaluated using the Finnish nationwide register of all children, aged ≤15years, on antiepileptic drugs (AEDs) prescribed for the treatment of epilepsy. The first registered entitlement to full-refundable AEDs was used as a proxy for newly diagnosed epilepsy. Incidence densities were calculated as ratios of annual new cases per 100,000person-years in each calendar year during 1968 to 2012., Results: The annual incidence density of newly treated childhood epilepsy increased from 35 in the 1960s to 87 per 100,000person-years in the 1990s and decreased thereafter to 61 per 100,000person-years. Since 1996, the incidence density decreased 1-2% per year in children aged <1, 1-5, or 6-10years (all 95% confidence intervals within 0.3%-3%), while no substantial change was seen in older children., Conclusion: The incidence of drug-treated childhood epilepsy from the late 1960s to the early 1990s distinctly increased. The reasons for the increase are not fully understood but may include increasing ascertainment through improved diagnosis and a wider acceptance of AED treatment. Since the 1990s, a slight decline can be seen, probably reflecting the recent improvement in child health and safety., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objectives: To analyze the growth trends of children in Beijing from 1955 to 2010., Methods: Data for the period 1955-1975 were derived from published records. Data for the period 1985-2010 were derived from the Chinese National Survey on Students' Constitution and Health (CNSSCH). Since 1985, the overall sampling and measurement methods have been consistent. The mean, the standard deviation, and the variance (ANOVA) of height, weight, and BMI by age and sex of students aged 7-17 were calculated and analyzed., Results: Between 1955 and 2010, the average height and weight of children in Beijing has increased. The average increments per decade for boys and girls were 2.45cm and 2.03cm in height and 2.68kg and 1.68kg in weight, respectively. The largest height increase per decade occurred between 1975 and 1985: 4.51cm and 3.23cm for boys and girls, respectively. The largest height increase for the entire 55-year period under study occurred among boys at age 13 (17.85cm) and among girls at age 11 (15.90cm.), Conclusions: During the period 1955-2010, growth trends among children in Beijing were positive. The health and nutritional status of these children improved significantly. Since 2007, might be related to government intervention, childhood obesity has been curbed., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Purpose: Engaging in prolonged screen-time behaviors (STBs) is detrimental for health. The objective of the present analyses was to examine temporal trends in TV viewing and computer use among adolescents across 30 countries., Methods: Data were derived from the cross-national Health Behaviour in School-aged Children study. Data on TV viewing and computer use for gaming and nongaming purposes were collected in 2002 (n = 139,725 [51.4% girls]), 2006 (n = 149,251 [51.3% girls]), and 2010 (n = 154,845 [51.2% girls]). The temporal trends in TV viewing and computer use were each tested for all countries combined and for each individual country by sex-specific univariate analysis of variance., Results: Between 2002 and 2010, TV viewing decreased slightly in most of the 30 countries among both boys and girls. This decrease was more than offset by a sharp increase in computer use, which was consistent across all countries. Overall, boys reported more hours of STBs. They also reported a slightly larger decrease in TV viewing and slightly larger increase in computer use. STBs were generally more frequent on weekend days., Conclusions: The overall cross-national increases in STBs should be a call to action for public health practitioners, policy-makers, and researchers that interventions specifically focused on reducing STBs in youth are sorely needed. Because all countries experienced a trend in the same direction, it might be fruitful to learn more about the determinants of STBs among those countries in which hours of STBs are generally low as compared with other countries., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Estimates of the numbers and rates of acute decompensated heart failure (ADHF) hospitalization are central to understanding health-care utilization and efforts to improve patient care. We comprehensively estimated the frequency, rate, and trends of ADHF hospitalization in the United States. Based on Atherosclerosis Risk in Communities (ARIC) Study surveillance adjudicating 12,450 eligible hospitalizations during 2005-2010, we developed prediction models for ADHF separately for 3 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 428 discharge diagnosis groups: 428 primary, 428 nonprimary, or 428 absent. We applied the models to data from the National Inpatient Sample (11.5 million hospitalizations of persons aged ≥55 years with eligible ICD-9-CM codes), an all-payer, 20% probability sample of US community hospitals. The average estimated number of ADHF hospitalizations per year was 1.76 million (428 primary, 0.80 million; 428 nonprimary, 0.83 million; 428 absent, 0.13 million). During 1998-2004, the rate of ADHF hospitalization increased by 2.0%/year (95% confidence interval (CI): 1.8, 2.5) versus a 1.4%/year (95% CI: 0.8, 2.1) increase in code 428 primary hospitalizations (P < 0.001). In contrast, during 2005-2011, numbers of ADHF hospitalizations were stable (-0.5%/year; 95% CI: -1.4, 0.3), while the numbers of 428-primary hospitalizations decreased by -1.5%/year (95% CI: -2.2, -0.8) (P for contrast = 0.03). In conclusion, the estimated number of hospitalizations with ADHF is approximately 2 times higher than the number of hospitalizations with ICD-9-CM code 428 in the primary position. The trend increased more steeply prior to 2005 and was relatively flat after 2005., (© The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The care of premature infants in the 20th century is remarkable for technical advances that have dramatically improved survival, but little is known about temporal changes in the neuropathology of the premature infant over this time frame. We hypothesize that the autopsy rate of germinal matrix hemorrhage changed in the 20th century relative to combined influences of clinical interventions that were both harmful and helpful. We examined germinal matrix hemorrhage with intraventricular hemorrhage (GMH-IVH) in 345 premature infants (gestational age 25-36 weeks) autopsied at Boston Children's Hospital from 1914 to 2015. There was a median of 19 cases/decade (range 7-68). Over the course of the study median gestational age decreased from 33 to 27 gestational weeks (P<0.001), and median postnatal survival increased from 2 to 26 days (P=0.02). The incidence of GMH-IVH increased from 4.7% before 1960 to 50.0% from 1975 to 1980, and then decreased to 12.5% after 2005 (P<0.001). The incidence of GMH-IVH increased >3-fold around the time of the introduction of positive pressure ventilation into premature intensive care in the mid-1960s. The increased incidence of GMH-IVH in the 1970s-1980s likely reflects respiratory and hemodynamic imbalances complicating mechanical ventilation. We speculate that the subsequent decreased incidence of GMH-IVH likely reflects stabilization of respiratory function with improvements in ventilators and in ventilator management beginning in the 1970s and the use of surfactant and antenatal steroids in the 1980s.

Aims: Vascular disease mortality has declined rapidly in most Western countries, against a background of improved treatments and falling prevalence of smoking, but rising obesity. We examined whether this decline differed by lifestyle risk factors for vascular disease., Methods and Results: During 2001-2010, there were 9241 vascular disease deaths in a prospective study of 1.3 million women in middle age, about one-quarter of all UK women in the eligible age range (50-64 years in 1996-2001). We estimated percentage declines in mortality from coronary heart disease, cerebrovascular disease and other vascular diseases, overall and by age, smoking, alcohol consumption, adiposity, physical activity, socioeconomic status and age at leaving school. Over 10 years, coronary heart disease mortality fell by half (52%), cerebrovascular disease mortality by two-fifths (42%) and other vascular disease mortality by one-fifth (22%). Lean women experienced greater declines in coronary heart disease mortality than overweight or obese women (70%, 48% and 26%, respectively; P < 0.001 for heterogeneity) and women in the highest and middle thirds of socioeconomic status experienced greater declines in other (non-coronary, non-cerebrovascular) vascular disease mortality than women in the lowest third (41% and 42% and -9%, respectively; P = 0.001). After accounting for multiple testing, there were no other significant differences in vascular mortality trends by any lifestyle risk factor, including by smoking status., Conclusion: Vascular disease mortality trends varied in this cohort by adiposity and socioeconomic status, but not by smoking status or other lifestyle risk factors. Prevention and treatment of vascular disease appear not to have been equally effective in all subgroups of UK women., (© The European Society of Cardiology 2014.)

Introduction: This study examined secular trends in reproductive outcome in women with inflammatory connective tissue disease compared with reference deliveries from the general population., Material and Methods: Historical cohort study based on data registered in the Medical Birth Register of Norway from 1967 to 2009. The study included singleton births in women recorded with connective tissue disease (n = 851) and reference deliveries from the general population (n = 2 437 110). Births were stratified in four periods, 1967-1979, 1980-1989, 1990-1999 and 2000-2009. Associations between connective tissue disease and maternal and perinatal outcomes by decade were assessed in logistic regression analyses and adjusted for maternal age at delivery and parity., Results: In the 1970s, around 2.7 deliveries/year were registered for women with connective tissue disease (0.004% of all deliveries). This increased to 42 deliveries/year (0.07% of all deliveries) after 2000. Adjusted odds ratios (aOR) for cesarean section were 5.0 (95% CI 2.1-11.9) in the first and 1.8 (95% CI 1.4-2.3) in the last period. For preterm delivery the aOR decreased from 4.9 (95% CI 2.1-11.4) to 3.1 (95% CI 2.3-4.2) and the aOR for birthweight <2500 g changed from 7.3 (95% CI 3.3-16.3) to 4.1 (95% CI 3.0-5.6)., Conclusions: An increasing number of births were observed over time among women with connective tissue disease. Adverse pregnancy outcomes were more common among women with connective tissue disease but risks have decreased over time., (© 2015 Nordic Federation of Societies of Obstetrics and Gynecology.)

Puberty presents remarkable individual differences in timing reaching over 5 years in humans. We put emphasis on the two edges of the age distribution of pubertal signs in humans and point to an extended distribution towards earliness for initial pubertal stages and towards lateness for final pubertal stages. Such distortion of distribution is a recent phenomenon. This suggests changing environmental influences including the possible role of nutrition, stress and endocrine disruptors. Our ability to assess neuroendocrine effects and mechanisms is very limited in humans. Using the rodent as a model, we examine the impact of environmental factors on the individual variations in pubertal timing and the possible underlying mechanisms. The capacity of environmental factors to shape functioning of the neuroendocrine system is thought to be maximal during fetal and early postnatal life and possibly less important when approaching the time of onset of puberty., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: A decline in prevalence of late-life disability in activities of daily living (ADLs) has been reported in Western countries. We investigate the time trend of disability in basic ADLs among Chinese older people in 1997-2006, and explore the potential contribution of cardiometabolic diseases to the trend., Methods: The study included 7,845 participants (age ≥ 60 years) in the China Health and Nutrition Survey who were examined in 1997, 2000, 2004, and 2006. Data on ADLs were collected through interviews. Disability in basic ADLs was defined as need of assistance or inability to perform at least one of the five self-care activities of bathing, dressing, toileting, feeding, and transferring. Generalized estimating equation models were used to test the time trend in ADL disability and its association with cardiometabolic diseases., Results: Prevalence of ADL disability decreased from 13.2% in 1997 to 9.9% in 2006; the trend was statistically evident among people aged 60-69 years, women, and rural residents (p trend < .05). From 1997 to 2006, the prevalence of ADL disability decreased at a relative annual rate of 3.1% in total sample; the decline was statistically more evident in young-olds than older-olds, in men than women, and in rural than urban residents. The disabling effect decreased over time for stroke (p trend = .032) and multiple cardiometabolic diseases (p trend = .014)., Conclusions: The prevalence of disability in basic ADLs among Chinese older adults decreased from 1997 to 2006. Stroke and multiple cardiometabolic diseases appear to become less disabling over time, which may partly contribute to the favorable trend in ADL disability., (© The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: In this research study, we examine how both overweight and nonoverweight adolescent girls and boys fared from 1999 to 2010 in terms of disordered eating behaviors and psychosocial well-being., Method: A repeated cross-sectional design was used. Participants were recruited from public schools in 1999 (n = 3072, mean age = 14.6 ± 1.8) and 2010 (n = 2793, mean age = 14.4 ± 2.0). Secular trends were examined by weight status and gender using inverse probability weighting to control for changes in socio-demographics., Results: In general, the prevalence of disordered eating behaviors and markers of psychosocial well-being among overweight girls and boys remained the same from 1999 to 2010. In contrast, among nonoverweight girls, chronic dieting, unhealthy weight control behaviors, and extreme weight control behaviors decreased, and body satisfaction improved during this time period. Further, among non-overweight boys, the prevalence of unhealthy and extreme weight control behaviors decreased, as did mean depression scores., Discussion: Overall, findings indicate a strong need to ensure that messages about the dangers of disordered eating behaviors are reaching overweight youth. Obesity prevention interventions should not overlook the comorbid nature of obesity, disordered eating and poor psychosocial health; prevention programming should address shared risk factors, including dieting, media use, body dissatisfaction, and weight-related teasing., (© 2015 Wiley Periodicals, Inc.)

Background: Several studies showed that the waist circumference of US adults has increased over the past 25 y. However, because of the high correlation between waist circumference and body mass index (BMI; in kg/m²) (r ∼ 0.9), it is uncertain if these trends in waist circumference exceed those expected on the basis of BMI changes over this time period., Objective: We assessed whether the recent trend in waist circumference was independent of changes in BMI, age, and race-ethnicity., Design: We analyzed data from the 1999-2000 through 2011-2012 cycles of the NHANES., Results: The mean waist circumference increased by ∼2 cm (in men) and ∼4 cm (in women) in adults in the United States over this 12-y period. In men, this increase was very close to what would be expected because of the 0.7 increase in mean BMI over this period. However, in women, most of the secular increase in waist circumference appeared to be independent of changes in BMI (mean: 0.6), age, and race-ethnicity over the 12-y period. We estimated that, independent of changes in these covariates, the mean waist circumference increased by 0.2 cm in men and 2.4 cm in women from 1999-2000 through 2011-2012; only the latter estimate was statistically significant., Conclusions: Our results indicate that, in women but not men, the recent secular trend in waist circumference is greater than what would be expected on the basis of changes in BMI. Possible reasons for this secular increase, along with sex differences, are uncertain., (© 2015 American Society for Nutrition.)

Recent reports on adult fracture epidemiology have focused mainly on the hip in the elderly, in whom increasing rates lately have changed to a decline. New reports of the preponderance of nonhip fractures in health expenditure call for a wider scope. We therefore examined current overall and site-specific fracture epidemiology in adults. We ascertained all fractures diagnosed in inpatient and outpatient care in all men and women aged 20 years or older in Skåne County, Sweden, from 1999 to 2010 (10 million person-years). For each fracture type, we estimated age-specific and sex-specific rates and evaluated potential time trends. We found 205,908 fractures yielding an overall fracture rate of 192 per 10,000 person-years. The age-standardized overall fracture rate increased by 1.2 per 10,000 and year (95% confidence interval, 0.8 to 1.5), but time trends were different for different fracture types, age strata, and for men and women. For example, in both women and men aged ≥50 years the rates of proximal humerus fracture increased (0.6 and 0.2 per 10,000 and year, respectively) while hip fracture rates declined (-1.0 and -0.3 per 10,000/year, respectively). Overall age-specific number of fractures increased with age in women but was stable in men. The increasing overall fracture rate is a major concern in the context of a growing and aging population. Effective and affordable preventive strategies and treatments should be an urgent priority to meet the challenges, especially in older women in whom most fractures occur. Comprehensive current detailed data, as provided in this study, may serve as reference for projections and for cost calculations of fracture care in other settings before results of similar examinations are available there., (© 2014 American Society for Bone and Mineral Research.)

The aim of this study was to investigate long-term trends in insomnia symptoms, tiredness and school performance among Finnish adolescents. A time-series from 1984 to 2011 was analysed from two large-scale survey studies, the Finnish School Health Promotion Study and the Health Behavior in School-Aged Children study. A total of 1,136,583 adolescents aged 11-18 years answered a standardized questionnaire assessing frequency of insomnia symptoms, tiredness and school performance. A clear approximately twofold increasing trend in insomnia symptoms and tiredness was found from the mid-1990s to the end of the 2000s. The increase was evident in all participating age groups and in both genders. After 2008, the increase seems to have stopped. Insomnia symptoms and tiredness were associated with lower school performance and they were more prevalent among girls (11.9 and 18.4%) compared to boys (6.9 and 9.0%, respectively). Unexpectedly, we also observed an increasingly widening gap in school performance between normally vigilant and chronically tired pupils. The underlying causes of these phenomena are unknown, but may concern changes in the broader society. The observed recent increasing trend in adolescents' sleep problems is worrisome: poor sleep quality has also been suggested to associate with clinical or subclinical mood or anxiety disorders and behavioural problems and predispose to sleep and psychiatric disorders later in life. Our results justify further studies and call for serious attention to be paid to adolescent's sleep in the Finnish educational system and society at large., (© 2014 European Sleep Research Society.)

Purpose: Hong Kong, in common with other Asian settings, has high rates of diabetes mellitus (DM) despite a relatively nonobese population. Given the rapid economic development in the region, most Asians grew up in limited living conditions. We examined the longitudinal mortality trends of DM. We assessed whether the first generation (birth cohorts in the 1930s) with late adolescence in a more economically developed environment had a lower risk of DM., Methods: We used DM deaths and population figures in Hong Kong, 1976 to 2010. We fitted age-period-cohort models to decompose mortality rates into effects for age at mortality, calendar period of mortality, and birth cohort., Results: The risk of death from DM fell for the first generation (births in the early 1930s) with late adolescence in Hong Kong, but possibly the risk rose again for the first generation (birth 1960s) affected by the obesity epidemic., Conclusions: Adiposity might contribute to diabetes in Hong Kong, and similar Asian settings, however current vulnerability of many older Asians to DM in plentiful environments may be the result of limited living conditions until adulthood. Furthermore, our findings are more consistent with limited adolescent conditions than fetal undernutrition playing a role in vulnerability to DM., (Copyright © 2015 Elsevier Inc. All rights reserved.)

This paper studies the trends in height-by-age across socioeconomic groups of Chilean boys aged 5-18 born between 1880 and 1997, by performing a meta-analysis of 38 studies reporting height-by-age published since 1898. We estimate the trends using quantile regressions and by analyzing detailed height data from five selected studies. Both methods yield an average decennial increase in height of 1-1.1cm, and 0.9 and 1.2-1.3 cm for boys of upper and lower socioeconomic status (SES), respectively. SES differences in heights of 9-11 cm are observed up to the late 1940s. However, boys born after the 1930s exhibit substantial convergence in height between socioeconomic groups, driven by an increase in height of middle and lower SES boys of 1.5 and 1.4-2 cm per decade, respectively. As a result, SES differences in height decreased to 5 cm in 1990s. Since these changes occurred in a context of moderate economic growth and persistent income inequality, we argue that our findings are associated with the emergence and expansion of social policies in Chile since the 1940s, which delivered steady improvements in health, nutrition and living conditions., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Eating meals, particularly dinner, with family members has been found to be associated with improved dietary intake, lower prevalence of disordered eating behaviors, lower levels of substance abuse, and improved academic outcomes among adolescents. Limited research has examined how the frequency of family meals has changed over time. The objective of this study was to examine secular trends in family dinner frequency over a 12-year period using a large, nation-wide sample of adolescents. Methods: Using data from two cohorts of the Growing up Today study (GUTS; n = 18,075 observations for 14,79,714 and 15 year olds), we compared family dinner frequency among 14–15-year-olds in 1996 (GUTS1) through 2008 (GUTS2) and rate of change in family dinner frequency from 1996 to 1998 (GUTS1) and 2004–2008 (GUTS2). We fit logistic models using generalized estimating equations with independence working correlation and empirical variance to account for correlation within individual and between siblings. Results: From 1996 to 2008, the number of family dinners per week among males decreased from 5.3 to 4.6 (p = 0.04) and among females from 5.0 to 4.4 (p = 0.03). We found that the rate of decline in frequency of family meals was consistent in GUTS1 (1996–1998) and GUTS2 (2004–2008) among both males and females. Conclusions: From 1996 to 2008, frequency of family dinners decreased among adolescents. Future research should explore reasons for this decline as well as strategies to increase family meals among adolescents.

Aims: Acute myocardial infarction (AMI) incidence reflects levels of risk factors in the general population and influences coronary heart disease mortality rates. We examined trends in AMI incidence in Norway during 2001-2009 and potential differences between sex and age groups., Methods: All AMI hospitalizations (ICD9 410; ICD10 I21, I22) and coronary out-of-hospital deaths (ICD9 410-414; ICD10 I20-I25) in Norway for individuals ≥25 years were obtained during 1994-2009. Incident AMI was defined as a hospitalization or out-of-hospital death due to AMI with no prior hospitalization for AMI during the previous 7 years. Age-standardized and age-group specific rates were calculated and expressed per 100,000 persons. The annual changes in rates were obtained from Poisson regression analyses. The total change in incidence rates during 2001-2009 were then calculated based on the estimated annual change., Results: We identified 148,522 incident AMIs (41% women; 21% out-of-hospital deaths) during 2001-2009. Incidence rates declined by 24% (incidence rate ratio, IRR, 0.76, 95% CI 0.75-0.78). Out-of-hospital death rates declined more than hospitalization rates (IRR 0.54, 95% CI 0.52-0.56 vs. IRR 0.84, 95% CI 0.82-0.85; p < 0.001). The decline in incidence rates was observed among those 45 years or older. Among persons under 45 years, AMI incidence rates did not change significantly, while hospitalization rates increased with 11%., Conclusion: AMI incidence rates declined during 2001-2009. The decline was due to reductions in rates of out-of-hospital deaths and hospitalizations in individuals 45 years or older. A worrying increase in hospitalization rates was observed in those younger than 45 years., (© The European Society of Cardiology 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

The current article examines changes over time in a commonly used measure of adult attachment style. A cross-temporal meta-analysis was conducted on 94 samples of American college students (total N = 25,243, between 1988 and 2011) who chose the most representative description of four possible attachment styles (Secure, Dismissing, Preoccupied, and Fearful) on the Relationship Questionnaire. The percentage of students with Secure attachment styles has decreased in recent years (1988: 48.98%; 2011: 41.62%), whereas the percentage of students with Insecure attachment styles (sum of Dismissing, Preoccupied, Fearful) has increased in recent years (1988: 51.02%; 2011: 58.38%). The percentage of students with Dismissing attachment styles has increased over time (1988: 11.93%; 2011: 18.62%), even after controlling for age, gender, race, and publication status. Positive views of others have declined across the same time period. We discuss possible implications and explanations for these changes., (© 2014 by the Society for Personality and Social Psychology, Inc.)

Abstract: Pima Indians from the Gila River Indian Community in Arizona have a high incidence rate of type 2 diabetes, and kidney disease attributable to diabetes is a major cause of morbidity and mortality in this population. Since 1965, each member of the population at least 5 years of age is invited to participate in a research examination every other year. During the past 43 years, the overall incidence of diabetes in the Pima Indians has not changed, but the incidence of diabetes among those less than 15 years of age has increased nearly 6-fold, as an increasing prevalence and degree of obesity in the youth have shifted the onset of diabetes to younger ages. The rising frequency of diabetes in the youth has led, in turn, to the emergence in mid-life of the major complications of diabetes, including kidney disease. On the other hand, the introduction and widespread use of medicines to control blood pressure, reduce hyperglycemia, and block the renin–angiotensin system (RAS) have lead to improvements in the average blood pressure and glycosylated hemoglobin levels in the diabetic population. These countervailing forces have influenced the course of diabetic nephropathy in a generally favorable direction in the past few years, as evidenced by the decline in the overall incidence of end-stage kidney disease since 1990. A continued increase in the incidence of type 2 diabetes in youth, however, threatens to reverse this trend. [Copyright &y& Elsevier]

In countries of the Mediterranean region, nuts have been consumed in moderate quantities since ancient times. Epidemiological studies show lower risk of cardiovascular diseases in populations with frequent nut consumption, independent from other dietary components. This article assesses nut consumption in Spain and other countries using different sources of data collected at the country, household or individual levels. The per capita consumption of nuts in Spain in 2001 was 7??9 g/person/d. The varieties most widely consumed are walnuts, almonds, hazelnuts and peanuts. Results of the eVe study estimate an average nut consumption in the Spanish population aged 25???60 years of 3??3 g/person/d. No significant statistical differences were observed between men and women. Consumption is higher in men aged between 35 and 44 years (4??5 g/d) and in women aged between 45 and 54 years (3??5 g/d). In the population of 2???24 years, according to the enKid study, nut consumption is estimated at 4??9??18??5 g/person per d. The age group with the highest consumption is teenagers between 14 and 17 years. The northeastern, northern and eastern regions of Spain show the highest consumption. According to FAO balance sheets, in 2001, Lebanon (16??5 kg/person peryear) and Greece (11??9 kg/person per year) were the countries in the Mediterranean region with the highest consumption of nuts, followed by Spain (7??3 kg/person per year), Israel and Italy. [ABSTRACT FROM PUBLISHER]

Despite wide variations in hip rates fractures worldwide, reasons for such differences are not clear. Furthermore, secular trends in the age-specific hip fracture rates are changing the world map of this devastating disease, with the highest rise projected to occur in developing countries. The aim of our investigation is to systematically characterize secular trends in hip fractures worldwide, examine new data for various ethnic groups in the United States, evidence for divergent temporal patterns, and investigate potential contributing factors for the observed change in their epidemiology. All studies retrieved through a complex Medline Ovid search between 1966 and 2013 were examined. For each selected study, we calculated the percent annual change in age-standardized hip fracture rates de-novo. Although occurring at different time points, trend breaks in hip fracture incidence occurred in most Western countries and Oceania. After a steep rise in age-adjusted rates in these regions, a decrease became evident sometimes between the mid-seventies and nineties, depending on the country. Conversely, the data is scarce in Asia and South America, with evidence for a continuous rise in hip fracture rates, with the exception of Hong-Kong and Taiwan that seem to follow Western trends. The etiologies of these secular patterns in both the developed and the developing countries have not been fully elucidated, but the impact of urbanization is at least one plausible explanation. Data presented here show close parallels between rising rates of urbanization and hip fractures across disparate geographic locations and cultures. Once the proportion of the urban population stabilized, hip fracture rates also stabilize or begin to decrease perhaps due to the influence of other factors such as birth cohort effects, changes in bone mineral density and BMI, osteoporosis medication use and/or lifestyle interventions such as smoking cessation, improvement in nutritional status and fall prevention., (© 2014 American Society for Bone and Mineral Research.)

Background: There is lack of data in Greece on the trends in energy and nutrient intake. The present study aimed to examine differences in these parameters among first-grade children of Crete, Greece, between 1992/93 and 2006/07., Methods: Children (aged 5.7-7.6 years) from two-representative cross-sectional samples participated during 1992/93 (n = 245) and 2006/07 (n = 257). Nutrient and food intakes were assessed using estimated 3-day-food records. Nutrient intakes were estimated as amounts per 4185 kJ (1000 kcal) of energy intake (EI), whereas macronutrients were estimated as percentage of total EI., Results: Between 1992/93 and 2006/07, respectively, significant increases (P < 0.05) were observed in the intake of energy (boys: 7996 versus 8646 kJ; girls: 7265 versus 7963 kJ), calcium (boys: 488 versus 587 mg; girls: 464 versus 594 mg), iron (boys: 5.8 versus 7.3 mg; girls: 5.7 versus 7.4 mg) and vitamins B2 (boys: 1.01 versus 1.17 mg; girls: 1.0 versus 1.16 mg) and B6 (boys: 0.80 versus 0.87 mg; girls: 0.75 versus 0.95 mg), for boys and girls, respectively. Among boys, the intake of protein (13.6 versus 14.6% of EI) and total trans fatty acids (TTFA) (0.84 versus 0.99 g) was also significantly lower in 1992/93 (P < 0.016). Between 1992/93 and 2006/07, total fat (boys: 42.9% versus 42.8%, girls: 42% versus 43.1%) and saturated fat (boys: 15.5% versus 15.4%, girls: 15% versus 15.3%) exceeded the 30-35% and <10% dietary recommendations, respectively, A significantly higher proportion of children in 2006/07, compared to 1992/93, had a higher intake of total energy (>120% of the recommended energy allowance)., Conclusions: The intake of several macronutrients (protein, TTFA, total and saturated fat) in this sample of children did not meet the recommended intakes in either time period., (© 2013 The Authors Journal of Human Nutrition and Dietetics © 2013 The British Dietetic Association Ltd.)

To assess recent trends in fracture incidence from all causes at all skeletal sites, we used the comprehensive (inpatient and outpatient) data resources of the Rochester Epidemiology Project to estimate rates for Olmsted County, MN, USA, residents in 2009 to 2011 compared with similar data from 1989 to 1991. During the 3-year study period, 2009 to 2011, 3549 residents ≥50 years of age experienced 5244 separate fractures. The age- and sex-adjusted (to the 2010 US white population) incidence of any fracture was 2704 per 100,000 person-years (95% confidence interval [CI] 2614 to 2793) and that for all fractures was 4017 per 100,000 (95% CI 3908 to 4127). Fracture incidence increased with age in both sexes, but age-adjusted rates were 49% greater among the women. Overall, comparably adjusted fracture incidence rates increased by 11% (from 3627 to 4017 per 100,000 person-years; p = 0.008) between 1989 to 1991 and 2009 to 2011. This was mainly attributable to a substantial increase in vertebral fractures (+47% for both sexes combined), which was partially offset by a decline in hip fractures (-25%) among the women. There was also a 26% reduction in distal forearm fractures among the women; an increase in distal forearm fractures among men aged 50 years and over was not statistically significant. The dramatic increase in vertebral fractures, seen in both sexes and especially after age 75 years, was attributable in part to incidentally diagnosed vertebral fractures. However, the fall in hip fracture incidence, observed in most age groups, continues the steady decline observed among women in this community since 1950. More generally, these data indicate that the dramatic increases in the incidence of fractures at many skeletal sites that were observed decades ago have now stabilized., (© 2014 American Society for Bone and Mineral Research.)

According to the recent estimates by the International Diabetes Federation (IDF), South East-Asia (SEA) Region consisting of India, Sri Lanka, Bangladesh, Bhutan, Mauritius and Maldives, is home to more than 72 million adults with diabetes in 2013 and is expected to exceed 123 million in 2035. Nearly 95% of people with diabetes have type 2 diabetes (T2DM). Although type 1 diabetes (T1DM) is relatively rare in these countries, its prevalence is also rising. Furthermore, a large number (24.3 million) of people also have impaired glucose tolerance (IGT). Several characteristic differences are seen in the clinical and immunological presentation of these people when compared with their European counterparts. A sharp increase in the prevalence of T2DM has been observed in the SEA Region, both in urban and rural areas, which is mostly associated with the lifestyle transitions towards urbanisation and industrialisation. Evidence suggests that a large portion of T2DM may be preventable by lifestyle modification. However, morbidity and early mortality occur as a result of inadequate healthcare facilities for early detection and initiation of therapy, as well as suboptimal management of diabetes and associated morbidities. This is largely preventable by primary prevention of diabetes and enhancing awareness about the disease among the public and the healthcare providers. There is an urgent need for concerted efforts by government and non-governmental sectors to implement national programmes aimed at prevention, management and surveillance of the disease., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background and Objectives: Cardiovascular risk factors, clinical features and early outcome of first-ever primary intracerebral haemorrhage (PIH) from 1986 to 2004 using the Sagrat Cor Hospital of Barcelona Stroke Registry were assessed, and compared with data from patients with first-ever ischemic stroke., Patients and Methods: The study population consisted of 380 patients with PIH and 2,082 patients with ischemic stroke. Secular trends for the periods 1986-1992, 1993-1998 and 1999-2004 were analyzed., Results: Age increased significantly (P<.001) throughout the 3 study periods and there was a significant increase in the percentage of patients with atrial fibrillation, chronic obstructive pulmonary disease (COPD) and lobar topography. The use of brain magnetic resonance imaging (MRI) also increased significantly throughout the study periods. In comparison with ischemic stroke in-hospital death was more frequent (28,2 vs. 12%) and lacunar syndrome (9,5 vs. 31,4%) and symptom-free patients at discharge were less frequent in the intracerebral haemorrhage group (6,1 vs. 18,3%)., Conclusions: Significant changes over a 19-year period included an increase in the patient's age, frequency of COPD and atrial fibrillation and use of MRI imaging studies. PIH is a severe subtype of stroke with a higher risk of early death and lower asymptomatic frequency at discharge than ischemic cerebral infarct., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Hip fractures represent the most severe complication of osteoporosis from the perspectives of the patient, carer, health care system and society. Given the strong association with age, numbers are set to rise significantly in the next few decades despite evidence that the age adjusted rates in some countries are either plateauing or falling. Given the almost invariable need for inpatient admission, hospital administrative data for hip fractures remain a robust measure of number of hip fractures in the community and can be extrapolated to determine the total expected number of clinical fragility fractures from the same population. Both process and outcome standards have now been developed to benchmark clinical quality in the care of patients with hip fractures and fragility fractures at other sites., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Major changes have recently occurred in the epidemiology of myocardial infarction (MI) that could possibly affect outcomes such as heart failure (HF). Data describing trends in HF after MI are scarce and conflicting and do not distinguish between preserved and reduced ejection fraction (EF). We evaluated temporal trends in HF after MI. All residents of Olmsted County, Minnesota (n = 2,596) who had a first-ever MI diagnosed in 1990-2010 and no prior HF were followed-up through 2012. Framingham Heart Study criteria were used to define HF, which was further classified according to EF. Both early-onset (0-7 days after MI) and late-onset (8 days to 5 years after MI) HF were examined. Changes in patient presentation were noted, including fewer ST-segment-elevation MIs, lower Killip class, and more comorbid conditions. Over the 5-year follow-up period, 715 patients developed HF, 475 of whom developed it during the first week. The age- and sex-adjusted risk declined from 1990-1996 to 2004-2010, with hazard ratios of 0.67 (95% confidence interval (CI): 0.54, 0.85) for early-onset HF and 0.63 (95% CI: 0.45, 0.86) for late-onset HF. Further adjustment for patient and MI characteristics yielded hazard ratios of 0.86 (95% CI: 0.66, 1.11) and 0.63 (95% CI: 0.45, 0.88) for early- and late-onset HF, respectively. Declines in early-onset and late-onset HF were observed for HF with reduced EF (<50%) but not for HF with preserved EF, indicating a change in the case mix of HF after MI that requires new prevention strategies.

Objective: To determine whether differences exist in the rates of obstetric intervention between women with type 1 diabetes and those with type 2 diabetes, and whether there has been any change in cesarean rates over time, paralleling that seen in the general obstetric population., Methods: Data were examined from a prospectively collected series on the outcomes of 1030 deliveries (382 by women with type 1 diabetes, 648 by women with type 2 diabetes) from 1988 to 2008., Results: There was a secular trend to increasing maternal age (type 1, P < 0.003; type 2, P < 0.03). Intervention rates (induction of labor or elective cesarean) did not differ between type 1 (88%) and type 2 (85%) diabetes. The overall cesarean rate was 52%-55% with no secular trend. Poorer glycemic control in early pregnancy and primiparity were associated with primary cesarean in both groups. In women with type 1 diabetes, greater maternal obesity and retinopathy were also associated with primary cesarean., Conclusion: Intervention rates are high in pregnancies among women with type 1 diabetes and those with type 2 diabetes but they have not changed significantly. Secular trends toward increasing maternal age and obesity suggest that intervention rates are unlikely to decrease in the near future., (© 2013.)

Aims: We evaluated trends in cardiovascular risk factors in a population-based sample of people with diabetes in England from 1994 to 2009., Methods: Data were obtained from Health Survey for England for 1994, 1998, 2003, 2006, 2008 and 2009. Participants were aged ≥30 years with self-reported diabetes., Results: The standerdised prevalence of diabetes increased from 2.8% in 1994 to 6.4% in 2009 and the prevalence among males was higher than females throughout. The trend in prevalence was more apparent in manual workers. From 1994 to 2009, mean systolic blood pressure declined from 148 mmHg to 137 mmHg; mean diastolic pressure declined from 80 mmHg to 70 mmHg; mean total cholesterol declined from 6.1 mmol/L to 4.5 mmol/L over the 15 years with linear trends. The proportion prescribed lipid lowering drugs increased from 2.2% to 47.4%. The percentage of current smokers declined from 17.5% to 13.4%. Mean body mass index increased from 27.7 kg/m(2) to 31.6 kg/m(2) with an overall increase of 0.24 kg/m(2) per year. Risk factor trends were generally similar between genders and social classes but the decline in smoking was not significant for men or for manual workers., Conclusions: People with clinical diabetes have experienced substantial reductions in blood pressure, total cholesterol and smoking over 15 years. Increasing body mass index and persistence of smoking in lower socioeconomic groups, may compromise these improvements., (Copyright © 2013 Primary Care Diabetes Europe. All rights reserved.)

Scarce data are available on epidemiology of varicocoele, the most common surgically correctable cause of male infertility. The objectives of this study were to evaluate the association between body mass index (BMI) and varicocoele and to assess trends in prevalence over time. We conducted a nationwide population-based long-term (1967-2010) study among 1 323 061 Israeli adolescent males using data from mandatory medical examination. BMI was grouped into underweight, normal weight, overweight and obese categories by percentiles adjusted for age in months and by further classification to five categories within normal weight. Univariable and multivariable logistic regression models were constructed, adjusting for possible confounders. Varicocoele prevalence (N = 47 398) increased during the study period from 1.6% for the 1950-1954 birth cohort to 4.6% for the 1990-1993 birth cohort, with the steepest rise in the normal weight group. Varicocoele unadjusted rates were highest (4.1%) among underweight and lowest (1.6%) among obese. In a multivariable model, adjusted for birth cohort, height, age and socio-demographic factors, we found a decreased risk for varicocoele in the overweight group [odds ratio (OR) = 0.51, 95% confidence interval (CI): 0.49, 0.54] and the obese group (OR = 0.34, 95% CI: 0.32, 0.37), compared with the normal weight group. Within the normal weight group, a monotonic inverse association between BMI percentile and varicocoele was observed, most notable among 75-84.9 percentile compared to 25-49.9 percentile (OR = 0.65, 95% CI: 0.63, 0.68). In conclusion, varicocoele is common among adolescents in Israel, and its prevalence had increased in recent decades, providing clues to direct further andrological research on the role of modern lifestyle and environment in the aetiology of varicocoele. BMI, across percentiles, was found to be monotonically inversely associated with varicocoele, thus directing research and clinical efforts., (© 2013 American Society of Andrology and European Academy of Andrology.)

Linear growth from birth to 2 years of children enrolled in the World Health Organization Multicentre Growth Reference Study was similar despite substantial parental height differences among the six study sites. Within-site variability in child length attributable to parental height was estimated by repeated measures analysis of variance using generalized linear models. This approach was also used to examine relationships among selected traits (e.g. breastfeeding duration and child morbidity) and linear growth between 6 and 24 months of age. Differences in intergenerational adult heights were evaluated within sites by comparing mid-parental heights (average of the mother's and father's heights) to the children's predicted adult height. Mid-parental height consistently accounted for greater proportions of observed variability in attained child length than did either paternal or maternal height alone. The proportion of variability explained by mid-parental height ranged from 11% in Ghana to 21% in India. The average proportion of between-child variability accounted for by mid-parental height was 16% and the analogous within-child estimate was 6%. In the Norwegian and US samples, no significant differences were observed between mid-parental and children's predicted adult heights. For the other sites, predicted adult heights exceeded mid-parental heights by 6.2-7.8 cm. To the extent that adult height is predicted by height at age 2 years, these results support the expectation that significant community-wide advances in stature are attainable within one generation when care and nutrition approximate international recommendations, notwithstanding adverse conditions likely experienced by the previous generation., (© 2013 John Wiley & Sons Ltd.)

Although socioeconomic position is conceptualized by social epidemiologists as a multidimensional construct, most research on socioeconomic disparities in health uses a limited set of observable indicators (e.g., educational attainment, household income, or occupational class) and typically analyzes and reports gradients in relation to one measure at a time. Societal changes in economic structures over time, however, can lead to changes in distributions of and associations between socioeconomic indicators, as has occurred with income returns to education in the United States over the last 50 years. Consequently, temporal comparisons of socioeconomic disparities from repeated cross-sectional surveys can be affected, particularly when salient dimensions of socioeconomic position are unobserved. We discuss this phenomenon within the framework of measurement error and identify sources of variation that can make identification of socioeconomic change difficult. Using simulations, we explore the utility of the quantile, slope index of inequality, and relative distribution approaches to minimizing bias in temporal comparisons and find that these methods yield correct inferences about temporal change only under limited conditions. We contrast these approaches with the use of an imputation model when validation data for the unobserved socioeconomic indicator exist. We discuss implications for analyzing changing socioeconomic health disparities over time.

What Is Already Known About This Subject: •  Turkey is in a state of rapid transition and urbanization. There is ample evidence for an increased cardiovascular risk over the past two decades in Turkey. •  Obesity, dyslipidemia and high blood pressure in children are markers of the future burden of cardiovascular disease and clustering of cardiovascular risk factors starts early in life. •  The patterns of cardiovascular risk factors in populations are not static over time and the secular trends in obesity and cardiovascular risk factors among children and adolescents of developing countries have not been completely defined., What This Study Adds: •  The prevalences of obesity and high blood pressure have increased several folds among Turkish children and adolescents over the past two decades. •  The temporal trends in fasting glucose and lipids did not correlate with the increasing prevalence of obesity with the exception of HDL-C levels. •  Finally, the prevalence of metabolic syndrome has doubled in Turkish children and adolescents over the last two decades. Our findings indicate that there may be an increase in the future morbidity and mortality from cardiovascular disease, thrombosis, stroke and diabetes mellitus throughout the developing countries., Summary: Patterns of cardiovascular risk factors and metabolic syndrome risk criteria in populations are not static over time. We analyzed the trends in lipid levels, blood pressure, fasting glucose and body mass index over the last two decades among children and adolescents. Two different cross-sectional studies were examined among students (ages 8-18) in 1989 (n = 1385) and in 2008 (n = 1746). Using the international cut-off points and percentiles, we identified children and adolescents with elevated blood pressure, triglycerides, fasting glucose (≥100 mg dL(-1) ), body mass index and low high-density lipoprotein cholesterol (HDL-C) levels. The prevalence of obesity has increased several folds over the last two decades. According to the international criteria, 4.3% of children were obese and 15.2% were overweight in 2008 vs. only 0.6% obese and 4.3% overweight in 1989 (P < 0.001). The prevalence of elevated systolic blood pressure also increased significantly among 8-12-year-old boys and girls (28.5 vs. 15.7%, P < 0.001). The temporal trends in fasting glucose and lipids did not correlate with the increasing prevalence of obesity with the exception of HDL-C levels. Low HDL-C (≤ 10th percentile) was observed in 16.3% in 1989 vs. 21.6% in 2008 (P = 0.016). HDL-C levels decreased significantly among adolescent boys. Finally, the prevalence of metabolic syndrome by modified National Cholesterol Education Program (NCEP) criteria has doubled over the last two decades (2.2 vs. 4.5%, P < 0.001). Strategies for combating the future cardiovascular mortality should focus on the prevention of obesity, high blood pressure and metabolic syndrome among children and adolescents., (© 2012 The Authors. Clinical Obesity © 2012 International Association for the Study of Obesity.)