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ObjectiveTo describe the participation of racial and ethnic minority groups (REMGs) in gynecologic oncology trials.MethodsGynecologic oncology studies registered on ClinicalTrials.gov between 2007 and 2020 were identified. Trials with published results were analyzed based on reporting of race/ethnicity in relation to disease site and trial characteristics. Expected enrollment by race/ethnicity was calculated and compared to actual enrollment, adjusted for 2010 US Census population data.Results2146 gynecologic oncology trials were identified. Of published trials (n = 252), 99 (39.3%) reported race/ethnicity data. Recent trials were more likely to report these data (36% from 2007 to 2009; 51% 2013-2015; and 53% from 2016 to 2018, p = 0.01). Of all trials, ovarian cancer trials were least likely to report race/ethnicity data (32.1% vs 39.3%, p = 0.011). Population-adjusted under-enrollment for Blacks was 7-fold in ovarian cancer, Latinx 10-fold for ovarian and 6-fold in uterine cancer trials, Asians 2.5-fold in uterine cancer trials, and American Indian and Alaska Native individuals 6-fold in ovarian trials. Trials for most disease sites have enrolled more REMGs in recent years - REMGs made up 19.6% of trial participants in 2007-2009 compared to 38.1% in 2016-2018 (p

Introduction: The prevalence of Down syndrome (DS) is approximately 1 per 1000 births and is influenced by increasing maternal age over the last few decades. DS is strongly associated with congenital heart defects (CHDs), especially atrioventricular septal defect (AVSD). Our objectives were to investigate the prevalence of live‐born infants with DS having a severe CHD in the Norwegian population over the last 20 years and compare outcomes in infants with AVSD with and without DS. Material and Methods: Information on all births from January 1, 2000 to December 31, 2019 was obtained from the Medical Birth Registry of Norway. We also obtained data on all infants with severe CHDs in Norway registered in Oslo University Hospital's Clinical Registry for Congenital Heart Defects during 2000–2019 and accessed individual‐level patient data from the electronic hospital records of selected cases. Infants with AVSD and DS were compared to infants with AVSD without chromosomal defects. Crude and adjusted odds ratios (ORs) of infant mortality and need for surgery during the first year of life, with associated 95% confidence intervals (CIs), were estimated by logistic regression. Results: A total of 1 177 926 infants were live‐born in Norway during the study period. Among these, 1456 (0.1%) had DS. The prevalence of infants with DS having a severe CHDs was relatively stable, with a mean of 17 cases per year. The most common CHD associated with DS was AVSD (44.4%). Infants with AVSD and DS were more likely to have cardiac intervention during their first year of life compared to infants with AVSD without chromosomal defects (adjusted OR [aOR]: 2.52; 95% CI 1.27, 4.98). However, we observed no difference in infant mortality during first year of life between the two groups (aOR: 1.08; 95% CI 0.43, 2.70). Conclusions: The prevalence of live‐born infants with severe CHDs and DS has been stable in Norway across 20 years. Infants with AVSD and DS did not have higher risk of mortality during their first year of life compared to infants with AVSD without chromosomal defects, despite a higher risk of operative intervention. [ABSTRACT FROM AUTHOR]

Background: Analysis of temporal trends of urinary diversion (UD) and identification of predictive factors for continent urinary diversion (CUD) in patients with bladder cancer (BC) is scarce and data on large cohorts are missing. We aimed to describe longitudinal temporal trends and predictive factors for UD among patients with BC receiving radical cystectomy (RC). Patients and Methods: We retrospectively analysed institutional data collected from patients undergoing RC from 1986 to 2022 to describe changes in patients' characteristics and UD. Primary end points were patients' characteristics associated with type of UD. Logistic regression analysis was used to determine predictive factors for CUD. Results: In total, 2224 patients (77.16% male, 22.84% female) with a mean age of 66 years [standard deviation (SD), 10.64 years] were included. We observed an increase in mean age from 59.86 (10.8) years (1986–1990) to 69.85 (9.99) years (2016–2022) (p < 0.001). The proportion of CUD gradually declined from 43.72% (94/215; 1986–1990) to 18.38% (86/468; 2016–2022). Patients who were male [odds ratio (OR): 1.92, 95% confidence interval (CI): 1.43–2.57, p < 0.001), younger (OR: 0.88, 95% CI: 0.87–0.89, p < 0.001) and had no hydronephrosis prior to RC (OR: 2.2, 95% CI: 1.66–2.92, p < 0.001) were more likely to receive CUD. Conclusions: We report the largest European single-center cohort of UD after RC, demonstrating a significant shift from CUD to IUD, accompanied by an increasing age. Finally, our data mirrors the development and extensive experience with the Mainz Pouch-I in the 1980's and 1990's together with other colon pouches. [ABSTRACT FROM AUTHOR]

Aim: To comprehensively analyze trends in myelodysplastic neoplasm (MDS) mortality across Spain (1999–2022), examining sex and regional differences. Methods: We analyzed nationwide death records and population data, calculating age-standardized mortality rates (ASMRs) and standardized mortality ratios (SMRs) stratified by sex and Autonomous Community (AC). Joinpoint regression identified significant shifts in trends. Results: Across Spain, MDS mortality risk varied among men, with rates ranging from 1.08 to 4.38 per 100,000 across regions, while women's rates ranged from 1.23 to 2.02. Five regions had higher risks than the national average, while six had lower risks. Joinpoint analysis revealed three periods nationally: a decline until 2008, and an increase until 2017, followed by a significant decrease. Despite the overall stable national trend (−0.5% annual change), significant regional variations emerged. Andalusia stood out with a worrying increase in MDS mortality, while Aragon and Murcia demonstrated promising declines. Extremadura displayed a unique trajectory with an initial rise followed by stabilization, while Galicia exhibited a contrasting trend with an initial decline and subsequent increase. Notably, men consistently faced a higher risk of MDS mortality compared to women, with significant disparities across regions. Extremadura, in particular, showed a marked difference in risk between genders. Conclusion: MDS mortality trends in Spain are complex, and influenced by gender, region, and time. Further research is needed to understand regional disparities, recent national decline, and higher risk in specific demographics. Tailored interventions based on local factors and targeted research are crucial to address these complexities and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Aim Materials and Methods Results Conclusions To assess the variation in patterns of use of insulin and other antidiabetic medicines across China, both geographically and over time.Nationally, we calculated the relative change in antidiabetic medicine purchases between the first and last quarters of 2020 through 2022 based on the number of defined daily doses procured per quarter. We used annual data to analyse differences in antidiabetic medicine use and patterns across seven regions of China. Considering large regional variations, we used multifactor linear regression to preliminarily explore the possible factors influencing this variation.Nationally, the procurement of antidiabetic medicines and insulin increased from 2020 to 2022, while the proportion of insulin among antidiabetic medicines remained stable at approximately 22%. Among all insulins, premixed insulin (human) was ranked first. Of the three subgroups of insulin, analogues were the most preferred and had the largest procurement, but different categories showed different trends in terms of purchases and proporation. Regionally, the growth rate of antidiabetic medicines, the proportion of insulin procurement and the preferred types of insulin across the seven regions were different. Regarding preliminary influencing factors, the level of education and owning a domestically funded producer had a positive effect on insulin procurement.From 2020 to 2022, the procurement of insulin increased, which may be due to the increased attention for diabetes from the country and residents.However, the proportion of insulin among all antidiabetic medicines was essentially unchanged, while the use of some non‐insulin hypoglycemic drugs increased significantly, especially the SGLT2i and GLP‐1 RA. Given the economic and cultural diversity, Insulin procurement and utilization patterns varied greatly across the regions. Owning domestic enterprises potentially influences the procurement of insulin. Enhancing education to further improve the self‐management of patients with diabetes is essential. [ABSTRACT FROM AUTHOR]

Simple Summary: The incidence and mortality rates of cancer in the Surveillance, Epidemiology, and End Results (SEER) Program for adolescent and young adult (AYA) patients show distinct patterns among early-onset cancers. For some cancers, AYA cancer rates varied by age group, sex, race, ethnicity and geography. Monitoring the rates and time trends of AYA cancer emphasizes the distinct health concern for this age group. (1) Background: The incidence rate of early onset-cancer (<50) has increased since 1995. Among younger people, cancers in AYAs (aged 15–39 y) are often biologically distinct tumors from those treated in the pediatric and older adult population. The current study describes trends in the United States for the most recent years including the first year of the COVID-19 epidemic. We aimed to describe the recent incidence and mortality trends of cancers in AYAs (aged 15–39 y). (2) Methods: We used data from the Surveillance, Epidemiology, and End Results (SEER 22) from 1 January 2016 to 31 December 2021. Age-adjusted incidence and mortality rates were assessed by SEER*Stat 8.4.3 for major cancer types by sex, race/ethnicity, age, and metropolitan/nonmetropolitan status. Time trends of age-adjusted incidence and mortality rates were examined by sex and metropolitan/nonmetropolitan status. (3) Results: Age-adjusted overall cancer incidence and mortality rates were stable during this study period. The age-adjusted incidence rates declined significantly for ependymoma, melanoma, carcinomas of lung, bronchus, and trachea, unspecified malignant neoplasms, and non-Hodgkin's lymphoma. Significant increases were found for gastrointestinal tract cancers and non-Kaposi sarcomas. The age-adjusted mortality rate decreased for acute myeloid leukemia, melanoma, carcinomas of liver and intrahepatic bile ducts, kidney and, in women, leukemia. For some cancers, rates differed by sex, race, ethnicity, and geography. Monitoring the rates and time trends of AYA cancer emphasizes the distinct health concern for this age group. [ABSTRACT FROM AUTHOR]

Background: Substance use is a global health concern and early onset among adolescents increases health risks. We explore national overall trends in prevalence and trends in socioeconomic inequalities in past year alcohol intoxication, cannabis use, and use of other illicit drugs among Norwegian adolescents (ages ∼ 15–19 years of age) between 2014 and 2022. Method: The present study builds on data from a nationwide repeated cross-sectional survey collected in 2014–2016 (T1), 2017–2019 (T2), 2021 (T3) and 2022 (T4). In total 415,560 adolescents (50.3% girls) completed the questionnaire during the study period. Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). Results: While the prevalence of alcohol intoxication remained fairly stable, the prevalence of cannabis and other illicit drug use increased between 2014 and 2022 among upper secondary school boys (13.3–17.6%, and 2.0–5.2%, respectively) and girls (8.8–12.8%, and 1.1–2.7%, respectively). Similar trends were observed among 10th-grade adolescents. Boys were more likely than girls to use cannabis or other illicit drugs, but the gender gap in cannabis use narrowed during the study period. Among upper secondary girls, use of cannabis and other illicit drugs was higher among those from less affluent backgrounds, with absolute and relative inequalities in cannabis use increasing between 2014 and 2022. Small inequalities in cannabis use and decreasing relative inequalities in the use of other illicit drug were observed among upper secondary boys. Conclusions: The increasing use of cannabis and other illicit drugs among Norwegian adolescents is concerning. Future studies should explore the underlying causes of this rise and explore the complex factors influencing adolescent substance use behaviours. A comprehensive understanding of these factors is essential for developing targeted and effective interventions. [ABSTRACT FROM AUTHOR]

We investigated time trends of the obesity-mortality association, accounting for age, sex, and cause-specific deaths. We analysed pooled nationwide data in Sweden for 3,472,310 individuals aged 17–39 years at baseline in 1963–2016. Cox regression and flexible parametric survival models investigated BMI-mortality associations in sub-groups of sex and baseline calendar years (men: <1975, 1975–1985, ≥1985 and women: <1985, 1985–1994, ≥1995). Comparing men with obesity vs. normal weight, all-cause and "other-cause" mortality associations decreased over periods; HR (95% CI) 1.92 (1.83–2.01) and 1.70 (1.58–1.82) for all-cause and 1.72 (1.58–1.87) and 1.40 (1.28–1.53) for "other-cause" mortality in <1975 and ≥1985, but increased for CVD mortality; HR 2.71 (2.51–2.94) and 3.91 (3.37–4.53). Higher age at death before 1975 coincided with more obesity-related deaths at higher ages. Furthermore, the all-cause mortality association for different ages in men showed no clear differences between periods (p-interaction=0.09), suggesting no calendar effect after accounting for attained age. Similar, but less pronounced, results were observed in women. Associations with cancer mortality showed no clear trends in men or in women. Accounting for differences in age and death causes between calendar periods when investigating BMI-mortality time trends may avoid misinterpreting the risks associated with obesity over time. • The study investigated time trends of obesity-mortality associations, accounting for sex, age, and different death causes. • The HR for mortality in obesity changed over time, likely explained by differential ages and main death cause compositions. • Studies should consider age and death cause compositions in BMI-mortality trends to avoid misinterpreting obesity risks. [ABSTRACT FROM AUTHOR]

The human sex ratio at birth (SRB) undergoes temporary changes around a mean proportion of 0.51 male births. SRB has been well studied for historical, geographical, and secular trends, but until now not linked to health outcomes in the total population, e.g. for cardiovascular disease (CVD) or mortality during follow-up of birth cohorts. We used linkage analysis based on national registers in Sweden that cover all births from 1900 to 2016. SRB at birth was calculated by every 10-year birth cohort in all survivors living in 1997 for a follow-up analysis of risk of CVD and mortality with data from national registers. When the highest quartile of SRB was used as reference, a slightly increased risk of fatal CVD (HR 1.03 (95% confidence intervals, CI): 1.02–1.04), non-fatal CVD (HR 1.01; 95%CI: 1.01–1.02) and mortality (HR 1.02; 95%CI, 1.01–1.03) was found after full adjustments in men belonging to the lowest SRB quartile. A similar pattern was also found for fatal CHD in women. in the lowest SBR quartile compared to the highest, HR 1.03 (95%CI: 1.02–1.05). In conclusion, in birth cohorts with a relatively lower than expected number of males born, long-term adverse health effects were observed with slightly increased cardiovascular risk and total mortality at the population level. This could indicate that men belonging to so-called "culled cohorts" in a developed country during the 20th century are characterized by a slightly increased risk that could reflect negative early life influences and environmental exposures in pregnant women resulting in selective loss of male embryos or fetuses. In a public health perspective SRB could be of some importance to monitor as an aspect of birth statistics linked to relatively minor population health effects. [ABSTRACT FROM AUTHOR]

Adaptive platform trials allow treatments to be added or dropped during the study, meaning that the control arm may be active for longer than the experimental arms. This leads to nonconcurrent controls, which provide nonrandomized information that may increase efficiency but may introduce bias from temporal confounding and other factors. Various methods have been proposed to control confounding from nonconcurrent controls, based on adjusting for time period. We demonstrate that time adjustment is insufficient to prevent bias in some circumstances where nonconcurrent controls are present in adaptive platform trials, and we propose a more general analytical framework that accounts for nonconcurrent controls in such circumstances. We begin by defining nonconcurrent controls using the concept of a concurrently randomized cohort, which is a subgroup of participants all subject to the same randomized design. We then use cohort adjustment rather than time adjustment. Due to flexibilities in platform trials, more than one randomized design may be in force at any time, meaning that cohort‐adjusted and time‐adjusted analyses may be quite different. Using simulation studies, we demonstrate that time‐adjusted analyses may be biased while cohort‐adjusted analyses remove this bias. We also demonstrate that the cohort‐adjusted analysis may be interpreted as a synthesis of randomized and indirect comparisons analogous to mixed treatment comparisons in network meta‐analysis. This allows the use of network meta‐analysis methodology to separate the randomized and nonrandomized components and to assess their consistency. Whenever nonconcurrent controls are used in platform trials, the separate randomized and indirect contributions to the treatment effect should be presented. [ABSTRACT FROM AUTHOR]

Abstract Background Substance use is a global health concern and early onset among adolescents increases health risks. We explore national overall trends in prevalence and trends in socioeconomic inequalities in past year alcohol intoxication, cannabis use, and use of other illicit drugs among Norwegian adolescents (ages ∼ 15–19 years of age) between 2014 and 2022. Method The present study builds on data from a nationwide repeated cross-sectional survey collected in 2014–2016 (T1), 2017–2019 (T2), 2021 (T3) and 2022 (T4). In total 415,560 adolescents (50.3% girls) completed the questionnaire during the study period. Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). Results While the prevalence of alcohol intoxication remained fairly stable, the prevalence of cannabis and other illicit drug use increased between 2014 and 2022 among upper secondary school boys (13.3–17.6%, and 2.0–5.2%, respectively) and girls (8.8–12.8%, and 1.1–2.7%, respectively). Similar trends were observed among 10th-grade adolescents. Boys were more likely than girls to use cannabis or other illicit drugs, but the gender gap in cannabis use narrowed during the study period. Among upper secondary girls, use of cannabis and other illicit drugs was higher among those from less affluent backgrounds, with absolute and relative inequalities in cannabis use increasing between 2014 and 2022. Small inequalities in cannabis use and decreasing relative inequalities in the use of other illicit drug were observed among upper secondary boys. Conclusions The increasing use of cannabis and other illicit drugs among Norwegian adolescents is concerning. Future studies should explore the underlying causes of this rise and explore the complex factors influencing adolescent substance use behaviours. A comprehensive understanding of these factors is essential for developing targeted and effective interventions.

Background: Rabies is a fatal disease with no cure but 100% preventable and effective vaccines are available. Time trends in epidemiological factors related to exposure to biting animal, management & adherence to vaccination have poorly studied. Hence, we have undertaken this study to analyze the time trends in epidemiological factors associated with animal bite cases over the period of eight years. Methods: Present study was cross sectional in nature conducted in patients presenting to ARV clinic. Results: Of the various age group classes, majority (47.46%) of the cases were from 15-44 years followed by 19.06% from 6-14 years age group. Majority (61.29%) of the cases were males. maximum (81.43%) cases were from category 2 of WHO classification of animal bite exposure. 89.42% cases type of animal bite exposure was dog. Male gender, age group of 15-44 years, category 3 exposures & cases presenting within 24 hours had shown significantly increasing trend with time (p

Background Silicosis is an occupational respiratory disease linked to silica dust inhalation. The main driver was traditional coal mining, but in recent decades, new sources of exposure have emerged. Our aim in this study was to assess the temporal and spatial distribution of mortality due to this disease over a 22-year period in Spain. Methods Silicosis records, as an Underlying Cause of Death, were extracted from the National Institute of Statistics from 1999 to 2020 using the International Classification of Diseases 10th revision (code J62.8). Age- and sex-adjusted mortality rates per 1,000,000 inhabitants were calculated for the territory and by province. A geographic analysis was performed, and clusters of deaths were identified at the municipal level, and then the outcomes were compared in two periods of 11 years. Results There were 2618 deaths due to silicosis in Spain. The mean age of death increased significantly by 0.66% annually from 1999 to 2013. The age-adjusted mortality rate decreased by 7.30% per year, falling from 3.00 to 0.65 per 1,000,000 inhabitants. The temporal pattern showed a significant decrease of mortality rate in 31% of the provinces (16 out of 52), while it increased in Pontevedra. Regarding the spatial analysis, 11 clusters were found in both periods, but some variations were observed in terms of their distribution in the Spanish territory, as well as in the affected municipalities. Conclusions The decrease in mortality due to Silicosis could be related to less exposure to silica dust over the years and an improvement in the survival of those affected. It is thus essential to analyze the role of preventive measures for this occupational disease.

Abstract Background Most studies infer increasing incidence of proximal humeral fractures (PHF) from the 1950´s until the 1990´s. Recent time trends are less clear. Objectives Our primary objective was to identify time trends in the age- and sex-adjusted adult incidence of PHF in Malmö, Sweden, from year 1944 until 2020. Our secondary objectives were to describe the variation in incidence according to age, the monthly distribution, and to compare data from the two most recent decades with earlier. Study design and methods Malmö has one emergency hospital where acute fractures are treated. We identified PHF in adult patients (≥ 18 years) by reviewing relevant radiology examinations during 17 sample years from year 1944 to 2020. We used jointpoint analyses to estimate time trends. Results We identified 3 031 PHF during the study period (3 231 161 person years), 73% were sustained by women with mean age of 69 years (mean age in men 59). Joinpoint analyses indicated an increase in the age- and sex-adjusted incidence of PHF from year 1944 (52 per 100 000 person years) until 1977 (120 per 100 000) and thereafter a decrease until 2020 (85 per 100 000). A seasonal variation with more fractures during winter months, was apparent in earlier but not recent decades. Conclusions The age- and sex-adjusted incidence of PHF increased in Malmö, Sweden, from the 1940´s until year 1977 and thereafter decreased until 2020. More fractures were seen during winter months in earlier but not recent decades.

Background: Maxillofacial trauma (MFT) caused by falls, interpersonal violence or traffic accidents leading to fractures of different facial regions, including the midface and the mandible, are common clinical conditions requiring open reduction and internal fixation. The aim of this study was to analyze the incidence and time trends in MFT-associated surgeries regarding different facial regions in the German healthcare system over time. Materials and methods: Nationwide data regarding the national diagnosis-related group (DRG) inpatient billing system was received from the German Federal Statistical Office for the years 2005–2022. We estimated the age–gender standardized incidence of MFT-associated procedures classified by the Operation and Procedure Classification System (OPS) and evaluated age- and gender-adjusted time trends using Poisson regression analysis. Results: The total standardized incidence rate of MFT-associated procedures in the observational period 2005–2022 was 25.1 (♀13.3; ♂37.5) per 100,000 person-years within a slight significant annual decrease of 0.5%. A significant increase in the incidence of MFT-related procedures within the observational period was found in older adults from 60 to 79 years (+55.1%; ♀+54.8%; ♂+56.3%) and elderly patients over 80 years (+66.7%; ♀+59.1%; ♂+85.1%). Other significant trends are decreases in MFT-related procedures performed in children from 0–14 years (−28.1%; ♀−30.3%; ♂−27.3%) and young adults between 15 and 35 years (−20.4%; ♀−7.3%; ♂−22.5%). Conclusions: MFT-associated surgery is a persisting challenge in the German healthcare system. There is an ongoing transition in MFT-associated surgeries from younger to older patients beyond the scope of demographic change, highlighting the increasing importance of interdisciplinary treatment of patients with pre-existing conditions in maxillofacial surgery. Implementation of injury prevention measures might be beneficial in this population. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions While research has described the profile of children with poor mental health, little is known about whether this profile and their needs have changed over time. Our aim was to investigate whether levels of difficulties and functional impact faced by children with a psychiatric disorder have changed over time, and whether sociodemographic and family correlates have changed.Samples were three national probability surveys undertaken in England in 1999, 2004 and 2017 including children aged 5–15 years. Psychiatric disorders were assessed using the Development and Well‐Being Assessment (DAWBA), a standardised multi‐informant diagnostic tool based on the tenth International Classification of Diseases (ICD‐10). The impact and difficulties of having a disorder (emotional, behavioural or hyperkinetic) were compared over time using total difficulty and impact scores from the Strengths and Difficulties Questionnaire (SDQ). Analyses explored the impact of having any disorder, as well as for each disorder separately. Regression analyses compared associations between disorders and sociodemographic factors over time.Parent‐ and adolescent‐reported total SDQ difficulty and impact scores increased between 1999 and 2017 for children and adolescents with disorders. No differences were noted when using teacher ratings. No differences in total SDQ difficulty score were found for children without a disorder. Comparison of sociodemographic correlates across the surveys over time revealed that ethnic minority status, living in rented accommodation and being in the lowest income quintile had a weaker association with disorder in 2017 compared to 1999.Our study reveals a concerning trend; children with a disorder in 2017 experienced more severe difficulties and greater impact on functioning at school, home and in their daily lives, compared to children with a disorder in earlier decades. Research is needed to identify and understand factors that may explain the changing nature and level of need among children with a disorder. [ABSTRACT FROM AUTHOR]

Objectives: This study analyzed trends in HIV/AIDS in Poland over the time period of 2009–2021 and the potential impact of COVID-19 and the migration of war refugees from Ukraine. Methods: Long-term trends were assessed by joinpoint regression using data from Polish HIV/AIDS registries. The HIV/AIDS burden was also compared before and during the pandemic and refugee migration. Results: In 2009–2021, the upward tendency in the rate of new HIV infections until 2017 and decrease after 2017 was accompanied by a downward trend in new HIV/AIDS diagnoses and mortality. From the pandemic's beginning until March 2022, rates of new HIV/AIDS diagnoses dramatically decreased to later increase to pre-pandemic levels, which partially coincided with the wave of migration of refugees from Ukraine. Conclusions: Long-term analysis of HIV/AIDS in Poland showed a downward trend in new HIV/AIDS diagnoses and related mortality in 2009–2021. While the pandemic has reduced the number of detected HIV/AIDS cases, a subsequent increase in new HIV diagnoses in 2022 may be related to lifting the COVID-19 restrictions and war refugees' migration. These observations have implications for the WHO European Region, seeking to end AIDS as a public health problem by 2030. [ABSTRACT FROM AUTHOR]

Informal childcare care by grandparents, other relatives or friends is an important source of support in many Western countries, including Germany. Yet the role of this type of care is often overlooked in accounts of social policies supporting families with children, which tend to focus on formal childcare. This article examines whether the large formal childcare expansion occurring in Germany in the last two decades has been accompanied by similar or opposite trends in informal childcare usage. It argues that accounting for both formal and informal childcare can offer a more accurate assessment of defamilisation effects of family policies. Drawing on representative data from the German Socio‐Economic Panel the analysis identifies long‐run developments of childcare arrangements for children aged 1–10 between 1997 and 2020, offering for the first time a comprehensive picture of how families with children of different ages mix informal care and service provision. Results show that on average the expansion of formal childcare was not associated with an equal reduction in informal childcare, lending little support to the crowding‐out hypothesis. Further analyses distinguishing between population groups with different propensity to use formal childcare reveal, unexpectedly, remarkable similarities in the use of informal care throughout the period examined. The only exception are families with a migrant background, who tend to use informal childcare less than their counterparts. The general trend is, however, one whereby informal and formal care are increasingly combined. [ABSTRACT FROM AUTHOR]

Background: With the increase in the aging population worldwide, Alzheimer's disease has become a rapidly increasing public health concern. In the Global Burden of Disease Study 2019, there are three risk factors judged to have evidence for a causal link to Alzheimer's disease and other dementias: smoking, high body-mass index (HBMI), and high fasting plasma glucose (HFPG). Objective: This study aimed to analyze trends in AD mortality and the relevant burden across China from 1990 to 2019, as well as their correlation with age, period, and birth cohort. Methods: The data were extracted from the GBD 2019. Trends in AD mortality attributable to metabolic risks (HFPG and HBMI) and smoking were analyzed using Joinpoint regression. The age-period-cohort (APC) model was used to evaluate cohort and period effects. Results: From 1990 to 2019, the overall age-standardized mortality rate of AD increased, especially in women. There was an increase in AD mortality due to smoking in the net drift, and it was more significant in women (0.46, 95%CI = [0.09, 0.82]) than men (-0.03, 95%CI = [-0.11, 0.05]). For the cause of HFPG, the net drift values for men and women were 0.82% and 0.43%. For HBMI, the values were 3.14% and 2.76%, respectively, reflecting substantial increases in AD mortality. Conclusion: Time trends in AD mortality caused by metabolic risks and smoking in China from 1990 to 2019 have consistently increased. Therefore, it is necessary to prevent excessive weight gain and obesity during the later stages of life, especially for females. [ABSTRACT FROM AUTHOR]

Background: Silicosis is an occupational respiratory disease linked to silica dust inhalation. The main driver was traditional coal mining, but in recent decades, new sources of exposure have emerged. Our aim in this study was to assess the temporal and spatial distribution of mortality due to this disease over a 22-year period in Spain. Methods: Silicosis records, as an Underlying Cause of Death, were extracted from the National Institute of Statistics from 1999 to 2020 using the International Classification of Diseases 10th revision (code J62.8). Age - and sex-adjusted mortality rates per 1,000,000 inhabitants were calculated for the territory and by province. A geographic analysis was performed, and clusters of deaths were identified at the municipal level, and then the outcomes were compared in two periods of 11 years. Results: There were 2618 deaths due to silicosis in Spain. The mean age of death increased significantly by 0.66% annually from 1999 to 2013. The age-adjusted mortality rate decreased by 7.30% per year, falling from 3.00 to 0.65 per 1,000,000 inhabitants. The temporal pattern showed a significant decrease of mortality rate in 31% of the provinces (16 out of 52), while it increased in Pontevedra. Regarding the spatial analysis, 11 clusters were found in both periods, but some variations were observed in terms of their distribution in the Spanish territory, as well as in the affected municipalities. Conclusions: The decrease in mortality due to Silicosis could be related to less exposure to silica dust over the years and an improvement in the survival of those affected. It is thus essential to analyze the role of preventive measures for this occupational disease. [ABSTRACT FROM AUTHOR]

Aim: To assess the use of non‐insulin antidiabetic medicines in China. Materials and Methods: We analysed the national procurement data for 29 non‐insulin antidiabetic medicines from nine subgroups in China from 2015 to 2022. We estimated the number of defined daily doses (DDDs) procured per year in seven regions of China for nine subgroups and adjusted the data by the number of patients with diabetes. For each subgroup, the regional ratio was calculated by comparing the procurement per patient in each region with the procurement nationwide. The regional disparity was the difference between the highest and lowest regional ratios. We compared the medication patterns across regions. Results: Nationally, between 2015 and 2022, the number of DDDs per patient increased from 14.45 to 47.37. The two most commonly used categories were sulphonylurea and biguanides, which increased from 7.04 to 15.39 (119%) and 3.28 to 11.11 (239%) DDDs per patient, respectively. The procurement of new drugs (dipeptidyl peptidase‐4 inhibitors, sodium‐glucose cotransporter type 2 inhibitors and glucagon‐like peptide‐1 receptor agonists) increased quickly and had >5000% relative changes. Particularly for sodium‐glucose cotransporter type 2 inhibitors, it increased from 0.08 to 5.03 DDDs (6662%). The southwest region had the highest relative change (319%), while the southern region had the lowest (118%). Biguanide and thiazolidinediones had the lowest (1.19) and highest level (2.21) of regional disparity in 2022, respectively. Conclusion: The procurement of non‐insulin antidiabetic medicines in China has increased a lot from 2015 to 2022. In terms of DDDs per patient, sulphonylurea ranked first, followed by metformin. The procurement of new drugs increased greatly. A large regional disparity existed in medicine usage and patterns. [ABSTRACT FROM AUTHOR]

Background: Most studies infer increasing incidence of proximal humeral fractures (PHF) from the 1950´s until the 1990´s. Recent time trends are less clear. Objectives: Our primary objective was to identify time trends in the age- and sex-adjusted adult incidence of PHF in Malmö, Sweden, from year 1944 until 2020. Our secondary objectives were to describe the variation in incidence according to age, the monthly distribution, and to compare data from the two most recent decades with earlier. Study design and methods: Malmö has one emergency hospital where acute fractures are treated. We identified PHF in adult patients (≥ 18 years) by reviewing relevant radiology examinations during 17 sample years from year 1944 to 2020. We used jointpoint analyses to estimate time trends. Results: We identified 3 031 PHF during the study period (3 231 161 person years), 73% were sustained by women with mean age of 69 years (mean age in men 59). Joinpoint analyses indicated an increase in the age- and sex-adjusted incidence of PHF from year 1944 (52 per 100 000 person years) until 1977 (120 per 100 000) and thereafter a decrease until 2020 (85 per 100 000). A seasonal variation with more fractures during winter months, was apparent in earlier but not recent decades. Conclusions: The age- and sex-adjusted incidence of PHF increased in Malmö, Sweden, from the 1940´s until year 1977 and thereafter decreased until 2020. More fractures were seen during winter months in earlier but not recent decades. [ABSTRACT FROM AUTHOR]

Daily maximum, TX, and minimum, TN, temperatures recorded at Fabra Observatory, for the period 1914–2020 (from June to September), have permitted to identify the daytime and night time heatwaves, HWs, at the Barcelona Metropolitan Region, BMR, along 107 years. Four heatwaves indices have been computed both for maximum and minimum temperatures: the number of events per season, HWN; their maximum duration, HWD; their frequency of occurrence, HWF; and the amplitude of the hottest day event, HWA. Trends in these indices have been obtained and their statistical significance quantified by means of the Mann-Kendall test. For the whole period (1914–2020), positive significant trends have been detected for the four indices, with a marked positive trend since year 2000 for TX, and since 1985 for TN. Nevertheless, when 31-year moving windows have been analysed, both positive and negative significant trends are obtained, being remarkable the change in trend signs around 1960s. The convenience of using the four HW indices is evaluated applying a Principal Component Analysis, PCA, obtaining two principal components. Additionally, the spatial distributions of the MODIS land surface temperatures, LST, corresponding to some extreme heatwaves, permits the detection of two hotspots in the BMR, one for TX and the other for TN. It is also worth mentioning that correlations between the Western Mediterranean Oscillation index, WeMOi, and HW episodes are detected, being notable that, at the beginning of these episodes, WEMOi values are usually lower. These correlations could improve the HWs forecasting. [ABSTRACT FROM AUTHOR]

This work presents a comprehensive literature review and real-world survey analysis examining the intricate relationship between communal media and psychological concerns within human–computer interaction (HCI). By systematically categorizing research from 1995 to 2023, we observe a significant increase in studies, reflecting the growing recognition of communal media’s impact on psychological well-being. Our review delves into various HCI aspects, including demographic effects, emotional sentiment analysis, online social networking, and communal media use intensity. A real-world survey focusing on TikTok users reveals diverse user perspectives on safety, privacy, and the platform’s impact on creativity and mental health. The data highlights a demographic predominance of young adults aged 16–24, with creativity, leisure, and content discovery being primary engagement motivators. Positive impacts such as creative inspiration and distraction from worries are contrasted with concerns over privacy invasion, harm to underaged users, and addiction. Correlation analysis underscores the complex interplay between user experiences and perceptions. Future research should prioritize enhancing privacy and safety measures, educational campaigns, and in-depth studies on the long-term psychological impacts of TikTok usage. Additionally, exploring platform modifications and conducting longitudinal and cross-platform studies will help create a safer and more engaging social media environment. This work contributes significantly to the expanding HCI body of knowledge, providing a robust foundation for future research to inform policies and interventions promoting positive psychological outcomes in the digital age.

BackgroundAlthough the national-based policy implemented an initiative program to offer diabetes care management in Thailand, there are limited time trends of evidence to gauge whether the quality of diabetes care in primary care practice is improving. As such, we aimed to identify temporal trends in the quality of diabetes care performance among type 2 diabetes mellitus (T2DM) patients in primary care practice.MethodsUsing assembled patient-level data from a suburban community in northern Thailand, this serial retrospective cross-sectional analytical study obtained adult T2DM patients from nine consecutive fiscal years 2013/14 (n = 976) to 2021/22 (n = 1,242). Based on international and national guidelines recommended, nine quality indicators were examined, namely, smoking cessation, hemoglobin A1c monitoring, foot and eye examinations, albuminuria testing, statin prescription, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) prescription for chronic kidney disease (CKD)/albuminuria, and blood pressure and glycemic control. Rates and time trends achieved in each quality indicator performance were estimated. Differences in the rates of patients who met each quality indicator across reimbursement schemes were explored.ResultsFrom 2013/14 to 2021/22, all quality indicators have increased over time (p for trend

BackgroundAnxiety disorders are a significant global mental health concern, contributing to substantial disability-adjusted life years (DALYs) and imposing considerable social and economic burdens. Understanding the epidemiology of anxiety disorders within the BRICS nations (Brazil, Russian Federation, India, China, and South Africa) is essential due to their unique socio-economic landscapes and ongoing transformations.MethodsThis study utilized data from the Global Burden of Disease (GBD) 2021 database to evaluate anxiety disorder incidence trends in BRICS countries from 1992 to 2021. The Age-Period-Cohort (APC) model with an intrinsic estimator (IE) algorithm was employed to disentangle the effects of age, period, and cohort on incidence rates. Data were categorized into 5-year age groups, and 95% uncertainty intervals (UIs) were calculated to account for data variability.ResultsFrom 1992 to 2021, the global number of anxiety disorders cases increased by 73.44%, with age-standardized incidence rates rising by 21.17%. Among BRICS nations, India experienced the largest increase in cases (113.30%), while China had the smallest increase (2.79%). Globally, young (15–49 years) and oldest (80–94 years) age groups showed predominantly positive local drift values, indicating rising incidence rates. Brazil and India mirrored this trend, while China and South Africa mostly exhibited negative local drift values. Russia Federation had mixed trends with younger groups showing negative and older groups positive local drift values. The incidence of anxiety disorders exhibited an “M-shaped” age pattern with peaks at 10–14 and 35–39 years. Period effects were stable globally but varied in BRICS countries, with Brazil showing a decline and India an increase. Cohort effects were stable globally but showed increasing trends in Brazil and India post-1955–1959 cohort.ConclusionThis study highlights a significant increase in anxiety disorders incidence globally and within BRICS nations over the past three decades, with marked variations across countries. The distinct trends observed in age, period, and cohort effects call for age-specific and gender-sensitive mental health policies. Continuous monitoring, research, and tailored public health strategies are essential to address the rising burden of anxiety disorders and improve mental health outcomes in these rapidly evolving regions.

Qilin Han,1,2 Yifan Li,3 Yao Liu,1 Xuehan Zhu,1 Qiqi An,4 Yameng Li,5 Tingting Wang,5 Yuzhen Zhang,1,2 Yingying Li,5 Weiwei Fang,1,2 Ningning Tao,1,&ast; Huaichen Li1,2,&ast; 1Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China; 2Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People’s Republic of China; 3Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital of Shandong First Medical University (Affiliated Hospital of Shandong Academy of Medical Sciences), Jinan, Shandong, 250031, People’s Republic of China; 4Department of Pulmonary and Critical Care Medicine, Xingyi People’s Hospital, Qianxinan, Guizhou, 561499, People’s Republic of China; 5Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250355, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ningning Tao, Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China, Email 826794467@qq.com Huaichen Li, Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwuweiqi Road, Huaiyin District, Jinan, Shandong, 250021, People’s Republic of China, Email lihuaichen@163.comPurpose: To analyze the time trends in the notification rates of registered tuberculosis (TB) and bacteriologically confirmed TB in Shandong Province. And analyze the changes in TB treatment outcomes during 2005– 2021.Patients and Methods: The information of TB patients registered in the Shandong Information Center for Disease Control and Prevention (CDC) was collected during 2005– 2021. We calculated the notification rates of registered TB and bacteriologically confirmed TB. Moreover, we calculated the year-to-year change rate of TB in treatment outcomes before and after COVID-19. The time trends were analyzed using the joinpoint regression method and illustrated as the annual percentage change (APC) of notification rates.Results: A total of 236,898 cases of TB were diagnosed during 2005– 2021, of which 51.11% were bacteriologically confirmed cases. Since 2008, the notification rates of registered TB have declined. The notification rates of bacteriologically confirmed TB had been declining during 2005– 2016, then remained stable after 2016. In subgroup, the notification rates of both registered TB and bacteriologically confirmed TB were higher among men, rural residents, and people aged ≥ 60 years. Compared with clinically confirmed TB, bacteriologically confirmed TB has shown higher rates of poor outcomes since 2008 and higher case fatality rate since 2005. The rate of poor outcomes remained stable during 2008– 2019. However, after the COVID-19 outbreak, the rate of poor outcomes and case fatality rate of TB has risen significantly.Conclusion: After unremitting efforts to fight against TB, the notification rates of registered TB and bacteriologically confirmed TB declined in Shandong Province. The rate of poor outcomes remained stable during 2008– 2019, then rise significantly after the COVID-19 outbreak. In the context of the long-term existence of COVID-19, further efforts should be made in TB diagnosis and treatment among high-risk population, especially with regard to males, rural residents and older adults.Keywords: tuberculosis, joinpoint regression, time trends, COVID-19

Abstract Over the past four decades, rates of emotional problems in adolescents have increased in many countries, and outcomes for those with mental health problems have worsened. In this review we explore existing population-based studies to evaluate possible explanations for these trends. We include population-based studies that examine both trends in adolescent emotional problems, as well as risk or protective factors previously hypothesised to be associated with trends in youth depression and anxiety. The available evidence on risk or protective factors trends related to family life, young people’s health behaviours and lifestyle, school environment, peer relationships, as well as poverty. Studies reviewed suggest that trends in emotional problems are associated with increases in parental emotional problems, youth weight-control behaviours and eating disorders, school-related stress, as well as a rise in family poverty and social inequality in the 21st Century. One of the biggest changes in young people’s lives over the last few decades has been the rise of digital media to access information and interact with others, but implications for trends in mental health remain unclear. Other trends are likely to have mitigated against even steeper increases in youth emotional problems, for example improvements in youth substance use and a possible long-term reduction in child maltreatment. Epidemiological studies of unselected cohorts testing explanations for secular trends in mental health are scarce and an urgent priority for future research. Such studies will need to prioritise collection of comparable data in repeated population cohorts. Improving young people’s mental health is a major societal challenge, but considerably more needs to be done to understand the connections between social change and trends in youth mental health.

Background: We examined recent global secular trends in 5 indicators of child and adolescent physical activity and sedentary behavior (Overall Physical Activity, Organized Sport and Physical Activity, Active Play, Active Transportation, and Sedentary Behavior) and 4 influences on these (Family and Peers, School, Community and Environment, and Government). Methods: Active Healthy Kids Global Alliance letter grades (A+ to F) were assigned numbers from 15 to 2, with 0 assigned for missing/incomplete grades. Trends from Active Healthy Kids Global Alliance Global Matrices 1.0 (2014) to 4.0 (2022) were analyzed using linear mixed-effects models with level of economic development and gender inequity considered as potential moderators. Results: Report card grades were generally relatively stable. Trends generally did not differ significantly by level of economic development (except for Active Transportation and Active Play), but gender inequality did significantly moderate trends for most of the indicators, with higher gender inequality associated with more adverse changes in grades. The number of "incomplete" grades decreased over time, but this did not reach statistical significance. Conclusions: While trends varied within and between countries, physical activity and sedentary behaviors, and the influences on these behaviors globally, were relatively stable over the past decade or so, albeit at undesirable levels. [ABSTRACT FROM AUTHOR]

Introduction: High prices, as a main factor, contributed to the lack of adequate access to essential anticancer medicines, especially for patients in developing countries. The Chinese Government has introduced a series of policies to control the prices of medicines during the last decade, but the effect on anticancer medicine is not yet clear. Methods: To evaluate the time trends and regional variation in the price of essential anticancer medicines in China, we used the procurement data of anticancer medicines from 2015 to 2022. We selected 29 anticancer medicines from the 2018 Chinese National Essential Medicines List. To measure the cost of a medicine, we used defined daily dose cost -the cost per defined daily doses. At national level, we focused on the price changes over time and compared the price between medicine categories. At provincial level, we assessed price variation among provinces over time. Results: For prices at the national level, all 6 targeted medicines exhibited a continuous decrease trend in price. Out of 23 non-targeted medicines, 4 (17.39%) experienced continuous increases in prices, and 9 (39.13%) showed price decreases from 2015 to 2019 and then an upward trend during 2019-2022; Of the remaining non-targeted medicines, 7 (30.43%) had continuous price decreases and 3 (13.04%) had price increases followed by decreases. For prices at the provincial level, provincial price variation became smaller for almost all targeted medicines, except rituximab; for 11 out of 23 non-targeted medicines, provincial price variations became larger. During the study period, the proportion of price-increased medicines in each province was geographically correlated, and no significant relationship between prices and GDP per capita was observed for both targeted and non-targeted anticancer medicines. Conclusion: The prices and regional disparity of most targeted anticancer medicines were decreasing, while for nearly half of the non-targeted anticancer medicines, the prices were increasing and the regional disparity became wider, which may lead to compromised access to these essential anticancer medicines and raise inequity health outcome among regions. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the contribution of obesity to the development of educational inequalities in physical health. Methods: We used data from the German Socio-Economic Panel for the period 2002-2020. Physical health was measured with the modified SF12-questionnaire. Logistic regression analyses were applied to estimate time trends. The Relative Index of Inequality (RII) and the Slope Index of Inequality (SII) were calculated to examine educational inequalities. The role of obesity as a mediator was analyzed using the Karlson-Holm-Breen (KHB) method. Results: Over time, educational inequalities in obesity as well as impaired physical health widened in men and women, particularly among those aged 30-49 years. For individuals with a low level of education at this age, the probability of impaired physical health increased significantly by 7.7%-points in women and 9.4%-points in men. Of this increase, 25.9% for women and 14.8% for men could be attributed to the increase in obesity. Conclusion: Our findings suggest that the steeper rise in obesity among individuals with a low level of education partly explains the observed widening in educational inequalities in physical health. [ABSTRACT FROM AUTHOR]

Platform trials are randomized clinical trials that allow simultaneous comparison of multiple interventions, usually against a common control. Arms to test experimental interventions may enter and leave the platform over time. This implies that the number of experimental intervention arms in the trial may change as the trial progresses. Determining optimal allocation rates to allocate patients to the treatment and control arms in platform trials is challenging because the optimal allocation depends on the number of arms in the platform and the latter typically varies over time. In addition, the optimal allocation depends on the analysis strategy used and the optimality criteria considered. In this article, we derive optimal treatment allocation rates for platform trials with shared controls, assuming that a stratified estimation and a testing procedure based on a regression model are used to adjust for time trends. We consider both, analysis using concurrent controls only as well as analysis methods using concurrent and non-concurrent controls and assume that the total sample size is fixed. The objective function to be minimized is the maximum of the variances of the effect estimators. We show that the optimal solution depends on the entry time of the arms in the trial and, in general, does not correspond to the square root of k allocation rule used in classical multi-arm trials. We illustrate the optimal allocation and evaluate the power and type 1 error rate compared to trials using one-to-one and square root of k allocations by means of a case study. [ABSTRACT FROM AUTHOR]

Low Apgar scores and low umbilical arterial (UA) blood pH are considered indicators of adverse perinatal events. This study investigated trends of these perinatal health indicators in Germany. Perinatal data on 10,696,831 in-hospital live births from 2008 to 2022 were obtained from quality assurance institutes. Joinpoint regression analysis was used to quantify trends of low Apgar score and UA pH. Additional analyses stratified by mode of delivery were performed on term singletons with cephalic presentation. Robustness against unmeasured confounding was analyzed using the E-value sensitivity analysis. The overall rates of 5-min Apgar scores < 7 and UA pH < 7.10 in liveborn infants were 1.17% and 1.98%, respectively. For low Apgar scores, joinpoint analysis revealed an increase from 2008 to 2011 (annual percent change (APC) 5.19; 95% CI 3.66–9.00) followed by a slower increase from 2011 to 2019 (APC 2.56; 95% CI 2.00–3.03) and a stabilization from 2019 onwards (APC − 0.64; 95% CI − 3.60 to 0.62). The rate of UA blood pH < 7.10 increased significantly between 2011 and 2017 (APC 5.90; 95% CI 5.15–7.42). For term singletons in cephalic presentation, the risk amplification of low Apgar scores was highest after instrumental delivery (risk ratio 1.623, 95% CI 1.509–1.745), whereas those born spontaneous had the highest increase in pH < 7.10 (risk ratio 1.648, 95% CI 1.615–1.682). Conclusion: Rates of low 5-min Apgar scores and UA pH in liveborn infants increased from 2008 to 2022 in Germany. What is Known: • Low Apgar scores at 5 min after birth and umbilical arterial blood pH are associated with adverse perinatal outcomes. • Prospective collection of Apgar scores and arterial blood pH data allows for nationwide quality assurance. What is New: • The rates of liveborn infants with 5-min Apgar scores < 7 rose from 0.97 to 1.30% and that of umbilical arterial blood pH < 7.10 from 1.55 to 2.30% between 2008–2010 and 2020–2022. • In spontaneously born term singletons in cephalic presentation, the rate of metabolic acidosis with pH < 7.10 and BE < −5 mmol/L in umbilical arterial blood roughly doubled between the periods 2008–2010 and 2020–2022. [ABSTRACT FROM AUTHOR]

Objectives: Severe maxillofacial space infection (MSI) as an end stage of dentoalveolar diseases or complication of sialadenitis is a potentially life-threatening disease accompanied by complications including airway obstruction, jugular vein thrombosis, descending mediastinitis, sepsis and acute respiratory distress syndrome. The aim of this study was to analyze the incidence and time trends of severe MSI and potentially influencing factors in the German healthcare system over time. Materials and methods: Nationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system was received from the German Federal Statistical Office. A retrospective analysis of incidence and time trends of MSI-associated procedures classified with the Operation and Procedure Classification System (OPS), were statistically evaluated using Poisson regression analysis between 2005 and 2022 and were associated with different epidemiological factors. Results: The total standardized incidence rate of MSI-associated procedures in the observational period 2005—2022 was 9.8 (♀8.2; ♂11.4) per 100,000 person years. For all age groups a significant increase of 46.1% in severe MSI – related surgical interventions was registered within the observational period. The largest increase (120.5%) was found in elderly patients over 80 years. There were significant differences of the incidences of MSI-associated surgeries between the different federal states in Germany. Conclusions: Severe MSI are a growing challenge in German health care especially among elderly patients over 80 years. Clinical relevance: Severe MSI is a promising target for prevention. There should be more focus in primary dental and medical care especially in groups depending on social support. [ABSTRACT FROM AUTHOR]

The cancer burden in China is increasing. We aimed to assess the time trends in the prevalence of 16 modifiable risk factors involved in lifestyle, diet, infection, and air pollution between 1997 and 2025 based on the China Health and Nutrition Survey, the Global Burden of Disease website, and publically available studies. The population attributable fraction (PAF) and its 95% uncertainty interval (UI) from 2007 to 2035 were calculated to quantify the attributable cancer burden in major 12 anatomic sites using the comparative risk assessment method, considering a 10‐year lag effect. As a result, 1,559,476 cancer cases (PAF = 54.1%, 95% UI: 36.8%–65.8%) from the 12 anatomic sites were attributable to these modifiable risk factors in 2007, with lung, liver, and gastric cancer raging the top three. It was predicted that by 2035, the attributable cancer cases would reach 1,680,098 (PAF = 44.2%, 95% UI: 29.1%–55.5%), with the top three of lung, liver, and colorectal cancer. Smoking, physical inactivity, insufficient fruit consumption, HBV infection, and Helicobacter pylori infection were the most attributable risk factors in 2007, contributing to 480,352, 233,684, 215,009, 214,455, and 187,305 associated cancer cases, respectively. In 2035, the leading factors for cancer would be smoking, physical inactivity, insufficient fruit intake, HPV infection, and HBV infection, resulting in 427,445, 424,327, 185,144, 156,535, and 154,368 cancer cases, respectively. Intervention strategies should be swiftly established and dynamically altered in response to risk factors like smoking, physical inactivity, poor fruit intake, and infectious factors that may cause a high cancer burden in the Chinese population. [ABSTRACT FROM AUTHOR]

Background: In the present study, we describe prevalence trends of asthma and investigate the association with asthma symptoms, use of asthma medication, and asthma severity among 8‐year‐old children in Norrbotten, Sweden in 1996, 2006, and 2017. Methods: Within the Obstructive Lung Disease in Northern Sweden (OLIN) studies, three pediatric cohorts were recruited in 1996, 2006, and 2017 respectively. Identical methods were used; all children in first and second grade (median age 8 years) in three municipalities were invited to a parental questionnaire survey, completed by n = 3430 in 1996 (97% participation), n = 2585 in 2006 (96%), and n = 2785 in 2017 (91%). The questionnaire included questions about respiratory symptoms and diagnosis, treatment, and severity of asthma. Results: The prevalence of wheezing was stable during the study, 10.1% in 1996; 10.8% in 2006; and 10.3% in 2017, p =.621, while physician‐diagnosed asthma increased: 5.7%, 7.4%, and 12.2%, p <.001. The use of asthma medication in the last 12 months increased: 7.1%, 8.7%, and 11.5%, p <.001. Among children diagnosed with asthma, the prevalence of asthma symptoms, the impact on daily life, and severe asthma decreased, while the use of inhaled corticosteroids increased from 1996 until 2017. Conclusion: The prevalence of wheezing was stable among 8‐year‐old in this area from 1996 to 2017, while the prevalence of physician‐diagnosed asthma doubled but without an increase in asthma morbidity. The increase of physician‐diagnosed asthma without a coincident increase in asthma morbidity can partly be explained by more and earlier diagnosis among those with mild asthma. [ABSTRACT FROM AUTHOR]

Purpose: To examine within-individual time trends in mental well-being and factors influencing heterogeneity of these trends. Methods: Longitudinal telephone survey of adults over 3 waves from the New York City (NYC) Metropolitan area during the COVID-19 Pandemic. Participants reported depression using the Patient Health Questionnaire (PHQ)-8, anxiety using the Generalized Anxiety Disorder (GAD)-7, and past 30-day increases in tobacco or alcohol use at each wave. Adjusted mixed effects logistic regression models assessed time trends in mental well-being. Results: There were 1227 respondents. Over 3 study waves, there were statistically significant decreasing time trends in the odds of each outcome (adjusted OR (95% CI) 0.47 (0.37, 0.60); p < 0.001 for depression; aOR (95% CI) 0.55 (0.45, 0.66); p < 0.001 for anxiety; aOR (95% CI) 0.50 (0.35, 0.71); p < 0.001 for past 30-day increased tobacco use; aOR (95% CI) 0.31 (0.24, 0.40); p < 0.001 for past 30-day increased alcohol use). Time trends for anxiety varied by race and ethnicity (p value for interaction = 0.05, 4 df); anxiety declined over time among white, Black, Hispanic, and Other race and ethnicity but not among Asian participants. Conclusions: In a demographically varied population from the NYC Metropolitan area, depression, anxiety and increased substance use were common during the first months of the pandemic, but decreased over the following year. While this was consistently the case across most demographic groups, the odds of anxiety among Asian participants did not decrease over time. [ABSTRACT FROM AUTHOR]

Over the past four decades, rates of emotional problems in adolescents have increased in many countries, and outcomes for those with mental health problems have worsened. In this review we explore existing population-based studies to evaluate possible explanations for these trends. We include population-based studies that examine both trends in adolescent emotional problems, as well as risk or protective factors previously hypothesised to be associated with trends in youth depression and anxiety. The available evidence on risk or protective factors trends related to family life, young people's health behaviours and lifestyle, school environment, peer relationships, as well as poverty. Studies reviewed suggest that trends in emotional problems are associated with increases in parental emotional problems, youth weight-control behaviours and eating disorders, school-related stress, as well as a rise in family poverty and social inequality in the 21st Century. One of the biggest changes in young people's lives over the last few decades has been the rise of digital media to access information and interact with others, but implications for trends in mental health remain unclear. Other trends are likely to have mitigated against even steeper increases in youth emotional problems, for example improvements in youth substance use and a possible long-term reduction in child maltreatment. Epidemiological studies of unselected cohorts testing explanations for secular trends in mental health are scarce and an urgent priority for future research. Such studies will need to prioritise collection of comparable data in repeated population cohorts. Improving young people's mental health is a major societal challenge, but considerably more needs to be done to understand the connections between social change and trends in youth mental health. [ABSTRACT FROM AUTHOR]

Background: Human herpesviruses are widespread among the human population. The infections often occur unnoticed, but severe disease as well as long-term sequelae are part of the symptom spectrum. The prevalence varies among subpopulations and with time. The aim of this study was to describe the seroprevalence of Immunoglobulin G against Herpes simplex 1, Herpes simplex 2, Epstein-Barr virus and Cytomegalovirus in the adult Swedish population over a time period of several decades. Methods: Serum samples (n = 892) from biobanks, originating from 30-year-old women, 50-year-old men and 50-year-old women sampled between 1975 and 2018, were analyzed for presence of anti-herpesvirus antibodies. Linear regression analysis was used to test for a correlation between birth year and seroprevalence. Multiple linear regression analysis was used to differentiate between other factors such as age and gender. Results: Birth year correlated negatively with the prevalence of immunoglobulin G against Herpes simplex 1 and Epstein-Barr virus (p = 0.004 and 0.033), and positively with Immunoglobulin G against Cytomegalovirus (p = 0.039). When participant categories were analyzed separately, birth year correlated negatively with the prevalence of Immunoglobulin G against Herpes simplex 1 and Herpes simplex 2 (p = 0.032 and 0.028) in 30-year-old women, and with the prevalence of Immunoglobulin G against Cytomegalovirus in 50-year-old men (p = 0.011). Conclusions: The prevalence of Immunoglobulin G against Herpes simplex 1, Herpes simplex 2 and Epstein-Barr virus decreases in later birth cohorts. This indicates a trend of declining risk of getting infected with these viruses as a child and adolescent. [ABSTRACT FROM AUTHOR]

Introduction: Youth drinking has been declining in Sweden since the year 2000. There is a paucity of studies examining trends in alcohol‐related harm during this period. The overall aim of the present study is to examine how trends in alcohol‐related harm match trends in drinking among Swedish youths during 2000–2021. Methods: Measures of alcohol use were obtained from national school surveys. Prevalence rates of any alcohol use and heavy episodic drinking were used. Alcohol‐related harm indicators were obtained from registry information from the National Board of Health and Welfare. Annual trends in harm indicators were tested with linear regression models and correlations between alcohol use and alcohol‐related harm indicators were assessed using Pearson's correlation on annual data. Results: Statistically significant negative trends were observed for all alcohol‐related harm indicators for the period 2000–2021. Significant correlations were found for both measures of alcohol use and all alcohol‐related harm indicators. Discussion and Conclusions: The levels of alcohol‐related harm have declined among youths in Sweden during the period 2000–2021. The trends in harm seem to reflect the decline in youth drinking that has occurred during the same period. [ABSTRACT FROM AUTHOR]

Introduction: In the 21st century, there has been a decline in alcohol use among adolescents in most Nordic countries, while trends of cannabis use have diverged. We explore how alcohol and cannabis use, respectively, and co‐use of the two substances, have changed among Nordic adolescents. Three hypotheses are used to frame the study: (i) cannabis use has substituted alcohol use; (ii) there has been a parallel decline in both substances; and/or (iii) there has been a 'hardening' of users, implying that alcohol users increasingly use cannabis. Methods: Data from the European School Survey Project on Alcohol and Other Drugs, conducted among 15‐ to 16‐year‐olds in Denmark, Finland, Iceland, Norway and Sweden (N = 74,700, 49% boys), were used to explore trends of past‐year alcohol and cannabis use in the period 2003–2019. Results: The proportion of adolescents reporting alcohol use decreased significantly in all Nordic countries except Denmark. The proportion of those using cannabis only was low (0.0%–0.7%) and stable in all countries. The total number of substance use occasions declined among all adolescents in all countries but Denmark. Among alcohol users, cannabis use became increasingly prevalent in all countries but Denmark. Discussion and Conclusions: We found no support for the 'parallel decline hypothesis' in alcohol and cannabis use among Nordic adolescents. Partially in line with the 'substitution hypothesis', cannabis use accounted for an increasing proportion of all substance use occasions. Our results suggests that the co‐use of alcohol and cannabis has become more common, thus also providing support to the 'hardening' hypothesis. [ABSTRACT FROM AUTHOR]

BackgroundSocioeconomic disparities in life expectancy are well-documented in various contexts, including Chile. However, there is a lack of research examining trends in life expectancy inequalities and lifespan variation over time. Addressing these gaps can provide crucial insights into the dynamics of health inequalities.MethodsThis study utilizes data from census records, population surveys, and death certificates to compare the life expectancy and the lifespan variation at age 26 of individuals according to their rank in the distribution of years of education within their own birth cohort. The analysis spans three periods (1991, 2002, and 2017) and focuses on two educational groups: individuals in the first (lowest) quintile and tenth (highest) decile of educational attainment. Changes in life expectancy are disaggregated by major causes of death to elucidate their contributions to overall trends.ResultsConsistent with existing literature, our findings confirm that individuals with lower education levels experience lower life expectancy and higher lifespan variation compared to their more educated counterparts. Notably, by 2017, life expectancy for individuals in the lowest quintile of education has caught up with that of the top decile in 1991, albeit with contrasting trends between genders. Among women, the gap has reduced, while it has increased for males. Moreover, lifespan variation decreased (increased) over time for individuals in the tenth decile (first quintile). The leading causes of death that explain the increase in life expectancy in women and men in the tenth decile as well as women in the first quintile are cardiovascular, cancer, respiratory and digestive diseases. In the case of males in the first quintile, few gains have been made in life expectancy resulting from cancer and a negative contribution is associated with digestive conditions.ConclusionsThis study underscores persistent socioeconomic disparities in life expectancy in Chile, emphasizing the importance of ongoing monitoring of health inequalities across different demographic segments. The gender-specific and educational gradient trends highlight areas for targeted interventions aimed at reducing health disparities and improving overall population health outcomes. Further research is warranted to delve into specific causes of death driving life expectancy differentials and to inform evidence-based policy interventions.

Background: The International Study of Asthma and Allergies in Childhood (ISAAC) and the Global Asthma Network (GAN) conducted a series of global asthma prevalence surveys, between 1990 and 2020, in adolescents aged 13–14 and children aged 6–7 years. We used them to assess whether potential asthma risk factors explain global asthma symptom prevalence trends over this period. Method: We fitted mixed-effects linear regression models to estimate associations between centre-level risk factor prevalence and both the mid-point asthma symptom prevalence and the change per decade. We also estimated the 2019 asthma symptom prevalence across all included centres. Results: For adolescents, across 50 centres in 26 countries there was weak evidence that decreasing asthma prevalence over time was associated with regular fast-food consumption and frequent television viewing. However, frequent television viewing, along with heavy truck traffic, were associated with higher prevalence of asthma symptoms at the study mid-point. For children, across 41 centres in 21 countries, no risk factors were associated with time trends in asthma symptom prevalence, but truck traffic and paracetamol in the first year of life were associated with higher mid-point prevalence.We estimated the 2019 asthma symptom prevalence, across a total of 124 centres, to be 12.8% (11.4%, 14.2%) with little evidence of a difference by age. Low-income countries had lower prevalence (children 5.2% [2.5%, 7.8%], adolescents 5.3% [2.8%, 7.8%]), than lower-middle-, upper-middle- and high-income countries (all approximately 14–15%). Including risk factors in the models did not change the estimates. Conclusion: Potential asthma risk factors do not seem to explain the global prevalence patterns or time trends. Country income accounts for some of the differences, but the unexplained variation is very high.

Abstract Background A national colorectal cancer (CRC) screening programme was launched in 2002 in Germany. A comprehensive evaluation of the programme effectiveness using real-world data is still lacking. In addition, there are regional reports on increasing colorectal cancer incidence in younger populations. Therefore, we aimed to describe and compare the overall, age- and stage-specific incidence trends for colorectal, colon and rectal cancer. Methods We used data from seven population-based cancer registries in Germany. We report absolute and relative changes in incidence rates between the early screening phase (2003–2005) and the most recent time period available (2015–2017), as well as annual percent changes. We analysed incidences according to tumour site (colorectum, colon, and rectum) and to six age groups (young adults: 15–34, 35–39, 40–49, screening-entitled/older adults: 50–54, 55–69 and 70 + years old). Results In our sample of 271,011 colorectal adenocarcinomas, about two-thirds were located in the colon and 95% of them occurred in the age group 50+ (50–54: 5%, 55–69: 32.8%, 70+: 57.2%). For the time period 2003–2005 the age-specific incidence rates of individuals in the age group 55–69 were about 76/100,00 for colon and 54/100,000 for rectal cancer (age group 70 + colon: 179/100,000; rectum: 84/100,000). The incidence rates in young adults were less than 13% of that of individuals in the age group 55–69 (

To describe the participation of racial and ethnic minority groups (REMGs) in gynecologic oncology trials. Gynecologic oncology studies registered on ClinicalTrials.gov between 2007 and 2020 were identified. Trials with published results were analyzed based on reporting of race/ethnicity in relation to disease site and trial characteristics. Expected enrollment by race/ethnicity was calculated and compared to actual enrollment, adjusted for 2010 US Census population data. 2146 gynecologic oncology trials were identified. Of published trials (n = 252), 99 (39.3%) reported race/ethnicity data. Recent trials were more likely to report these data (36% from 2007 to 2009; 51% 2013–2015; and 53% from 2016 to 2018, p = 0.01). Of all trials, ovarian cancer trials were least likely to report race/ethnicity data (32.1% vs 39.3%, p = 0.011). Population-adjusted under-enrollment for Blacks was 7-fold in ovarian cancer, Latinx 10-fold for ovarian and 6-fold in uterine cancer trials, Asians 2.5-fold in uterine cancer trials, and American Indian and Alaska Native individuals 6-fold in ovarian trials. Trials for most disease sites have enrolled more REMGs in recent years – REMGs made up 19.6% of trial participants in 2007–2009 compared to 38.1% in 2016–2018 (p < 0.0001). Less than half of trials that published results reported race/ethnicity data. Available data reveals that enrollment of REMGs is significantly below expected rates based on national census data. These disparities persisted even after additionally adjusting for population size. Despite improvement in recent years, additional recruitment of REMGs is needed to achieve more representative and equitable participation in gynecologic cancer clinical trials. • REMGs are understudied and under-enrolled in gynecologic oncology clinical trials. • Ovarian cancer trials enroll fewer REMGs compared to other cancer trials. • The recruitment of REMGs is modestly increasing in recent years. • Further efforts to increase REMG enrollment to achieve health equity are needed. [ABSTRACT FROM AUTHOR]

Perceived loneliness in adolescence is associated with a plethora of adverse outcomes. However, data on its temporal trends are scarce. Therefore, we aimed to examine the temporal trend of perceived loneliness among school-going adolescents aged 12–15 years from 28 countries in Africa, Asia, and the Americas, where temporal trends of loneliness are largely unknown. Cross-sectional data from the Global School-based Student Health Survey 2003–2017 were analyzed. Perceived loneliness referred to feeling lonely most of the time or always in the past 12 months. Crude linear trends of perceived loneliness by country were assessed by linear regression models. Data on 180,087 adolescents aged 12–15 years were analyzed [Mean (SD) age 13.7 (1.0) years; 51.4 % females]. The overall prevalence of perceived loneliness was 10.7 %. Among the 28 countries included in the study, significant increasing and decreasing trends were observed in six counties each, with stable trends found in 16 countries. The most drastic increase and decrease were observed in Egypt between 2006 (7.9 %) and 2011 (14.3 %), and in Samoa between 2011 (23.3 %) and 2017 (8.0 %), respectively. Stable trends with high prevalence across time were also common. Our data suggest that perceived loneliness among adolescents is a global phenomenon, which has seen little improvement if any in recent years. It would be prudent to implement nationwide policies to combat loneliness globally. • 180,087 adolescents aged 12–15 years (51.4 % females), from 28 countries. • The overall prevalence of loneliness was 10.7 %. • Significant increasing and decreasing trends were observed in six counties each. • Stable trends found in 16 countries. • Our data suggest that loneliness among adolescents is a global phenomenon [ABSTRACT FROM AUTHOR]

Introduction: Preeclampsia and gestational diabetes mellitus share risk factors such as obesity and increased maternal age, which have become more prevalent in recent decades. We examined changes in the prevalence of preeclampsia and gestational diabetes between 2005 and 2018 in Denmark and Alberta, Canada, and investigated whether the observed trends can be explained by changes in maternal age, parity, multiple pregnancy, comorbidity, and body mass index (BMI) over time. Material and methods: This study was a register‐based cohort study conducted using data from the Danish National Health Registers and the provincial health registers of Alberta, Canada. We included in the study cohort all pregnancies in 2005–2018 resulting in live‐born infants and used binomial regression to estimate mean annual increases in the prevalence of preeclampsia and gestational diabetes in the two populations across the study period, adjusted for maternal characteristics. Results: The study cohorts included 846 127 (Denmark) and 706 728 (Alberta) pregnancies. The prevalence of preeclampsia increased over the study period in Denmark (2.5% to 2.9%) and Alberta (1.7% to 2.5%), with mean annual increases of 0.03 (95% confidence interval [CI] 0.02–0.04) and 0.06 (95% CI 0.05–0.07) percentage points, respectively. The prevalence of gestational diabetes also increased in Denmark (1.9% to 4.6%) and Alberta (3.9% to 9.2%), with average annual increases of 0.20 (95% CI 0.19–0.21) and 0.44 (95% CI 0.42–0.45) percentage points. Changes in the distributions of maternal age and BMI contributed to increases in the prevalence of both conditions but could not explain them entirely. Conclusions: The prevalence of both preeclampsia and gestational diabetes increased significantly from 2005 to 2018, which portends future increases in chronic disease rates among affected women. Increasing demand for long‐term follow up and care will amplify the existing pressure on healthcare systems. [ABSTRACT FROM AUTHOR]

Accurate estimation of annual changes in autism spectrum disorders (ASD) prevalence is critical for planning the expansion of diagnostic, education, and intervention services at an adequate rate. Previous studies from Israel have reported that ASD prevalence among 8‐year‐old children has increased from estimates of 0.3% in 2008 to 0.65% in 2015 and 1.3% in 2018. Here, we analyzed data acquired from the National Insurance Institute of Israeli (NII), a governmental organization that approves and monitors all ASD children who receive welfare services in Israel, and Clalit Health Services (CHS), the largest Health Maintenance Organization in Israel that provides health services to ~52% of the population. Data from both sources included annual data files from 2017 to 2021 containing the number of ASD cases per year of birth for 1–17‐year‐old children. This allowed us to estimate annual ASD prevalence among 3.5 million children born between 2000 and 2020 in Israel. Both data sources revealed a nearly two‐fold increase in ASD prevalence among 1–17‐year‐old children from 2017 to 2021. Estimated prevalence rates differed across age groups with 2–3‐year‐old (day‐care) children increasing from 0.27% to 1.19% (>4 fold change), 4–6‐year‐old (pre‐school) children increasing from 0.8% to 1.83%, and 8‐year‐old children increasing from 0.82% to 1.56% in NII data. These results demonstrate that autism prevalence continues to increase in Israel with a shift towards diagnosis at earlier ages. These findings highlight the challenge facing health and education service providers in meeting the needs of a rapidly growing autism population. Lay Summary: What is the prevalence of autism in children of specific ages and how has it changed from 2017 to 2021 in Israel? This national study of ~3.5 million children, 1–17‐years‐old, revealed that overall autism prevalence has doubled while prevalence in 2–3‐year‐old children has increased by a factor of 4.4. These results demonstrate that autism prevalence is increasing rapidly in Israel, particularly at young ages. These findings highlight the need for expanding the availability of services and interventions that will match prevalence changes with a specific focus on early development, where the intervention may have larger impact. [ABSTRACT FROM AUTHOR]

Objective To use disability - adjusted life years (DALYs) to assess unequal differences in the burden of disease due to diabetes across global socioeconomic groups. Methods Number of DALYs due to diabetes, age 一 standardized DALYs rates from the GBD database, 1990 -2019, and national Human Development Index(HDI) data from the Human Development Report 2021 - 2022 were collected. The relationship between age 一 standardized DALY rates and HDI was analyzed to understand socioeconomic differences in diabetes disease burden. Calculation of Annual Percentage Change(APC) and Average Annual Percentage Change(AAPC) to assess temporal trends in the burden of diabetes disease during recent decades. Results From 1990 一 2019, the number of DALYs due to diabetes globally increased from 28. 3 million to 69. 9 million, an increase of 146. 85%, with the fastest growth (206. 49%) in Lower middle 一 income countries. The age - standardized DALYs rates were negatively correlated with HDI(r = -0. 480, P <0. 001). Countries with medium HDI exhibit higher DALYs rates due to diabetes mellitus. From 1990 一 2019, the average annual increase in the rate of age 一 standardized DALYs was 0. 78% (AAPC =0. 78%, 95% CI = 0. 74% to 0. 81%), and the average annual increase in the age 一 standardized mortality rate was 0. 46% (AAPC = 0.46%, 95% CI = 0. 41% ~ 0. 51%). Conclusion The global burden of diabetes disease has increased substantially over the last few decades, with the fastest growth in Lower middle - income countries. The age 一 standardized burden was higher in developing countries. Although a slower increase in the burden of diabetes was observed, the persistence of the increase in the burden of disease suggests that more diabetes prevention programs and health - care services should be made available to developing countries. [ABSTRACT FROM AUTHOR]

To investigate the practice patterns and quality of care for uterine cancer on a national level in Belgium, including trends in practice over the period 2012–2016. Quality indicators were measured using the EFFectiveness of Endometrial Cancer Treatment (EFFECT) database. Multivariable logistic mixed regression was used to test for associations between the quality indicators and year of diagnosis, adjusted for potential confounders and intra-cluster correlations. The EFFECT database includes 4178 patients diagnosed with uterine cancer in the period 2012–2016. Minimally invasive surgery (laparoscopic or robotic-assisted) was applied in 61.6% of patients who had surgery for clinical stage I endometrial carcinoma (EC), increasing from 52.9% in 2012 to 66.4% in 2016. At least pelvic lymph node staging was performed in 69.0% of patients with clinical stage I, high-grade EC; and in 63.9% of patients with clinical stage I-II serous carcinoma, clear cell carcinoma or carcinosarcoma. The latter increased from 48.8% in 2012 to 77.2% in 2016. Adjuvant radiotherapy (external beam and/or brachytherapy) was offered to 33.5% of patients who had surgery without lymph node staging for pathological stage I EC at high-intermediate or high risk of recurrence. Adjuvant chemotherapy was administered to 64.4% of patients with pathological stage III-IVA EC. Study results indicate an overall good quality of care for patients with uterine cancer in Belgium. Treatment areas with potential room for improvement include the use of minimally invasive surgery, comprehensive surgical staging and adjuvant therapy, which confirms the remaining controversies in uterine cancer treatment and the need for further research. • This study is the first to extensively map the patterns and quality of care of uterine cancer on a national level in Belgium. • Study results indicate an overall good quality of care for patients with uterine cancer in Belgium. • Potential areas for improvement include minimally invasive surgery, comprehensive surgical staging and adjuvant therapy. • The present study may inform initiatives to improve the quality of uterine cancer treatment in Belgium and other countries. • Results also confirm the remaining controversies in uterine cancer treatment, highlighting the need for further research. [ABSTRACT FROM AUTHOR]