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

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

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

Background Previous epidemiological studies have indicated the seasonal variability of serum lipid levels. However, little research has explicitly examined the separate secular and seasonal trends of dyslipidemia. The present study aimed to identify secular and seasonal trends for the prevalence of dyslipidemia and the 4 clinical classifications among the urban Chinese population by time series decomposition. Methods A total of 306,335 participants with metabolic-related indicators from January 2011 to December 2017 were recruited based on routine health check-up systems. Multivariate direct standardization was used to eliminate uneven distributions of the age, sex, and BMI of participants over time. Seasonal and trend decomposition using LOESS (STL decomposition) was performed to break dyslipidemia prevalence down into trend component, seasonal component and remainder component. Results A total of 21.52 % of participants were diagnosed with dyslipidemia, and significant differences in dyslipidemia and the 4 clinical classifications were observed by sex (P 23.9). Conclusions There were significant secular and seasonal features for dyslipidemia prevalence among the urban Chinese population. Different seasonal trends were found in the 4 clinical classifications of dyslipidemia. Precautionary measures should be implemented to control elevated dyslipidemia prevalence in specific seasons, especially in the winter and during traditional holidays.

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

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

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

Introduction: Life expectancy is widely used as an indicator of socio-economic development of territories and public health in general. Aim: To study secular trends and peculiarities of life expectancy in the Irkutsk region and in the Siberian Federal District from 1990 to 2018. Methods: Data on life expectancy for all regions included in the Siberian Federal District (Siberian FD) were obtained from Rosstat and from the Center for Demographic Research of the Russian School of Economics. Linear regression was applied to study trends in life expectancy. Results: There was a consistent improvement in the demographic situation in Russia 2006 to 2018 caused by decreasing mortality and increasing life expectancy. On the national level, life expectancy increased from 66.7 to 72.9 years. The corresponding data for Siberian FD were 64.6 and 70.7 years while in the Irkutsk region the increase was from 62.9 to 69.3 years. Similar patterns were observed in all FDs, but the improvements in the demographic indicators were less pronounced in the Eastern regions of the country. Life expectancy in the Irkutsk region and the Siberian FD remained lower compared to other FDs except for the Far Eastern District over the study period. Significant linear increase in life expectancy was observed in regions with coefficient of determination ranging from 0.960-0.989, p < 0.001 for all tests. In 2018, the annual increase in life expectancy dropped from 0.3-0.9 to 0.1-0.2 years. Conclusions: Our findings suggest less favorable state of public health in the Siberian FD and in the Irkutsk region compared to the other FDs and the national average. These findings are in line with the conclusions from earlier studies performed by the authors about lower quality of the life of the population in Siberia than in Russia in general.

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

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

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

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

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

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

Objectives: This study analyzed secular trends in sex ratio at birth in Korea by birth order using birth records from Statistics Korea between 1981 and 2017. Methods: A total of 21,685,402 birth records were used and the sex ratio was measured as the number of males per 100 females. Sex order was categorized into the first, second, and third and higher. Births of unclassified sex order (n=47,445) were excluded from the analysis. We conducted logistic regression analyses to test if there are significant changes in sex ratio at birth for all other periods, using the period 1981-1984 as the reference group, and to test if there are significant changes for the higher order births, using the first order births as the reference group. Odds ratio and 95% confidence interval were calculated for each period. Results: Since having peaked at 116.5 in 1990, the ratio for total births gradually declined to reach the lowest point of 105.0 in 2016. The sex ratio increased with rising birth order. A baby born for the second and the third and higher birth order was 1.07 (95% confidence interval, 95% CI: 1.06-1.08) and 1.86 (95% CI: 1.85-1.88), respectively, times more likely to be male than a first-born baby for period 1990-1994. Conclusions: Having peaked at 209.7 in 1993, the sex ratio for the third and higher order births reverted to the naturally occurring level of 105.5 in 2015. Despite the return, the abnormally high sex ratio for the third and higher order births persisted until the early 2010s.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

To estimate secular changes in the body fatness, assessed using the Slaughter equation, in the context of changes in BMI in different developmental periods among Polish schoolchildren studied over nearly 50 years. Data were collected during Polish Anthropological Surveys (1966, 1978, 1988, 2012). The total random sample consisted of 69,746 schoolchildren, aged 7–18. Three periods of development were identified: childhood, early adolescence, and late adolescence. Raw data of BMI were standardized for age classes. Based on the body fat percentage, calculated using Slaughter equation (involving triceps and subscapular skinfold thickness), fat mass (FM; kg), and then fat mass index (FMI = FM/height6; kg/m6) was assessed to enable comparison between body fatness and BMI. Statistical analyses included two-way ANOVA and post-hoc Tukey’s tests. In boys, in terms of changes per decade, between 1966 and 2012 acceleration in Z-BMI and deceleration in FMI were found, irrespective of developmental period. Regarding girls, deceleration of trend was found in terms of both features, with different intensity, depending on developmental period and year of study. The pattern of changes in FMI depending on developmental period was, to some extent, similar for both sexes. Slaughter equation for abovementioned two skinfolds, as a method of body fatness assessment, might be a useful tool for research on boys across different developmental periods, but not on girls. Moreover, it should be used with caution when applied to secular changes in adiposity in both sexes, since the distribution of fat tissue varies across ontogenesis, but also over generations.

Background and aims: Cutaneous leishmaniasis (CL) is one of the most important parasitic diseases in the world. Sabzevar city is endemic area for CL in the north east of Iran. The aim of this study was to evaluate the time distribution of cutaneous leishmaniasis (CL) in Sabzevar County using the segmented regression model. Methods: This ecological study used the existing data related to the rural districts of Sabzevar County that were obtained from the Health Deputy of this county during 2011-2017. In addition, the segmented regression model was applied to evaluate the time trend of CLs. Finally, Joinpoint software was used for time series analysis. Results: A total of 1912 CL cases occurred in Sabzevar County from 2011 to 2017, with an incidence rate of 93.61 per 100000. The highest and lowest observed incidence rates were in 2011 (25 per 10000 persons) and 2015 (3.24 per 10000 persons), respectively. Based on the results, the annual incidence of CL in the intended region decreased and the annual percent change was equal to -22.40. Further, the time series analysis using segmented regression by rural districts showed a change point in the trend of the incidence of leishmaniasis in three rural districts (Pain Joveyn and Joghatai in 2014 and Qasabeh-ye Sharqi in 2013). In other words, the trend was different before and after the change point in the mentioned districts. Conclusion: In general, the results indicated that interventional, preventive, and therapeutic measures for breaking the chain of CL transmission in Sabzevar have been desirable in recent years. Eventually, it is suggested that further time-series studies be conducted at the level of the month or a longer interval in order to better evaluate the period effect and secular trend.

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

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

Introduction. Notwithstanding the general increase in world population, there is a steady decline in birth rate. Studies have shown a tendency towards worsening of qualitative and quantitative indices of the ejaculate. From the foregoing we may also presume a decline in size of male gonads. Nevertheless, information about the tendency of change in testicular size in the population is currently unavailable.Purpose of the study. Assessment of global secular trend as regards changes in the size of testes in men.Materials and methods. A search was conducted on published scientific research in the English language and Russian language in Pubmed and eLibrary. Additional searches in citations of identifiable investigations. A selection of data from publications with metric characteristics of gonads in relatively healthy men aged 18‒60 years. The mean of values obtained were determined and homogenized with the aid of formulae for volume calculations. Statistical analysis of the data was carried out with the aid of the program STATISTICA for Windows v.10.Results. The search yielded 126 identified publications, published between 1902 and 2018. Analysis of the various works led to a selection of 33, which contained information that satisfied the inclusion criteria. Analysis of the obtained data did not reveal any trends in change of testicular size over the past century. Mean arithmetic weighted value was 17,43±5,64; 95% CI (17,32; 17,54).Conclusion. In the light of global trends towards a reduction in fertility, it is necessary to conduct a wide range of varied investigations in order to understand the nature of this process. Standardization of methods of assessment results obtained will help in reducing errors whilst assisting in the analysis of existing tendencies.

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

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

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

Background: Weight can be adjusted for height using the Benn parameter (kg/mB), where B is the power that minimises the correlation with height. Aim: To investigate how the Benn parameter changes across age (10–65 years) and time (1956–2015) and differs between sexes. Subjects and methods: The sample comprised 49,717 individuals born in 1946, 1958, 1970 or 2001. Cross-sectional estimates of the Benn parameter were produced and cohort differences at ages 10/11 and 42/43 years were examined using linear regression. Multilevel modelling was used to develop trajectories showing how the Benn parameter changed over age from childhood to mid-adulthood in the three older cohorts. Results: The Benn parameter was closest to 2 in childhood but consistently lower across adulthood, particularly in females and the most recent cohort. At ages 10/11 years, the Benn parameter was greater than 3 in both sexes in the 2001 cohort but between 2.2 and 2.7 in the three older cohorts. This difference was estimated to be +0.67 (0.53, 0.81) in males and +0.53 (0.38, 0.68) in females, compared to the 1946 cohort, and was driven by a much higher weight SD in the 2001 cohort. Conversely, at ages 42/43 years, the Benn parameter was lowest in the 1970 cohort due to a slightly lower weight-height correlation. This difference was estimated to be −0.12 (−0.34, 0.10) in males and −0.15 (−0.42, 0.13) in females, compared to the 1946 cohort. Conclusions: Changes over time in the obesogenic environment appear to have firstly reduced the Benn parameter due to a lowering of the weight-height correlation but secondly and more drastically increased the Benn parameter due to increasing weight variation.

AIM To present specific reference values for cardiorespiratory fitness (CRF) in children with obesity and to analyse secular trends of CRF in the studied population. METHODS Cardiorespiratory fitness, the maximal oxygen uptake (VO2 max), was estimated with the Astrand-Rhyming submaximal bicycle test, in 705 Swedish children (356 girls, 8-20 years) with obesity according to the International Obesity Task Force (IOTF). Data were collected from 1999 to 2013. Secular trends, analysed with multiple linear regression, were adjusted for age, height and body mass index standard deviation score (BMI SDS). RESULTS All children had low CRF compared with normal weight standards but there was a marked variability of CRF in children with obesity, which was possible to quantify with the developed obesity specific CRF reference values. The mean value of absolute VO2 max (L/min) increased with age and relative VO2 max (mL/kg/min) decreased with age in both boys and girls. There was a negative secular trend in both sexes (P

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

Trends in body size in young men and women in the early 21st century were analyzed based on the results of anthropometric examination of more than 6300 undergraduate students of various departments of Moscow State University that were obtained in 2000–2018. The retrospective analysis was conducted by comparing data of total body dimensions collected based on a sample of Moscow youth examined in different years since the 1920s. The observations of 17–18-year-old young men and women demonstrated an increase in height during the last 80 years until the beginning of the 21st century in Moscow. This parameter was noted to be relatively stable in both sexes since the beginning of 2000s until present. Against the background of the secular increase in body weight, which continues at present, some sex differences in growth dynamics of this index were observed. From the microevolutionary prospect, the noted tendencies could be explained as a result of changing lifestyle in modern human populations. Along with secular changes in body size, both sexes were observed to have concomitant changes of head and face dimensions, which were probably related to debrachycephalization (decrease in cephalic index) and a tendency toward leptoprosopia (increase in facial index). The observed patterns of secular (cross-generational) changes in morphological characteristic of modern youth can reflect socio-economic processes occurring in society and could be of great importance for fundamental studies in biology and sociology as well as for preventive medicine.

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

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

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

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

Introduction: It was previously found that age of sexual maturity during the last two decades has declined. The purpose of this study was to investigate whether chronologic age, dental age and skeletal developmental stage at onset of orthodontic treatment have changed during the last few decades in the same manner. In addition, to find out whether correlations exist between these ages. Such changes might have implications on clinical orthodontic practice. Methods: Panoramic and lateral cephalometric radiographs of 300 adolescents (139 males, 161 females) who began their orthodontic treatment during the years 1990-1992 or 2010-2012 (152 and 148 subjects, respectively) were examined. Chronologic, dental and skeletal ages were determined and compared between the two groups and correlations between these ages were calculated. Results: Mean chronologic age was 12.26 ± 1.22 years during 1990-1992 and 12.63 ± 1.64 during 2010-2012 (p=0.028). Mean dental age was 12.27 years ± 1.88 during 1990-1992 and 13.02 ± 2.20 during 2010-2012 (p=0.002). Mean skeletal developmental stage of subjects was 2.68 ± 1.60 during 1990-1992 and 2.99 ± 1.75 during 2010-2012 (p>0.1). Significant correlations were found between chronologic, dental and skeletal ages. Conclusions: Although no significant change of skeletal developmental stage upon commencing orthodontic treatment has occurred over the last two decades, both chronologic and dental ages have increased, particularly for females. There is significant correlation between chronologic, dental and skeletal ages for the entire group, particularly for females.

Introduction: The health-related physical fitness (HRPF) show an inverse association with several cardiovascular risk factors in young people, however, a few studies have investigate the changes of HRF indicators throughout a determined period. Objective: To check the secular trend of HRPF indicators in children of seven to 10 years old. Methods: were analyzed 1.136 subjects with seven to 10 years in three-time period (2002, 2005, 2010-2011). The HRPF tests were: sit-and-reach (SR), abdominal resistance (AB), 9 min walk/run test (9min) and the body adiposity by skinfold sum (?SF). The classification of the HRPF indicators were made by the Physical Best cut off point. The ANCOVA test (controlled by BMI, height, ?SF) compared the difference of the HRPF indicators amongst the three-time period. Results: The boys presented 6% of decrease in the flexibility between 2010 and 2002 period; no significance was found in the AB test; children of both sexes presented higher values in the 9min test on 2005 period. Conclusion: It was concluded that there was a negative secular trend for an HRPF, and gifts were the results in 2010 were compared as their peers (2002-2005) to an HRPF group, in both sexes, except for abdominal strength and endurance.

BACKGROUND: Globally, 80% of cardiovascular disease (CVD) occur in low-income /middle-income countries. High blood pressure (BP), a major risk factor for CVD, has its origins in early-life. We investigated how age trajectories of BP (childhood to late-adolescence) have changed recently in China and the mediating roles of physical growth. METHODS: Using the longitudinal data on 3785 children from the China Health and Nutrition Survey 1991-2015, we estimated mean BP trajectories (7-18 years) for cohorts born in 1981-1985, 1986-1990, 1991-1995 and 1996-2000 using random effect models. Models were adjusted for BMI and/or height growth to assess their impact on BP trends. RESULTS: BP trajectories shifted upwards across cohorts. Compared with the earliest cohort, mean BP was higher in the latest cohort throughout childhood to late adolescence. For example, the increment in SBP was 4.4 mmHg (95% confidence interval: 2.9-5.8) in boys and 4.0 mmHg (2.6-5.5) in girls at 9 years, narrowed slightly during adolescence, and was 3.0 mmHg (0.7-5.4) and 2.6 mmHg (0.4-4.8) respectively at 17 years. BMI and height trajectories also shifted upwards. The overall increment was greater for height than BMI. When adjusting for physical growth, the increment in BP trajectories reduced (more for height than BMI), but remained in childhood (P

Abstract. Background: Few reports from developing countries have described long-term trends in suicide. Aims: To investigate the age-, sex-, and method-specific trends in suicide over the period 1904–2017 in São Paulo. Method: Mortality data were obtained from SEADE, DATASUS, and PRO-AIM. Results: Suicide peaked in the mid-1910s and mid-1950s, being higher among men. There was an upward trend from the 1920s for men and from the 1930s for women. Suicide rates have declined since the mid-1950s, reaching lower rates in the past 40 years. Men aged 60+ had higher rates at the beginning and a decreasing trend. Suicide rates among men aged 20–39 and 40–59 peaked in the mid-1950s and declined until the late 1970s, thereafter remaining stable. Women aged 20–39 years had the highest rates with decreasing trends from the mid-1950s. No trends were detected for the age group 40–59, and women aged 60+ presented a decreasing trend. Rates among women aged 0–19 declined after the late 1970s. Suicide by poisoning peaked in the 1950s, and there was a downward trend for firearms and an upward trend for hanging. Conclusion: Suicide trends vary by sex, age group, and method. Accurate monitoring of these trends is an important task for suicide prevention and public health agencies and personnel.

Background Hepatitis C virus (HCV) is the main etiology of cryoglobulinemia with mortality around 25%. Little is known on the changes in cryoglobulinemia mortality after the introduction of direct-acting antivirals (DAA) for treatment of HCV in 2014 in the US. Methods We calculated cryoglobulinemia mortality from 1999 to 2018. The proportionate mortality ratio (PMR) of cryoglobulinemia cases with HCV and those with autoimmune diseases were computed to assess the impact of introduction of DAA. Results We identified 1299 people aged ≥ 20 years who died with cryoglobulinemia between 1999 and 2018. The cryoglobulinemia mortality (deaths per million) declined from 1999 (0.4) to 2010 (0.22) and mildly increased from 2010 to 2014 (0.26), and then decreased abruptly from 2014 to 2018 (0.19). The proportion of cryoglobulinemia patients with HCV was 39% (118/302) in 2009–2013 and 26% (81/310) in 2014–2018, with a PMR of 0.67 (95% CI 0.50–0.89). By contrast, the proportion of cryoglobulinemia patients with systemic autoimmune diseases was 2.6% (8/302) in 2009–2013 and 4.2% (13/310) in 2014–2018, with a PMR of 1.58 (95% CI 0.66–3.82). Conclusion The changes in cryoglobulinemia mortality during the past two decades are mainly related to the aging and dying of the “baby boomer” cohort who had a high HCV prevalence and to the introduction of a DAA in 2014.