Search

Zhiqiang Wang,1 Huiying Zhang,2 Meina Liu2 1Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; 2Public Health College, Harbin Medical University, Harbin, China Objective: We aimed to assess if the gap in mortality between adults with and without diabetes has widened over time in US adults. Methods and study design: This cohort study included 44,041 adults with diabetes from the US National Health Interview Survey between 1986 and 2009 linked to the National Mortality Index data up to 2011. Each participant with diabetes was matched to two participants without diabetes by age, sex, race, survey year, and region of residence (88,082 persons without ­diabetes). Mortality differences and hazard ratios were calculated for different time periods defined by three methods, according to 1) survey years with original follow-up durations, 2) follow-up calendar years, and 3) survey years with a fixed 3-year follow-up duration. Results: Different methods of defining time periods produced substantially different mortality rates and changing patterns over time. The decline in mortality was higher when time periods were defined according to survey years with original follow-up durations than with the fixed 3-year duration. Different time periods had comparable baseline and attained ages only when the fixed duration was used. With this method, the gap between adults with and without diabetes progressively decreased from 224 (95% confidence interval 188–260) in 1992–1994 to 99 (65–132) per 10,000 person-years in 2007–2009. Hazard ratios declined significantly from 2.12 (1.88–2.38) in 1995–1997 to 1.70 (1.44–2.00) in 2007–2009. Conclusion: The decline in mortality over time was greater among adults with diabetes than those without diabetes. The gap in mortality between adults with diabetes and those without diabetes significantly narrowed in recent years, and was more than halved over the last 15 years. Keywords: survival, matching, confounding, National Health Interview Survey, time trend

Abstract Background Detailed knowledge of the evolutionary potential of polymorphic sites in a viral protein is important for understanding the development of drug resistance in the presence of an inhibitor. We therefore set out to analyse the molecular evolution of the HIV-1 subtype B integrase at the inter-patient level in Germany during a 20-year period prior to the first introduction of integrase strand inhibitors (INSTIs). Methods We determined 337 HIV-1 integrase subtype B sequences (amino acids 1–278) from stored plasma samples of antiretroviral treatment-naïve individuals newly diagnosed with HIV-1 between 1986 and 2006. Shannon entropy was calculated to determine the variability at each amino acid position. Time trends in the frequency of amino acid variants were identified by linear regression. Direct coupling analysis was applied to detect covarying sites. Results Twenty-two time trends in the frequency of amino acid variants demonstrated either single amino acid exchanges or variation in the degree of polymorphy. Covariation was observed for 17 amino acid variants with a temporal trend. Some minor INSTI resistance mutations (T124A, V151I, K156 N, T206S, S230 N) and some INSTI-selected mutations (M50I, L101I, T122I, T124 N, T125A, M154I, G193E, V201I) were identified at overall frequencies >5%. Among these, the frequencies of L101I, T122I, and V201I increased over time, whereas the frequency of M154I decreased. Moreover, L101I, T122I, T124A, T125A, M154I, and V201I covaried with non-resistance-associated variants. Conclusions Time-trending, covarying polymorphisms indicate that long-term evolutionary changes of the HIV-1 integrase involve defined clusters of possibly structurally or functionally associated sites independent of selective pressure through INSTIs at the inter-patient level. Linkage between polymorphic resistance- and non-resistance-associated sites can impact the selection of INSTI resistance mutations in complex ways. Identification of these sites can help in improving genotypic resistance assays, resistance prediction algorithms, and the development of new integrase inhibitors.

Abstract Background The structure of long-term care (LTC) for old people has changed: care has been shifted from institutions to the community, and death is being postponed to increasingly old age. The aim of the study was to analyze how the use and costs of LTC in the last two years of life among old people changed between 2002 and 2013. Methods Data were derived from national registers. The study population contains all those who died at the age of 70 years or older in 2002–2013 in Finland (N = 427,078). The costs were calculated using national unit cost information. Binary logistic regression and Cox proportional hazard models were used to study the association of year of death with use and costs of LTC. Results The proportion of those who used LTC and the sum of days in LTC in the last two years of life increased between 2002 and 2013. The mean number of days in institutional LTC decreased, while that for sheltered housing increased. The costs of LTC per user decreased. Conclusions Use of LTC in the last two years of life increased, which was explained by the postponement of death to increasingly old age. Costs of LTC decreased as sheltered housing replaced institutional LTC. However, an accurate comparison of costs of different types of LTC is difficult, and the societal costs of sheltered housing are not well known.

Objectives: This study aimed to investigate the disparities in pneumonia-specific under-five mortality rates (U5MRs) among and within three geographic regions in Mainland China from 1996 to 2015. Methods: Data were obtained from the national Under-Five Child Mortality Surveillance System and grouped into 2-year periods. The Cochran–Armitage trend test and Cochran–Mantel–Haenszel test were used to assess trends and differences in the pneumonia-specific U5MRs among and within geographic regions. Relative risks (RRs) and 95% confidence intervals (95% CIs) were calculated. Results: The pneumonia-specific U5MR decreased by 90.6%, 89.0%, and 83.5% in East, Middle, and West China, respectively, with a larger decrease in rural areas. The pneumonia-specific U5MR was highest in West China, and was 7.2 (95% CI 5.9–8.7) times higher than that in East China in 2014–2015. In 2014–2015, the RRs were 1.7 (95% CI 1.2–2.5), 1.6 (95% CI 1.1–2.1), and 3.4 (95% CI 2.8–4.0) between rural and urban areas in East, Middle, and West China, respectively. Conclusions: Pneumonia-specific U5MRs decreased from 1996 to 2015 across China, particularly in rural areas. However, disparities remained among and within geographic regions. Additional strategies and interventions should be introduced in West China, especially the rural areas, to further reduce the pneumonia-specific U5MR.

The aim of our study was to describe cancer burden and time trends of all cancers combined, the most frequent as well as the rare cancers in Slovenia.

OBJECTIVE: The aim of this study was to describe time trends of incidence/prevalence of carpal tunnel syndrome (CTS), one of the most common musculoskeletal disorders, in a French region over an 8-year period. METHODS: Three independent data sources were analyzed for the population of the Pays de la Loire region aged 20–59 between 2004 and 2011: hospital discharge records for “surgically treated CTS” (SURG-CTS), the social insurance data on “CTS compensated for as an occupational disease” (OD-CTS), and the regional surveillance program of “work-related diseases” (WRD-CTS). Case counts were analyzed using negative binomial regression models and cubic spline curves with year as the main covariate. RESULTS: The annual incidence rates of SURG-CTS decreased from 3.35 to 2.98 per 1000 person-years over the 8-year period, with an overall declining trend [-2.00%, 95% confidence interval (95% CI) -3.07– -0.91%), P

Abstract Objective: This paper describes and compares magnitudes of socioeconomic (SES) inequalities in oral health among Indigenous and non‐Indigenous children over a 10‐year period. Methods: We analysed annual oral health survey data from NSW, NT and SA. Data were extracted for time period 1 (2000–2002, N=215,317) and time period 2 (2007–2010, N=34,495). Oral health outcomes were untreated decayed deciduous teeth (dt) and cumulative dental caries experience (dmft). Postcode‐level Socioeconomic Index for Areas was used to assess SES. Age standardisation and complex survey weights were used. Indices of socioeconomic inequality in health (Slope Index of Inequality, Relative Index of Inequality, Absolute and Relative Concentration Index) were used to quantify inequality in dental caries and its changes over time. Results: Oral health outcomes deteriorated in both Indigenous and non‐Indigenous populations over time. Indigenous children experienced higher levels of disease at both times. Untreated dt increased in both populations. The cummulative disease (dmft) increased at higher rate among children in low‐SES areas in both populations. Over time, there was an increase in socioecononomic inequalities in dmft in all children and in dt in non‐Indigenous children. Conclusion: Area‐level socioeconomic inequality in child oral health has widened due to deterioration in low‐SES children.

North American river otters ( Lontra canadensis ) are top predators in riverine ecosystems and are vulnerable to per- and polyfluoroalkyl substance (PFAS) exposure. Little is known about the magnitude of exposure and tissue distribution of PFAS in river otters. We measured 45 PFAS in various tissues of 42 river otters collected from several watersheds in the state of West Virginia, USA. The median concentrations of ∑All (sum concentration of 45 PFAS) varied among tissues in the following decreasing order: liver (931 ng/g wet weight) > bile > pancreas > lung > kidney > blood > brain > muscle. Perfluoroalkylsulfonates (PFSAs) were the predominant compounds accounting for 58-75% of the total concentrations, followed by perfluoroalkyl carboxylates (PFCAs; 21-35%). 8:2 fluorotelomer sulfonate (8:2 FTS), 10:2 FTS, and 6:2 chlorinated polyfluoroalkyl ether sulfonate were frequently found in the liver (50-90%) and bile (96-100%), whereas hexafluoropropylene oxide dimer acid (HFPO-DA) was rarely found. The hepatic concentrations of ∑All in river otters collected downstream of a fluoropolymer production facility located along the Ohio River were 2-fold higher than those in other watersheds. The median whole body burden of ∑All was calculated to be 1580 μg. PFOS and perfluorooctanoic acid (PFOA) concentrations in whole blood of some river otters exceeded the human toxicity reference values, which warrant further studies.

Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for portal hypertension and its' complications in liver cirrhosis, yet the development of hepatic encephalopathy (HE) remains a significant concern. This review covers the reported incidence, risk factors, and management strategies for post-TIPS HE over the past decade. Incidence varies widely (7-61%), with factors like age, liver function, hyponatremia, and spontaneous portosystemic shunts influencing risk. Procedural aspects, including TIPS timing, indication, and stent characteristics, also contribute. Pharmacological prophylaxis with lactulose and rifaximin shows promise, but current evidence is inconclusive. Procedural preventive measures, such as shunt embolization and monitoring portal pressure gradients, are explored. Treatment involves pharmacological options like lactulose and rifaximin, and procedural interventions like stent diameter reduction. Ongoing studies on novel predictive markers and emerging treatments, such as faecal microbiota transplant, reflect the evolving landscape in post-TIPS HE management. This concise review provides clinicians with insights into the multifaceted nature of post-TIPS HE, aiding in improved risk assessment, prophylaxis, and management for patients undergoing TIPS procedures.

This paper investigates the time trend coefficients in the temperatures in 48 US states using monthly data from January 1895 to December 2017, as well as in their anomalies with respect to the base period 1901–2000. For this purpose, we use techniques based on fractional integration, which is a more general approach than the standard methods used in the literature based on integer differentiation. The results indicate that with the exception of 10 states, in the remaining 38, the temperature anomalies have increased across time, with the increase being higher than the one expected under the other more standard approaches. The highest increases correspond to New Jersey and Rhode Island, with an increase of approximately 2.9°C over the last 100 years. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to investigate the registry‐based national time trends in incidence and prevalence rates of dementia from 1996 to 2015. Methods: We assessed annual incidence and prevalence using longitudinal data from nationwide registries on dementia status and demographics on all residents ≥ 65 years old in Denmark. Results: Our population comprised 2 million people, of whom 152,761 were diagnosed with dementia. The age‐ and sex‐adjusted incidence rate increased, on average, by 9% annually from 1996 to 2003, followed by a 2% annual decline, while total prevalence increased during the whole period. Discussion: This is the first study to report continuous time trends of incidence and prevalence in an entire national population. The incidence rate has declined steadily since 2003, while the total prevalence is still increasing. Future health care planning on prevention and treatment of dementia should take these findings into account. Highlights: The national incidence rate of dementia has declined by 2% annually since 2003.The total incidence increased from 4875 people in 1996 to 8017 in 2015.The total prevalence increased from 14,019 people in 1996 to 36,129 in 2015.The elderly population increased from 803,334 people in 1996 to 1,055,984 in 2015.While total incidence has decreased since 2009, prevalence is still increasing. [ABSTRACT FROM AUTHOR]

Objectives: To compare trends in the use of robot‐assisted radical cystectomy (RARC) and changes over time in peri‐operative outcomes in selected North American and European centres. Materials and Methods: We conducted a retrospective evaluation of 2401 patients treated with open radical cystectomy (ORC) or RARC for bladder cancer at 12 centres in North America and Europe between 2006 and 2018. We used the Kruskal–Wallis and chi‐squared test to evaluate differences between continuous and categorical variables. Results: Overall, 49.5% of patients underwent RARC and 51.5% ORC. RARC became the most commonly performed procedure in contemporary patients, with an increase from 29% in 2006–2008 to 54% in 2015–2018 (P < 0.001). In the North American centres the use of RARC was higher than that of ORC from 2006, and remained stable over time, whereas in the European centres its use increased exponentially from 2% to 50%. In both groups patients who underwent RARC had less advanced T stages (P < 0.001), lower American Society of Anesthesiologists scores (P < 0.05), lower blood loss (P = 0.001) and shorter length of hospital stay (P < 0.05). No differences were found in early complications. Early readmission and re‐operation rates were worse for patients treated with RARC in the European centres; however, when contemporary patients only were considered, the statistical significance was lost. Conclusion: The present study shows that the use of RARC has constantly increased since its introduction, overtaking ORC in the most contemporary series. While RARC was more frequently performed than ORC since its introduction in the North American centres and its use remained substantially stable over time, its use increased exponentially in the European centres. The different trends in use of RARC/ORC and changes over time in peri‐operative outcomes between the North American and European centres can be attributed to the earlier introduction and spread of RARC in the former compared with the latter. [ABSTRACT FROM AUTHOR]

Objectives: To describe recent trends in the prevalence of gout and asymptomatic hyperuricemia regarding urate-lowering treatment (ULT) in Japan. Methods: A database of health insurance claims managed by the Japan Medical Data Center was used to estimate the annual prevalence of gout and asymptomatic hyperuricemia during 2010-2014. ULT was evaluated for status of the two diseases during the same period. The significance of time trends was evaluated by Cochrane-Armitage trend test. Results: The prevalence of physician-diagnosed gout in men aged 20-64 years was 1.54% (95% CI: 1.49%-1.58%) in 2010, with a slight but significant (p<0.001) annual increase, up to 1.66% (95% CI: 1.62%-1.71%) in 2014. In women, gout prevalence was somewhat constant about 0.09% during 2010-2014. Among male patients with gout, 78% received ULT. The prevalence of male patients with asymptomatic hyperuricemia in the same age range, who received ULT, increased significantly from 1.77% (95% CI: 1.72%-1.81%) to 2.14% (95% CI: 2.09%-2.19%) during 2010-2014 (p<0.001). Conclusion: Gout prevalence in adult men in Japan has increased significantly in recent years. The prevalence of asymptomatic hyperuricemia under ULT has also increased significantly and was higher than that of gout. [ABSTRACT FROM AUTHOR]

DINCH (cyclohexane-1,2-dicarboxylic acid-diisononyl ester) is a phthalate plasticizer substitute introduced into the market in 2002. It is increasingly used especially in the production of toys, food contact materials and medical devices. In this measurement campaign on 24-h urine samples of young adults (20–29 years) from the German Environmental Specimen Bank (ESB) collected in 2010, 2011, 2013, 2015 and 2017 (in total 300 samples, 60 samples/year) we analyzed three specific, oxidized DINCH metabolites (OH-MINCH: cyclohexane-1,2-dicarboxylic acid-mono(hydroxy-isononyl) ester; cx-MINCH: cyclohexane-1,2-dicarboxylic acid-mono(carboxy-isooctyl) ester, oxo-MINCH: cyclohexane-1,2-dicarboxylic acid-mono(oxo-isononyl) ester). We merged these data with earlier data of the ESB from the years 1999–2012 and are now able to report levels and time trends of internal DINCH exposure from 1999 to 2017. After first detections of the major oxidized DINCH metabolite OH-MINCH in 2006 (6.7%) detection rates rapidly increased to 43.3% in 2009, 80% in 2010 and 98.3% in 2011 and 2012. From the year 2013 on we could detect OH-MINCH in every urine sample analyzed. The median concentrations of OH-MINCH rapidly increased from 0.15 μg/L in 2010 to twice the concentration in 2011 (0.31 μg/L) with further increases in 2013 (0.37 μg/L), 2015 (0.59 μg/L) and 2017 (0.70 μg/L). Similar increases, albeit at lower detection rates and concentration levels, could be observed for cx-MINCH and oxo-MINCH. All metabolites strongly correlate with each other. For the ESB study population, DINCH exposures are still far below health based guidance values such as the German Human Biomonitoring Value (HBM-I; 4,500 μg/L for the sum of OH-MINCH and cx-MINCH) or the tolerable daily intake (TDI) of EFSA (1 mg/kg bw/d). The median daily DINCH intake (DI) calculated for 2017 was 0.23 μg/kg bw/d, thus 4,310-times lower than the TDI. The maximum DI calculated for one individual in 2012 (42.60 μg/kg bw/d) was a factor of more than 20 below the TDI. The ongoing increase in DINCH exposure needs to be closely monitored in the future, including populations with potentially higher exposures such as children. This close monitoring will enable timely exposure and risk reduction measures if exposures reached critical levels, or if new toxicological data lead to lower health based guidance values. DINCH belongs to the European Human Biomonitoring Initiative (HBM4EU) priority substances for which policy relevant questions still have to be answered. [ABSTRACT FROM AUTHOR]

Background: This study describes the temporal changes in risk profiles and outcomes among patients with aortic stenosis (AS) undergoing surgical aortic valve replacement (SAVR) in Australia between 2002 and 2015. Methods: Using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons database, we identified first‐recorded SAVR for AS over 14 years. Patients' surgical risk profiles, procedures, 30‐day and 12‐month outcomes were summarized before and after the introduction of transcatheter aortic valve implantation in Australia, in 2008. We applied multivariable regression models to investigate the changes over time on risk‐adjusted 30‐day mortality, re‐hospitalization and 12‐month mortality. Results: We identify a total of 18 147 patients with AS who underwent SAVR; mostly men (64%) with a mean age of 72 years. The proportion of major cardiac surgeries devoted to SAVR increased from 14% in 2002 to 20% in 2015. More SAVRs were performed electively (80% in 2002 versus 86% in 2015), and the recipients were at lower surgical risk (mean multi‐risk score 3.9% in 2002 versus 3.0% in 2015). The use of bioprosthetic aortic valves increased over time (67% in 2002 to 88% in 2015). We found no significant changes in 30‐day mortality, a significant decrease in 30‐day readmission and minor fluctuations in 12‐month mortality over the study period. Conclusion: SAVR comprises an increasingly larger proportion of all adult cardiac surgeries in Australia. There has been a greater use of bioprosthetic aortic valves, a fall in 30‐day readmission but no significant changes in mortality. [ABSTRACT FROM AUTHOR]

Background: Co-evolution of host and aeromonads has diversified their spectrums of diseases and antibiograms, while a paucity of data was concerning about this diversity in China. To fill this gap, this study was aimed to investigate and compare antimicrobial resistance (AMR) patterns of clinically important Aeromonas spp. from various clinical sources. Methods: A multicenter retrospective surveillance study was conducted in Chongqing from 2011 to 2017. Data of strains were retrieved from the database of China Antimicrobial Resistance Surveillance System (CARSS). Whonet 5.6 and Graphpad Prism 6 Software were adopted to determine and compare distribution and AMR patterns. Results: Among 1135 Aeromonas strains, Aeromonas hydrophila complex (65.6%, 745/1135) was the most predominant species, followed by Aeromonas veronii complex (16.7%, 190/1135) and Aeromonas caviae complex (15.3%, 174/1135). Sputum was the most frequent source of strains (27.7%), followed by wound (20.8%), bloodstream (10.8%) and urine (8.8%). Urinary strains demonstrated the highest resistance rates to ceftriaxone (65.6%), ceftazidime (52.1%), cefepime (38.3%), ciprofloxacin (47.7%) and trimethoprim-sulfamethoxazole (56.6%). Similar AMR pattern was observed in intestinal strains, with corresponding resistance rates of 29.4%, 28.9%, 22.2%, 27.3% and 45%, respectively. However, respiratory, bloodstream and skin strains exhibited resistance rates of less than 20% to most of the antimicrobials tested. In terms of species, approximately 30% of Aeromonas hydrophila complex and Aeromonas caviae complex strains were resistant to ceftriaxone and trimethoprim-sulfamethoxazole, while Aeromonas veronii complex strains harbored resistance rates of less than 20% to all tested antimicrobials. Although antibiograms of these species were distinct, they remained constant from 2011 to 2017. Conclusions: Distinct AMR patterns between species and sources highlighted the predominance of Aeromonas hydrophila complex and high resistance of strains in urine and intestine to extended-spectrum cephalosporins, ciprofloxacin and trimethoprim-sulfamethoxazole in Southwest China. Temporally constant AMR patterns should not relax the vigilance of antimicrobial resistance in clinically important Aeromonas species. [ABSTRACT FROM AUTHOR]

Objectives: To identify time trend pattern in toothache and to estimate whether toothache prevalence differs by socioeconomic position and residential location over time. Methods: Data from nine successive National Dental Telephone Interview Surveys (NDTIS) from 1994 (n = 6907) to 2013 (n = 6778) performed in Australia among individuals aged 15 years or over were used. The dependent variable was toothache reported very often, often or sometimes during the previous 12 months. Independent variables were age group, household income (tertiles), insurance/cardholder status and geographical remoteness. Prais‐Winsten analyses were performed, and the average annual percentage change (AAPC) for toothache prevalence was estimated. Results: Toothache affected slightly more than 10% of the overall population in 1994 (11.6%) and 1995 (11.4%), reaching approximately one‐sixth (16.2%) of individuals in 2013. Overall, there was a significant increase in toothache prevalence over time (AAPC = 2.0% [95% CI 0.7;1.34]) and in those aged 25‐44 (AAPC 2.1% [95% CI 0.6;3.6]) and 45‐64 (AAPC 3.4% [95% CI 1.5;5.3]) years and markedly among those in the lowest income group (AAPC 3.4% [95% CI 0.1;6.7]). All geographic locations except for remote/very remote areas had upward toothache prevalence over time. Insured status was not associated with increased toothache prevalence during the investigated period. Conclusions: Toothache prevalence increased from 1994 to 2013 in Australian adults particularly among the lowest socioeconomic group. [ABSTRACT FROM AUTHOR]

• Antimicrobial use in Dutch companion animal clinics is changing and decreasing. • Aminopenicillins account for the largest group of used antimicrobials. • Strong seasonal differences in antimicrobial use are observed. • The distribution of different animal species appears to affect antimicrobial use. • Especially the classes of antimicrobials prescribed could be further optimised. Any antimicrobial use (AMU) in humans and animals selects for antimicrobial resistance (AMR) and responsible AMU should therefore be promoted both in human and veterinary medicine. Insight into current AMU in companion animal clinics is necessary to be able to optimise antimicrobial (AM) prescribing behaviour. The objective of this study was to describe systemic AMU in 44 Dutch companion animal clinics over a 3-year time period (2012–2015), using retrospectively collected data. The number of Defined Daily Doses for Animals (DDDAs) per month and per clinic were calculated from prescription data for total, 1st, 2nd and 3rd choice AMU (classification according to Dutch policy on veterinary AMU). Time trends, seasonality and the influence of potential determinants (e.g., the number of dogs, cats and rabbits per clinic and other clinic characteristics) were explored using statistical modelling. Overall, the findings show that total AMU decreased over time and a shift in used classes of antimicrobials towards more 1st choice AMs was visible. Mean total AMU decreased from 1.82 DDDA/year in 2012–2013 to 1.56 DDDA/year in 2014-2015. Aminopenicillins, with and without clavulanic acid, accounted for the largest group of antimicrobials used; 38.7% (2012–2013), 40.2% (2013–2014) and 39.3% (2014–2015) of total AMU, respectively. Strong seasonal differences in AMU were found, with highest AMU in July-August and lowest in February-March. The distribution of different animal species per clinic appeared to affect AMU as well. In clinics with a larger proportion of dogs, 2nd choice AMU was significantly higher, whereas in clinics with a larger proportion of rabbits, 2nd choice AMU was significantly lower. Despite the decrease of AMU during the study period, there is still room for improvement left, especially with regard to the antimicrobial classes prescribed. According to Dutch classification of veterinary AMU, 1st choice AMs should be used as empirical therapy. A decrease in 2nd (might select for ESBL-producing bacteria) and 3rd choice AMU (i.e. fluoroquinolones and 3rd generation cephalosporins) should be aimed for. [ABSTRACT FROM AUTHOR]

The occurrence of classical and emerging halogenated flame retardants in bird samples collected between 2010–17 from the Castrejón reservoir (central Spain) was studied. Different wetland bird samples were analysed, including unhatched bird eggs and liver of dead nestlings. Polybrominated diphenylethers (PBDEs) were detected in all the samples at high concentration values, with levels up to 5167 ng/g lw. Dechloranes were found in 78% of analysed samples, but at lower concentration levels, between not detected (nd) and 2153 ng/g lw. The time trend evaluation over the sampling period showed an approximately 50% decline in mean concentrations of PBDEs. However, the most recent data for PBDEs (2016–17) still indicate that, in some cases, and based on reported LOECs, wetland birds were exposed to PBDE concentrations that are associated with possible ecological hazards. • PBDEs were detected at high concentrations, with levels up to 5167 ng/g lw. • Dechloranes were found in 78% of samples, at concentrations up to 2153 ng/g lw. • Time trend evaluation for PBDEs along 2010–2017 showed a level decline. • Based on reported LOECs, birds were still exposed to PBDEs associated to ecological hazards. [ABSTRACT FROM AUTHOR]

Background: Mental health problems and mental health related mortality have increased among adolescents, particularly girls. These trends have implications for etiology and prevention and suggest new and emerging risk factors in need of attention. The present study estimated age, period, and cohort effects in depressive symptoms among US nationally representative samples of school attending adolescents from 1991 to 2018.Methods: Data are drawn from 1991 to 2018 Monitoring the Future yearly cross-sectional surveys of 8th, 10th, and 12th grade students (N = 1,260,159). Depressive symptoms measured with four questions that had consistent wording and data collection procedures across all 28 years. Age-period-cohort effects estimated using the hierarchical age-period-cohort models.Results: Among girls, depressive symptoms decreased from 1991 to 2011, then reversed course, peaking in 2018; these increases reflected primarily period effects, which compared to the mean of all periods showed a gradual increase starting in 2012 and peaked in 2018 (estimate = 1.15, p < 0.01). Cohort effects were minimal, indicating that increases are observed across all age groups. Among boys, trends were similar although the extent of the increase is less marked compared to girls; there was a declining cohort effect among recently born cohorts, suggesting that increases in depressive symptoms among boys are slower for younger boys compared to older boys in recent years. Trends were generally similar by race/ethnicity and parental education, with a positive cohort effect for Hispanic girls born 1999-2004.Conclusions: Depressive symptoms are increasing among teens, especially among girls, consistent with increases in depression and suicide. Population variation in psychiatric disorder symptoms highlight the importance of current environmental determinants of psychiatric disorder risk, and provide evidence of emerging risk factors that may be shaping a new and concerning trend in adolescent mental health. [ABSTRACT FROM AUTHOR]

Abstract We investigated the temporal trend of mercury (Hg) in arctic foxes from Svalbard, Norway sampled in the period 1997–2014 (n = 109, from 11 trapping seasons). We used linear models to investigate the effect of trapping season, feeding habits (δ 13C), food availability from marine and terrestrial ecosystems (reindeer carcasses and sea ice cover), sex, age and body condition on liver total Hg (THg) levels. Liver THg levels increased in arctic foxes with 7.2% (95% CI: 2.3, 9.6) per year when the concentrations were adjusted for variation of δ 13C, sea ice cover, and reindeer carcasses, whereas the raw annual trend was 3.5% (CI: −0.11, 7.2). However, the THg levels in arctic foxes from Svalbard are still lower than other marine mammals. We also demonstrate that arctic fox terrestrial food consumption is important for lowering the overall THg levels in this species. Graphical abstract Unlabelled Image Highlights • We analyzed liver concentrations of THg in 109 arctic foxes from Svalbard. • THg levels in arctic foxes increased with 7.2% per year from 1997 to 2014. • The increase in THg per year is lower than in other Arctic regions. • Terrestrial food consumption reduced THg levels in arctic foxes. [ABSTRACT FROM AUTHOR]

Purpose: In contrast to the downsizing trend of psychiatric beds in the Western world, the psychiatric bed capacity in Taiwan has steadily increased in recent decades. This study aimed to assess the suicide rates and their variations over time among psychiatric inpatients and recently discharged patients.Methods: Data on psychiatric inpatients admitted from 2002 to 2013 were extracted from the psychiatric inpatient registry of the National Health Insurance and merged with information from the Cause of Death data by means of unique identified numbers. Suicides occurring during admission and within 90 days after discharge were defined as inpatient and postdischarge suicides, respectively. Calendar year was fitted as a continuous variable in multivariate Poisson regression models to evaluate these rates over time. The analyses were adjusted for sex, age, primary psychiatric diagnosis, and number of admissions in the preceding year.Results: The overall inpatient suicide rate was very low (81 per 100,000 person-years). It decreased significantly from 146 to 74 per 100,000 person-years over the study period. This fall was observed among both genders and across all psychiatric diagnoses. The postdischarge suicide rate was comparatively high (1108 per 100,000 person-years) and did not show statistically significant change over the study period.Conclusions: Our results suggest that efforts to increase public awareness of mental disorders and efficient utilization of psychiatric inpatient care are essential for suicide prevention despite the comparatively high bed capacity. The discharge plans of inpatients should be bridged with population suicide prevention programs for continuity of care after discharge. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the genus profile of isolated pathogens and antibiotic susceptibility trends of microbial keratitis over nine years at a large referral eye center in southern China. Methods: Data of corneal specimens from January 2010 to August 2018 of patients clinically diagnosed with infectious keratitis were obtained from the center's microbiology database. Results with positive cultures along with antibiotic susceptibility were reviewed and analyzed. Results: We collected and reviewed 7,229 specimens, including 3,092 with positive cultures. Among them, 1,630 (52.72%) were bacterial, 1781 (57.60%) were fungal, and 319 (10.32%) were coinfected. A significant decreasing trend was observed in the isolates of Gram-positive cocci (r =−0.711, P=0.032), among which the proportion of coagulase-negative staphylococcus (CNS) was also reduced (r =−0.883, P=0.002). In contrast, an increasing trend in the proportion of Gram-negative bacilli was observed (r=0.661, P=0.053). The susceptibility rates of Gram-positive cocci to cephalosporins were near 90%, which was relatively high compared to fluoroquinolones. Fluoroquinolones represented the antibiotics to which Gram-negative bacilli were the most susceptible. Their susceptibility to moxifloxacin was 78.79%. The overall performance of aminoglycosides and vancomycin was both around 70%. The susceptibility of Gram-positive cocci to several antibiotics including levofloxacin (r=−0.717, P=0.03), tobramycin (r= −0.933, P<0.001), cefazolin (r= −0.964, P<0.001), ceftazidime (r=−0.929, P=0.003), chloramphenicol (r=−0.929, P=0.003), and cefuroxime (r=−0.829, P=0.042) decreased over time. The susceptibility of Gram-negative bacilli to ofloxacin increased over time (r=0.854, P=0.004), whereas that to cefazolin (r=−0.833, P=0.005) and chloramphenicol (r=−0.886, P=0.019) decreased over time. Conclusion: From 2010 to 2018 in Zhongshan Ophthalmic Center, most isolates from infectious keratitis were Gram-positive cocci (mainly CNS), which decreased over time, with an increase in Gram-positive bacilli. More than half of the antibiotics showed reducing trend of susceptibilities, and the antibiotic resistance situation in southern China was not encouraging. [ABSTRACT FROM AUTHOR]

Purpose: Breast-conserving therapy (BCT) is the standard procedure for most patients with primary breast cancer (BC). By contrast, axillary management is still under transition to find the right balance between avoiding of morbidity, maintaining oncological safety, and performing a staging procedure. The rising rate of primary systemic therapy creates further challenges for surgical management.Methods: Patients with primary, non-metastatic BC treated between 01.01.2003 and 31.12.2016 under guideline-adherent conditions were included in this study. For this prospectively followed cohort, breast and axillary surgery patterns are presented in a time-trend analysis as annual rate data (%) for several subgroups.Results: Overall, 6700 patients were included in the analysis. While BCT rates remained high (mean 2003-2016: 70.4%), the proportion of axillary lymph node dissection has declined considerably from 80.1% in 2003 to 16.0% in 2016, while the proportion for sentinel lymph node biopsy (SLND) has increased correspondingly from 10.3 to 76.4%. Among patients with cT1-2, cN0 breast cancer receiving BCT with positive SLND, the rate of axillary completion has decreased from 100% in 2008 to 24.4% in 2016.Conclusions: In the past decade, SLNB has been established as the standard procedure for axillary staging of clinically node-negative patients. Surgical morbidity has been further reduced by the rapid implementation of new evidence from the ACOSOG Z0011 trial into clinical routine. The results reflect the transition towards more individually tailored, less invasive treatment for selected patient subgroups, especially in regards to axillary lymph node management. [ABSTRACT FROM AUTHOR]

Abstract Background While numerous studies have shown that the impact of cold waves is decreasing as result of various processes of adaptation, far fewer have analysed the time trend shown by such impact, and still fewer have done so for the different provinces of a single country, moreover using a specific cold waves definition for each. This study thus aimed to analyse the time trend of the impact of cold days on daily mortality in Spain across the period 1983–2003. Methods For study purposes, we used daily mortality data for all natural causes except accidents in ten Spanish provinces. The time series was divided into three subperiods. For each period and province, the value of T threshold was obtained via the percentile corresponding to the cold day's definition for that province obtained in previous studies. Relative Risks (RRs) and Population Attributable Fraction (PARs) were calculated using Generalised Linear Models (GLMs) with the Poisson regression link. Seasonalities, trends and autoregressive components were controlled. Global RRs and ARs were calculated with the aid of a meta-analysis with random effects for each of the periods. Results The results show that the RRs for Spain as a whole were 1.12 (95% CI: 1.08 1.16) for the first period, 1.15 (95% CI: 1.09 1.22) for the second and 1.18 (95% CI: 1.10 1.26) for the third. The impact of cold days has risen slightly over time, though the differences were not statistically significant. These findings show a clearly different behaviour pattern to that previously found for heat. Conclusion The results obtained in this study do not show a downward trend for colds days. The complexity of the biological mechanisms involved in cold-related mortality and the lack of robust results mean that more research must be done in this particular field of public health. Graphical abstract Unlabelled Image Highlights • This study analyses the time trend of the impact of cold on daily mortality in Spain. • The results obtained show a clearly different behaviour pattern to that found for heat. • The impact of cold days has remained constant over time. • It is necessary to implement prevention plans to reduce the impact of cold on health. [ABSTRACT FROM AUTHOR]

Highlights • A long-term (36-year) soil monitoring data was analyzed. • Soil chemical properties considered indicative of acidification trends in soils. • Statistical analysis indicated decreasing trends in pH and base saturation. • Necessary to distinguish the importance of statistical and biological differences. Abstract Long-term soil acidification monitoring was initiated in 1981 to track potential effects of acidic atmospheric deposition on soils in Alberta, Canada. Six of eight long-term sampling sites were located in forest ecosystems on sandy soils in northern and central Alberta, and two were situated in grasslands on sandy and fine-loamy soils in southern Alberta. Sampling was undertaken every four or five years, with 12 replicate samples taken from seven depth increments from 0–60 cm at each site. The statistical analysis of pH, exchangeable base saturation (BS) percentage, and solution base cation (BC) to aluminum (Al) ratio was conducted in the topmost soil layers (0–2, 2–5 and 5–10 cm). Analysis of variance (ANOVA) and linear regression indicated decreasing trends in pH and BS percentage in some of the sites. Comparison of the initial and most recent monitoring data indicated decreases of up to 0.5 pH units in these layers at five of the forested sites. At two forested sites located in the vicinity of oil sands and heavy oil processing plants, decreasing BS was observed early in the monitoring period, but the trend showed more variability since 2000, even though pH has continued to decline since 1981. BC to Al ratio showed statistically significant variations within some sites over time, but except for a downward trend at one central Alberta site, there were no overall patterns evident at the other sites over time. Both grassland sites had much higher BC to Al ratio and exchangeable BS percentages than the forested sites, and acidification trends were not detected at either of these sites. ANOVA and linear modelling approaches showed significant differences even in instances where pH differed by 0.1–0.2 units, or where other parameters showed very small differences. It is therefore necessary to distinguish between statistically important and biologically important differences in this monitoring program, which is intended to continue for several more years. [ABSTRACT FROM AUTHOR]

Despite the increasing incidence of acute coronary syndrome (ACS) in Japan, its prognosis has improved. However, there is a paucity of longitudinal registry data providing trends of in-hospital care and prognosis of ACS in Japan. ACS patients undergoing percutaneous coronary intervention (PCI) included in the Shinken Database 2004-2014 were divided into two groups according to admission year (2004-2009, n = 390; 2010-2014, n = 328). Patient characteristics, lesion/procedure characteristics, medications at discharge, all-cause mortality, cardiovascular death, acute myocardial infarction (AMI), target lesion revascularization (TLR), re-PCI to new lesion, and coronary artery bypass graft (CABG) within 2 years after discharge were compared between the groups. Prevalence of hypertension, dyslipidemia, and dual antiplatelet/statin prescription increased significantly between periods. Usage of second-generation drug-eluting stents (DES) increased markedly between the two periods (2.6, 66.8%), while those of bare metal stents (64.4, 26.5%) and first-generation DES (25.6, 1.5%) decreased (all, p < 0.01). Two-year event-free survival rate increased for all-cause mortality (94.6-98.3%, p = 0.01), TLR (79.4-96.1%, p < 0.01), and re-PCI to new lesion (87.3-95.1%, p < 0.01). There were no significant differences in cardiovascular death, AMI, or CABG between the two periods. The event-free rates for TLR and re-PCI to new lesion in ACS patients have increased over the last decade in Japan. These observations should be confirmed in larger, longitudinal, multicenter registries. [ABSTRACT FROM AUTHOR]

Objectives: The management of HIV disease is complicated by the incidence of a new spectrum of comorbid noncommunicable diseases (NCDs). It is important to document changes in the prevalence of NCDs over time. The aim of the study was to describe the impact of ageing on HIV markers and on the prevalence of NCDs in people living with HIV (PLWHIV) in the Italian Cohort of Individuals, Naïve for Antiretrovirals (ICONA) seen for care in 2004–2014. Methods: Analyses were conducted separately for a closed cohort (same people seen at both times) and an open cohort (all people under follow‐up). We used the χ2 test for categorical factors and the Wilcoxon test for quantitative factors to compare profiles over time. Results: The closed cohort included 1517 participants and the open cohort 3668 under follow‐up in 2004 and 6679 in 2014. The median age of the open cohort was 41 [interquartile range (IQR) 37–46] years in 2004 and 44 (IQR 36–52) years in 2014. Analysis of the closed cohort showed an increase in the prevalence of some NCDs [the prevalence of dyslipidaemia increased from 75% in 2004 to 91% in 2014, that of hypertension from 67 to 84%, and that of cardiovascular disease (CVD) from 18 to 32%] and a decrease in renal function (5% with eGFR < 60 mL/min per 1.73 m2 in 2004 versus 30% in 2014); the percentage of people in the high‐risk group for the Framingham CHD score more than tripled (from 13 to 45%). Results in the open cohort were similar. Conclusions: The burden of NCDs in our PLWHIV population markedly worsened over a 10‐year time‐span, which is likely to be a result of the effects of both ageing and HIV infection as well as their interaction. Special attention must be given to the management and prevention of NCDs. [ABSTRACT FROM AUTHOR]

Rainfall erosivity index (EI30) is widely used in soil erosion models for predicting soil loss. This index consists in the product between the maximum intensity of 30-min rainfall and the total kinetic energy of a precipitation event. The main goal of this study was to characterize the soil erosion in Piedmont (Northwestern Italy), studying the magnitude, frequency, and trends of rainfall erosivity. Rainfall erosivity for twelve stations well distributed over the whole region were firstly computed on the basis of 10-min timeresolution rainfall data using a continuous 17-year series of daily rainfall events. For each station the equation to predict EI30 from daily rainfall data was calculated, and, using the Nash and Sutcliffe (1970) model-efficiency, the relationships between real EI30 and modeled EI30 was validated. The rainfall erosivity model was applied to the long term daily rainfall series of the selected stations, to create annual and seasonal erosivity time series for the climate normal period 1986-2015. Afterwards, the Mann-Kendall non-parametric test statistic to detect time trends in the rainfall erosivity time series was applied. The results have led to the conclusion that the annual rainfall erosivity should have experienced mixed trends in most of the study area, although more than half of the stations did not show a statistical trend. [ABSTRACT FROM AUTHOR]

Abstract Objectives This study analyzed the relative time trends of prices of healthy versus unhealthy foods in South Korea for the 20 years from 1995 to 2015. Study design Time series analysis was used. Methods We analyzed price trends of selected food items in the food groups of grains, vegetables, meats, sweets, spices, fast foods, and non-alcoholic beverages. We obtained nominal prices from the monthly reports of the 2006 Consumer Price Survey for representative items in each food group. Results The real price of processed meat increased by 1.2 percentage points less than the overall Consumer Price Index (CPI) increase, whereas beef prices increased by 2.4 percentage points more than the CPI increase. The price of soda was cheaper than that of other non-alcoholic beverages, whereas the real prices of milk showed statistically significantly larger yearly increases (by 1.4 percentage points, respectively) than that of the CPI. The yearly increases in the real prices of pizza, hamburgers, and fried chicken—three representative fast-food items that were mostly consumed by eating out or through home delivery—were statistically significantly less than those of the CPI (by 1.5, 1.4, and 0.3 percentage points, respectively). Conclusions Our results show that relatively healthy foods showed higher real price increases than the CPI increase, whereas the opposite occurred for unhealthy foods. Highlights • We analyzed the relative time trends of prices of selected foods in South Korea. • Time series analysis was used for the 20 years from 1995 to 2015. • Relatively healthy foods showed higher real price increases than the Consumer Price Index increase. [ABSTRACT FROM AUTHOR]

Background: Although survival has improved in recent decades, the short-term prognosis of patients with immunoglobulin light chain (AL) amyloidosis remains grim. We aimed to assess overall survival (OS) of AL amyloidosis patients by comparing cohorts in two consecutive time periods. Methods: Data were collected and compared on 126 patients from two tertiary referral centres in The Netherlands during the time periods 2008-2012 and 2013-2016. Results: There was a non-significant trend to improved 6-month OS in the last cohort (78% vs. 67%, p = .216, crude odds ratio 1.66, 95%CI 0.74-3.70, adjusted odds ratio 2.22, 95%CI 0.88-5.56). Patients in this cohort had higher Mayo risk scores (stage III 40% vs. 24%, p < .001 and revised stage IV 14% vs. 11%, p < .001), higher use of bortezomib (50% vs. 30%), and better haematological response (complete response/very good partial response in 39% vs. 27%, p < .001). Diagnostic delay was similar in both time periods. Conclusions: In the 2013-2016 cohort there was a trend toward improved 6-month OS, and an improved haematological response. Patients in this cohort had more advanced cardiac disease and received bortezomib more frequently, but diagnostic delay was similar to the 2008-2012 cohort. For further prognostic improvement, practitioners should be more alert, especially for cardiac amyloidosis. [ABSTRACT FROM AUTHOR]

Siloxanes and synthetic musk compounds (SMCs) have been widely used as additives in household and personal care products. Humans are easily exposed to siloxanes and SMCs originating from these products through ingestion and dermal absorption of indoor dust. In the present study, indoor dust samples were analyzed for 19 siloxanes (cyclic and linear) and 12 SMCs (polycyclic, macrocyclic, and nitro musks) to assess their occurrence, time trends over time, source, and health risks. A total of 18 siloxanes and 10 SMCs were detected in all indoor dust samples obtained from 2011⎯2021, indicating widespread and long-term contamination. Higher detection frequencies and concentrations were associated with siloxanes and SMCs with higher use and strong resistance against degradation processes. Indoor dust samples were dominated by linear siloxanes (L11–L13), 1,3,4,6,7,8-hexahydro-4,6,6,7,8,8-hexamethylcyclopenta-(g)-2-benzopyran (HHCB), musk ketone (MK), and 7-acetyl-1,1,3,4,4,6-hexamethyl-1,2,3,4-tetrahydronaphthalene (AHTN). The frequent use of household and personal care products is likely an important source of siloxane and SMC contamination in indoor environments. The concentrations of siloxanes and SMCs in indoor dust increased from 2011 to 2021, particularly, those of linear siloxanes, reflecting the impact of regulatory actions addressing cyclic siloxanes. The profiles of siloxanes remained stable throughout the study period, whereas those of SMCs shifted from nitro to polycyclic musks. The estimated daily intakes (EDIs) of siloxanes and SMCs arising from ingestion were greater than from dermal absorption of indoor dust. The EDIs of siloxanes and SMCs associated with indoor dust indicated that children are exposed to these pollutants. [Display omitted] • Eighteen siloxanes and 10 SMCs were detected in house dust during the past 10 years. • Linear siloxanes (L11–L13) and HHCB were predominant in indoor dust from Korea. • There was a trend toward increasing siloxane and SMC concentrations during 2011–2021. • Contamination profiles of siloxanes remained stable, but those for SMCs changed over time. • A greater fraction of siloxane and SMC intakes was obtained through ingestion of indoor dust than dermal absorption. [ABSTRACT FROM AUTHOR]

Numerous studies have revealed associations between high intake of whole grains and reduced risk of various cancers. Yet, in recent decades, the traditional Chinese diets have been challenged by reduction in whole grains and increase in refined grains. To assess the impact of this dietary transition on cancer prevention, we analyzed the time trend of whole grain intake using nationally representative sampling data of over 15 thousand individuals from the China Health and Nutrition Survey. We applied the comparative risk assessment method to estimate the population attributable fraction of cancers due to insufficient whole grain intake from 1997 to 2011 and projected the trend of whole grain intake and the associated burden of cancers to 2035. We found a significant decrease of approximately 59% of whole grain intake in the Chinese population from 1997 to 2011. Compared with 1997, insufficient intake of whole grains was responsible for 9940 more cases of breast cancer, 12,903 more cases of colorectal cancer and 434 more cases of pancreatic cancer in 2011. Our projections suggest that if every Chinese would consume 125 g whole grain per day as recommended by the latest Chinese Dietary Guidelines, 0.63% bladder cancer, 8.98% breast cancer, 15.85% colorectal cancer, 3.86% esophageal cancer, 2.52% liver cancer and 2.22% pancreatic cancer (totaling 186,659 incident cases) could theoretically be averted by 2035. Even if everyone maintained the 2011 whole grain intake level, an estimated 8.38% of cancer events could still be prevented by 2035. • From 1997 to 2011, whole grain intake decreased by 59% in the Chinese population. • If everyone consumes 125 g/d whole grain may reduce 8.43% of cancer in China by 2035. • Keeping the whole grain intake in 2011 may reduce 8.38% of cancer in China by 2035. [ABSTRACT FROM AUTHOR]

Abstract Background In 2001, the National Health Interview Survey (NHIS) commenced in Taiwan. This survey, conducted on a sample of the whole Taiwanese population, is nationally representative and has a high response rate (>80 %). As a result, the four already completed surveys from 2001 to 2013 can be used to investigate the time trend of smoking prevalence, the rate of cessation, and exposure to secondhand smoking. Methods There were 72918 adults combined from the 2001, 2005, 2009 and 2013 National Health Interview Surveys (NHIS). Smoking status, exposure to secondhand smoking, and smoking cessation were asked, as well as demographic characteristics and other variables. Statistical analyses with sampling weights were carried out using SAS and SUDAAN. Results In males, the prevalence of smoking significantly decreased (rates in 4 surveys were 44.4 %, 44.6 %, 38.9 %, and 34.2 %, respectively). Since 2005 the rate of smoking cessation increased significantly (p = 0.033). The odd ratio (OR) exposure of secondhand among non-smokes (OR) in 2009 and 2013 were 0.96 (CI = 0.85–1.08) and 0.78 (CI = 0.70–0.88) comparing to 2005. In females, the prevalence of smoking was stable over time. The rate of smoking cessation only appeared significantly high in the older age group. The OR for exposure to secondhand smoking were 0.81 (CI = 0.74–0.89) and 0.68 (CI = 0.62–0.74), for 2009 and 2013 comparing to 2005, respectively. Conclusion Early anti-smoking legislation in Taiwan might have raised the awareness of the harm of smoking. However, the implementation of the Tobacco Hazards Prevention Act (THPA) in 2009 had great contribution to the reduction of smoking rate, especially in males.

Identifying trends in the prevalence and incidence of Parkinson's disease (PD) may yield information that supports public health goals. Our aim was to evaluate time-trend changes in the prevalence and incidence of PD in Taiwan between 2004 and 2011. Methods: This retrospective, nationwide, longitudinal study used the Taiwan National Health Insurance Research Database to identify patients with PD from 2004 to 2011 based on having ICD-9-CM diagnostic codes, which were assigned by neurologists, and being prescribed PD medication. Annual incidence and prevalence were calculated, and time-trend analyses were estimated assuming a Poisson distribution. Results: Over the study period, 19,302 patients in 2004 and 41,606 patients in 2011 fulfilling the study criteria for PD were included in the analysis. The average age-standardized prevalence of PD per 100,000 of population was 84.8 in 2004 and 147.7 in 2011, with a 7.9% yearly increase. Increasing prevalence trends of PD were statistically significant (p

Jane Bendix,1 Hanne Kristine Hegaard,2 Jens Langhoff-Roos,3 Thomas Bergholt3 1Department of Gynaecology and Obstetrics, Nordsjaellands Hospital Hillerod, University of Copenhagen, Hillerod, Denmark; 2The Research Unit of Women’s and Children’s Health, The Juliane Marie Centre for Women, Children and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; 3Department of Obstetrics, The Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark Purpose: Population-based studies evaluating the use and extent of antenatal obstetric hospitalizations (AOH) are sparse. The objective of the present study was to describe the prevalence, time trend, and risk factors for AOH in Denmark. Materials and methods: A retrospective national register-based cohort study was conducted that included all pregnancies with delivery after 22 gestational weeks in Denmark from 2003 to 2012. The outcomes were AOH and the diagnoses leading to these hospitalizations. AOH was defined as an antenatal hospitalization for at least 1 day with at least one obstetric International Classification of Diseases-10 diagnosis and admission date more than 3 days before delivery. Results: The study included 617,906 pregnancies; 48,366 (7.8%) pregnancies were associated with 64,072 AOH before delivery. The percentage of pregnancies with AOH decreased from 8.6% to 7.1%. The median length of stay decreased from 3 to 2 days, and admission for at least 7 days was almost halved. Threatened preterm delivery was the most frequent diagnostic category for AOH. A decline was seen in all diagnostic categories except maternal diseases. Significant risk factors for AOH were multiple pregnancies, low or high maternal age and body mass index, nulliparity, lower educational levels, unemployment or being outside the workforce, single partner status, and smoking. The relative risk of very preterm delivery before gestational age of 34 weeks was higher in pregnancies with AOH compared with pregnancies without AOH (relative risk 15.2; 95% confidence interval: 14.6–15.8). Conclusion: This study shows a shift toward less use and shorter duration of antenatal hospitalization in Denmark. The most common indication used in pregnancies with AOH was threatened preterm delivery, and more than one-third resulted in very preterm deliveries. Keywords: obstetric admissions, pregnancy complications, diagnosis, Danish health registry study, time trend

Aidan G O’Keeffe,1 Irwin Nazareth,2 Irene Petersen2 1Department of Statistical Science, 2Department of Primary Care and Population Health, University College London, London, UK Background: Statins are widely prescribed for the primary prevention of cardiovascular disease. Guidelines exist for statin prescriptions, but there is little recent analysis concerning prescription trends over time and how these vary with respect to demographic variables.Methods and results: Using The Health Improvement Network primary care database, statin therapy initiation and statin prescription prevalence rates were calculated using data from 7,027,711 individuals across the UK for the years 1995 to 2013, overall and stratified by sex, age group, and socioeconomic deprivation level (Townsend score). Statin therapy initiation rates rose sharply from 1995 (0.51 per 1,000 person-years) up to 2006 (19.83 per 1,000 person-years) and thereafter declined (10.76 per 1,000 person-years in 2013). Males had higher initiation rates than females and individuals aged 60–85 years had higher initiation rates than younger or more elderly age groups. Initiation rates were slightly higher as social deprivation level increased, after accounting for age and sex. Prescription prevalence increased sharply from 1995 (2.36 per 1,000 person-years) to 2013 (128.03 per 1,000 person-years) with males generally having a higher prevalence rate, over time, than females. Prevalence rates over time were generally higher for older age groups but were similar with respect to social deprivation level.Conclusion: The uptake of statins within UK primary care has increased greatly over time with statins being more commonly prescribed to older patients in general and, in recent years, males appear to have been prescribed statins at higher rates than females. After accounting for age and sex, the statin therapy initiation rate increases with the level of social deprivation. Keywords: cardiovascular disease, primary prevention, statin therapy, time trend, United Kingdom

Background Acute heart failure (AHF) is a heterogeneous condition, and its characteristics and management patterns differ by region. Furthermore, limited evidence is available on AHF outside of Western countries. A project by the National Consortium of Acute Heart Failure Registries was designed to evaluate the trends over time in patient backgrounds, in‐hospital management patterns, and long‐term outcomes of patients with AHF over 9 years in Japan. Methods and Results Between 2007 and 2015, registry data for patients with AHF were collected from 3 large‐scale quality AHF registries (ATTEND/WET‐HF/REALITY‐AHF). Predefined end points were trends over time in age, sex, and clinical outcomes, including short‐ and long‐term mortality and readmission for heart failure. The final data set consisted of 9075 patients with AHF. No significant differences in patient backgrounds and laboratory findings (eg, anemia or renal function) were observed, with the exception of patient age; mean age became substantially higher over 9 years (71.6–77.0 years; P for trend,

Purpose: Antidepressant use has increased in many European countries, mostly driven by longer treatment duration. The aim of this study was to provide prevalence rates of long-term users of antidepressants for the Swiss population over the last decade and to investigate associated factors for longer use., Methods: We examined the prevalence rates of individuals with at least one prescription for antidepressants using longitudinal health claims data for 2013 to 2021. We defined short- (< one year), medium- (one-two years), and long-term users (> two years) for 2015 to 2019. We applied a binary logistic regression model to investigate the effects of population (gender, age, area of living, language, health insurance plan, and nursing home) and treatment characteristics (psychiatric or psychotherapeutic care) on long-term compared to short- and medium-term users in 2019., Results: In 2021, 9% of the Swiss population (n = 770,698) received at least one antidepressant prescription, which remained stable since 2013. In 2019, the proportion of long-term users was 57.4%, with steady increase since 2015. The proportion of medium- and short-term users has decreased. Older age, being a woman, living in an urban area, living in a nursing home, being enrolled in a standard care plan, and receiving psychiatric or psychotherapeutic care were factors positively associated with being a long-term user., Conclusion: The proportion of long-term users in Switzerland is high and steadily increasing. Given the ongoing debate about the confounding effects of relapse and withdrawal, more research is needed to investigate longer use of antidepressants that could indicate overprescribing., (© 2023. The Author(s).)

Aim: To investigate time trends in myopia and high myopia prevalence over 6y among young university adults in China., Methods: This is a 6-year series cross-sectional study from 2016 to 2021. Totally 4910 freshmen were enrolled and completed a questionnaire concerning age, gender, and disease history. Students with eye diseases were excluded after a detailed eye examination. The refractive status was measured by non-cycloplegic objective refraction and ocular parameters were measured by Lenstar 900. The examination followed the same protocol each year. Trends over time in myopia and high myopia prevalence, as well as ocular biometry parameters, were analyzed., Results: From 2016 to 2021, the axial length (AL) and corneal radius (CR) increased significantly ( P =0.002 for AL; P =0.04 for CR). However, the spherical equivalent (SE) and the ratio of axial length to the corneal radius (AL/CR) did not change significantly ( P =0.59 for SE; P =0.24 for AL/CR). The frequency of AL ≥26.0 mm increased from 26.6% in 2016 to 29.3% in 2021 ( P =0.05 for trend). The prevalence of myopia and high myopia did not change significantly in our study ( P ≥0.18). Compared to a similar cross-sectional study conducted 10 years ago, the prevalence of myopia decreased significantly (94.9% vs 91.8%, P <0.001). Whereas the prevalence of high myopia increased largely (18.12% vs 27.6%, P <0.001)., Conclusion: The prevalence of high myopia increases in young university adults during 10y period. Myopia control should begin earlier in childhood. However, these interventions are still needed for high myopia even in young adulthood., (International Journal of Ophthalmology Press.)

Of the thousands of per- and polyfluoroalkyl substances (PFAS) known to exist, only a small fraction (≤1%) are commonly monitored in humans. This discrepancy has led to concerns that human exposure may be underestimated. Here, we address this problem by applying a comprehensive fluorine mass balance (FMB) approach, including total fluorine (TF), extractable organic fluorine (EOF), total oxidizable precursors (TOP), and selected target PFAS, to human serum samples collected over a period of 28 years (1986, 2007, and 2015) in Tromsø, Norway. While concentrations of TF did not change between sampling years, EOF was significantly higher in 1986 compared to 2007 and 2015. The ∑ 12 PFAS concentrations were highest in 2007 compared to 1986 and 2015, and unidentified EOF (UEOF) decreased from 1986 (46%) to 2007 (10%) and then increased in 2015 (37%). While TF and EOF were not influenced by sex, women had higher UEOF compared to men, opposite to target PFAS. This is the first FMB in human serum to include TOP, and it suggests that precursors with >4 perfluorinated carbon atoms make a minor contribution to EOF (0-4%). Additional tools are therefore needed to identify substances contributing to the UEOF in human serum.

Aims and Objectives: To determine the global prevalence of nursing burnout syndrome and time trends for the last 10 years., Background: The prevalence of burnout syndrome varied greatly in different regions in the last 10 years, so the average prevalence and time trends of nursing burnout syndrome for the last 10 years were not completely clear., Design: A meta-analysis conducted in the PRISMA guidelines., Methods: CINAHL, Web of Science, and PubMed were searched for trials on the prevalence of nursing burnout syndrome from 2012 to 2022 systematically. Hoy's quality assessment tool was used to evaluate the risk of bias. The global prevalence of nursing burnout syndrome was estimated, and subgroup analysis was used to explore what caused heterogeneity. Time trends for the last 10 years were evaluated by meta-regression using Stata 11.0., Results: Ninety-four studies reporting the prevalence of nursing burnout were included. The global prevalence of nursing burnout was 30.0% [95% CI: 26.0%-34.0%]. Subgroup analysis indicated that the specialty (p < .001) and the region (p < .001) and the year (p < .001) were sources of the high heterogeneity. Meta-regression indicated that it tended to increase gradually for the last 10 years (t = 3.71, p = .006). The trends increased in Europe (t = 4.23, p = .006), Africa (t = 3.75, p = .006) and obstetrics (t = 3.66, p = .015). However, no statistical significance was found in ICU (t = -.14, p = .893), oncology (t = -0.44, p = .691) and emergency department (t = -0.30, p = .783)., Conclusions: A significant number of nurses were found to have moderate-high levels of burnout syndrome for the last 10 years. The meta-analysis also indicated an increased trend over time. Therefore, more attention to the prevalence of nursing burnout syndrome is urgently required., Relevance to Clinical Practice: High prevalence of nursing burnout may attract more attention from the public. This analysis may serve as an impetus for relevant policy to change nurses' working conditions and reduce the occurrence of burnout., (© 2023 John Wiley & Sons Ltd.)