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Background The trend of added sugar ( AS) intake has not been investigated in the Australian population, including in older adults. The present study aimed to assess trends and food sources of AS intake among a cohort of older Australians during 15 years of follow-up. Methods Dietary data from participants of the Blue Mountains Eye Study (1264 men and 1614 women), aged ≥49 years at baseline, were collected. Dietary intakes were assessed at 5-yearly intervals (1992-94 to 2007-09) using a 145-item food frequency questionnaire ( FFQ). AS content of FFQ food items was estimated using a stepwise systematic method. Trends for AS intake between baseline and the three follow-up periods were assessed using linear mixed modelling. Results In men, the mean ( SEM) percentage of energy provided by AS intake ( EAS%) declined from 10.4% (0.1%) at baseline to 9.4% (0.2%) at 15-year follow-up ( Ptrend = 0.028). Women's mean ( SEM) EAS% intake at baseline and 15-year follow-up was 9.2% (0.1%) and 8.8% (0.2%), respectively ( Ptrend = 0.550). EAS% intake of men was significantly higher than that of women for 10 years ( P < 0.05). Sugar products (table sugar, syrup, jam and honey) were the major sources of AS at all-time points and contributed to more than 40% and 35% of AS intake in men and women, respectively. Intake of sugar products decreased in men during follow-up ( Ptrend < 0.001). Conclusions An overall downward trend was observed in AS intake in both genders, however, was only significant for men during 15 years of follow-up. Table sugar and sugar-containing spreads represent the major source of AS in this cohort of older Australians. [ABSTRACT FROM AUTHOR]

Summary 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. [ABSTRACT FROM AUTHOR]

Background and purpose Data on mortality in patients with epilepsy have been available since the 1800s. They consistently show a 2−3-fold increase compared to the general population. Despite major advances in diagnostic tools and treatment options, there is no evidence for a decrease in premature deaths. The temporal trend of mortality in a hospital-based epilepsy cohort over three decades was assessed. Methods A hospital-based incidence cohort was recruited from a specialized epilepsy outpatient clinic at Innsbruck Medical University between 1980 and 2007, divided by decade into three cohorts and followed for 5 years after initial epilepsy diagnosis. Deaths and their primary causes were determined using probabilistic record linkage with the Austrian death registry. Age-, sex- and period-adjusted standardized mortality rates ( SMRs) were computed in relation to the general population of the same area and grouped according to time of diagnosis. Results In all, 122 deaths in 4549.9 person-years (1954.5 women, 2595.2 men) were identified. The overall SMR was 2.2 [95% confidence interval ( CI) 1.8-2.6] and decreased from 3.0 (95% CI 2.1-4.3) in 1980-1989, to 2.7 (95% CI 2.0-3.5) in 1990-1999 and to 1.4 (95% CI 1.0-2.0) in 2000-2007. Conclusions This study indicates a decrease in mortality in newly diagnosed epilepsy patients over the last three decades. This may be due to advances in diagnosis and treatment over the past three decades, including early identification of drug resistance, introduction of new anti-epileptic drugs and establishment of a comprehensive epilepsy surgery programme in this region. [ABSTRACT FROM AUTHOR]

Previous studies have argued that tourism policy has a long-term positive relationship with tourism development. This study explored temporal trends in and seasonal effects of the number of tourists traveling to Taiwan between 2001 and 2016, and compared the effects of adjustments in tourism policy on tourism development to determine whether Taiwan's international tourism policies have had long-term effects on tourism development. Temporal trends and seasonal factors were not significantly related to adjustments in tourism policy but there was a relationship between the economic status of tourist exporters and Taiwan's tourist development. [ABSTRACT FROM AUTHOR]

Esophagogastric junction ( EGJ) adenocarcinoma has been on the increase in Western countries. However, in Asian countries, data on the incidence of EGJ adenocarcinoma are evidently lacking. In the present review, we focus on the current clinical situation of EGJ adenocarcinoma in three Asian countries: Japan, Hong Kong, and Malaysia. The incidence of EGJ adenocarcinoma has been reported to be gradually increasing in Malaysia and Japan, whereas it has stabilized in Hong Kong. However, the number of cases in these countries is comparatively low compared with Western countries. A reason for the reported difference in the incidence and time trend of EGJ adenocarcinoma among the three countries may be explained by two distinct etiologies: one arising from chronic gastritis similar to distal gastric cancer, and the other related to gastroesophageal reflux disease similar to esophageal adenocarcinoma including Barrett's adenocarcinoma. This review also shows that there are several concerns in clinical practice for EGJ adenocarcinoma. In Hong Kong and Malaysia, many EGJ adenocarcinomas have been detected at a stage not amenable to endoscopic resection. In Japan, histological curability criteria for endoscopic resection cases have not been established. We suggest that an international collaborative study using the same definition of EGJ adenocarcinoma may be helpful not only for clarifying the characteristics of these cancers but also for improving the clinical outcome of these patients. [ABSTRACT FROM AUTHOR]

Esophagogastric junction (EGJ) adenocarcinoma has been on the increase in Western countries. However, in Asian countries, data on the incidence of EGJ adenocarcinoma are evidently lacking. In the present review, we focus on the current clinical situation of EGJ adenocarcinoma in three Asian countries: Japan, Hong Kong, and Malaysia. The incidence of EGJ adenocarcinoma has been reported to be gradually increasing in Malaysia and Japan, whereas it has stabilized in Hong Kong. However, the number of cases in these countries is comparatively low compared with Western countries. A reason for the reported difference in the incidence and time trend of EGJ adenocarcinoma among the three countries may be explained by two distinct etiologies: one arising from chronic gastritis similar to distal gastric cancer, and the other related to gastroesophageal reflux disease similar to esophageal adenocarcinoma including Barrett's adenocarcinoma. This review also shows that there are several concerns in clinical practice for EGJ adenocarcinoma. In Hong Kong and Malaysia, many EGJ adenocarcinomas have been detected at a stage not amenable to endoscopic resection. In Japan, histological curability criteria for endoscopic resection cases have not been established. We suggest that an international collaborative study using the same definition of EGJ adenocarcinoma may be helpful not only for clarifying the characteristics of these cancers but also for improving the clinical outcome of these patients. [ABSTRACT FROM AUTHOR]

In this study, we present a new theory of partitioning of disease prevalence and incidence-based mortality and demonstrate how this theory practically works for analyses of Medicare data. In the theory, the prevalence of a disease and incidence-based mortality are modeled in terms of disease incidence and survival after diagnosis supplemented by information on disease prevalence at the initial age and year available in a dataset. Partitioning of the trends of prevalence and mortality is calculated with minimal assumptions. The resulting expressions for the components of the trends are given by continuous functions of data. The estimator is consistent and stable. The developed methodology is applied for data on type 2 diabetes using individual records from a nationally representative 5% sample of Medicare beneficiaries age 65 + . Numerical estimates show excellent concordance between empirical estimates and theoretical predictions. Evaluated partitioning model showed that both prevalence and mortality increase with time. The primary driving factors of the observed prevalence increase are improved survival and increased prevalence at age 65. The increase in diabetes-related mortality is driven by increased prevalence and unobserved trends in time-periods and age-groups outside of the range of the data used in the study. Finally, the properties of the new estimator, possible statistical and systematical uncertainties, and future practical applications of this methodology in epidemiology, demography, public health and health forecasting are discussed. [ABSTRACT FROM AUTHOR]

Aim: Time trends in multimorbidity have rarely been examined and no criteria have been developed to measure the development of multimorbidity over time. Against the backdrop of increasing numbers of diagnoses a robust measure is needed that is sensitive to changes over time and allows to differentiate between multimorbid and non-multimorbid individuals. We examine how prevalence estimates change as criteria for defining multimorbidity are varied systematically and how this influences the observed time trend. Subject and methods: Our analyses are based on the data of a German statutory health insurance from 2005 to 2013. Measures are compared using different minimal numbers of chronic conditions required to define multimorbidity: three and six. As a stricter criterion both variants are then combined with polypharmacy. Results: All definitions of multimorbidity are leading to increasing prevalence rates over time. Defining multimorbidity as the presence of three or more chronic conditions leads to very high prevalence rates and is lacking discriminative power in the oldest old. Lower prevalence rates with a sharp increase over time can be observed in the proportion of insured with at least six chronic conditions. Adding polypharmacy reduces the growth over time remarkably. Conclusion: The analyses suggest that the increase of multimorbidity is mainly driven by chronic conditions that are not in need of complex medication. Simple disease counts are inappropriate for defining multimorbidity. [ABSTRACT FROM AUTHOR]

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Background: Suicide is a significant public health issue worldwide, resulting in loss of lives, and burdening societies. Aims: To describe and analyze the time trends of suicide rates (SRs) in the Slovak Republic in 1993–2015 for targeted suicide prevention strategies. Methods: Data for this study were obtained from the mortality database of the Statistical Office of the Slovak Republic. Crude and standardized annual SRs were calculated. Trends and relative risks of suicide according to age and sex were analyzed by joinpoint regression and negative binomial regression. Results: In total, there were 14,575 suicides in the Slovak Republic in the period 1993–2015 (85.3% were men). The overall average age-standardized SR for the study period was 11.45 per 100,000 person years. The rate increases with age, the highest is in men aged 75+ (42.74 per 100,000 person years). Risk of suicide is six times higher in men than in women and nine times higher in men than in women in the age group 25–34. The time trend of SRs is stable or decreasing from 1993 to 2007, but increasing after 2007, corresponding with increased unemployment rate in the country. Conclusion: The SR in the Slovak Republic is slightly below the average of Organisation for Economic Co-operation and Development (OECD) nations. Highest SR is observed in men of working age and in retirement. Society might benefit from a strategy of education for improving the recognition of suicide risks. [ABSTRACT FROM AUTHOR]

Objective/Background To review the incidence of post-carotid endarterectomy (CEA) cranial nerve injury (CNI), and to evaluate the risk factors associated with increased CNI risk. Methods The study was a meta-analysis. Pooled rates with 95% confidence intervals (CIs) were calculated for CNIs after primary CEA. Odds ratios (ORs) were calculated for potential risk factors. A fixed-effects model or a random effects model (Mantel–Haenszel method) was used for non-heterogeneous and heterogeneous data, respectively. Meta-regression analysis was performed to examine the influence of publication year upon CNI rate. Results Twenty-six articles, published between 1970 and 2015, were included in the meta-analysis, corresponding to 20,860 CEAs. Meta-analysis revealed that the vagus nerve was the most frequently injured cranial nerve (pooled injury rate 3.99%, 95% CI 2.56–5.70), followed by the hypoglossal nerve (3.79%, 95% CI 2.73–4.99). Fewer than one seventh of these injuries are permanent (vagus nerve: 0.57% [95% CI 0.19–1.10]; hypoglossal nerve: 0.15% [95% CI 0.01–0.39]). A statistically significant influence of publication year on the vagus and hypoglossal nerve injury rate was found, with the injury rate having decreased from about 8% to 2% and 1%, respectively, over the last 35 years. Urgent procedures (OR 1.59, 95% CI 1.21–2.10; p = .001), as well as return to the operating room for a neurological event or bleeding (OR 2.21, 95% CI 1.35–3.61; p = .002) were associated with an increased risk of CNI, whereas no statistically significant association was found between CNIs and the type of anaesthesia, the use of a patch, redo operation, and the use of a shunt. Conclusion The vagus nerve appears to be the most frequently injured cranial nerve after CEA, followed by the hypoglossal nerve, with only a small proportion of these injuries being permanent. The CNI rate has significantly decreased over the past 35 years to a point indicating that CNIs should not be considered a major influencing factor in the decision making process between CEA and stenting. [ABSTRACT FROM AUTHOR]

The broadband herbicide glyphosate (N-[phosphonomethyl]-glycine) and its main metabolite aminomethylphosphonic acid (AMPA) were analyzed by GC-MS-MS in 24h-urine samples cryo-archived by the German Environmental Specimen Bank (ESB). Samples collected in 2001, 2003, 2005, 2007, 2009, 2011, 2012, 2013, 2014, and 2015 were chosen for this retrospective analysis. All urine samples had been provided by 20 to 29 years old individuals living in Greifswald, a city in north-eastern Germany. Out of the 399 analyzed urine samples, 127 (=31.8%) contained glyphosate concentrations at or above the limit of quantification (LOQ) of 0.1μg/L. For AMPA this was the case for 160 (=40.1%) samples. The fraction of glyphosate levels at or above LOQ peaked in 2012 (57.5%) and 2013 (56.4%) after having discontinuously increased from 10.0% in 2001. Quantification rates were lower again in 2014 and 2015 with 32.5% and 40.0%, respectively. The overall trend for quantifiable AMPA levels was similar. Glyphosate and AMPA concentrations in urine were statistically significantly correlated (spearman rank correlation coefficient=0.506, p≤0.001). Urinary glyphosate and AMPA levels tended to be higher in males. The possible reduction in exposure since 2013 indicated by ESB data may be due to changes in glyphosate application in agricultural practice. The ESB will continue monitoring internal exposures to glyphosate and AMPA for following up the time trend, elucidating inter-individual differences, and contributing to the ongoing debate on the further regulation of glyphosate-based pesticides. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to describe temporal trends in tumour pathology and long-term outcomes in 5217 patients recorded in a registry of colorectal cancer resections initiated at Concord Hospital, Sydney, Australia, in 1971. Methods This report is based on consecutive resections up to December 2013, with no exclusions. Categories in variables examined were expressed as percentages over annual totals of relevant patients or annual mean values. The statistical significance of temporal trends was examined by least squares regression. Results The percentages of patients with local spread beyond the muscularis propria, nodal metastasis, distant metastasis and tumour in a line of resection all declined significantly. In consequence, the percentage of stage D patients fell, whereas the percentage in stage A rose. Other tumour variables that increased significantly were polypoid morphology, contiguous adenoma and invasion of a free serosal surface. Tumours in which an adherent adjacent structure was partly or completely removed also increased. There were significant declines in high-grade malignancy, venous invasion and tumour size. The recurrence rate for rectal cancers declined significantly, whereas for rectal and colonic cancers combined, both the overall 5-year survival rate and the 5-year cancer-specific survival rate increased markedly. Conclusion These results show a reduction in adverse pathology findings and favourable trends in recurrence and survival after colorectal cancer resections in a high-incidence country over a period of 43 years. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to describe temporal trends in presentation, surgical management and immediate postoperative outcomes in patients recorded in a registry of colorectal cancer resections that was initiated at Concord Hospital, Sydney, Australia, in 1971. A companion paper describes tumour pathology and long-term recurrence and survival. Methods This report is based on 5217 consecutive resections up to 2013, with no exclusions. Categories in variables examined were expressed as percentages over annual totals of relevant patients or annual mean values. The statistical significance of trends was examined by least squares regression. Results The percentage of asymptomatic patients increased over time, whereas urgent presentations declined. Tumour size declined. The percentage of rectal cancers fell but the percentage of low rectal tumours rose. Initially, restorative rectal resections increased rapidly but later remained stable. There was no trend in medical complications, whereas surgical complications declined. Anastomotic leakage after restorative rectal resections declined but it was low and stable for colonic tumours. The rate of early reoperation remained stable, whereas 30-day mortality declined. Neoadjuvant radiotherapy for rectal cancer and adjuvant chemotherapy for stages B and C were introduced in 1992 and applied increasingly thereafter. Conclusion Our findings, based on a 43-year prospective study, indicate sustained trends towards the earlier diagnosis of colorectal cancer and favourable short-term outcomes following bowel resection. [ABSTRACT FROM AUTHOR]

Unhealthy food in advertising has been suggested as a mediator for the increase in diet-related illness. This study quantitatively investigates changes in food advertising between 1995 and 2014 in terms of food categories promoted, macronutrient content, and percentage of foods classified as heathy or unhealthy from a sample of 7,199 ads from three Swedish food magazines. With the exception of increased alcoholic beverage and decreased carbohydrate-rich-food promotion, no monotonic trends of increasingly unhealthy food advertisement are found. From these findings, it is argued that food magazine advertising is not a mediator of the adverse dietary trend. [ABSTRACT FROM PUBLISHER]

Trace elements are chemical contaminants spread in the environment by anthropogenic activities and threaten wildlife and human health. Many studies have investigated this contamination in apex raptors as sentinel birds. However, there is limited data for long-term biomonitoring of multiple trace elements in raptors. In the present study, we measured the concentrations of 14 essential and non-essential trace elements in the livers of the common buzzard (But eo buteo) collected in the United Kingdom from 2001 to 2019 and investigated whether concentrations have changed during this period. In addition, we estimated the importance of selected variables for modelling element accumulations in tissues. Except for cadmium, hepatic concentrations of harmful elements in most buzzards were lower than the biological significance level of each element. Hepatic concentrations of certain elements, including lead, cadmium, and arsenic, varied markedly seasonally within years. Their peak was in late winter and trough in late summer, except copper which showed an opposite seasonal pattern. In addition, lead in the liver consistently increased over time, whereas strontium showed a decreasing trend. Hepatic concentrations of cadmium, mercury, and chromium increased with age, whereas selenium and chromium were influenced by sex. Hepatic concentrations of arsenic and chromium also differed between different regions. Overall, our samples showed a low risk of harmful effects of most elements compared to the thresholds reported in the literature. Seasonal fluctuation was an important descriptor of exposure, which might be related to the diet of the buzzard, the ecology of their prey, and human activities such as the use of lead shot for hunting. However, elucidating reasons for these observed trends needs further examination, and biomonitoring studies exploring the effects of variables such as age, sex, and seasonality are required. [Display omitted] • Liver Pb, Cd, As, Se, Cu, and Co fluctuated seasonally within a year. • Fluctuation peak was in late winter and trough in late summer, except for Cu. • Liver Pb increased over the monitoring period. • Body and liver weights were negatively correlated with liver essential elements. • Relative importance of variables for predictive models of metal burden was estimated. [ABSTRACT FROM AUTHOR]

Over the last twenty-five years it has become evident that exposure to several phthalates can have adverse effects on human health, such as endocrine disruption. This led to a series of EU regulations that resulted in a decrease in the production volumes of the restricted phthalates and an increased production of substitutes. The current study describes the impact of regulations and changes in production and use of phthalates and their substitutes on internal exposure patterns in two European populations since the beginning of the 2000′ies. Using harmonised data from young adults in Denmark (Danish Young Men Study, n = 1,063, spot urine) and Germany (Environmental Specimen Bank, n = 878, 24-h urine) with repeated cross-sectional design (3–11 cycles per biomarker) we applied Locally Estimated Scatterplot Smoothing (LOESS) and Generalized Linear Models (GLMs) to estimate time trends and the role of covariates on the trend (e.g. age, BMI). Time trends of daily excretion (μg/24h) are comparable between the two samples for the regulated (DEHP, BBzP, DiNP, DnBP, DiBP, DiDP/DPHP) as well as the non-regulated substances (DMP, DEP, DINCH, DEHTP) although the rate of change differ for some of the compounds. GLM results indicate that the daily excretion of the most regulated phthalates has decreased over time (DEHP yearly about 12–16%, BBzP 5%, DnBP 0.3–17%, and DiBP 4–12%). Interestingly, also the non-regulated phthalates DMP and DEP decreased by 6–18% per year. In sharp contrast, the phthalate substitutes DINCH and DEHTP show very steep annual increases (∼10–68% and ∼100%, respectively) between 2009 and 2017. We did not find an effect of age, sex, BMI, or education on the time trend. The present study provides comparable insights into how exposure to phthalates and two of their substitutes have changed over the last two decades in Germany and Denmark. • Comparable time trends in Danish and German young adults. • Strongest decline per year for the regulated phthalates DEHP (16% in DYMS) and MnBP (17% in ESB). • Decline also for non-regulated phthalates DEP and DMP. • Harmonising 24-h urine and spot urine via estimating their 24-h excretion. • Substitutes DEHTP and DINCH show sharp yearly increases between 2009 and 2017. [ABSTRACT FROM AUTHOR]

Objective: To describe the practice of prostate-specific antigen (PSA) testing over more than 20 years in Friuli Venezia Giulia (FVG), North-Eastern Italy., Methods: A population-based, ecological study was conducted using information derived from regional administrative health-related databases. Data on PSA and prostate biopsies performed on resident men aged ⩾45 years from 1998 to 2019 were retrieved. PSA and biopsy rates were calculated as the number of men who had at least one such procedure in each calendar year over the mean resident male population of the same year. Temporal trends were analyzed using joinpoint regression (annual percentage change -APC)., Results: A total of 2,502,670 PSA were made between 1998 to 2019 in men aged ⩾45 years. The number of PSA steadily increased from 51,055 in 1998-1999 to 134,504 in 2010-2011, then dropped to 122,080 in 2018-2019. Significant changes in the slopes of PSA rates emerged in 2002 and 2009: the largest increase occurred during 1998-2002 (APC 18.4), followed by a smaller increase in 2002-2009 (APC 3.4) and a subsequent reduction (APC -2.5). Similar patterns emerged for all ages, but the decrease since 2009 was smaller for men aged ⩾65 years. An upward trend emerged in biopsy rate from 1998 to 2001 (APC 13.0), followed by a smaller increase until 2007 (APC 5.7) and a subsequent decrease. Biopsies as percentage of PSA decreased from 3.2% to 2.2%, particularly in those aged ⩾75 years., Conclusions: Although overall declining PSA rates have been observed in FVG since 2009, rates remained higher in the ⩾65-year-old group than in the 45-64-year-old group.

This article describes the recent prevalence and trend in weight status in young men over three and half decades among Austrian conscripts overall and by subgroups defined by education and smoking behavior. We extracted medical record data from six medical examination stations across the country of all Austrian military conscripts (aged 17-19 years) recruited between 1983 and 2017 (n = 1.5 million). Weight and height were measured to calculate body mass index (BMI). Mean BMI increased from 22.7 to 24.3 kg/m 2 between 1983 and 2017. Over time, the prevalence of obesity (BMI ≥ 30 kg/m 2 ) increased from 1.6% (95% CI 1.6-1.7%) to 8.2% (95% CI 8.1-8.3%). The prevalence of obesity among Austrian young men increased remarkably in the past 35 years. Higher levels of education appeared to be associated with lower prevalence of obesity, particularly among the non-smokers., (© 2021. The Author(s).)

Schistosomiasis (Schistosomiasis japonica) remains an important public health problem in China, and the Chinese government has set an ambitious goal of eliminating schistosomiasis by 2030. Based on the observational study of the Global Burden of Disease Study database in 2019 (GBD2019) and the World Bank database, this study aimed to analyze the prevalence trend of schistosomiasis in China from 1990 to 2019 by using the joinpoint regression model, and the relationship between economic and social development and schistosomiasis prevalence. The data of age-standardized infection rates (ASRs) from the Global Burden of Disease Study Global Health Data Exchange were collected, and Gross national product per capita (GDP) and people using safely managed sanitation services ((PPMS) % of population) were extracted from the World Bank database. Trends of ASR were analyzed using joinpoint regression analysis, the association of ASR with GDP, and PPMS using the Pearson correlation analysis. The results reveal that, from 1990 to 2019, the overall trend of ASR from schistosomiasis showed a decrease for both sexes, the decreases in men were relatively smaller compared with women. A larger decrease has been observed in the age groups from 15 to 49 years compared with other age groups. The ASR of schistosomiasis had a significant negative correlation with GDP and PPMS. This observational study identified decreasing prevalence rate of schistosomiasis in China since 1990. Continuous investment, optimization of control strategy, and economic development will help to achieve the goal of schistosomiasis elimination.

Background: Alarming levels of emotional symptoms among youth were reported during the COVID-19 pandemic. Studies assessing these figures against the pre-pandemic developments are rare. We examined the trend of generalized anxiety (GA) in adolescents in the 2010s and the effect of the COVID-19 pandemic against this trend., Methods: Data from the Finnish School Health Promotion study with 750,000 participants aged 13-20 between 2013 and 2021 was analyzed using GAD-7 to measure self-reported GA (cut-off ≥10). Inquiries were made about remote learning arrangements. Effects of time and COVID-19 were analyzed with logistic regression., Results: Among females, an increasing trend in GA between 2013 and 2019 was found (OR per year 1.05), and the prevalence increased from 15.5 % to 19.7 %. Among males, the trend was decreasing (OR = 0.98), with prevalence from 6.0 % to 5.5 %. Increase in GA from 2019 to 2021 was stronger in females (19.7 % to 30.2 %) than males (5.5 % to 7.8 %), while the effect of COVID-19 on GA was equally strong (OR = 1.59 vs. OR = 1.60) against the pre-pandemic trends. Remote learning was associated with elevated levels of GA, especially among those with unmet needs for learning support., Limitations: The design of repeated cross-sectional surveys doesn't allow analyses of within individual changes., Conclusions: Given the pre-pandemic trends of GA, the COVID-19 effect on it appeared equal in both sexes. The increasing pre-pandemic trend among adolescent females and the strong effect of COVID-19 on GA among both sexes warrants constant monitoring of mental health of the youth in the aftermath of the COVID-19 pandemic., Competing Interests: Conflict of interest The authors declare no conflict of interest., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Oral cancer is a significant public health problem world-wide and exerts high economic, social, psychological, and physical burdens on patients, their families, and on their primary care providers. We set out to describe the changing trends in incidence and survival rates of oral cancer in Ireland between 1994 and 2009. Methods: National data on incident oral cancers [ICD 10 codes C01-C06] were obtained from the National Cancer Registry Ireland from 1994 to 2009. We estimated annual percentage change (APC) in oral cancer incidence during 1994-2009 using joinpoint regression software (version 4.2.0.2). The lifetime risk of oral cancer to age 79 was estimated using Irish incidence and population data from 2007 to 2009. Survival rates were also examined using Kaplan-Meier curves and Cox proportional hazard models to explore the influence of several demographic/lifestyle covariates with follow-up to end 2012. Results: Data were obtained on 2,147 oral cancer incident cases. Men accounted for two-thirds of oral cancer cases (n = 1,430). Annual rates in men decreased significantly during 1994-2001 (APC = -4.8 %, 95 % CI: −8.7 to −0.7) and then increased moderately (APC = 2.3 %, 95 % CI: −0.9 to 5.6). In contrast, annual incidence increased significantly in women throughout the study period (APC = 3.2 %, 95 % CI: 1.9 to 4.6). There was an elevated risk of death among oral cancer patients who were: older than 60 years of age; smokers; unemployed or retired; those living in the most deprived areas; and those whose tumour was sited in the base of the tongue. Being married and diagnosed in more recent years were associated with reduced risk of death. Conclusion: Oral cancer increased significantly in both sexes between 1999 and 2009 in Ireland. Our analyses demonstrate the influence of measured factors such as smoking, time of diagnosis and age on observed trends. Unmeasured factors such as alcohol use, HPV and dietary factors may also be contributing to increased trends. Several of these are modifiable risk factors which are crucial for informing public health policies, and thus more research is needed. [ABSTRACT FROM AUTHOR]

Objectives: Road traffic injuries, particularly pedestrian injuries, are a major health issue among children worldwide. The present study quantitatively analyzed the time trends of child pedestrian injuries in Japan from 1975 to 2013 by age. Study design: Time trend analysis of nationally aggregated data. Methods: We analyzed police data on pedestrian injuries requiring medical treatment among children aged 0e15 years occurring between 1975 and 2013. To quantify the time trends of pedestrian injury morbidity rates and to identify change-points in the trends, joinpoint regression analysis was applied by age group. Children were categorized into the age groups of 0e3, 4e6, 7e9, 10e12, and 13e15 years old. Results: Preschool children aged 0e6 years old showed continuous declining trends throughout the study period; these declining trends accelerated in the 2000s. School-age children aged 7e15 years old showed minimal changes from the early 1970s to the 1990s; of this age group, children aged 7e12 years old showed slight but significant declining trends in the first half and increasing trends in the latter half of this period. Children aged 7e15 years old showed declining trends in the 2000s. Despite the consistent declining trends among all age groups in the 2000s, the younger age groups showed steeper declines during this period. Conclusions: The declining trends in all age groups in the 2000s may reflect the improved traffic environments in Japan although the environmental approaches are not yet sufficiently adopted yielding modest effects. The continuing contrast between preschool and school-age children may reflect different behaviour changes by age such as more restricted outdoor activities among young children. [ABSTRACT FROM AUTHOR]

Testate amoebae have a great potential for use in scientific researches due to their ecological characteristics such as abundance, wealth, and generation time. In this way, this study aimed to present a scientometric analysis to describe the evolution of the different advances in researches on testate amoebae and identify a temporal pattern in this evolution. The literature review was based on papers indexed by Thomson Reuters (www.isiwebofknowledge.com) and SciVerse Scopus (www.scopus.com). In total 562 papers were examined. Results showed a pattern of evolution in scientific studies, most with ecological approach with descriptive and predictive designs. At the global level, researches on testate amoebae progressed in both the number of articles published as well as in the areas studied, especially in Europe and North America. The low number of experimental studies and review articles can characterize the lack of more knowledge to be acquired, both from particular observations (descriptive studies) as well as the observations noted sufficiently predictive of work. In Brazil, studies with testate amoebae are still developing, concentrated in only some regions, but the increased number of studies in recent years allows the prediction of the same overall patterns of advance for Brazilian researches. Thus, we conclude that these organisms are being increasingly used as a tool response in ecological studies.

Processes related to biological invasion of inland waters have become a major issue due to the increasing number of cases associated with the potential effects of invasions. Kellicottia bostoniensis and K. longispina are rotifer species originating from North America and have become invasive in several continents. In this sense, this study carried out a scientometric analysis to analyze the geographical distribution and identify patterns of occurrence as well as to fill gaps on the knowledge of these species. The survey was based on articles indexed in databases from 1896 to 2014. There is a greater scientific knowledge of these species in the temperate region, and these are present in many different environments. In Brazil, there is a very small number of studies, and no record of K. longispina. Therefore, it is noteworthy the importance of studies on the occurrence and abundance of these species in poorly studied areas, such as subtropical and tropical regions, for a better understanding of their invasive potential, given the potential effects on different communities, which can affect the structure and dynamics of environments.

Objectives This study was conducted to describe the regional malaria incidence in relation to the geographic and climatic conditions and describe the effect of altitude on the expansion of malaria over the last decade in Papua New Guinea. Methods Malaria incidence was estimated in five provinces from 1996 to 2008 using national health surveillance data. Time trend of malaria incidence was compared with rainfall and minimum/maximum temperature. In the Eastern Highland Province, time trend of malaria incidence over the study period was stratified by altitude. Spatio-temporal pattern of malaria was analyzed. Results Nationwide, malaria incidence was stationary. Regionally, the incidence increased markedly in the highland region (292.0/100000/yr, p =0.021), and remained stationary in the other regions. Seasonality of the malaria incidence was related with rainfall. Decreasing incidence of malaria was associated with decreasing rainfall in the southern coastal region, whereas it was not evident in the northern coastal region. In the Eastern Highland Province, malaria incidence increased in areas below 1700 m, with the rate of increase being steeper at higher altitudes. Conclusions Increasing trend of malaria incidence was prominent in the highland region of Papua New Guinea, while long-term trend was dependent upon baseline level of rainfall in coastal regions.

Objectives: Perfluoroalkyl acids (PFAAs) have been detected in human blood, breast milk and umbilical cord blood across the globe. PFAAs do accumulate in the marine food chain in Arctic regions. In Greenland, increasing PFAA concentrations were observed during 1982–2006 in ringed seals and polar bears. However, until now, no data have been reported for PFAAs in Greenlandic Inuit. This study assesses the level and temporal trend of serum PFAAs in Greenlandic Inuit. Study design: Cross-section and temporal time trend survey. Methods: Serum PFAA levels were determined in 284 Inuit from different Greenlandic districts using liquid chromatography-tandem mass spectrometry with electrospray ionization. The temporal time trend of serum PFAAs in Nuuk Inuit during 1998–2005 and the correlation between serum PFAAs and legacy persistent organic pollutants (POPs) were explored. Results: Serum PFAA levels were higher in Nuuk Inuit than in non-Nuuk Inuit. Within the same district, higher PFAA levels were observed for males. An age-dependent, increasing trend of serum PFAA levels in the period from 1998–2005 was observed for Nuuk Inuit. For the pooled gender data, no significant association between PFAAs and legacy POPs was observed for Nuuk Inuit while for non-Nuuk Inuit this correlation was significant. No correlation between PFAAs and legacy POPs was found for male Inuit, whereas significant correlation was observed both for pooled female Inuit and for non-Nuuk Inuit females. Conclusions: We suggest that sources other than seafood intake might contribute to the observed higher PFAA levels in Nuuk Inuit compared to the pooled non-Nuuk Inuit.

Objectives: This study aimed to assess the incidence and trend of childhood leukaemia in Basrah. Methods: This was a hospital-based cancer registry study carried out at the Pediatric Oncology Ward, Maternity & Children’s Hospital and other institutes in Basrah, Iraq. All children with leukaemia, aged 0 to 14 years diagnosed and registered in Basrah from January 2004 to December 2009 were included in the study. Their records were retrieved and studied. The pattern of childhood leukaemia by year of diagnosis, age at diagnosis, morphological subtypes, and geographical distribution was analysed. Rates of childhood leukaemia over time were calculated for six years using standard linear regression. Results: The total number of cases of childhood leukaemia was 181. The number of cases ranged from 21 in year 1, to 31 in the final year reaching a peak of 39 in 2006. Leukaemia rates did not change over the study period (test for trend was not significant, P = 0.81). The trend line shows a shift towards younger children (less than 5 years). The commonest types of leukaemia were acute lymphoblastic leukaemia (ALL), then acute myeloid leukaemia (AML) and finally chronic myeloid leukaemia (CML). Conclusion: Annual rates of childhood leukaemia in Basrah were similar to those in other countries with a trend towards younger children. This raises the question about the effect of environmental catastrophes in the alteration of some specific rates of childhood leukaemia, rather than the overall incidence rate. There is a need for further epidemiological studies to understand the aetiology of childhood leukaemia in Basrah.

Background: The burden of asthma is recognized as an important public health problem worldwide. In most countries, the prevalence of asthma has been reported to increase in the last few decades. However, more recent epidemiological studies have shown that the prevalence of asthma has been flat or even decreasing after the 1990s in some developed countries. The recent time trend in the prevalence of adult asthma in Japan is unknown. Methods: Population-based surveys were conducted three times in the same region, in 1985, 1999, and 2006, at Fujieda City, Shizuoka, Japan, and the results were reported previously. We compared the results of these surveys to reveal the time trend in the prevalence of adult asthma. Although the questionnaires used in these surveys were not exactly the same, the time trend was assessed by comparing the responses to relevant questions between questionnaires. Results: The prevalences of wheeze following a common cold and dyspneal feeling at night increased significantly from 1985 to 1999 (4.2% to 7.6%, and 3.2% to 5.3%, respectively). The prevalences of lifetime asthma and current asthma also significantly increased from 1999 to 2006 (5.1% to 6.7%, and 1.5% to 3.4%, respectively). Conclusions: The prevalences of asthma among adults in Fujieda City consistently increased from 1985 to 2006. There was no evidence that the prevalences were in plateau or decreasing. These findings suggest that more efforts are required to stop the increase in the burden of this disease in Japan.