Linear Time Trend Research Articles

Epidemiology of recurrent myocardial infarction in the reperfusion era

Abstract Introduction During the past decades, the incidence, management, and outcomes of myocardial infarction (MI) have improved considerably.(1-4) However, the characteristics and outcomes of patients who experience a recurrent MI are sparsely described. Purpose This study aimed to analyse the epidemiology and temporal trends of recurrent MI during the reperfusion era. Methods A nationwide registry-based cohort study was conducted, including all hospital admissions for recurrent MI in Denmark during 2000 to 2020. Descriptive statistics were used to analyse changes in patient characteristics and management. Survival analyses, taking competing risks into account when relevant, and multivariable Cox proportional hazards models adjusted for sex, age, comorbidities, and pre-recurrent MI pharmaceutical treatment were used to analyse the outcomes of interest: all-cause mortality, hospitalisation for heart failure (HHF), and additional recurrent MI. Results A total of n=55,722 admissions for recurrent MI between 2000 and 2020 were included. Median age at admission was 73 years, 68.0% were male, and 32.9% were patients with a 3rd or more recurrent MI. Between 2000-02 (n=9,490) and 2018-20 (n=5,520), patients admitted with a recurrent MI had an increased prevalence of comorbidities such as diabetes, chronic kidney disease, and cancer (Condensed Table 1). Likewise, the use of guideline directed management at the time of recurrent MI increased during the study period: percutaneous coronary intervention (PCI) from 12.8% to 47.2%, coronary angiography (CAG) from 21.8% to 68.0%, statins from 30.5% to 74.2%, and adenosine diphosphate (ADP) receptor inhibitors from 8.2% to 41.8%. Statistically significant linear calendar time trends were observed for all three outcomes (Figure 1). Between 2000-02 and 2018-20 (Figure 2), the absolute 1-year risk of mortality declined from 31.6% to 16.0% (adjusted hazard ratio [aHR]: 0.46 [95% CI: 0.43-0.50]). The absolute 1-year risk of an additional recurrent MI declined from 13.9% to 6.2% (aHR: 0.38 [0.34-0.43]). The absolute 1-year risk of HHF increased from 8.8% in 2000-02 to 10.5% in 2009-11 (aHR: 1.09 [0.99-1.21]), before declining to 7.4% in the final calendar year period (aHR: 0.75 [0.66-0.84]). Interpretation and conclusion Despite remarkable advances in the management and outcomes of patients experiencing recurrent MI during the reperfusion era, this remains a vulnerable, high-risk population. Special attention is warranted regarding the optimization of guideline directed care and prevention of heart failure following a recurrent MI.Figure 1Figure 2 & Condensed Table 1

Harnessing Available Evidence in Single-Case Experimental Studies: The Use of Multilevel Meta-Analysis.

The use of multilevel models to combine and compare the results of multiple single-case experimental design (SCED) studies has been proposed about two decades ago. Since then, the number of multilevel meta-analyses of SCED studies steadily increased, together with the complexity of multilevel models used. At the same time, many studies were done to empirically evaluate the approach in a variety of situations, and to study how the flexibility of multilevel models can be employed to account for many complexities that often are encountered in SCED research, such as autocorrelation, linear and nonlinear time trends, specific designs, external event effects, multiple outcomes, and heterogeneity. In this paper, we give a state-of-the-art of the multilevel approach, by making an overview of basic and more extended models, summarizing simulation results, and discussing some remaining issues.

Public Mass Shootings: Counterfactual Trend Analysis of the Federal Assault Weapons Ban.

Assault weapon and large-capacity magazine bans are potential tools for policy makers to prevent public mass shootings. However, the efficacy of these bans is a continual source of debate. In an earlier study, we estimated the impact of the Federal Assault Weapons Ban (FAWB) on the number of public mass shooting events in the United States. This study provides an updated assessment with 3 additional years of firearm surveillance data to characterize the longer-term effects. This study aims to estimate the impact of the FAWB on trends in public mass shootings from 1966 to 2022. We used linear regression to estimate the impact of the FAWB on the 4-year simple moving average of annual public mass shootings, defined by events with 4 or more deaths in 24 hours, not including the perpetrator. The study period spans 1966 to 2022. The model includes indicator variables for both the FAWB period (1995-2004) and the period after its removal (2005-2022). These indicators were interacted with a linear time trend. Estimates were controlled for the national homicide rate. After estimation, the model provided counterfactual estimates of public mass shootings if the FAWB was never imposed and if the FAWB remained in place. The overall upward trajectory in the number of public mass shootings substantially fell while the FAWB was in place. These trends are specific to events in which the perpetrator used an assault weapon or large-capacity magazine. Point estimates suggest the FAWB prevented up to 5 public mass shootings while the ban was active. A continuation of the FAWB and large-capacity magazine ban would have prevented up to 38 public mass shootings, but the CIs become wider as time moves further away from the period of the FAWB. The FAWB, which included a ban on large-capacity magazines, was associated with fewer public mass shooting events, fatalities, and nonfatal gun injuries. Gun control legislation is an important public health tool in the prevention of public mass shootings.

The Potential of Minimum Wage Increases to Reduce Youth Homicide Disparities: Diminishing Returns for Black Youth.

We examine and compare the relationship between minimum wage increases and youth homicide rates in three groups: all youth, White youth only, and Black youth only. Using 2001-2019 mortality data from the National Vital Statistics System (NVSS) for all 50 states and Washington DC, we apply a difference in differences (DD) design to compare the change in youth homicides across states with varying changes in the state-specific minimum wage. With the inclusion of state-specific linear time trends, we find that a $1 increase in minimum wage leads to a significant 4% reduction (RR = 0.96, 95%CI [0.92, 0.99]) in homicides among White youth, but no significant reduction among Black youth (RR = 0.98, 95%CI [0.91, 1.04]). Findings are consistent with research on marginalization-related diminished returns for Black youth. While minimum wage increases are a promising step to reduce youth homicides overall, reducing homicide disparities experienced by Black youth requires additional components. Future research should examine policies with the specific intention to dismantle structural racism.

Randomized Trial of the Effectiveness of Videoconferencing-Based Versus Message-Based Psychotherapy on Depression.

The authors compared the engagement, clinical outcomes, and adverse events of text or voice message-based psychotherapy (MBP) versus videoconferencing-based psychotherapy (VCP) among adults with depression. The study used a sequential multiple-assignment randomized trial design with data drawn from phase 1 of a two-phase small business innovation research study. In total, 215 adults (ages ≥18 years) with depression received care from Talkspace, a digital mental health care company. Participants were initially randomly assigned to receive either asynchronous MBP or weekly VCP. All therapists provided evidence-based treatments such as cognitive-behavioral therapy. After 6 weeks of treatment, participants whose condition did not show a response on the Patient Health Questionnaire-9 or was rated as having not improved on the Clinical Global Impressions scale were randomly reassigned to receive either weekly VCP plus MBP or monthly VCP plus MBP. Longitudinal mixed-effects models with piecewise linear time trends applied to multiple imputed data sets were used to address missingness of data. Participants who were initially assigned to the MBP condition engaged with their therapists over more weeks than did participants in the VCP condition (7.8 weeks for MBP vs. 4.9 weeks for VCP; p<0.001). No meaningful differences were observed between the two groups in rates of change by 6 or 12 weeks for depression, anxiety, disability, or global ratings of improvement. Neither treatment resulted in any adverse events. MBP appears to be a viable alternative to VCP for treating adults with depression.

Disproportionate increase in cannabis use among people with serious psychological distress and associations with psychiatric service use in the United States, 2009–2019

BackgroundCannabis use is on the rise, but it is unclear how use is changing among individuals with serious psychological distress (SPD) compared to the general population as well as what associations this may have with mental health service use. MethodsRetrospective cohort study using the National Survey on Drug Use and Health (NSDUH) 2009–19 public use files of 447,228 adults aged ≥ 18 years. Multivariable logistic regression and predictive margin methods were used to estimate linear time trends in any and greater-than-weekly levels of cannabis use by year and SPD status and rates of psychiatric hospitalization and outpatient mental health care.Findings: Rates of any and weekly-plus cannabis use increased similarly among individuals with SPD compared to those without from 200 to 2014 but more rapidly in SPD every year from 2015 to 2019 (p < 0.001). Among individuals with SPD, no use was associated with a 4.2 % probability of psychiatric hospitalization, significantly less than less-than-weekly (5.0 %, p = 0.037) and weekly-plus cannabis use (5.1 %, p = 0.028). For outpatient mental health care, no use was associated with a 27.4 % probability (95 % CI 26.7–28.1 %) of any outpatient care, significantly less than less than weekly use (32.6 % probability, p < 0.001) and weekly-plus use (29.9 % probability, p = 0.01). ConclusionsCannabis use is increasing more rapidly among individuals with SPD than the general population, and is associated with increased rates of psychiatric hospitalization and outpatient service use. These findings can inform policy makers looking to tailor regulations on advertising for cannabis and develop public health messaging on cannabis use by people with mental illness.

Changes in forced vital capacity over ≤ 13 years among patients with late-onset Pompe disease treated with alglucosidase alfa: new modeling of real-world data from the Pompe Registry

BackgroundChronic respiratory insufficiency from progressive muscle weakness causes morbidity and mortality in late-onset Pompe disease (LOPD). Previous Pompe Registry (NCT00231400) analyses for ≤ 5 years’ alglucosidase alfa treatment showed a single linear time trend of stable forced vital capacity (FVC) % predicted.MethodsTo assess longer term Pompe Registry data, piecewise linear mixed model regression analyses estimated FVC% predicted trajectories in invasive-ventilator-free patients with LOPD aged ≥ 5 years. We estimated annual FVC change 0–6 months, > 6 months–5 years, and > 5–13 years from treatment initiation, adjusting for baseline age, sex, and non-invasive ventilation.FindingsAmong 485 patients (4612 FVC measurements; 8.3 years median follow-up), median ages at symptom onset, diagnosis, and alglucosidase alfa initiation were 34.3, 41.1, and 44.9 years, respectively. FVC% increased during the first 6 months’ treatment (slope 1.83%/year; 95% confidence interval: 0.66, 3.01; P = 0.0023), then modestly declined −0.54%/year (−0.79, −0.30; P < 0.0001) during > 6 months–5 years, and −1.00%/year (−1.36, −0.63; P < 0.0001) during > 5–13 years. The latter two periods’ slopes were not significantly different from each other (Pdifference = 0.0654) and were less steep than published natural history slopes (−1% to −4.6%/year). Estimated individual slopes were ≥ 0%/year in 96.1%, 30.3%, and 13.2% of patients during the 0–6 month, > 6 month–5 year, and > 5–13 year periods, respectively.ConclusionThese real-world data indicate an alglucosidase alfa benefit on FVC trajectory that persists at least 13 years compared with published natural history data. Nevertheless, unmet need remains since most individuals demonstrate lung function decline 5 years after initiating treatment. Whether altered FVC trajectory impacts respiratory failure incidence remains undetermined.Trial registrationThis study was registered (NCT00231400) on ClinicalTrials.gov on September 30, 2005, retrospectively registered.

Trends in Gastric Cancer Mortality in Montenegro, 1990–2018: Joinpoint Regression

Introduction: Gastric cancer (GC) remains a significant global public health problem, despite the decreasing trends in GC mortality rates in the last 5 decades. Our study aimed to examine the pattern of GC mortality in Montenegro between 1990 and 2018 and to contribute to the future by designing a national long-term strategy for the control and prevention of GC. Methods: Gastric cancer mortality data in Montenegro from 1990 to 2018 were collected. Mortality rates were age-standardized to the World Standard Population for estimating both the overall and gender-specific trends. The joinpoint regression model was used to assess GC mortality and identified significant changes in the linear time trend. Linear and Poisson regressions were also applied for additional trend analyses. Results: Joinpoint regression reveals a statistically significant decrease in the age-standardized rate for the overall level, on average by 1.4% per year (AAPC [95% IP] = −1.4 [−2.4 to −0.4]; p = 0.007), which was due to a decrease in the age-standardized rate in men with an average annual change of −1.8% (AAPC [95% IP] = −1.8 [−2.9 to −0.6]; p = 0.003), while in women the rates were stable (p = 0.565). The results for age groups indicate that a decline was registered at the overall level, and among men, as a consequence of the trend of decreasing age-specific rates for the age group 55–64 on average annually by 2% among men (AAPC [95% IP] = −2 [−3.8 to −0.1]; p = 0.035), and for the overall level (AAPC [95% IP] = −2 [−3.7 to −0.3]; p = 0.026). Conclusion: Our findings indicate a noteworthy decline in age-standardized overall GC mortality rates among men in Montenegro, while rates for women have remained constant. National strategies to further reduce mortality rates for GC are necessary.

Cigarette smoking behaviors and nicotine dependence at the intersection of sexual identity and sex in the United States: Findings from the National Survey on Drug Use and Health

Introduction: Cigarette smoking is disproportionately high among lesbian, gay, and bisexual (LGB) adults. Yet, collapsing these identities into a monolith can disguise important within group disparities (e.g., lesbian/gay versus bisexual female). The purpose of this study is to report recent national prevalence estimates and trends of cigarette smoking behaviors and nicotine dependence by sexual identity and sex. Methods: Data were from the 2015–2019 National Survey on Drug Use and Health (n = 210,392; adults 18+), a nationally representative, repeated cross-sectional study of substance use and mental health in the U.S. We examined bivariate and multivariable associations between sexual identity and cigarette smoking measures (i.e., former smoking, lifetime smoking, current smoking, current daily smoking, nicotine dependence) by sex. We also examined linear time trends in current and former smoking. Covariates included age, race/ethnicity, education, annual household income, and survey year. Results: Bisexual women had the highest unadjusted prevalence of current smoking (31 %) and lowest of former smoking (25 %). LGB females and males had higher adjusted prevalence of current smoking, daily smoking, and nicotine dependence than heterosexual adults. Bisexual females and gay and bisexual males had lower adjusted prevalence of former smoking (adjusted prevalence ratio range: 0.78–0.85) than heterosexual counterparts. Discussion: This is the first study to identify disproportionately low prevalence of former smoking among bisexual females. Paired with findings of high prevalence of current cigarette smoking and nicotine dependence, these data suggest that tobacco control interventions targeted toward bisexual females are urgently needed to reduce the burden of cigarette smoking among these individuals.

Patterns of Alcohol, Marijuana, and Tobacco Use Among U.S. Adolescents and Young Adults by Disability Status: 2015–2019

PurposeTo estimate the national prevalence of tobacco, marijuana, and alcohol use among U.S. adolescents (age 12–17) and young adults (aged 18–25; adolescents and young adults [AYAs]) with a disability and examine associations between disability and substance use from 2015 to 2019. MethodsData from the 2015–2019 National Survey on Drug Use and Health were used to estimate the prevalence of tobacco, marijuana, and alcohol use among AYAs with disabilities. Modified Poisson regression models evaluated linear time trends in past-month substance use and estimated adjusted prevalence ratios (aPRs) for past-month cigarette, any tobacco, alcohol, and marijuana use. ResultsAdolescents with any disability had a higher prevalence of past-month cigarette (aPR = 1.87; 95% CI 1.67–2.09), alcohol (aPR = 1.21; 95% CI 1.11–1.31), and marijuana use (aPR = 1.47; 95% CI 1.36–1.60) compared to those without disabilities. Cigarette smoking among adolescents decreased over this time period; however, the decline among adolescents without a disability was greater than those with any disability. Young adults with any disability had a higher prevalence of past-month cigarette (aPR = 1.42; 95% CI 1.35–1.48) and marijuana use (aPR = 1.39; 95% CI 1.34–1.45), but a lower prevalence of past-month alcohol use (aPR = 0.93; 95% CI 0.90–0.95) than those without disabilities. Alcohol use remained constant among young adults with any disability but decreased for those without disabilities. DiscussionPopulation-level disparities in cigarette and marijuana use exist in AYAs with disabilities. Future studies should identify strategies tailored to AYAs with disabilities to encourage smoking cessation and prevent cannabis use disorder.

Did the 2012 Spanish law reform to protect mortgage debtors modify banks’ lending behavior?

Royal Decree-Law 6/2012 introduced a new Code of Good Practice for Spanish banks and financial institutions with the aim of protecting low-income debtors. In this study, we examine the impact of this legal reform on the lending behavior of banks. We analyze quarterly data spanning from 2005 to 2020(Q1) across the 17 Spanish NUTS II regions. Our analysis employs panel data models incorporating regional, year, and quarter fixed effects, as well as linear and quadratic region-specific time trends. We also include other relevant control variables at the regional level, such as house prices, inflation rates, and unemployment rates. Our findings indicate that the Code had a significant and negative effect on the number of new mortgage loans, the average interest rate, and the average ratio between monthly mortgage payments and wage costs.

Trends in past-month cannabis use among US adults across a range of disabilities and health conditions, 2015–2019

IntroductionWhile there is increasing interest in the use of cannabis to manage a range of health-related symptoms, little is known about trends in recent cannabis use with respect to various health conditions. MethodsWe examined data from a US representative sample of noninstitutionalized adults age ≥ 18 from the 2015–2019 National Survey on Drug Use and Health (N = 214,505). We estimated the pooled prevalences followed by linear time trends, overall, and by disability (i.e., difficulty hearing, seeing, thinking, walking, dressing, doing errands) and lifetime (i.e., bronchitis, cancer, diabetes, hepatitis, kidney disease) and current (i.e., asthma, depression, heart disease, hypertension) health condition status using logistic regression. Models with year-by-condition status interaction terms were used to assess differential time trends, adjusting for demographic characteristics. ResultsFrom 2015 to 2019, cannabis use increased significantly among adults with and without each disability and health condition examined. However, the increase was more rapid among those with (versus without) difficulty hearing (89.8% increase [4.9% to 9.3%] vs. 37.9% increase [8.7% to 12.0%], p = 0.015), difficulty walking (84.1% increase [6.3% to 11.6%] vs. 36.8% increase [8.7% to 11.9%], p < 0.001), 2–3 impairments (75.3% increase [9.3% to 16.3%] vs. 36.6% increase [8.2% to 11.2%], p = 0.041), and kidney disease (135.3% increase [3.4% to 8.0%] vs. 38.4% increase [8.6% to 11.9%], p = 0.045). ConclusionGiven the potential adverse effects of cannabis, prevention and harm reduction efforts should focus on groups at increasingly higher risk for use, including those with disabilities and kidney disease.

Caselaw and England's economic performance during the Industrial Revolution: Data and evidence

We generate and analyze data pertinent to examining whether developments in caselaw were consequential for England's economic performance during the Industrial Revolution. Applying topic modeling to a corpus of 67,455 reports on English court cases, we construct annual time series of caselaw developments between 1765 and 1865. We then add a real per-capita GDP series to our caselaw series and estimate a structural VAR featuring a linear time trend. Our evidence shows that caselaw developments were an important determinant of economic fluctuations. Caselaw shocks jointly account for more of the variability in per-capita GDP around its long-term trend than do shocks directly to per-capita GDP. The response of per-capita GDP to caselaw innovations critically depends on the legal domain. Developments in caselaw on intellectual property, organizations, debt and finance, and inheritance boosted economic performance while developments in property and ecclesiastical caselaw had negative effects on per-capita GDP. Our analysis uncovers a 'bleak-law era' when the legal system misallocated attention between output-promoting and output-hindering areas of law.

Veterans Health Administration enrollees' choice of care setting relates to the expansion of care options: Evidence from screening colonoscopies before and after the MISSION Act.

To estimate whether those enrolled in the Veterans Health Administration (VHA) were less likely to use VHA-delivered colorectal cancer screening colonoscopies after the MISSION Act. Secondary data were collected on VHA-enrolled Veterans from FY2017-FY2021. This retrospective cross-sectional study measured the volume and share of screening colonoscopies that were VHA-delivered over time and by drive time eligibility-defined as living more than 60 min away from the nearest VHA specialty-care clinic. We used a multivariable logistic regression to adjust for patient and facility factors. Data were extracted for VHA enrollees (n = 773,766) who underwent a screening colonoscopy either performed or purchased by the VHA from FY2017-FY2021. In the 9 months after the implementation of the MISSION Act, and before the onset of the Covid-19 pandemic, the average monthly VHA-share of screening colonoscopies decreased by 3 percentage points (pp; 95% confidence interval [CI] = [-4 to -2 pp]) for the non-drive time eligible group and it decreased by 16 pp (95% CI = [-22 to -9 pp]) for the drive time eligible group. The total number of screening colonoscopies did not significantly change in either group during this time period. After adjusting for patient characteristics, a linear time trend, and parent facility fixed effects, implementation of the MISSION Act was associated with a reduction in the probability of a VHA-delivered screening colonoscopy (average marginal effect [AME]: -2.5 pp; 95% CI = [-5.1 to 0.0 pp]) for the non-drive time eligible group. The drive time eligible group (AME: -9.4 pp; 95% CI = [-13.2 to -5.5 pp]) experienced a larger change. The VHA-share of screening colonoscopies among VHA enrollees fell in the 9 months immediately after the passage of the MISSION Act. This decline was larger for VHA enrollees who were targeted for eligibility due to a longer drive time. These results suggest that the MISSION Act led to more VHA-purchased care among targeted VHA enrollees, though it is unclear whether total utilization increased.

Sixteen-year trends in fruit consumption and related socioeconomic inequalities among adolescents in Western European countries.

To investigate time trends in daily fruit consumption among Western European adolescents and in related socioeconomic inequalities. We used nationally representative data from 18 countries participating in five rounds (2002 to 2018) of the cross-sectional "Health Behaviour in School-aged Children" (HBSC) survey (n = 458,973). The questionnaire, standardised across countries and rounds, was self-administered at school by 11-, 13- and 15-year-old adolescents. Daily fruit consumption was assessed using a short food frequency questionnaire (sFFQ). Socioeconomic inequalities were measured using the Family Affluence Scale (FAS). Multilevel logistic regressions were applied to study linear time trends in daily fruit consumption, overall, by country and by FAS. Between 2002 and 2018, daily fruit consumption increased in 10 countries (OR range, 1.04 to 1.13, p < 0.05) and decreased in 3 (OR range 0.96 to 0.98, p < 0.05). In all survey years combined, prevalence of daily fruit consumption was significantly higher among high FAS groups (42.6%) compared to medium (36.1%) and low FAS groups (31.7%; all countries: p < 0.001). Between 2002 and 2018, socioeconomic inequalities in fruit consumption increased in Austria, Germany, Italy, Netherlands, Scotland, Sweden, and Switzerland. Only in Norway FAS inequalities decreased while the prevalence increased. The prevalence of daily fruit consumption generally increased among adolescents between 2002 and 2018 in Western European countries, yet socioeconomic inequalities increased in some countries. Public health interventions should continue to promote fruit consumption with special attention to lower socioeconomic groups.

Utility of Borrelia-specific IgM and IgG antibody titer determinations during a 12-year period - results from a clinical laboratory in Northern Sweden.

Interpretation of serological findings in suspected Lyme borreliosis (LB) is challenging and IgM reactivities may have low predictive value. Therefore, if used indiscriminately, there is a risk for incorrect diagnosis of LB. To evaluate the usefulness of IgM titer determination, we performed a study of the prevalence of Borrelia-specific antibodies in serological samples from patients with suspected LB analyzed during the period 2010 - 2021 at the University Hospital of Umeå in Sweden. In total, 19,335 samples had been analyzed for the presence of IgG and IgM antibodies. Overall, there were higher percentages of IgM positive or borderline titers, 1,847 (9.6%) and 905 (4.7%), respectively, than IgG positive or borderline titers, 959 (5.0%) and 406 (2.1%), respectively. Peak number of samples were recorded 2012 - 2013, exceeding 1,800, whereas there were around 1,200 during 2020 - 2021. The peak number of positive IgG and/or positive IgM samples were observed during the period 2015 - 2017 with close to, or above 400, and concomitantly, the proportion of IgG positive samples increased markedly. For IgG positive samples, the increase followed a positive linear time trend (P< 0.001). Peak monthly numbers were observed during August, September, and October. This seasonal increase was significant for the IgG positive group (P< 0.05), but not for the IgM positive/IgG negative group. Repeated samples were obtained from 3,188 individuals and of the initial samples 2,817 were (88%) IgG negative and 2,315 (72%) were IgM negative and of these, 130 (4%) showed IgG seroconversion and 300 (9%) IgM seroconversion. Collectively, the data demonstrate that IgG and/or IgM positive samples represented a minority of all samples, even when repeated sampling had occurred, and IgM positive samples were much more common than IgG positive samples. Thus, the accuracy of the clinical suspicion was low and this will lead to a low predictive value of the analysis, in particular of IgM. These findings question the use of IgM titer determination as a routine analysis.

Cross-national time trends in adolescent body weight perception and the explanatory role of overweight/obesity prevalence

ABSTRACT Introduction Body weight perception (BWP) is associated with health behaviors. Current evidence points to an increase over time in both actual and perceived weight status among adolescents, however there is limited evidence on time trends in BWP in cross-national samples of adolescents. Therefore, the aims of this study were to examine time trends in BWP between 2002 and 2018 among adolescents from 41 countries and regions, including gender and country differences and to explore the role of changes over time in country-level overweight/obesity prevalence in these trends. Methods Data were used from five cycles (2002, 2006, 2010, 2014, 2018) of the repeated cross-sectional Health Behavior in School-Aged Children (HBSC) study (n = 746,121; mean±standard deviation age 13.7 ± 1.6 years, 51.0% girls). Multilevel logistic models estimated cross-national linear time trends in adolescent BWP (correct perception, underestimation, or overestimation), adjusted for gender, age, and family affluence. Next, we tested whether country-level changes over time overweight/obesity prevalence could explain these trends in BWP among adolescents. Results Correct weight perception increased over time among girls, while it decreased among boys. Underestimation of weight status increased, and overestimation of weight status decreased over time among both genders, with stronger trends for girls. Furthermore, country differences in trends in both BWP and overweight/obesity were found. Changes over time in country-level overweight/obesity prevalence could not explain these trends. Conclusion The linear increase over time in correct weight perception and the decrease in overestimation may have a positive effect on unhealthy weight reduction behaviors among adolescents. However, the increase in underestimation could signal a need for interventions to strengthen correct weight perception among adolescents. Several implications for policy and practice are discussed.

Carvedilol for prevention of heart failure in anthracycline-exposed survivors of childhood cancer: Results from COG ALTE1621.

10013 Background: Carvedilol improves cardiac function in patients with heart failure (HF), but remains untested as cardioprotective therapy in long-term childhood cancer survivors at risk for HF due to high-dose anthracycline exposure. We hypothesized that low-dose carvedilol would be safe and efficacious in reducing anthracycline-related heart failure risk in long-term survivors without evidence of HF. Methods: This was a randomized, double-blind, placebo-controlled phase 2B trial (NCT02717507) conducted at 28 sites. Eligibility included ≥250 mg/m2 cumulative anthracycline exposure by age 21 years (y), ≥2y from completion of cancer treatment, and preserved systolic function (ejection fraction [EF] ≥55% and/or fractional shortening [FS] ≥28%) at enrollment. Patients were randomized 1:1 to take low-dose carvedilol (12.5 mg/day) or placebo for 2y; dose up-titration started at 3.125 mg/day. The primary objective was to determine the impact of carvedilol on echocardiographic indices of HF risk: standardized left ventricular (LV) wall thickness/dimension ratio (LVWT/Dz; primary endpoint), LV end-systolic wall stress (ESWS), LV chamber diameters, systolic and diastolic function. These indices were obtained every 6 months and measured centrally in a blinded fashion. Common Terminology Criteria for Adverse Events (CTCAE v4.0) was used to assess toxicity. Cardiac event was defined as relative EF/FS decline &lt; 20% from baseline or both &lt; 55% [EF] and &lt; 28% [FS]. Treatment effects were analyzed using the Generalized Estimating Equation for normally distributed data, assuming linear time-trend. Group differences were evaluated by treatment*time interaction. Results: Of 196 participants enrolled, 182 were eligible and randomized. Characteristics (median, range): age at enrollment, 24.7y (10.4-53.9); time from cancer diagnosis, 13.4y (2.9-43.6); anthracycline dose, 374 mg/m2 (250-1760); 19% had received chest-directed radiotherapy. There were no group differences in baseline participant demographics, cardiotoxic treatment exposure, or cardiac endpoints. LVWT/Dz was similar (+0.053, p = 0.15) between arms at 2y. However, treatment effects varied by time since diagnosis (p = 0.008) suggesting greater efficacy among longer-term survivors. Compared to placebo, carvedilol arm participants had significantly better LV end-diastolic diameter (-0.16 cm, p = 0.005) and LVESWS (-7.53, p = 0.027) at 2y. There were no CTCAE grade ≥3 events; all except 2 participants tolerated full dose escalation. Six out of eight cardiac events occurred on the placebo arm; longer-term follow-up of study participants is ongoing. Conclusions: In this randomized trial of long-term survivors of childhood cancer treated with high-dose anthracyclines, low-dose carvedilol was safe and effective in reducing established biomarkers of HF risk and could serve as a risk reduction strategy. Clinical trial information: NCT02717507 .

Stagnant daily smoking prevalence between 2008 and 2019 among Black and Hispanic adults with serious psychological distress

BackgroundRacial/ethnic minority status and mental illness independently drive inequity in cigarette smoking and related morbidity. Racial/ethnic minority groups suffer a disproportionate burden of tobacco-related diseases. People with serious mental illness (SMI) smoke at up to 7 times the rate of the general population. There is a need to quantify smoking prevalence and trends among people at the intersection of both groups. MethodsThis study analyzes 2008–2019 data from the National Survey on Drug Use and Health. Linear time trends of daily smoking prevalence were assessed among people with serious psychological distress (SPD; marker for SMI) and people without SPD reporting White, Black, Hispanic, and Other race/ethnicity using logistic regression, with survey year as the predictor. Models with year-by-smoking status interaction terms and F-tests assessed differential time trends. ResultsThe prevalence of daily smoking among people without SPD decreased over time among people reporting White (aOR=0.96, p<0.001), Black (aOR=0.96, p<0.001), Hispanic (aOR=0.95, p<0.001), and Other (aOR=0.97, p=0.002) race/ethnicity. Among people with SPD, the smoking prevalence decreased among people with White race/ethnicity (aOR=0.95, p<0.001), with no significant changes among people of Black, Hispanic, and Other race/ethnicity. ConclusionsSmoking among people with SPD who report Black and Hispanic race/ethnicity has not changed significantly in the past 11 years, despite decreasing among non-SPD and White groups. People who are Black/Hispanic and people with SPD struggle to quit smoking, which is amplified intersectionally. Tailored interventions may be a better mechanism to reduce barriers to smoking cessation in this population.

Motivation states to move, be physically active and sedentary vary like circadian rhythms and are associated with affect and arousal.

Motivation to be physically active and sedentary is a transient state that varies in response to previous behavior. It is not known: (a) if motivational states vary from morning to evening, (b) if they are related to feeling states (arousal/hedonic tone), and (c) whether they predict current behavior and intentions. The primary purpose of this study was to determine if motivation states vary across the day and in what pattern. Thirty adults from the United States were recruited from Amazon MTurk. Participants completed 6 identical online surveys each day for 8 days beginning after waking and every 2-3 h thereafter until bedtime. Participants completed: (a) the CRAVE scale (Right now version) to measure motivation states for Move and Rest, (b) Feeling Scale, (c) Felt Arousal Scale, and (d) surveys about current movement behavior (e.g., currently sitting, standing, laying down) and intentions for exercise and sleep. Of these, 21 participants (mean age 37.7 y; 52.4% female) had complete and valid data. Visual inspection of data determined that: a) motivation states varied widely across the day, and b) most participants had a single wave cycle each day. Hierarchical linear modelling revealed that there were significant linear and quadratic time trends for both Move and Rest. Move peaked near 1500 h when Rest was at its nadir. Cosinor analysis determined that the functional waveform was circadian for Move for 81% of participants and 62% for Rest. Pleasure/displeasure and arousal independently predicted motivation states (all p's < .001), but arousal had an association twice as large. Eating, exercise and sleep behaviors, especially those over 2 h before assessment, predicted current motivation states. Move-motivation predicted current body position (e.g., laying down, sitting, walking) and intentions for exercise and sleep more consistently than rest, with the strongest prediction of behaviors planned for the next 30 min. While these data must be replicated with a larger sample, results suggest that motivation states to be active or sedentary have a circadian waveform for most people and influence future behavioral intentions. These novel results highlight the need to rethink the traditional approaches typically utilized to increase physical activity levels.