Positive Secular Trend Research Articles

Secular Trends in Physical Growth Among Peruvian Children and Adolescents Living at High Altitudes.

We aim (1) to examine secular trends in height, weight, and waist circumference (WC) among Peruvian children and adolescents living in the city of Junín and (2) to compare their growth status with the World Health Organization (WHO) and US Centers for Disease Control and Prevention (CDC) reference data. The sample included 2874 Peruvians (n = 1681 in the 2009 cohort and n = 1193 in the 2019 cohort) aged 6-16 years from the district of Junín (4107 m of altitude). Height, weight, and WC were measured using standardized protocols. Within each sex, a two-way between-subjects analysis of variance-age, and cohort as main factors and age-by-cohort as the interaction-was used to test for differences in height, weight, and WC. STATA 17 software was used in all statistical analyses. Height revealed a positive secular trend among girls, aged 6-11 years, and among boys up to 14 years of age. Similar positive secular trends in weight and WC were found across all age groups in both boys and girls. Compared to North American peers, children in the 2009 cohort were shorter, lighter, and had a smaller WC. For weight and WC, the 2019 cohort overlapped the 50th percentile across all age groups (except for 16-year-old girls). Both boys' and girls' height, weight, and WC showed positive secular trends between 2009 and 2019, with statistically significant differences varying across age groups. Peruvian youth of both sexes were shorter and lighter than their North American peers.

Secular trends in anthropometric characteristics and their associations with external skeletal robustness among Slovenian young adults’ population

Objectives: To determine secular trends in body height, fat-mass, fat-free mass, and external skeletal robustness in young adults and examine possible relationship between them. Methods: Anthropometric data (body height, body mass; skinfold thickness (SFT) – triceps, abdominal, thigh; circumferences (C) – waist, upper arm, thigh; width – elbow, knee) of young adults aged 20-25 years (N = 5303; males 1985, females 3318) were used from the Slovenian (data)Base of Anthropometric Measurements from 1960 to 2023. Multiple linear regressions were performed. Results: The most significant positive secular trends (p < 0.000) were observed in males for abdominal SFT (B = 0.151, R2 = 0.169) and thigh SFT (B = 0.131, R2 = 0.142). In females, similar trend was observed in waist C (B = 0.151; R2 = 0.169). The most significant negative secular trend (p < 0.001) was observed in muscle area of lower limbs in both sexes (males: B = - 0.427, R2 = 0.000; females: B = - 0.875, R2 = 0.300). Body height and overall body mass were the most important factors influencing the observed decline in external skeletal robustness assessed with frame index according to elbow and knee width according to multiple linear regression. Conclusion: Over the last 60 years, a positive secular trend was observed in body height and body fat, while a negative trend was noted in muscle mass. Increases in body height and overall body mass had the most significant impact on the observed decrease in assessed external skeletal robustness over time.

Secular trends in physical growth, biological maturation, and intelligence in children and adolescents born between 1978 and 1993.

Human physical growth, biological maturation, and intelligence have been documented as increasing for over 100 years. Comparing the timing of secular trends in these characteristics could provide insight into what underlies them. However, they have not been examined in parallel in the same cohort during different developmental phases. Thus, the aim of this study was to examine secular trends in body height, weight, and head circumference, biological maturation, and intelligence by assessing these traits concurrently at four points during development: the ages of 4, 9, 14, and 18 years. Data derived from growth measures, bone age as an indicator of biological maturation, and full-scale intelligence tests were drawn from 236 participants of the Zurich Longitudinal Studies born between 1978 and 1993. In addition, birth weight was analyzed as an indicator of prenatal conditions. Secular trends for height and weight at 4 years were positive (0.35 SD increase per decade for height and an insignificant 0.27 SD increase per decade for weight) and remained similar at 9 and 14 years (height: 0.46 SD and 0.38 SD increase per decade; weight: 0.51 SD and 0.51 SD increase per decade, respectively) as well as for weight at age 18 years (0.36 SD increase per decade). In contrast, the secular trend in height was no longer evident at age 18 years (0.09 SD increase per decade). Secular trends for biological maturation at 14 years were similar to those of height and weight (0.54 SD increase per decade). At 18 years, the trend was non-significant (0.38 SD increase per decade). For intelligence, a positive secular trend was found at 4 years (0.54 SD increase per decade). In contrast, negative secular trends were observed at 9 years (0.54 SD decrease per decade) and 14 years (0.60 SD decrease per decade). No secular trend was observed at any of the four ages for head circumference (0.01, 0.24, 0.17, and - 0.04 SD increase per decade, respectively) and birth weight (0.01 SD decrease per decade). The different patterns of changes in physical growth, biological maturation, and intelligence between 1978 and 1993 indicate that distinct mechanisms underlie these secular trends.

Decline in pubertal timing and its relationship with excess weight. A study of the secular trend in age at menarche in girls from La Plata district (Buenos Aires, Argentina).

To provide information on the secular trend in age at menarche (AgM) in Argentinean girls in relation to excess weight (EW) and body adiposity. Two cohorts (C) (C1, 2005-2007 and C2, 2015-2019) of children aged 8-14 years from La Plata district were studied using identical methodological criteria. Each participating child was asked about menarche (M) status: M presence (MP) or absence (MA). The AgM was estimated using the status quo method and logistic regression analysis. Body weight, height, and tricipital and subscapular skinfolds were collected to estimate EW (overweight + obesity) according to WHO criteria, and body adiposity (sum of skinfolds, SSK = [tricipital + subscapular]). The prevalence of EW by C was estimated and compared using the Chi-square test. The MP probability in relation to age, C, and EW was analyzed by applying logistic regression. Parents completed a questionnaire to assess family socioeconomic conditions. Data were compared using the Chi-square test. Differences in MP prevalence between C were significant (C1: 21.1% vs. C2: 28.7%). Median AgM was 12.81 years in C1 and 12.22 in C2. The prevalence of EW was higher in C2 (35.3%) than in C1 (24.6%). The probability of MP was higher in C2 than in C1 and children with EW. Both BMI and SSK showed inter-cohort increases. Socioeconomic conditions were substantially deteriorated between C. In an obesogenic context marked by the significant increase in body adiposity and EW, M prevalence exhibited a positive secular trend and AgM reduced by nearly seven months between the cohorts studied.

Inequalities in adiposity trends between 1979 and 1999 in Guatemalan children.

Guatemala suffered from civil war and high levels of inequality and childhood stunting in the second half of the 20th century, but little is known about inequalities in secular trends in adiposity. To investigate differences in childhood body mass index (BMI) and skinfold thickness trajectories from 1979 to 1999 between three groups of children: High socioeconomic position (SEP) Ladino, Low SEP Ladino, and Low SEP Indigenous Maya. The sample comprised 19 346 children aged 7-17 years with 54 638 observations. The outcomes were height, BMI, triceps skinfold thickness (TST), and subscapular skinfold thickness (SST) Z-scores according to the Centers for Disease Control and Prevention (CDC) references. Sex-specific multilevel models were used to estimate and compare mean trajectories from 1979 to 1999 between the three groups. Mean Z-scores were always highest for High SEP Ladino children and lowest for Low SEP Maya children. Despite their very short stature, the Low SEP groups had SST trajectories that were above the 50th centile. The BMI trajectories were relatively flat and within one major centile band of the CDC median, with differences between the three groups that were small (0.2-0.3 Z-scores) and did not attenuate over time. Conversely, the TST Z-score trajectories demonstrated larger positive secular trends (e.g., from -1.25 in 1979 to -0.06 in 1999 for Low SEP Maya boys), with differences between the three groups that were large (0.5-1.2 Z-scores) and did attenuate over time (in boys). Secular trends and between-group difference in the SST Z-score trajectories were less pronounced, but again we found stronger evidence in boys that the estimated inequalities attenuated over time. Secular trends and inequalities in skinfolds differ from those for BMI in Guatemalan children. Differences between groups in skinfolds attenuated over time, at least in boys, but whether this is good news is questionable given the very short stature yet relatively large subscapular skinfolds of the Low SEP groups.

Secular trends in height, weight, and body mass index in the context of economic and political transformations in Russia from 1885 to 2021.

To study and analyze the impact of socio-economic factors on secular changes in height, weight, and body mass index (BMI) among Moscow's youth over the time interval from the late 19th-early 20th century to the present. Anthropometric data, including height, weight, and BMI, were collected through surveys conducted on youths aged 17-20 years in Moscow from the 1880s for males and from the 1920s for females to the present. The dataset includes information on 6434 individuals surveyed from 2000 to 2019, as well as previously published mean values. Economic development indicators, such as gross domestic product (GDP) per capita, monthly average income per capita, and the Gini coefficient, were examined to analyze the association between secular trends in body size and socio-economic conditions. A positive secular trend in height and weight has been observed among Moscow's youth from the early 20th century to the present. Substantial increases in height occurred during the second half of the previous century, stabilizing in the 2000s. Over the analyzed period, both average body weight and BMI values showed a consistent rise. The pattern for BMI exhibited a U-shaped trend, with a decline from the 1970s to the mid-1990s, followed by a subsequent increase. Strong correlations were found between the secular changes in body size among Moscow's youth and temporal fluctuations in key socio-economic indicators, including GDP per capita, monthly average income per capita, and the Gini coefficient. The study demonstrates the significant influence of socio-economic conditions on intergenerational changes in body size, as evidenced by the positive secular trend in physique indicators (height, weight, and BMI) among Moscow's youth.

Height and body mass index trajectories from 1975 to 2015 and prevalence of stunting, underweight and obesity in 2016 among children in Chinese cities: findings from five rounds of a national survey

BackgroundA more comprehensive assessment of growth and nutrition in children is required in China due to rapid socioeconomic processes. We aimed to investigate height and body mass index (BMI) trajectories from 1975 to 2015 and the prevalence of stunting and obesity in 2016 among children in Chinese cities.MethodsA total of 904,263 children from birth to 6.9 years were collected from a series of nationally representative surveys in China. Height and BMI trajectories and prevalence of stunting, underweight, overweight and obesity were assessed.ResultsThe average height level of Chinese urban children under 7 years presented a positive secular trend from 1975 to 2015; however, a slowing tendency occurred in 2005‒2015. An apparent increase was observed at the 5th, 50th and 95th percentiles of BMI in urban children aged 3 years and older, with a more prominent increase at the 95th percentile. The total prevalence of stunting and underweight under 7 years was 1.4% and 2.0%, respectively. The total prevalence of overweight and obesity under 7 years was 12.6% and 4.3%, respectively, with 12.7% and 4.9% for boys, 12.6% and 3.6% for girls, 12.1% and 4.0% in urban areas and 13.1% and 4.5% in suburban rural areas.ConclusionsThe average height level of Chinese urban children has reached World Health Organization child growth standards since 2005 and presented a slowing tendency in secular trend in 2005‒2015. More attention and efforts and public health interventions should be urgently made to combat overweight and obesity among preschool children.6vUvDz8DH1EFmJqaqHYybhVideo

Study of head and chest growth and their equalization in Churachandpur, Manipur during the first year of life

Background: The study of head and chest circumferences and the subsequent age at equalization, when studying infant growth, played a vital role in a community as it helps in identifying those who are susceptible to nutritional issues. Keeping in view the importance, a journey was embarked upon with the object of finding out the growth of head and chest circumferences as well as their age of equalization among the tribal infants in Churachandpur, Manipur.Methods: Using longitudinal setting, infants taken into account were full term born and measurements were recorded within 24 hours of birth from maternity clinics and hospitals in Churachandpur. The growth pattern of head and chest circumferences were measured independently from birth till the child attained 1 year of age at monthly interval following standard techniques given by Weiner and Lourie by using a narrow, flexible, non-stretch steel tape calibrated in centimetres.Results: Observation of earlier equalization of head and chest circumferences is recorded among the tribal group studied. After the observation of equalization, chest circumference remains larger than head circumference in both sexes throughout the first year of life, which signifies a good growth among the infant group studied.Conclusions: It can be recommended from the present study the use of head and chest circumference for identifying vulnerable infant/children from their nutritional standpoint in any kind of settings as it is easily accessible and cost effective. The present study shows a positive secular trend when compared with other available literatures.

Linear and ponderal growth changes in boys and girls from Puerto Madryn (Patagonia, Argentina) between 2001 and 2016

Background: The phenotypic plasticity in growth pattern that takes place over time is described as “secular trend”. The presence of secular changes evidences shifts in the environmental conditions under which a population lives. In this regard, the study of the population residing in the northeast of Argentine Patagonia is interesting because it underwent a rapid demographic growth and urban sprawl in the last 50 years.
 Objective: To compare height and body weight of two groups of boys and girls between 6 and 14 years old from Puerto Madryn (northeast of Argentine Patagonia) and estimate secular trend changes during the first decades of 21st century.
 Sample and Methods: Height and body weight of two groups of schoolchildren were compared. Data of the first group (G1) was collected in the 2001–2006 period, and of the second (G2) during 2014–2016.
 To analyze the comparison between groups, the Friedman and Wilcoxon test (p < 0.05) were used. Centile values (3rd, 50th and 97th) of the variables by sex and age in both groups were also calculated. Then, they were compared using the Wilcoxon test.
 Results: Both sexes showed statistically significant differences for height in all centiles and for body weight in the 50th and 97th centiles. G2 values were above G1 for most ages.
 Conclusion: Boys and girls from Puerto Madryn show a positive secular trend in linear and ponderal growth patterns. These changes, registered during the first decades of the 21st century, are possibly related to the urban sprawl of the city and the variations in the associated socio-environmental and demographic conditions.

Analysis of secular trends in physical fitness of children and adolescents (8-18 years) from Kraków (Poland) between 2010 and 2020.

The aim of the study was to analyze the changes of the motor skills of children and adolescents from Kraków between 2010 and 2020. The group included 4106 children and adolescents (8-18 years of age). The analysis of changes included results of the following fitness tests: backwards overhead medicine ball throw, standing broad jump, dynamometric strength of the hand, flexibility test, as well as shuttle run (10× 5 m). A negative trend in both sexes was observed in the results of overhead medicine ball throw. The girls also had a negative intergenerational changes in the results of the shuttle run and the flexibility test. A positive secular trend was also observed in both sexes in relations to the dynamometric force of the right and left hand. In addition, the boys studied in more contemporary times showed better results in the shuttle run, compared to their peers in 2010. The study reported a decline in overall motor performance in children and adolescents. The observed results may be related to a decrease in the level of physical activity, as well as a higher incidence of overweight and high levels of body fat in the modern population.

Changes in the adiposity level and prevalence of overweight/obesity among children from Kraków (Poland) within the last decade (from 2010 to 2020).

The aim of this study was to assess the changes in the prevalence of overweight, obesity and high adiposity in children and adolescents from Krakow (Poland), between the years 2010 and 2020. Two cross-sectional series of anthropometric measurements were carried out in 2010 and 2020. Analysed characteristics included: body height and weight, BMI (Body Mass Index), body adiposity (%BF). The subjects were categorised according to their BMI (underweight, normal weight, overweight, obesity), as well as %BF (low, normal, high body fat).The research was conducted in randomly selected primary schools in Krakow (Poland). Studied cohorts (8-15 years of age), which represented four of the traditional residential districts: Śródmieście, Podgórze, Krowodrza and Nowa Huta. Among the girls, there was a negative secular trend regarding the prevalence of underweight and obesity. On the other hand, there also was a positive trend concerning the prevalence of overweight and low and high body fat. In boys, there was a negative secular trend regarding the prevalence of underweight and low adiposity. There was also a generally positive secular trend regarding the prevalence of overweight, obesity as well as high adiposity in boys. The findings of this study are particularly significant because detailed knowledge of the prevalence of overweight/obesity in childhood and adolescence is crucial for the future health of entire populations. Further studies should also take into account the levels of physical fitness and activity of the examined population.

Secular trends in Javanese adult height: the roles of environment and educational attainment

BackgroundSince its independence in 1945, Indonesia has undergone rapid socioeconomic development. The fastest changes occurred in Java, which is the main island where more than half of the Indonesian population lives.ObjectiveThis study aimed to analyze the secular trend in the height of adults living in Java born between 1953 and 1995 by comparing their residence (rural, small city, or large city) and considering factors that contribute to adult height.MethodsThe analysis used the following data: birth year, body height, weight, body mass index, sex, educational attainment, share of household food expenditures, and residence of 20- to 40-year-old men and women collected by the Indonesia Family Life Survey (IFLS) waves 1 to 5. Multiple linear regression was conducted to analyze several factors that influence adult height. Significance was set at p < 0.05 with a 95% confidence interval (CI).ResultsThe study included 30,656 measurements of individuals born between 1953 and 1995 (54.9% female). Positive secular trends (95% CI) were observed for men and women: 1.3 (1.1–1.4) cm and 0.9 (0.8–1.0) cm per decade, respectively. Multiple linear regression analyses showed that, in addition to the year of birth, the adult height of both males and females was independently associated with level of education and share of household food expenditure. Stratifying the data into residence in rural areas, small cities, and large cities showed that education levels influenced the adult height of men and women living in all regions, whereas the influence of birth year and share of household food expenditure differed between areas and genders.ConclusionsWe observed positive secular trends in the height of adults living in Java who were born between 1953 and 1995. The birth year, educational attainment, and share of household food expenditure significantly influenced adult height. A higher education level was consistently associated with taller adult height in both men and women living in rural areas, small cities, and large cities.

Height, Nutritional and Economic Inequality in Central Spain, 1837-1936.

This article analyzes the evolution of inequality in mean male height in central Spain considering the generations born from 1837 to 1915, measured in the drafts from 1858 to 1936 (n = 53,503). Mean adult height reflects a crude indicator of net nutritional status, a proxy for currently known measures of stunting and wasting. The results reveal a cycle of stagnation and decline in average height at the age of 21 for those born from the 1850s to the 1870s and a subsequent positive secular trend to exceed baseline levels. The coefficient of variation shows how inequality in height followed an opposite pattern, with an increase in the mid-nineteenth century and a subsequent decline, with an overall decline. The great migratory wave towards Latin America (1880–1930) barely affected the area studied here. The available evidence on the occupations and educational level of the recruits reveals a ranking in average height related to family background and personal income, educational level and literacy, propinquity to food and ownership and/or management of land. Therefore, socioeconomic status largely predicted adult height in Spanish men during the period. Reducing absolute poverty and increasing access to education remain cornerstones to reducing malnutrition, even in the current world.

Secular growth trend characteristics of the body structure in Hungarian athlete boys.

The aim of the present study was to get more knowledge of the nature of athlete boy's secular body changes and to differentiate it from the individual acceleration. A positive secular trend was supposed in athlete youth similar to normal population, but with different extent because of the sport selection. In this study some specific trend characteristics of athlete (basketball player) boys between the 1990th and 2010th are analyzed and compared to that of the reference values of the Hungarian National Growth Study I and II (HNGS I - 1980's, Eiben et al. 1991; HNGS II - 2003-2006, Bodzsár & Zsákai 2007). The individual data were collected in Budapest (capital) basketball club boys aged 10-15 years (N = 1376). Body measurements were taken by the first author by the request of coaches and parents. Secular trend was characterized by the changes in some of the measured body parameters by three birth cohorts. The secular changes followed a positive trend, though the traditional decade analyses the variables did not follow a balanced, proportional manner of change. The largest difference in body height occurred in 12-years of age, with a total of +8.27 cm height difference between Cohort III and I and +9.31 kg total difference in body mass at the same age, respectively. Some differences in the tendentious changes occurred between the age groups, characteristic shift of the fat content and the trunk/extremity fat ratio increase toward the younger age, and more excessive increase in BMI were found. Though it could be expected to have favourable body composition in young athletes, nowadays some unfavourable changes in the secular growth trend of body structure have been occurred. One explanation could be the less active leisure time spent. Our results can provide more practical information for coaches to enrich their professional attitude towards a better understanding how to choose and modify training methods during the varied growth and developmental process of young athletes.

The age at which adult height is achieved during adolescence in the Birth to Twenty Cohort, Johannesburg, South Africa

Background. The core of the study involves comparing the secular trends in height among self-reported black and white racial groups in South Africa (SA). The white group represents that part of the population that has always been affluent and therefore has growth trends comparable with those of developed nations of the world. In comparing the groups, we wanted to see the extent to which the black population has caught up, if it all, since the introduction of democracy in 1994. Objectives. To establish the age at which linear growth plateaus; to compare the age of growth cessation and the achieved adult height between sexes and racial groups in SA; and to compare data from the Bone Health Cohort with previous similar studies to ascertain the secular trend. Methods. We analysed prospective data of 569 individuals who had annual anthropometric assessments from age nine until 20 years (1999 - 2010). The SuperImposition by Translation and Rotation (SITAR) statistical programme was used to model height and age at growth cessation. Results. There was a total of 183 black females, 93 white females, 205 black males and 88 white males. Black and white females achieved adult height at a similar age (15.1 and 15.3 years), but black females were 5.7 cm shorter. Black and white males achieved their adult height at 17.5 and 16.5 years, respectively, black males being 4.6 cm shorter. Mean adult black male height is currently 170.7 cm v. 166.9 cm in 1971, while there were no significant secular changes in the other groups. Conclusions. There has been a positive secular growth trend in height over 30 years among black males, but no changes in the other groups.

Head circumference from birth to five years in France: New national reference charts and comparison to WHO standards.

BackgroundThe monitoring of head circumference (HC) is essential to early detect any conditions affecting its growth in early childhood. A positive secular trend and regional specificities in HC suggested the need to provide updated national HC reference growth charts.MethodsWe extracted all growth data collected from 42 primary-care physicians from across the French metropolitan territory who used the same electronic medical-records software. We selected HC measurements up to age five years for all children who were born after 1990 with birth weight > 2500 g. We derived new HC growth charts by using Generalized Additive Models for Location, Scale and Shape, then externally validated them until 30 months of age by comparison with the national population-based Étude Longitudinale Française depuis l'Enfance (ELFE) birth cohort and compared them to previous French and WHO growth charts.FindingsWith 973,869 HC measurements from 157,762 children, new calibrated HC growth charts from birth to age five years were generated. The new HC growth charts showed good external fit by comparison with the ELFE birth cohort. As compared with the new HC growth charts, the previous French and WHO growth charts mean HC z-scores were, respectively, -0.4 and -0.6 SD for girls and -0.2 and -0.6 SD for boys.InterpretationWe produced and validated national calibrated HC growth charts by using a novel big-data approach applied to data routinely collected in clinical practice. Comparison with previous French and WHO growth charts confirmed a positive secular trend since the 1960s and regional specificities.FundingThe French Ministry of Health; Laboratoires Guigoz—General Pediatrics section of the French Society of Pediatrics—Paediatric Epidemiological Research Group; the French Association of Ambulatory Pediatrics; and educational grant from the Regional Health Agency of Ile-de-France.

The impact of the COVID-19 pandemic on health services utilization in China: Time-series analyses for 2016–2020

BackgroundThe aim of this study is to quantify the effects of the SARS-CoV-2 pandemic on health services utilization in China using over four years of routine health information system data. MethodsWe conducted a retrospective observational cohort study of health services utilization from health facilities at all levels in all provinces of mainland China. We analyzed monthly all-cause health facility visits and inpatient volume in health facilities before and during the SARS-CoV-2 outbreak using nationwide routine health information system data from January 2016 to June 2020. We used interrupted time series analyses and segmented negative binomial regression to examine changes in healthcare utilization attributable to the pandemic. Stratified analyses by facility type and by provincial Human Development Index (HDI) – an area-level measure of socioeconomic status – were conducted to assess potential heterogeneity in effects. FindingsIn the months before the SARS-CoV-2 outbreak, a positive secular trend in patterns of healthcare utilization was observed. After the SARS-CoV-2 outbreak, we noted statistically significant decreases in all indicators, with all indicators achieving their nadir in February 2020. The magnitude of decline in February ranged from 63% (95% CI 61–65%; p<0•0001) in all-cause visits at hospitals in regions with high HDI and 71% (95% CI 70–72%; p<0•0001) in all-cause visits at primary care clinics to 33% (95% CI 24–42%; p<0•0001) in inpatient volume and 10% (95% CI 3–17%; p = 0•0076) in all-cause visits at township health centers (THC) in regions with low HDI. The reduction in health facility visits was greater than that in the number of outpatients discharged (51% versus 48%; p<0•0079). The reductions in both health facility visits and inpatient volume were greater in hospitals than in primary health care facilities (p<0•0001) and greater in developed regions than in underdeveloped regions (p<0•0001). Following the nadir of health services utilization in February 2020, all indicators showed statistically significant increases. However, even by June 2020, nearly all indicators except outpatient and inpatient volume in regions with low HDI and inpatient volume in private hospitals had not achieved their pre-SARS-COV-2 forecasted levels. In total, we estimated cumulative losses of 1020.5 (95% CI 951.2- 1089.4; P<0.0001) million or 23.9% (95% CI 22.5–25.2%; P<0.0001) health facility visits, and 28.9 (95% CI 26.1–31.6; P<0.0001) million or 21.6% (95% CI 19.7–23.4%; P<0.0001) inpatients as of June 2020. InterpretationInpatient and outpatient health services utilization in China declined significantly after the SARS-CoV-2 outbreak, likely due to changes in patient and provider behaviors, suspension of health facilities or their non-emergency services, massive mobility restrictions, and the potential reduction in the risk of non-SARS-COV-2 diseases. All indicators rebounded beginning in March but most had not recovered to their pre-SARS-COV-2 levels as of June 2020. FundingThe National Natural Science Foundation of China (No. 72042014).

The Effect of the SARS-CoV-2 Pandemic on Health Services Utilization in China: Time-Series Analyses for 2016-2020

Background: The aim of this study is to quantify the effects of the SARS-CoV-2 pandemic on health services utilization in China using over 5 years of routine health information system data. Methods: We conducted a retrospective observational cohort study of health services utilization from health facilities at all levels in all provinces of mainland China. We analyzed monthly all-cause health facility visits and inpatient volume in health facilities before and during the SARS-CoV-2 outbreak using nationwide routine health information system data from January 2016 to June 2020. We used interrupted time series analyses and segmented negative binomial regression to examine changes in healthcare utilization attributable to the pandemic. Stratified analyses by facility type and by provincial Human Development Index (HDI) – an area-level measure of socioeconomic status – were conducted to assess potential heterogeneity in effects. Findings: In the months before the SARS-CoV-2 outbreak, a positive secular trend in patterns of healthcare utilization was observed. After the SARS-CoV-2 outbreak, we noted statistically significant decreases in all indicators, with all indicators achieving their nadir in February 2020. The magnitude of decline ranged from 63% (95% CI 61-65%; p<0.001) in all-cause visits at hospitals in regions with high HDI and 71% (95% CI 70-72%; p<0.001) in all-cause visits at primary care clinics to 33% (95% CI 24-42%; p<0.001) in inpatient volume at hospitals in regions with low HDI and 10% (95% CI 3-17%; p<0.01) in all-cause visits at township health centers (THC) in regions with low HDI. The reduction in health facility visits was greater than that in the number of outpatients discharged (51% vs. 48%; p<0.01). The reductions in both health facility visits and outpatient volume were greater in hospitals than in primary health care facilities (p<0.001) and greater in developed regions than in underdeveloped regions (p<0.001). Following the nadir of health services utilization in February 2020, all indicators showed statistically significant increases. However, even by June 2020, nearly all indicators had not achieved their pre-SARS-COV-2 levels. In total, we estimated cumulative losses of 1020.5 (95% CI 952.7- 1088.6; P<0.001) million health facility visits and 28.9 (95% CI 26.1-31.6; P<0.001) million inpatients as of June 2020. Interpretation: Inpatient and outpatient health services utilization in China declined significantly after the COVIID-19 outbreak, likely due to changes in patient and provider behaviors, suspension of health facilities or their non-emergency services, massive mobility restrictions, and the potential reduction in the risk of non-SARS-COV-2 diseases. All indicators rebounded beginning in March but most had not recovered to their pre-SARS-COV-2 levels as of June 2020. Funding: The National Natural Science Foundation of China (No. 72042014). Conflict of Interest: We declare no competing interests.

Secular changes in the anthropometrics of Chilean workers and its implication in design.

Anthropometrics is very important when ensuring a physical match between end users and product or workstations. The purpose of this study are twofold, to provide anthropometric data for the design of products and to examine the secular changes in the adult Chilean workers in a period of more than 20 years. Nineteen anthropometric measurements from two samples from 1995 and 2016 were compared using independent t-test (95% confidence interval), where additionally absolute and relative differences were calculated. The secular trend observed for Stature is characterized by an increase average of 20mm and 10.5mm per decade for females and males, respectively. There is a positive secular trend for both genders, which is observed for most of the selected body measurements. The most pronounced increases were onWeight, Shoulder breadth, Body mass index, Popliteal height; Buttock-popliteal length and Hip width. Segmental dimensions that experienced a positive secular trend, together with Weight and Stature, are highly correlated with seating design, addressing the need to review products targeting Chilean adult workers, such as public transport seats, office furniture or industrial workplaces.

Secular Trends in Height, Body Mass and Mean Menarche Age in Romanian Children and Adolescents, 1936-2016.

Secular trends in anthropometric parameters have been documented in most European countries, but no data is available regarding Romanian. The aim of the study was to calculate secular trend in height, body mass and mean menarche age for Romanian children and adolescents. Methods: A secondary data analysis was performed using ten data sets for urban and eight data sets for rural boys and girls, age 5–15 years, covering 80 years (1936 to 2016). Secular trend in height (cm/decade), body mass(kg/decade) and mean menarche age (years) were calculated. Results: Overall, there was a positive secular trend for height in both genders, which parallels the gross domestic product (GDP)/capita difference, more pronounced in boys, across all age-groups, with a maximum for 15 years-old boys (~3 cm/decade) and 13 years-old girls (~2 cm/decade). Body mass trend was also positive, more accentuated in the rural population. Mean age at menarche was higher in rural compared to urban girls, had a negative trend with the disappearance of the difference in the latest available data set (2013). Conclusion: In summary, an overall positive and ongoing secular trend in height and body mass was documented in Romanian children and adolescents, especially for the pubertal age-range, in concordance to other western countries, but out of phase by approximately 20 years.