Series Of Cross-sectional Studies Research Articles

Development of a Brief, Positively Framed Care Team Experience Measure.

Measures that quantify clinician fulfillment and engagement with work (clinician experience measures) have the potential to improve the quality, effectiveness, and enjoyment of patient care. Many existing measures of clinician fulfillment and engagement with work are relatively long and potentially burdensome, negatively framed, or address personal well-being. A measure with a small number of items that address positive attributes to which a team aspires may be a more useful measure to guide organizational improvement efforts. In a series of cross-sectional studies we asked: (1) Can we develop a brief, positively framed, and team-oriented care team experience measure (CTEM)? (2) How does the CTEM perform relative to the Team Climate Inventory (TCI)? In a first step, the clinical leadership group of a nascent multispecialty group practice curated 21 items, some from existing engagement and burnout measures and others based on suggestions from clinical leaders. After pilot testing and interviews with specific clinicians, these items were then administered to all clinicians in the practice, and 44% (120 of 274) participated. Factor analysis identified three groups of items (factors). In a second step, 43% (493 of 1135) of patient-facing employees (75% [368] of whom were women and 45% [222] of whom were ages 42 to 61 years) of a statewide musculoskeletal specialty practice rated 12 items (two from each of the factors identified in the first stage and six new items recommended by administrative leaders) and completed the TCI. Participants were then randomly allocated to a learning cohort (70% [343 participants]), in which we performed factor analysis and item response theory to develop a new CTEM and validation cohort (30% [150 participants]) to test the consistency of the findings. The best-performing items in terms of factor loadings (the degree to which an individual item represents an identified factor or "theme"; we chose a minimum of 0.4 as items above this threshold are generally regarded as stable), item discrimination (ability to measure different experiences among participants), item difficulty (the ability of an item to contribute to variation in scores), and model fit (the degree to which the estimates of the statistical model align with the observed data) were selected to form a new three-item CTEM. The CTEM was subsequently evaluated for internal consistency (Cronbach alpha, which measures the extent to which different subsets of the included items would provide the same measurement), floor and ceiling effects (the percentage of the lowest and highest possible scores, with high percentages indicating that information is lost because of the inability of a tool to measure the extremes of variation), and correlation with the TCI. Factor analysis identified two groups of items representing "effectiveness" (nine items, including "I am proud of the work we do") and "collaboration" (three items, including "Our team encourages everyone's input before making changes"). The best-performing items of "effectiveness" (two items) and "collaboration" (one item) were selected to form the three-item CTEM, which had good internal consistency (Cronbach α = 0.77; > 0.7 generally considered acceptable); a notable ceiling (37%; higher than desired, common with experience measures, and-in our opinion-acceptable for routine use given the trade-off of limited participant burden) and limited floor effect (1.3%); strong correlation with the TCI (Spearman ρ 0.77 [95% confidence interval 0.70 to 0.85]), which supports convergent validity (part of construct validity, meaning correlation with measures of related concepts); and similar correlations with participant characteristics compared with the TCI, supporting construct and criterion validity (association with real-world outcomes). A small number of positively framed, team-oriented questions (the CTEM) can quantify clinician and care team experience and provide a practical and feasible method for health organizations to monitor and improve the experience of their clinicians. Routine measurement of organizational climate at regular intervals using a brief, user-friendly, team-oriented measure might help organizations improve their culture and help their clinicians feel appreciated and engaged.

Comparison of functional disabilities, place of death and end-of-life medical expenditures among centenarians and non-centenarians in China: a series of cross-sectional studies

BackgroundLong-term and end-of-life (EOL) care for older adults has become a global concern due to extended longevity, which is generally accompanied by increased rates of disability. However, differences in the rates of disability in activities of daily living (ADLs), place of death and medical expenditures during the last year of life between centenarians and non-centenarians in China remain unknown. This study aims to fill this research gap to inform policy efforts for the capacity-building of long-term and EOL care for the oldest-old, especially for centenarians in China.MethodsData from 20,228 decedents were derived from the 1998–2018 Chinese Longitudinal Healthy Longevity Survey. Weighted logistic and Tobit regression models were used to estimate differences in the prevalence of functional disability, rate of death in hospitals and EOL medical expenditures by age groups among oldest-old individuals.ResultsOf the 20,228 samples, 12,537 oldest-old individuals were female (weighted, 58.6%, hereafter); 3,767 were octogenarians, 8,260 were nonagenarians, and 8,201 were centenarians. After controlling for other covariates, nonagenarians and centenarians experienced a greater prevalence of full dependence (average marginal differences [95% CI]: 2.7% [0%, 5.3%]; 3.8% [0.3%, 7.9%]) and partial dependence (6.9% [3.4%, 10.3%]; 15.1% [10.5%, 19.8%]) but a smaller prevalence of partial independence (-8.9% [-11.6%, -6.2%]; -16.0% [-19.1%, -12.8%]) in ADLs than octogenarians. Nonagenarians and centenarians were less likely to die in hospitals (–3.0% [–4.7%, –1.2%]; –4.3% [–6.3%, –2.2%]). Additionally, nonagenarians and centenarians reported more medical expenditures during the last year of life than octogenarians with no statistically significant differences.ConclusionThe oldest-old experienced an increased prevalence of full and partial dependence in ADLs with increasing age and reported a decline in the prevalence of full independence. Compared with octogenarians, nonagenarians and centenarians were less likely to die in hospitals. Therefore, future policy efforts are warranted to optimise the service provision of long-term and EOL care by age patterns for the oldest-old population in China.

Rising trends in obesity prevalence among Royal Thai Army personnel from 2017 to 2021

Obesity is an essential health issue leading to noncommunicable diseases (NCDs) as well as atherosclerotic cardiovascular diseases. We aimed to determine the trends in obesity prevalence among Royal Thai Army (RTA) personnel and their associated factors using the health examination of RTA personnel database. A series of cross-sectional studies were conducted from 2017 to 2021. A self-report guide was created using a standardized case report form to obtain demographic characteristics and determine behavioral risk factors. Obesity was defined as BMI ge 25 kg/m2, and a total of 512,476 RTA personnel nationwide were included. Obesity prevalence rose from 42.1% (95% CI 41.7–42.4) in 2017 to 44.2% (95% CI 43.9–44.5) in 2021 (p for trend < 0.001). A significant surge was observed in obesity prevalence among young RTA personnel aged 18–24 years from 23.7% in 2017 to 28.4% in 2021 (p for trend < 0.001). Higher age individuals, male participants and RTA personnel residing in Bangkok tended to have a significantly higher risk for obesity. Further, regular exercise was a protective factor for obesity. Our data emphasized that obesity among the RTA personnel has been continuously rising over one half-decade, especially among young adults.

227The use of cross-sectional series as a source of evidence for policymaker decision in Brazil

Abstract Background To verify the effectiveness of public policies, two or more cross-sectional studies can be carried out in series. The objective of this work is to present the maternal and child health research of Ceará (PESMIC), Brazil, a series of cross-sectional studies carried out in a partnership between the university and the local government. Methods PESMIC is a series of cross-sectional studies with constant methodology, a sample obtained in multiple stages, with systematic and clusters sampling, state-wide representative, which visits 8000 households in 1987, 1990, 1994, 2001, 2007 and 2017. Around 300 variables are collected, in three different questionnaires, for the home, mothers, and children. Results PESMIC demonstrated over 30 years the improvement of several indicators such as the drop in infant mortality from 120 to 10 per thousand, the reduction of child malnutrition from 26.8% to 8.6%, the increase in infant breastfeeding for six months from 3% to 99%, the increase in maternal literacy from 58% to 97%. Conclusions Over 30 years, PESMIC presented results that allowed the evaluation of public policies and the occurrence of epidemiological transitions that occurred at the population level. The use of oral rehydration serum applied by community health workers, both unprecedented in Brazil when they started in Ceará, had their effectiveness demonstrated by PESMIC and were expanded to the rest of the country soon afterward. We conclude that the transversal series are studies that can help guide decision making by public health managers. Key messages The use of cross-sectional series can be a feasible alternative for the formation of evidence to aid decision-making The use of the PESMIC transversal series in Ceará helps Brazil in making important decisions such as the expansion of the community health workers program

The relationship between ambient temperature and fasting plasma glucose, temperature-adjusted type 2 diabetes prevalence and control rate: a series of cross-sectional studies in Guangdong Province, China

BackgroundThere existed evidence that type 2 diabetes mellitus (T2DM) prevalence and control rate have seasonal variation. Our study aimed to examine the ambient temperature and fasting plasma glucose (FPG) association and estimate temperature-adjusted T2DM prevalence and control rate.MethodsFour cross-sectional health surveys with 26,350 respondents were conducted in Guangdong Province from 2007 to 2015. Multistage cluster sampling was used to recruit study participants. The data of demographic characteristics, lifestyle factors, diet and use of hypoglycemic medicine, height, weight, FPG and meteorological information were collected. And an inverse distance-weighted method was employed to estimate daily temperature exposures at the individual’ s residential district/county. Base on World Health Organization 2006 criteria, participants were divided into normal fasting glucose (NFG) participants (n = 23,877), known T2DM patients (n = 916) and newly detected T2DM patients (n = 1557). Generalized additive mixed model was employed to evaluate the nonlinear associations between temperature and FPG among different T2DM subgroups. The T2DM prevalence and control rate were estimated based on temperature-FPG association.ResultsThe curves of temperature and FPG were downward parabola for total, NFG and known T2DM groups, while it was “U”-shaped for newly detected T2DM patients. When temperature decreased from 30 °C to 4 °C, the FPG significantly increased 0.24 (95%CI: 0.15, 0.33) mmol/L, 0.10 (95%CI: 0.06, 0.14) mmol/L and 1.34 (95%CI: 0.56, 2.12) mmol/L in total, NFG and known T2DM groups, respectively. Compared to 19 °C, newly detected T2DM patients’ FPGs were increased 0.73 (95%CI: 0.13, 1.30) mmol/L at 4 °C and 0.53 (0.00, 1.07) mmol/L at 30 °C. The model-estimated temperature-adjusted T2DM prevalence had a down and up trend, with 9.7% at 5 °C, 8.9% at 20 °C and 9.4% at 30 °C, respectively. At 5, 10, 15, 20, 25 and 30 °C, the model-estimated temperature-adjusted T2DM control rates were 33.2, 35.4, 38.2, 43.6, 49.1 and 55.2%.ConclusionTemperature was negatively associated with FPG for NFG and known T2DM subgroups, while their association was U-shape for newly detected T2DM patients. Hence, the temperature-adjusted T2DM prevalence show a dip/peak pattern and T2DM control rate display a rising trend when temperature increase. Our findings suggest temperature should be considered in T2DM clinic management and epidemiological survey.

Temperature-adjusted hypertension prevalence and control rate: a series of cross-sectional studies in Guangdong Province, China.

Previous studies have shown negative relationships between ambient temperature and blood pressure (BP). However, few studies estimated temperature-adjusted hypertension prevalence and control rate in different population. To estimate the effects of temperature on BP, and further calculate temperature-adjusted hypertension prevalence and control rate. Meteorological and BP data in Guangdong Province from 2004 to 2015 were collected. There were 31 351 participants aged 18 years and over. Based on 2018 European society Arterial Hypertension Guidelines, participants were divided into normotensive patients (n = 23 046), known hypertensive patients (n = 2807), and newly detected hypertensive patients (n = 5498). We first used generalized additive model to establish the nonlinear relationship between daily mean temperature and BP, and then calculated the linear effects of temperature on BP among populations with different hypertension status. Finally, we calculated the temperature-adjusted hypertension prevalence and control rate. Generally, there is an inverse relationship between temperature and BP. For a 1 °C increase in temperature, the decreased SBPs for normotensive patients, newly detected hypertensive patients, and known hypertensive patients were 0.37 [95% confidence interval (CI): -0.40, -0.33] mmHg, 0.21 (95% CI: -0.32, -0.10) mmHg and 0.81 (95% CI: -1.02, -0.59) mmHg, while reduced DBPs were 0.19 (95% CI: -0.21, -0.16) mmHg, 0.01 (95% CI: -0.06,0.08) mmHg, and 0.44 (95% CI: -0.56, -0.32) mmHg, respectively. At 5, 10, 15, 20, and 25 °C, the hypertension prevalence rates were 32.5, 29.7, 27.7, 26.0, and 25.0%, respectively, and the control rates were 12.0, 17.5, 23.5, 30.1, and 37.1%, respectively. Low temperature increased BP for all populations, especially for known hypertensive patients, which makes hypertension prevalence increase and control rate decrease if temperature reduce. Our findings suggest that temperature should be considered in hypertension clinic management and epidemiological survey.

Submicroscopic malaria infection is not associated with fever in cross-sectional studies in Malawi

BackgroundSubmicroscopic Plasmodium falciparum infections are widespread in many areas. However, the contribution of these infections to symptomatic malaria is not well understood. This study evaluated whether participants with submicroscopic P. falciparum infections have higher prevalence of fever than uninfected participants in southern Malawi.MethodsA total of 16,650 children and adults were enrolled in the course of six cross-sectional surveys during the dry season (October–November) and after the rainy season (April–May) between 2012 and 2014 in three districts in southern Malawi. Demographic and socioeconomic data were collected in conjunction with data on clinical histories, use of malaria preventive measures, and anti-malarial medication taken within 2 weeks of the survey. Axillary temperatures were measured, and blood samples were collected for P. falciparum detection by microscopy and PCR. Participants without malaria parasites detected on microscopy but with a positive PCR for P. falciparum were defined as having submicroscopic infection. Fever was defined as having any one of: reported fever in the past 2 weeks, reported fever in the past 48 h, or a temperature of ≥ 37.5 °C measured at the time of interview.ResultsSubmicroscopic P. falciparum infections and fever were both detected in 9% of the study population. In the final analysis adjusted for clustering within household and enumeration area, having submicroscopic P. falciparum infection was associated with reduced odds of fever in the dry season (odds ratio = 0.52; 95% CI 0.33–0.82); the association in the rainy season did not achieve statistical significance (odds ratio = 1.20; 95% CI 0.91–1.59). The association between submicroscopic infection and fever was consistent across all age groups. When the definition of fever was limited to temperature of ≥ 37.5 °C measured at the time of interview, the association was not statistically significant in either the rainy or dry season.ConclusionsIn this series of cross-sectional studies in southern Malawi, submicroscopic P. falciparum infection was not associated with increased risk of fever. Submicroscopic detection of the malaria parasite is important in efforts to decrease transmission but is not essential for the clinical recognition of malaria disease.

Another frontier for harm reduction: contraceptive needs of females who inject drugs in Estonia, a cross-sectional study

BackgroundDespite increasing contraceptive availability, unintended pregnancy remains a global problem. Developing strategies to reverse this trend and increasing occurrence of withdrawal syndrome among newborn children of females currently injecting drugs warrants special attention. The knowledge base on the uptake of effective contraception among females who inject drugs (FWID) is scant. We aimed to examine the prevalence of and factors associated with the use of non-condom contraceptives among sexually active FWID with the focus on effective contraception.MethodsIn a series of cross-sectional studies (2007–2013), 265 current FWID were recruited through respondent-driven sampling (RDS), interviewed, and tested for HIV. RDS weights were used to estimate the prevalence of effective contraception (hormonal contraception, intrauterine device, sterilization) use in the last 6 months.ResultsOf the sexually active women with main partners (n = 196) 4.8% (95% CI 2.3–9.7) were using effective contraception, 52.7% (95% CI 42.5–62.7) less-effective or no contraception. 42.5% (95% CI 32.7–52.9) relied on condoms for contraception. The odds for using effective contraception were higher among women with > 10 years of education (OR 7.29, 95% CI 1.4–38.8). None of the women lacking health insurance (n = 84) were using effective contraception.ConclusionsThe very low coverage with effective contraception highlights the need to improve contraceptive services for FWID. Reproductive health service including contraception should be considered essential components of harm reduction and of comprehensive prevention and care for HIV among persons who use drugs.

Associations between Trends in Aging, Physical Activity, Central Obesity and Body Mass Index with Diabetes Prevalence in Korea: A Series of Cross-Sectional Studies from the 1st to 5th Korean National Health and Nutrition Examination Survey (1998–2012)

Associations between Trends in Aging, Physical Activity, Central Obesity and Body Mass Index with Diabetes Prevalence in Korea: A Series of Cross-Sectional Studies from the 1st to 5th Korean National Health and Nutrition Examination Survey (1998–2012)

Prevalence of overweight and malnutrition among ethnic minority children and adolescents in China, 1991-2010.

This study aimed to determine the trends in prevalence of childhood overweight and malnutrition in a large Chinese ethnic minority population from 1991 to 2010. In the Chinese National Survey on Students’ Constitution and Health from 1991 to 2010, multistage stratified sampling was conducted in the series of cross-sectional studies. Participants were 7–18-year-old students randomly selected by sex and region, and included Han and 26 ethnic minorities. During the survey period, the overall prevalence of overweight increased from 5.8% to 13.5%, and malnutrition trend increased from 3.6% to 4.1% in ethnic minority children and adolescents. Moreover, Korean and Mongol children were more likely than Han children to be obese (Korean: RR = 1.52; 95% CI: 1.48–1.56; Mongol: RR = 1.24; 95% CI: 1.20–1.28). Among these minorities, the Dongxiang and Li children were more likely to be malnourished (Li: RR = 1.47; 95% CI: 1.37–1.57; Dongxiang: RR = 1.45; 95% CI: 1.34–1.58). Shui, Khalkhas, Lisu, and Monguor children were less likely to be overweight and malnourished compared with the Hans. The prevalence of overweight among ethnicities increased yearly while that for malnutrition has fluctuated over the past few decades.

Cardiovascular Risk Factors of Adults Age 20-49 Years in the United States, 1971-2012: A Series of Cross-Sectional Studies.

BackgroundThe health of younger adults in the U.S. has important public health and economic-related implications. However, previous literature is insufficient to fully understand how the health of this group has changed over time. This study examined generational differences in cardiovascular risk factors of younger adults over the past 40 years.MethodsData were from 6 nationally representative cross-sectional National Health and Nutrition Examination Surveys (1971–2012; N = 44,670). Participants were adults age 20–49 years who self-reported sociodemographic characteristics and health conditions, and had examination/laboratory measures for hypertension, hyperlipidemia, diabetes, obesity, and chronic kidney disease. Prevalences of sociodemographic characteristics and health status were determined by study period. Logistic regression was used to determine the odds [odds ratio (OR), 95% confidence interval] of health conditions by study period: models adjusted only for age, sex, and race, and fully adjusted models additionally adjusted for socioeconomic characteristics, smoking, BMI, diabetes, and/or hypertension (depending on the outcome) were assessed.ResultsParticipants in 2009–2012 were significantly more likely to be obese and have diabetes compared to those in 1971–1975 (OR = 4.98, 3.57–6.97; OR = 3.49, 1.59–7.65, respectively, fully adjusted). Participants in 2009–2012 vs. 1988–1994 were significantly more likely to have had hypertension but uncontrolled hypertension was significantly less likely (OR = 0.67, 0.52–0.86, fully adjusted). There was no difference over time for high cholesterol, but uncontrolled high cholesterol was significantly less likely in 2009–2012 vs. 1988–1994 (OR = 0.80, 0.68–0.94, fully adjusted). The use of hypertensive and cholesterol medications increased while chronic kidney and cardiovascular diseases were relatively stable.ConclusionsCardiovascular risk factors of younger U.S. adults have worsened over the past 40 years, but treatment for hypertension and high cholesterol has improved. The sub-optimal and worsening health in younger adults may have a substantial impact on health care utilization and costs, and should be considered when developing health care practices.

Development and Validation of a Short Version of the Cornell Scale for Depression in Dementia for Screening Residents in Nursing Homes

To develop and validate a short version of the Cornell Scale for Depression in Dementia (CSDD-19) for routine detection of depression in nursing homes. Australian nursing homes. A series of cross-sectional studies were conducted involving: 1) descriptive analysis of pooled data from five nursing home studies that used the CSDD-19 (N = 671) to identify patterns of responses and missing data on individual CSDD items; 2) analysis of four of the five studies (N = 556) to assess CSDD-19 for unidimensionality, item fit, and differential item functioning using Rasch modeling to develop a shorter version, the CSDD-4; 3) validation of the CSDD-4 against the DSM-IV using the fifth study of 115 residents and through expert consultations; and 4) evaluation of the clinical utility of CSDD-4 using an independent cohort of 92 nursing home residents. Four items from the original CSDD-19 were found to be most suitable for depression screening: anxiety, sadness, lack of reactivity to pleasant events, and irritability. The CSDD-4 highly correlated with the original scale (N = 474, r = 0.831, p < 0.001), with acceptable internal consistency (Cronbach's alpha = 0.70). At the cutoff score of less than 2, sensitivity and specificity of CSDD-4 were 81% and 51%, respectively, for the independent cohort (N = 92), of whom 50% had dementia. The CSDD-4 had an area under the curve (AUC) of 0.73 (z = 3.47, p < 0.001), which was compatible with the CSDD-19 (AUC = 0.69, z = 2.89, p < 0.01). The CSDD-4 is valid for routine screening of depression in nursing homes. Its adoption is feasible and practical for nursing home staff, and may facilitate more comprehensive assessment and management of depression in nursing home residents.

Is organizational progress in the EFQM model related to employee satisfaction?

BackgroundTo determine whether there is greater employee satisfaction in organisations that have made more progress in implementation of the European Foundation for Quality Management (EFQM) model.MethodsA series of cross-sectional studies (one for each assessment cycle) comparing staff satisfaction survey results between groups of healthcare organisations by degree of implementation of the EFQM model (assessed in terms of external recognition of management quality in each organisation). Setting: 30 healthcare organisations including hospitals, primary care and mental health providers in Osakidetza, the Basque public health service. Participants: Employees of 30 Osakidetza organisations. Intervention: Progress in implementation of EFQM model. Main outcome measures: Scores in 9 dimensions of employee satisfaction from questionnaires administered in healthcare organisations in 4 assessment cycles between 2001 and 2010.ResultsComparing satisfaction results in organisations granted Gold or Silver Q Awards and those without this type of external recognition, we found statistically significant differences in the dimensions of training and internal communication. Then, comparing recipients of Gold Q Awards with those with no Q Certification, differences in leadership style and in policy and strategy also emerged as significant.ConclusionsProgress of healthcare organisations in the implementation of the EFQM Excellence Model is associated with increases in their employee satisfaction in dimensions that can be managed at the level of each organisation, while dimensions in which no statistically significant differences were found represent common organisational elements with little scope for self-management.

Associations between trends in race/ethnicity, aging, and body mass index with diabetes prevalence in the United States: a series of cross-sectional studies.

The increase in the prevalence of diabetes over the past few decades has coincided with an increase in certain risk factors for diabetes, such as a changing race/ethnicity distribution, an aging population, and a rising obesity prevalence. To determine the extent to which the increase in diabetes prevalence is explained by changing distributions of race/ethnicity, age, and obesity prevalence in U.S. adults. Cross-sectional, using data from 5 NHANES (National Health and Nutrition Examination Surveys): NHANES II (1976-1980), NHANES III (1988-1994), and the continuous NHANES 1999-2002, 2003-2006, and 2007-2010. Nationally representative samples of the U.S. noninstitutionalized civilian population. 23 932 participants aged 20 to 74 years. Diabetes was defined as a self-reported diagnosis or fasting plasma glucose level of 7.0 mmol/L (126 mg/dL) or more. Between 1976 to 1980 and 2007 to 2010, diabetes prevalence increased from 4.7% to 11.2% in men and from 5.7% to 8.7% in women (P for trends for both groups < 0.001). After adjustment for age, race/ethnicity, and body mass index, diabetes prevalence increased in men (6.2% to 9.6%; P for trend < 0.001) but not women (7.6% to 7.5%; P for trend = 0.69). Body mass index was the greatest contributor among the 3 covariates to the change in prevalence estimates after adjustment. Some possible risk factors, such as physical activity, waist circumference, and mortality, could not be studied because data on these variables were not collected in all surveys. The increase in the prevalence of diabetes was greater in men than in women in the U.S. population between 1976 to 1980 and 2007 to 2010. After changes in age, race/ethnicity, and body mass index were controlled for, the increase in diabetes prevalence over time was approximately halved in men and diabetes prevalence was no longer increased in women. Centers for Disease Control and Prevention and National Institutes of Diabetes and Digestive and Kidney Diseases.

Trends in child and adolescent obesity prevalence according to socioeconomic position: protocol for a systematic review.

BackgroundObesity is a significant public health issue and is socially patterned, with greater prevalence of obesity observed in the most socioeconomically disadvantaged groups. Recent evidence suggests that the prevalence of childhood obesity is levelling off in some countries. However, this may not be the case across all socioeconomic strata. The aim of this review is to examine whether trends in child and adolescent obesity prevalence since 1990 differ according to socioeconomic position in developed countries.MethodsAn electronic search will be conducted via Ovid Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus and Cochrane Collaboration to identify articles that report trends in obesity prevalence in children and adolescents according to socioeconomic position. We will also search grey literature databases including the Virtual Library for Public Health and the System for Information on Grey Literature, as well as websites from relevant organisations. Articles that report on a series of cross sectional studies; describe one or more measure of obesity with data recorded at two or more time points since 1990; and report trends by at least one indicator of socioeconomic position will be included. Quality of included studies will be evaluated according to criteria that consider both internal and external validity. Descriptive analysis will be performed to examine trends since 1990 in childhood obesity prevalence according to socioeconomic position.DiscussionThe review will provide a picture of change over time in developed countries of childhood obesity prevalence across socioeconomic strata and identify whether changes in childhood obesity prevalence are experienced equally across socioeconomic groups.Systematic review registrationPROSPERO CRD42014007625.

The attraction of online games: An important factor for Internet Addiction

This study examined the attraction of online games and their contribution to Internet Addiction (IA) among college students in China in a series of cross-sectional studies. Study 1 tested the theoretical framework of the online games attraction and developed an assessment instrument: the Online Game Attraction Inventory (OAI). Study 2 surveyed 635 students using a battery of questionnaires that included the Chen Internet Addiction Scale (CIAS) to assess IA levels and determine which predictor contributed the most to IA. The results indicated the OAI to be a psychometrically sound tool with acceptable levels of reliability and validity. The OAI score was positively related to the CIAS score (r=.397, p<.01), and the structural equation modeling results revealed that online game attraction mediates the relationships among personality, family function, life events, social support and IA. Thus, the attraction of online games may affect the IA of college students; therefore, more attention should be paid to this issue.

Mice lacking the Parkinson's related GPR37/PAEL receptor show non‐motor behavioral phenotypes: age and gender effect

Non-motor symptoms in Parkinson's disease (PD) have been often described at different stages of the disease but they are poorly understood. We observed specific phenotypes related to these symptoms in mice lacking the PD-associated GPR37/PAEL receptor. GPR37 is an orphan G-protein-coupled receptor highly expressed in the mammalian central nervous system. It is a substrate of parkin and it is involved in the pathogenesis of PD. GPR37 interacts with the dopamine transporter (DAT), modulating nigro-striatal dopaminergic signaling and behavioral responses to amphetamine and cocaine. GPR37 knockout (KO) mice are resistant to MPTP and exhibit several motor behavioral abnormalities related to altered dopaminergic system function. To evaluate non-motor behavioral domains, adult and aged, male and female GPR37 KO mice and their wild-type (WT) littermates were analyzed in a series of cross-sectional studies. Aged GPR37 KO female mice showed mild improvements in olfactory function, while anxiety and depression-like behaviors appeared to be significantly increased. A reduction of the startle response to acoustic stimuli was observed only in adult GPR37 KO mice of both genders. Furthermore, HPLC analysis of major neurotransmitter levels revealed gender differences in the striatum, hippocampus and olfactory bulb of mutant mice. The absence of GPR37 receptor could have a neuroprotective effect in an age and gender-dependent manner, and the study of this receptor could be valuable in the search for novel therapeutic targets.

OVERWEIGHT AND OBESITY IN RURAL GIRLS FROM POLAND: CHANGES BETWEEN 1987 AND 2001

Several studies have documented increased prevalence of overweight and obesity in inhabitants of rural regions, but determinants of their prevalence are complex and not always in one direction. The aim of this study was to estimate both the prevalence and extent of overweight and obesity among rural girls in Poland between 1987 and 2001, as well as to assess differentiation of the phenomenon between regions of different social structures. The data come from two series of cross-sectional studies; the first in 1987 included 7764 girls, and the second in 2001 included 9431 girls aged 9-18. Body mass index (according to the International Obesity Task Force, IOTF) and the EOW index (extent of overweight), which shows by what mean BMI value the overweight boundaries are exceeded, were calculated. Overweight and obesity prevalences in the whole sample, were, respectively, 14.9% and 2.7% in 1987 and 15.5% and 2.5% in 2001, but significant differentiation in the direction of the changes was observed between the examined regions. In one of them, characterized by sudden, mass and long-term unemployment, there was a considerable decrease in overweight and obesity prevalence, whereas in a relatively wealthier region no changes were observed during the 14-year period. Two other regions with a relatively low standard of living and low incomes and education status presented a significant increase in overweight and obesity prevalence. The EOW index increased from 1.9 to 2.1 in the whole examined sample, and it also confirmed significant differences in expansion of overweight and obesity between the examined regions. The complex character of political and socioeconomic changes in Poland during the 1990 s has resulted in two-directional changes in biological measures of living conditions. The analysis of the whole sample led to different results in comparison to separate analyses of each of the examined regions.

Is Mental Health in the Canadian Population Changing over Time?

Mental health in populations may be deteriorating, or it may be improving, but there is little direct evidence to support either possibility. Our objective was to examine secular trends in mental health indicators from national data sources. We used data (1994-2008) from the National Population Health Survey and from a series of cross-sectional studies (Canadian Community Health Survey) conducted in 2001, 2003, 2005, and 2007. We calculated population-weighted proportions and also generated sex-specific, age-standardized estimates of major depressive episode prevalence, distress, professionally diagnosed mood disorders, antidepressant use, self-rated perceived mental health, and self-rated stress. Major depression prevalence did not change over time. No changes in the frequency of severe distress were seen. However, there were increases in reported diagnoses of mood disorders and an increasing proportion of the population reported that they were taking antidepressants. The proportion of the population reporting that their life was extremely stressful decreased, but the proportion reporting poor mental health did not change. Measures based on assessment of symptoms showed no evidence of change over time. However, the frequency of diagnosis and treatment appears to be increasing and perceptions of extreme stress are decreasing. These changes probably reflect changes in diagnostic practice, mental health literacy, or willingness to report mental health concerns. However, no direct evidence of changing mental health status was found.

Monitoring time-related trends in dental caries in permanent teeth in Japanese national surveys

According to dental examinations of 3- and 12-year-old children conducted throughout Japan, the prevalence of dental caries in children is decreasing. However, little is known about changes in the prevalence of dental caries in adults. This study analysed past and present prevalences of dental caries in permanent teeth and predicted future trends in dental caries in adults. Data were sourced from nine national dental surveys conducted in Japan at 6-year intervals from 1957 to 2005. Data from oral examinations were recorded as indices of decayed, missing and filled teeth. The mean number of filled teeth increased markedly, whereas mean numbers of decayed teeth and missing teeth decreased substantially in people aged ≥ 40 years. By contrast, the mean number of filled teeth first increased and then decreased in groups aged 5-39 years. Among Japanese respondents sampled in a series of cross-sectional studies between 1957 and 2005, the incidence of dental caries in young adults decreased, suggesting a decrease in prevalences of dental caries in future generations. However, this tendency was not observed in respondents aged ≥ 40 years. The results suggest adults will experience less dental caries in the near future.