In the last decade, the prevalence of obesity has increased significantly in populations worldwide. A less dramatic, but equally important increase has been seen in our knowledge of its effects on health and the burden it places on healthcare systems. This systematic review aims to assess the current published literature on the direct costs associated with obesity. A computerized search of English language articles published between 1990 and June 2009 yielded 32 articles suitable for review. Based on these articles, obesity was estimated to account for between 0.7% and 2.8% of a country's total healthcare expenditures. Furthermore, obese individuals were found to have medical costs that were approximately 30% greater than their normal weight peers. Although variations in inclusion/exclusion criteria, reporting methods and included costs varied widely between the studies, a lack of examination of how and why the excess costs were being accrued appeared to be a commonality between most studies. Accordingly, future studies must better explore how costs accrue among obese populations, in order to best facilitate health and social policy interventions.

OBJECTIVE: HPV testing has emerged as an effective cervical cancer screening test. The use of HPV self-testing has the potential to address many barriers to screening and reach at-risk women through engagement in screening. However, there is a need to examine the evidence for whether offering self-collected HPV testing in practice increases screening compliance. The objective of this review is to determine to what extent providing self-collected HPV testing increases screening participation in women who are never or underscreened for cervical cancer. METHODS:A systematic literature review conducted in the databases Medline and Embase identified articles examining the use of HPV self-testing on cervical cancer screening participation. A meta-analysis using a random-effects model was used to calculate the relative compliance, with an intent-totreat analysis of HPV self-testing compared to Pap testing, with 95% confidence intervals (CI). All statistical tests were two-sided. SYNTHESIS:Ten studies were reviewed, with 8 being European and 2 North American. Of the 10 studies, 9 employed a randomized design. In all studies, the relative compliance of HPV self-collected testing compared to Pap testing was significantly greater than 1.0 (p<0.01). The overall relative compliance was 2.14 (95% CI 1.30-3.52). There was large heterogeneity of screening compliance between studies for both HPV self-testing and Pap testing. CONCLUSION:HPV self-collected testing significantly improved the participation of women who did not routinely attend cervical cancer screening programs. New approaches to HPV self-test delivery should be considered as HPV testing becomes more widely incorporated as a primary screening tool.

IMPORTANCE Notable increases in mortality from alcohol-induced causes over the past 2 decades in the United States have been reported. However, comprehensive assessments of trends in alcoholinduced mortality by sex, age, race/ethnicity, and social and geographic factors are lacking. OBJECTIVE To examine trends in alcohol-induced mortality rates from 2000 to 2016, comparing results by demographic characteristics including sex, race/ethnicity, age, county-level socioeconomic status, and geographic location. DESIGN, SETTING, AND PARTICIPANTS This serial cross-sectional study used US national vital statistics data for years 2000 to 2016 for all US residents older than 15 years. Data analysis was conducted from January to September 2019. EXPOSURES Trends in alcohol-induced mortality by sex, race/ethnicity, age, county-level socioeconomic status (ie, median income, percentage of unemployed residents, percentage of residents with a bachelor's degree), rurality level, and US state. MAIN OUTCOMES AND MEASURES Alcohol-induced mortality, ie, deaths for which alcohol holds a population-attributable fraction of 1. Deaths were expressed per 100 000 residents as absolute and age-standardized rates. Mortality trends were measured as average annual percentage changes (AAPCs) for the entire period (ie, 2000-2016) and annual percentage changes (APCs) for individual periods of change within the study period.

Background Pediatric differentiated thyroid cancer (DTC) rates have increased over time in the United States and worldwide. Improvements in imaging for the diagnosis of DTC have been hypothesized as a potential driver of these increases. This study stratifies temporal trends in pediatric DTC by stage and tumor size to assess whether rates of large, late‐stage cancers, which are likely to be clinically meaningful, are increasing over time. Methods Age‐standardized incidence rates (ASRs) of DTC and annual percent changes (APCs) in primary DTC rates were estimated for 0‐ to 19‐year‐olds with data from 39 US cancer registries during 1998‐2013. Results During 1998‐2013, 7296 cases of DTC were diagnosed (6652 papillary cases and 644 follicular cases). APCs of pediatric DTCs significantly increased by 4.43%/y [95% CI, 3.74%/y‐5.13%/y], primarily because of increases in papillary histologies. Increasing trends were observed for children aged 10 to 19 years for both sexes and for non‐Hispanic whites, non‐Hispanic blacks, and Hispanics. Rates increased significantly over the time period for all tumor stages (APClocalized, +4.06%/y [95% CI, 2.84%/y‐5.29%/y]; APCregional, +5.68%/y [95% CI, 4.64%/y‐6.73%/y]; APCdistant, +8.55%/y [95% CI, 5.03%/y‐12.19%/y]) and across tumor sizes (APC<1 cm, +9.46%/y [95% CI, 6.13%/y‐12.90%/y]; APC1‐2 cm, +6.92%/y [95% CI, 4.31%/y‐9.60%/y]; APC>2 cm, +4.69%/y [95% CI, 2.75%/y‐6.67%/y]). Conclusions Significantly increasing rates of DTC over time among 10‐ to 19‐year‐olds in the United States are unlikely to be entirely explained by increases in medical surveillance during childhood because rates of large and late‐stage DTC are increasing over time. Future studies should examine environmental and other factors that may be contributing to rising DTC rates.

Summary Background Increasing premature mortality among some groups of Americans has been largely driven by increases in drug poisoning deaths. However, to our knowledge, a formal descriptive study by race and ethnicity, socioeconomic status, rurality, and geography has not been done. In this study, we examined US trends in premature all-cause and drug poisoning mortality between 2000 and 2015 at the county level among white, black, and Latino people. Methods We used US mortality data for the period Jan 1, 2000, to Dec 31, 2015, including underlying cause of death and demographic data, collected from death certificates by the Centers for Disease Control and Prevention National Center for Health Statistics, and ascertained county attributes from the 2011–15 Census American Community Survey. We categorised counties into quintiles on the basis of the percentage of people unemployed, the percentage of people with a bachelor’s degree, median income, and rurality. We estimated premature (ie, deaths in those aged 25–64 years) age-standardised mortality for all causes (by race and ethnicity) and drug poisoning, by county, for the periods of 2000–03 and 2012–15. We estimated annual percentage changes in mortality (2000–15) by county-level characteristics. Findings Premature mortality declined from 2000–03 to 2012–15 among black and Latino people, but increased among white people in many US counties. Drug poisoning mortality increased in counties throughout the country. Significant increases between 2000 and 2015 occurred across low and high socioeconomic status and urban and rural counties among white people aged 25–64 years (annual percentage change range 4·56% per year [95% CI 3·56–5·57] to 11·51% per year [9·41–13·65]), black people aged 50–64 years (2·27% per year [0·42–4·16] to 9·46% per year [7·02–11·96]), Latino women aged 25–49 years (2·43% per year [1·18–3·71] to 5·01% per year [3·80–6·23]), and Latino men aged 50–64 years (2·42% per year [0·53–4·34] to 5·96% per year [3·86–8·11]). Although drug poisoning mortality increased rapidly in counties with the lowest socioeconomic status and in rural counties, most deaths during 2012–15 occurred in the largest metropolitan counties (121 395 [76%] in metropolitan counties with ≥250 000 people vs 2175 [1%] in the most rural counties), reflecting population size. Interpretation Premature mortality has declined among black and Latino people in the USA, and increased among white people, particularly in less affluent and rural counties. Increasing drug poisoning mortality was not limited to poor white people in rural areas. Rapid increases have occurred in communities throughout the USA regardless of race and ethnicity, socioeconomic status, or rurality. Widespread public health interventions are needed to addess this public health emergency.

In Japan, cervical cancer incidence has increased since the late 1990s especially among young women, despite a decreasing trend in most developed countries. Here, we examined age, period and birth cohort trends in cervical cancer incidence rates from 1985 to 2012. Incidence rates were ascertained using three population-based cancer registries and analyzed using Joinpoint regression and age-period-cohort models. We compared the findings in Japan to trends among Japanese-Americans in the Surveillance, Epidemiology, and End Results Registries and among women in South Korea using the Korea Central Registry. Age-standardized incidence rates in Japan decreased by 1.7% per year (95% confidence interval − 3.3%, 0.0%) until 1997 and thereafter increased by 2.6% per year (1.1%, 4.2%). Incidence rates increased among women under age 50, were stable among women aged 50-54, and decreased or remained stable among women aged 55 and over. The age-standardized incidence rate ratio by birth cohort showed a U-shaped pattern with the lowest rates in women born in the late 1930s and 1940s. In comparison, women born before 1920 and after 1970 had about double the incidence. Increasing risk in recent birth cohorts was not evident in Japanese-American or South Korean women. The trends in Japan may be attributable to increasing prevalence of human papillomavirus (HPV) infection among young women. Screening and vaccination have been shown to be highly effective and would help reverse these trends.

• The results of this study indicate a possible therapeutic benefit of lymph node removal in node negative patients. Future research should focus on gaining a better understanding of the biologic mechanisms of a possible therapeutic benefit of PLND, particularly for those lower risk patients with histologically negative lymph nodes.

States has higher infant and youth mortality rates than other high-income countries, with striking disparities by racial/ethnic group. Understanding changing trends by age and race/ethnicity for leading causes of death is imperative for focused intervention. OBJECTIVE To estimate trends in US infant and youth mortality rates from 1999 to 2015 by age group and race/ethnicity, identify leading causes of death, and compare mortality rates with Canada and England/Wales.