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This study aimed to evaluate the association between age at menarche and cardiovascular (CV) events through a systematic review and meta-analysis of observational studies. A comprehensive literature search covering studies published from January 1, 2000, to October 31, 2023, was conducted in PubMed, MEDLINE, Embase, and Scopus. Twenty-nine observational studies involving 4,931,160 adult women aged 18 years or older were included. The meta-analysis revealed a J-shaped association between age at menarche and CV events. Individuals with menarche at 12-13 years exhibited the lowest risk, while those with younger (≤ 11 years) or older ages (14-15 years and ≥ 16 years) showed an increased risk. Notably, individuals with age at menarche of 16 years and older had the highest risk of CV events. The pooled odds of CV mortality in age at menarche categories 14-15 years and ≥ 16 years were 37% (OR: 1.37, 95% CI 1.14-1.64, I2: 76.9%) and 64% (OR: 1.64, 95% CI 1.20-2.24, I2: 87%) higher than referent age at menarche 12-13 years. No statistically significant difference was found in CV mortality risk between individuals with age at menarche ≤ 11 years and those with age at menarche 12-13 years. The ORs for coronary heart disease were significantly higher for age at menarche ≥ 16 years (35% increase), while no significant difference was found for age at menarche ≤ 11 years or 14-15 years compared to age at menarche 12-13 years. Regarding stroke, the ORs for age at menarche ≤ 11, 14-15, and ≥ 16 years were significantly higher (7%, 24%, and 94% increase, respectively) compared to age at menarche 12-13 years. Dose-response meta-analysis and one-stage random-effect cubic spline models confirmed the J-shaped risk pattern. Meta-regression indicated that age and BMI were not significant sources of heterogeneity. Sensitivity analyses and the absence of publication bias further supported the robustness of the findings. This study concludes that age at menarche is independently associated with CV events, with a J-shaped pattern. The findings underscore the significance of considering menarche age as an independent risk factor for CV events. Further research is warranted to validate these findings and explore potential underlying mechanisms.

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Objectives: To describe the evolution of the national vaccination programme in Norway and how changes in national policy informed by risk and equity shaped international vaccine debates, public trust and vaccine hesitancy. Methods: Documentary analysis of publicly available statistics, government documents and media sources. Results: Process equity founded on social solidarity was central to the approach taken to vaccination in Norway but within the context of a very low level of COVID-19 Infection. Conclusions: In the context of Norway with very low levels of infection, the risks associated with vaccine side effects were of a similar order to the risk of infection which led to an early decision to exclude the AstraZeneca vaccine and limit access to the Janssen vaccine. Public trust in the way the state managed the changes in the vaccination programme resulted in very limited public resistance to the vaccine programme, high levels of vaccine uptake and an acceptance of delays associated with the exclusion of two approved vaccines. Vaccination rates among Norwegian residents born in Eastern Europe were significantly lower than both foreign born and Norwegian born residents.

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OBJECTIVES: To describe the impact and policy response to the COVID-19 Pandemic on Norway and the implications this has for future policy development and Norwegian society. METHODS: Documentary analysis of publicly available statistics, government documents and media sources. RESULTS: Three different agendas motivated Norwegian policy: stemming the spread of the virus domestically, mitigating the impact on the economy and addressing the social costs of the policy response. CONCLUSIONS: The oil and gas industry and the Sovereign Wealth Fund have permitted Norway to manage the costs of the pandemic. But may also lead to a shift in government priorities in health, social and economic policy.