Rising frequency of ozone-favorable synoptic weather patterns contributes to 2015-2022 ozone increase in Guangzhou

Objective weather classification methods have been extensively applied to identify dominant ozone-favorable synoptic weather patterns (SWPs), however, the consistency of different classification methods is rarely examined. In this study, we apply two widely-used objective methods, the self-organizing map (SOM) and K-means clustering analysis, to derive ozone-favorable SWPs at four Chinese megacities in 2015-2022. We find that the two algorithms are largely consistent in recognizing dominant ozone-favorable SWPs for four Chinese megacities. In the case of classifying six SWPs, the derived circulation fields are highly similar with a spatial correlation of 0.99 between the two methods, and the difference in the mean frequency of each SWP is less than 7%. The six dominant ozone-favorable SWPs in Guangzhou are all characterized by anomaly higher radiation and temperature, lower cloud cover, relative humidity, and wind speed, and stronger subsidence compared to climatology mean. We find that during 2015-2022, the occurrence of ozone-favorable SWPs days increases significantly at a rate of 3.2 day/year, faster than the increases in the ozone exceedance days (3.0 day/year). The interannual variability between the occurrence of ozone-favorable SWPs and ozone exceedance days are generally consistent with a temporal correlation coefficient of 0.6. In particular, the significant increase in ozone-favorable SWPs in 2022, especially the Subtropical High type which typically occurs in September, is consistent with a long-lasting ozone pollution episode in Guangzhou during September 2022. Our results thus reveal that enhanced frequency of ozone-favorable SWPs plays an important role in the observed 2015-2022 ozone increase in Guangzhou.

Trends, transitions and patterning in social activity over time among aging women and men: A secondary analysis of the Canadian Longitudinal Study on Aging (CLSA)

Social isolation matters for health and longevity, but little research examines transitions into or out of social isolation or whether transitions are gendered or socially patterned. We described gender-specific trends in breadth and lack of social participation over 6 years overall and by age, country of origin, geographic location, education, wealth, and household income. We used three waves of CLSA data to evaluate changes in social isolation (0-1 activities) and broad social participation (5+ activities) in adults aged 45-75 (n = 24,788), by gender and socio-demographics, in linear and multinomial logistic regressions with post-estimated predicted probabilities. The number of social activities decreased over time, with greater declines for women. About half the sample (more men than women) stayed not highly socially active (<5 activities) and almost 1 in 5 became not highly socially active. Most adults (77 %) remained not socially isolated and 14 % became or remained socially isolated. Women were more likely than men to remain not highly socially active and less likely to have multiple social isolation transitions. Broad social participation changed over time for several subgroups of women and men, with gender differences notable for income levels. Social disparities in social isolation transitions differed by gender only for education. Older age and socioeconomically disadvantaged adults had higher probabilities of becoming socially isolated or becoming less socially active. Findings indicated the diversity of social activities declined as Canadians age into later life and transitions in both social isolation and social participation differed between genders, especially for specific vulnerable subpopulations.

Trends in inpatient versus outpatient upper extremity fracture surgery from 2008 to 2021 and their implications for equitable access: a retrospective cohort study

PURPOSE

The aim of this study is to describe trends in inpatient and outpatient upper extremity fracture surgery between 2008 and 2021, along with identifying patient factors (age, sex, race, socioeconomic status) associated with outpatient surgery.

METHODS

Retrospectively, 12,593 adult patients who underwent upper extremity fracture repair from 2008 to 2021 at one of five urban hospitals in the Northeastern USA were identified. Using Distressed Communities Index (DCI), patients were divided into five quintiles based on their level of socioeconomic distress. Multivariable logistic regression was performed on patients from 2008 to 2019 to identify independent factors associated with outpatient management.

RESULTS

From 2008 to 2019, outpatient procedures saw an average increase of 31%. The largest increases in the outpatient management were seen in humerus (132%) and forearm fractures (127%). Carpal and hand surgeries had the lowest percent increase of 8.1%. Clavicle and wrist fractures were independently associated with outpatient management. Older age, male sex, higher Elixhauser comorbidity index, DCI scores in the 4th or 5th quintile, and fractures of the scapula, humerus, elbow, and forearm were associated with inpatient management. During the onset of the COVID-19 pandemic, there was a decrease in outpatient procedures.

CONCLUSION

There is a shift toward outpatient surgical management of upper extremity fractures from 2008 to 2021. Application of our findings can serve as an institutional guide to allocate patients to appropriate surgical settings. Moreover, physicians and institutions should be aware of the potential socioeconomic disparities and implement plans to allow for equal access to care.

The hidden epidemic: Hypertension-related mortality surges amongst younger adults in the United States

BACKGROUND

The prevalence of hypertension (HTN) has significantly increased among younger adults (15-45 yrs) in the U.S. Despite this, there is limited data on trends of HTN-related mortality within this population.

METHODS

Data from the CDC WONDER multiple-cause of death database was analyzed from 1999 to 2021, focusing on HTN-related mortality in young adults aged 15 to 45 years. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes (APCs) were calculated and stratified by year, sex, race/ethnicity, urbanization status, and census region.

RESULTS

Between 1999 and 2021, there were 201,860 HTN-related deaths among young adults in the U.S. The AAMR increased from 2.8 in 1999 to 5.0 in 2001 (APC 35.3; 95 % CI 20.6 to 44.5) and then to 9.4 in 2019 (APC 3.1; 95 % CI 2.7 to 3.5) before sharply rising to 13.9 in 2021 (APC 22.3; 95 % CI 15.1 to 26.4). Men consistently exhibited higher AAMRs than women from 1999 (AAMR men: 3.6 vs women: 1.9) to 2021 (AAMR men: 18.9 vs women: 8.8). In 2020, the highest AAMR was observed among non-Hispanic (NH) Black or African American young adults (30.2), followed by NH American Indian/Alaska Natives (29.6), NH White (9.9), Hispanics or Latino (9.3) and NH Asian or Pacific Islander (5.0). The Southern region had the highest AAMR (9.3), followed by the Midwest (6.4), West (5.8), and Northeast (5.4). Nonmetropolitan areas consistently had higher AAMR (8.5) than metropolitan areas (7.0). States in the top 90 th percentile for AAMRs included Mississippi, the District of Columbia, Oklahoma, West Virginia, and Arkansas, with these states exhibiting approximately five times the AAMRs of those in the lower 10th percentile.

CONCLUSION

HTN-related mortality among young adults in the U.S. increased steadily until 2019, followed by a sharp rise in 2020 and 2021. The highest AAMRs were observed among men, NH Black young adults, and individuals residing in the Southern and non-metropolitan areas of the U.S. These findings underscore the need for targeted interventions to reduce the burden and address disparities in HTN-related mortality among young adults in the U.S.

Temporal changes and educational disparities in the frequent consumption of sugar-sweetened beverages among Estonian adults during 2006-2022

Objectives

Excessive consumption of sugar-sweetened beverages (SSBs) contributes to adverse health outcomes but is differentiated by socio-economic indicators. The study analyses the educational disparities in adults frequent consumption of sugar-sweetened beverages (SSBs) in Estonia and its temporal changes between 2006 and 2022.

Study design

Repeated cross-sectional survey.

Methods

Nationally representative data from 9 biennial cross-sectional surveys on 25-64-year-old Estonian residents (n = 20396) was used for the study. Changes in frequent (on 6-7 days per week) consumption of SSBs by study year, sex, age, and education is analysed using descriptive statistics and binomial logistic regression. Prevalence and odds ratios (OR) with 95 % confidence intervals (CIs) are presented focusing on temporal and educational patterns in frequent SSB consumption.

Results

The prevalence of frequent SSB consumption among Estonian adults declined consistently from 2006 (14.0 %) to 2018 (5.2 %), followed by statistically non-significant increases in 2020 (6.8 %) and 2022 (7.1 %). Prevalence of frequent SSB consumption was significantly (p < 0.01) higher among adults with primary or lower education (12.4 %) compared to tertiary education group (4.8 %). The educational differences in SSB consumption (12.4 % in primary or lower vs. 4.8 % in tertiary education) were nearly three-fold after adjusting for sex, age, and period effects (OR 2.84, 95 % CI 1.71-4.74) and have been consistent since 2010.

Conclusions

Although frequent consumption of SSBs has been generally decreasing among Estonian adults, the findings illustrate the persisting educational gradients in exposure that expectedly translates into socio-economic inequalities in adverse health outcomes resulting from excessive SSB consumption.

Variations of compound warm, dry, wet, and cold climate extremes in India during 1951 to 2014

The simultaneous occurrence of climate extremes significantly impacts ecosystems, increasing the vulnerability to physical risks. Despite extensive research on hot extremes and droughts globally, there remains a significant gap in comprehending the occurrence, magnitude, spatial extent, and associated risks of compound extremes, encompassing scenarios like warm/dry, cold/dry, warm/wet, and cold/wet. This study investigates various compound extreme scenarios by examining combinations of maximum temperature (Tx) and the Standardized Precipitation Evapotranspiration Index (SPEI) using monthly data from 1951 to 2014 acquired from the India Meteorological Department (IMD) for Indian landmass. From the results, the spatial extent of warm/dry events has increased at 1.8 % per decade, while cold/wet events decreased by 1.1 % over India. The warm/wet events have shown an increased trend of about 0.3 %, and cold/dry events at modest rise of 0.7 % per decade. Furthermore, compound warm/dry and cold/wet extremes over India exhibit extreme frequency and shorter return periods, posing greater risk. Conversely, compound cold/dry and warm/wet extremes occur less often, indicating longer return periods and lower risk. Across much of the country, the frequency of warm/dry, cold/dry, warm/wet, and cold/wet extremes ranges from 30 to 45, 15-30, 20-30, and 25-45 months, respectively. Notably, warm/dry conditions exhibit increased frequency in the recent period (1983-2014) with 31 years compared to the base period (1951-1982) which had approximately 24 years for a spatial extent exceeding 5 %. The findings of this study contribute to an enhanced understanding of the changes in compound climate extremes from a multivariate perspective.

Trends and projections of mild and moderate hearing loss among adolescents, young adults, middle-aged adults and age-standardised population in Malaysia from 1996 to 2030

PURPOSE

This study aims to assess the prevalence of mild and moderate hearing loss spanning three decades, from 1990 to 2019, and to project the anticipated trends from 2020 to 2030 among adolescents, young adults, middle-aged adults, and age-standardised groups in Malaysia.

METHODS

This study involved secondary data analysis of mild and moderate hearing loss prevalence over 30 years among the Malaysian population aged 15-19, 25-29, 35-39, 45-49, and age-standardised groups. Subsequently, three time-series models were evaluated and the best models with the minimal Mean Absolute Percentage Error (MAPE) and Root Mean Squared Error (RMSE) were selected for projecting the prevalence of hearing loss until 2030.

RESULTS

A relatively stable trend of mild hearing loss prevalence and gradual decline of moderate hearing loss were observed across all age groups throughout the study period. The prevalence of mild hearing loss was consistently higher than moderate hearing loss across all age groups, with its prevalence increasing with age. The projected prevalence of hearing loss exhibits a gradual declining trend in the future for all age groups, except for mild hearing loss for the 15-19-year-old group.

CONCLUSION

Over the past 30 years, there has been a relatively stable and slightly declining trend in the prevalence of mild and moderate hearing loss among the Malaysian population, respectively with projections showing a slow reduction in the future. These findings highlighted the need for identifying the best intervention and vulnerable age groups, directing increased resources and prioritization towards them.

Iron-rich food consumption and predictors among children aged 6-59 months old in Ethiopia using 2005-2016 national representative data

Children who do not consume enough iron have decreased growth, reduced immunity, and poor cognitive development. This study aimed to assess the pooled iron-rich food consumption, trends, and predictors among children aged 6-59 months old in Ethiopia. This study used Ethiopian demographic and health survey (EDHS-2005-2016) data with a total weighted sample size of 26,773 among children aged 6-59 months old. A multilevel mixed-effects logistic regression analysis was used to identify predictors of good iron-rich food consumption. The pooled proportion of iron-rich food consumed among children aged 6-59 months in Ethiopia was 11.77% (10.71, 12.92%). In Ethiopia, the proportion of iron-rich food intake by children aged 6-59 months was slightly increased from 9.25% (8.04, 10.62%) in EDHS 2005 to 10.86% (9.06, 12.95%) in EDHS 2011, and sharply increased to 17.49% (15.04, 20.24%) in EDHS 2016. The findings indicated that being children born to mothers aged 20 to 34 years old [AOR = 0.56, 95% CI: 0.35, 0.89], mothers aged ≥ 35 years old [AOR = 0.47, 95% CI: 0.28, 0.82], married parents [AOR = 1.68, 95% CI: 1.14, 2.48], completed primary education [AOR = 1.32, 95% CI: 1.02, 1.73], secondary education [AOR = 2.66, 95% CI: 1.53, 4.59], a higher education status of mother [AOR = 3.98, 95% CI: 1.92, 8.23], medium family [AOR = 1.39, 95% CI: 1.03, 1.89], rich family [AOR = 1.45, 95% CI: 1.09, 1.95], media exposure [AOR = 1.35, 95% CI: 1.06, 1.72], residents of the Tigray [AOR = 2.69, 95% CI: 1.51, 4.79], Oromia [AOR = 3.30, 95% CI: 1.30, 4.02], Benishangul [AOR = 2.12, 95% CI: 1.15, 3.88], Gambela [AOR = 5.85, 95% CI: 2.97, 11.50], and Dire Dawa region [AOR = 3.38, 95% CI: 1.76, 6.47], were significantly associated with good iron-rich food consumption among children aged 6-59 months old. The findings revealed that iron-rich food intake was considerably low among Ethiopian children aged 6-59 months. Increasing women's literacy and economic empowerment improves iron-rich food consumption among children aged 6-59 months old.

Changes in the Johne's disease situation in GB dairy herds over 10 years, as revealed by regular milk ELISA data

Effective management of cattle infected with Johne's Disease (JD) is crucial to minimizing transmission and within-herd prevalence. Within Great Britain (GB), the voluntary National Johne's Management Plan (NJMP) requires farmers and a certified vet to conduct a risk assessment to determine the herd risk, examine the herd JD status and formulate a management plan. Individual milk ELISA tests for JD antibodies are widely used to monitor infection. The JD Tracker application, available within the dairy data management software InterHerd+ and other web-based environments, is being used by farmers and veterinarians to facilitate the practical use of milk ELISA data to aid JD-related management decisions. The JD Tracker application uses a herd's milk ELISA data to calculate a collection of 'JD parameters' that are indicative of the current JD status of the herd alongside contemporary and retrospective drivers linked to transmission and maintenance of infection. Herein, we use milk ELISA data from 154 regularly testing herds to review the temporal trends in JD parameters from 2013 to 2022. Since 2015, JD Tracker parameters have improved in these herds, most notably average test value (ATV) and within-herd prevalence (%Pos30). Trends in driver parameters suggest that farmers are progressively less likely to serve repeat test-positive (J5) cows and are more readily removing them. The data also reveal that the burden of JD is disproportionately greater in herds with higher ATV. In 2022, the 25 % of herds with the highest ATVs accounted for 42 % of positive tests and 42 % of repeat ELISA positive (J5) cows. Retrospectively, it is not possible to identify with certainty factors that directly contributed to the trends in JD parameters, but it is notable that the introduction of the NJMP was coincided with the improving JD situation. In 2019, participation in the NJMP or an equivalent scheme became mandatory for dairy farms to be compliant with the food and farms standards assurance scheme Red Tractor, with the result that JD management plans are now completed by 95 % of UK dairy farms. As far as we know, the UK is unique in its development of a tool (the JD Tracker) which adds utility to milk ELISA data using specifically designed JD parameters. Anticipated further work includes the development of a national database of JD testing herds and application of the JD Tracker at national scale to enable more comprehensive industry-level monitoring of JD within GB dairy farms.

The effects of COVID-19 on the development of reported incidents of child maltreatment over time: A systematic literature review

BACKGROUND

During the COVID-19 pandemic, the life of families all over the world changed unprecedentedly, risks and vulnerabilities for child maltreatment might have altered. While several studies and reviews look at altered reports to child protective services and other organizations in the child protection system, particularly during the first lockdown in spring 2020, there is a gap in research on trends of reported child maltreatment incidents over time.

OBJECTIVE

To bridge the gap on mid- to long-term developments and trends of changes over time, we aimed at summarizing findings on monthly breakdowns of CM reports over time during the pandemic.

METHODS

In systematic searches of academic literature databases, we have identified 11 articles that adhere to the inclusion criteria of monthly breakdown data from child protective services during the COVID-19 pandemic with a pre-pandemic comparison period. Three additional grey literature reports haven been identified. Both studies and reports had to be published in either English, Arabic, French, German, Portuguese, or Spanish.

RESULTS

Notably, overall, the level of reported incidents has decreased compared to the years before the COVID-19 pandemic. Overall, no clear and reliable picture emerges in developments by different types of reporters. If the number of reports decreases overall, consequently, the overall number or responses to reports does. Some studies, however, report an altered proportion of responses that increased.

CONCLUSION

There is still a lot to be investigated and understood when it comes to the impact of the COVID-19 pandemic on CM. Policy-makers are called to not only invest into more research on the topic, but, first and foremost, to anticipate a potentially surging need in improved responses to a vulnerable group.

Progressive Thickening of Retinal Nerve Fiber and Ganglion Cell Complex Layers Following SDM Laser Vision Protection Therapy in Open-Angle Glaucoma

INTRODUCTION

This work aims to determine the effect on nerve fiber layer (NFL) and ganglion cell complex (GCC) thickness trends in eyes with open-angle glaucoma (OAG) treated with Vision Protection Therapy™ (VPT).

METHODS

A retrospective analysis of spectral-domain optical coherence tomography (OCT) measured NFL and GCC thickness trends was performed, excluding eyes with poor-quality scans and principal diagnoses other than OAG. This study compares eyes with OAG managed conventionally with IOP control alone (controls) to eyes managed with the addition of VPT (VPT eyes). The direction (+ or -) and magnitude (microns/year) of the OCT trends were the study endpoints.

RESULTS

Seventy-eight control eyes of 40 patients and 61 VPT-treated eyes of 39 patients were included in the study. Positive NFL trends were noted in 5% of control eyes vs. 71% of VPT eyes (p < 0.0001). Positive GCC trends were noted in 8% of control eyes vs. 43% of VPT eyes (p < 0.0001). Mean NFL trends (µm/year) were - 0.692 for controls vs. 0.347 for VPT (p < 0.0001). Mean GCC trends (µm/year) were - 0.554 for controls vs. - 0.148 for VPT (p = 0.0175).

CONCLUSIONS

The addition of VPT to the conventional management of OAG resulted in highly significant improvements in NFL and GCC trends, indicating a reversal of key indicators of glaucoma severity and progression.

Racial disparities in trend, clinical characteristics and outcomes in Takotsubo syndrome

INTRODUCTION

Takotsubo syndrome (TTS) is an acute transient nonischemic cardiomyopathy often characterized by its hallmark feature of left ventricular apical ballooning. The correlation between racial backgrounds and the prognosis of individuals with TTS remains poorly defined. Our study aimed to explore the influence of race on the trends, clinical presentations, and outcomes in patients diagnosed with TTS.

METHODS

We queried the National Inpatient Sample (NIS) database from 2016 to 2020 and identified hospitalizations with TTS. We compared the clinical features and outcomes across three different races - non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic population. The primary outcome was in-hospital mortality.

RESULTS

76,505 weighted hospitalizations for TTS were identified, of which 65,495 (85.6%) were non-Hispanic White, 5,830 (7.6%) were non-Hispanic Black, and 5,180 (6.8%) were Hispanics. After propensity-score matching, NHB patients had higher odds of acute kidney injury (OR: 1.49, 95% CI: 1.21-1.84, p < 0.001) and mechanical ventilation (OR: 1.33, 95% CI: 1.04-1.68, p = 0.02). Hispanic patients had a higher incidence of acute kidney injury requiring dialysis when compared to NHW patients (OR: 2.53, 95% CI: 1.11-5.77, p = 0.027). There was no significant difference in terms of in-hospital mortality between NHB and Hispanic patients when compared to NHW patients. Notably, Hispanic populations experienced a higher mortality rate during the COVID-19 period.

CONCLUSION

Our study suggested significant differences in the outcomes of TTS across different racial groups. Hispanic populations experienced a higher mortality rate with TTS during the COVID-19 era. Further research should emphasize discovering the factors contributing to the observed disparities.

Is 90 the new 80? Temporal trends in nonagenarians undergoing percutaneous coronary interventions

BACKGROUND

Coronary artery disease (CAD) is a leading cause of death in the elderly population. Data regarding percutaneous coronary interventions (PCIs) in nonagenarians are scarce, and differences in long term outcomes between generations remain unclear. We aimed to study the pattern and temporal trends of nonagenarians treated with PCI.

MATERIALS AND METHODS

A total of 14,695 patients underwent PCI between 2009-2020. We identified 2,034 (13.8%) octogenarians (age 80-89), and 222 (1.5%) nonagenarians (age 90-99). Endpoints included mortality and major adverse cardiac events (MACE) at 1 year.

MATERIALS AND METHODS

A total of 14,695 patients underwent PCI between 2009-2020. We identified 2,034 (13.8%) octogenarians (age 80-89), and 222 (1.5%) nonagenarians (age 90-99). Endpoints included mortality and major adverse cardiac events (MACE) at 1 year.

RESULTS

The number of nonagenarians undergoing PCI has increased substantially during the study time period, from 89 patients in the earlier time period (2009-2014) to 133 patients in the later time period (2015-2020). At 1-year, nonagenarians had significantly higher rates of both death (24.3% vs. 14.9%, p<0.01), and MACE (30.6% vs. 22.0%, p<0.01), as compared to octogenarians. The cumulative survival rate was higher among octogenarians both in the early and late time period (p<0.01 and p=0.039, respectively). A significant reduction in nonagenarian MACE rates were observed during the study time period, resulting in a non-significant difference in MACE rates in the later time period between both groups.

CONCLUSION

The number of nonagenarians who undergo PCI is on the rise. While their clinical outcomes are inferior as compared to younger age groups, improvement was noted in the late time period.

Ten-year trends in non-surgical patients requiring intensive care: Long-term prognostic differences by year of admission

BACKGROUND

The aim of the present study is to elucidate prognostic impact of temporal trends of non-surgical patients requiring intensive care over a 10-year period.

METHODS AND RESULTS

A total of 4276 non-surgical patients requiring intensive care from 2012 to 2021 were enrolled. Patients' backgrounds, in-hospital management, and prognoses were compared between five groups [2012-2013 (n = 825), 2014-2015 (n = 784), 2016-2017 (n = 864), 2018-2019 (n = 939), and 2020-2021 (n = 867)]. During the study period, mean age significantly increased from 69 years in 2012-2013 to 72 years in 2020-2021. Mean Acute Physiology and Chronic Health Evaluation scores significantly increased from 10 points in 2012-2013 to 12 points in 2020-2021. The median duration of intensive care unit stays increased from 3 to 4 days. Kaplan-Meier survival curve analysis showed that survival rates during 30- and 365-days were significantly lower in 2020-2021 than in 2012-2013, but it was not significantly different by a Cox proportional hazards regression model in 30 days. A Cox proportional hazards regression model revealed that the risks of 365-day all-cause death were significantly higher in patients enrolled in 2016-2017 (HR: 1.324, 95 % CI: 1.042-1.680, p = 0.021), in 2018-2019 (HR: 1.329, 95 % CI: 1.044-1.691, p = 0.021), and in 2020-2021 (HR: 1.409, 95 % CI: 1.115-1.779, p = 0.004).

CONCLUSION

The condition of patients requiring intensive care is becoming more critical year by year, leading to poorer long-term prognoses despite improvements in treatment strategies. These findings emphasize the importance of additional care management after admission into non-surgical intensive care units, particularly for the aging society of Japan.

Temporal trends of the burden of ischemic stroke attributable to high low-density lipoprotein cholesterol in China from 1999 to 2019

BACKGROUND

High levels of low-density lipoprotein cholesterol (LDL-C) can lead to the occurrence and development of atherosclerosis, which is one of the important risk factors for ischemic stroke (IS). However, details regarding the evolution of the IS burden attributable to high LDL-C in China has not been available. The objective of this study was to examine the changes over time, from 1990 to 2019, in the burden of IS attributed to high levels of LDL-C in China and to estimate the individual impacts of age, period, and cohort on the burden of IS associated with high LDL-C.

METHODS

Detailed data on IS burden attributable to high LDL-C from 1990 to 2019 in China were extracted from the Global Burden of Disease (GBD) Study 2019. The numbers and age-standardized rates of IS-related mortality and disability-adjusted life years (DALYs) attributable to high LDL-C were assessed by age and sex. The annual percentage change (APC) and average annual percentage change (AAPC) in the burden of IS due to high LDL-C were analyzed using Joinpoint regression model. The age-period-cohort analysis was carried out to assess the individual impacts of age, period, and cohort on the trends over time of mortality and DALY rate.

RESULTS

The number of IS-related deaths and DALYs due to high LDL-C in China were 182.7 thousand and 4.43 million in 2019, respectively, both more than double the corresponding numbers reported in 1990. However, despite these increased, the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) remained unchanged. In 2019, men under 84 years of age had higher death and under 79 years of age had higher DALYs than women. However, above these ages, the gender disparities were reversed. Furthermore, age-specific rates of death, as well as DALY of IS attributable to high LDL-C in 2019 increased with age for both women and men, except for death in adults over 95 years old; and were greater in men than in women. From 1990 to 2019, males consistently had a higher ASMR and ASDR than females in China. During 1990-2019, the ASMR in women slightly decreased before 1997, sharply increased from 1997 to 2004, and then continuously decreased from 2004 to 2019, with an overall AAPC value of -0.4% (95% CI -0.8%, -0.0%). However, for the ASMR of men in China, the overall trend is upward and the AAPC is 0.5%(95% CI 0.1%, 0.8%). The ASDR in women and men had the similar trend as the ASMR over the time, with an AAPC of -0.4% (95% CI -0.7%, -0.1%) and 0.3% (95% CI 0.1%, 0.5%), respectively. The age-period-cohort analysis indicated a rise in period effects and a decline in cohort effects on mortality and DALY rate associated with IS caused by high LDL-C in both genders. Age effect on mortality rates from IS due to high LDL-C showed an exponential increased with age in all women and men except for the 60-69 age group and over 95 age group. The age relative risk of IS DALY rate due to high LDL-C increased with age in both genders except for 65-74 age group and over 95 age group.

CONCLUSIONS

From 1990 to 2019, the burden of IS caused by high LDL-C in China significantly increased among both sexes combined and among men, while significantly decreased among women. Elderly have a substantial burden of IS attributable to high LDL-C. Therefore, effective and tailored strategies based on gender and age for IS primary prevention and management of IS and high LDL-C are urgently needed in China.

Changing indications for and trends of keratoplasty in a tertiary comprehensive hospital in northern part of China from 2002 to 2021: a 20-year review

OBJECTIVE

To investigate indications and surgical procedures of keratoplasty in a tertiary comprehensive hospital in northern part of China over a 20-year period.

METHODS

All patients undergoing keratoplasty between January 1, 2002 to December 31, 2021 in a tertiary comprehensive hospital in northern part of China were retrospectively reviewed. The annual proportion of keratoplasty indications and surgical procedures was recorded and analyzed.

RESULTS

A total of 8266 keratoplasty procedures were included. Leading indications were keratoleukoma (n = 2108, 25.50%), followed by regraft (n = 1453 ,17.58%), corneal endothelial dysfunction (n = 1085, 13.13%), and keratoconus (n = 922,11.15%). A decreasing trend was observed for keratoleukoma (P < 0.01) and an increasing trend for corneal endothelial dysfunction (P < 0.01), regraft (P = 0.012), corneal limbal dermoids (P < 0.01) and congenital corneal opacity (P < 0.01). From 2002 to 2021, the proportion of penetrating keratoplasty (PK) had decreased from 73.95% (2002 to 2006) to 53.49% (2017 to 2021). On contrary, anterior lamellar keratoplasty (ALK) (459-705, 26.05-31.96%, P = 0.034) and endothelial keratoplasty (EK) (0-321, 0.00-14.55%, P < 0.01) became more prevalent from 2002 to 2021. For cases with corneal endothelial dysfunction, EK became the preferred technique (74.72%) in the recent 5 years.

CONCLUSION

Over the past 20 years, keratoleukoma and regraft have been the leading indications for keratoplasty. A noticeable shift in surgical preference from PK to DSAEK and ALK is evident, with key indications for keratoplasty including keratoleukoma, regraft, limbal dermoids, endothelial dysfunction, and keratoconus, respectively.

Atmospheric pollution in Chinese cities: Trends and persistence

This paper applies fractional integration to investigate the behaviour of various pollutants in seven Chinese cities. The objective is to establish if the series exhibit long memory and if time trends are statistically significant over the sample period going from January 2014 to November 2022. The results suggest that the steps recently taken by the Chinese authorities to reduce emissions and improve air quality have already had some effect: in most cases the air pollutant series are in the stationary range, with mean reversion occurring and shocks only having temporary effects, and there are significant downward trends indicating a decline over time in the degree of pollution in China. It is also interesting that in the most recent period, the Zero-Covid policy of the Chinese authorities has led to a further fall. On the whole, it would appear that the action plan adopted by the Chinese government is bringing the expected environmental benefits and therefore it is to be hoped that such policies will continue to be implemented and extended to improve air quality even further.

Trend analysis, gender-specific patterns, and age dynamics of childhood and adolescent obesity: insights from the Tehran lipid and glucose study

BACKGROUND

Childhood and adolescent obesity pose significant challenges to global health, with escalating prevalence and associated short- and long-term health consequences. This longitudinal study leveraged data from the Tehran Lipid and Glucose Study (TLGS) to investigate the trends of obesity among Tehranian children and adolescents over a 21-year period.

METHODS

Utilizing data from TLGS phases I to VII (1999-2021), we included 3845 participants aged 3-18 years at the beginning of phase I. Anthropometric measures, including height and weight, were collected, and body mass index (BMI) was calculated. Childhood obesity (2-19 years) was defined as BMI-for-age > 2SD based on World Health Organization (WHO) standards, and adult obesity was defined as BMI ≥ 30. Descriptive statistics, trend analysis, prevalence calculations, odds ratios, and interaction analyses were employed for data interpretation.

RESULTS

The mean BMI increased from 18.46 ± 4.37 kg/m² at Phase I to 26.36 ± 5.03 kg/m² at Phase VII. Boys exhibited a greater increase in BMI than girls, and age at study entry influenced BMI trajectories. The prevalence of obesity rose from 6.4% at Phase I to 21.5% at Phase VII, with a more pronounced increase in boys. Odds ratios for obesity steadily increased across phases, indicating a growing risk. Interaction analyses revealed age-specific dynamics, with older participants demonstrating lower odds ratios initially but higher odds ratios in later phases.

CONCLUSION

Our study shows a worrisome increase in childhood obesity among Tehranian children and adolescents over 21 years. Sex- and age-specific trends emphasize the necessity for targeted interventions, informing policymakers, healthcare practitioners, and educators regarding public health strategies and interventions against the obesity epidemic.

Urologic oncology case volume among early career urologists: An analysis of certification data from the American board of urology between 2003 and 2019

INTRODUCTION

The incidence of urologic cancer is expected to increase as the U.S. population ages, but the size of the urologic workforce is not expected to increase at a commensurate rate. To understand this growing imbalance, we explored the extent to which early career urologists performed oncology cases, particularly open surgical cases, between 2003 and 2019.

MATERIALS AND METHODS

We examined case logs submitted by early career urologists applying for their oral American Board of Urology Certifying Examination (Part 2) between 2003 and 2019. We included case logs spanning at least 120 days between the first and last record. We used CPT® codes to identify urologists who performed an open radical cystectomy, nephrectomy, or prostatectomy, as well as those who performed a minimally invasive (MIS) radical nephrectomy or prostatectomy. We calculated the annual percentage of urologists who performed each procedure. Multivariable logistic regression analysis analyzed the association between performing each procedure and specialization or fellowship training in oncology, adjusting for gender, practice type, and year of case log submission.

RESULTS

We identified 4,166 unique urologists submitting case logs between 2003 and 2019. Their average age was 34.9 years, 81.3% were male, 14.2% specialized in oncology, and 8.2% reported oncology fellowship training. From 2003 to 2019, the percentage of urologists who performed open oncologic procedures decreased, while the percentage who performed MIS oncologic procedures increased. Fellowship training in oncology significantly increased the odds of performing the following procedures: open radical cystectomy (72.5% with fellowship training vs. 30.0% without fellowship training, OR 2.51, 95% CI 0.63-0.92, P < 0.001), open radical nephrectomy (74.3% with fellowship training vs 42.4% without fellowship training, OR 2.02, 95% CI 1.48-2.78, P < 0.001), open radical prostatectomy (42.1% with fellowship training vs. 26.9% without fellowship training, OR 1.86, 95% CI 1.34-2.58, P < 0.001) and MIS radical prostatectomy (80.4% with fellowship training vs. 45.0% without fellowship training, OR 1.69, 95% CI 1.16-2.48, P = 0.006). When comparing those with solely oncology specialization to those with both oncology specialization and fellowship training, we found that those with oncology fellowship training had over 2 times higher odds of performing open radical cystectomy (OR 2.58, CI 1.78-3.74, P < 0.001), open radical nephrectomy (OR 2.06, CI 1.42-2.99, P < 0.001) and open radical prostatectomy (OR 2.12, CI 1.44-3.12, P < 0.001). Female urologists had significantly lower odds of performing each oncologic procedure.

CONCLUSIONS

In this analysis of early career urologist case logs, the proportion of urologists performing a radical cystectomy, radical nephrectomy, and open prostatectomy declined between 2003 and 2019. Oncology specialization or fellowship training, however, significantly increased the odds of performing the procedures. Specifically, oncology fellowship alone was associated with over 2 times the odds of performing major open oncologic procedures. These findings reflect ongoing specialization among early career urologists, such that an oncology fellowship or practice focus has likely become necessary for access to open urologic procedures and to become a high-volume urologic oncology surgeon.

Temporal trends and treatment patterns in anal fissure management: insights from a multicenter study in Italy

INTRODUCTION

Anal fissure (AF) poses a common challenge in clinical practice, prompting various treatment approaches. This multicenter study, conducted by the Italian Society of Colorectal Surgery, aimed to assess treatment trends in AF over a 10 year period.

METHODS

A survey of proctologists and retrospective analysis of patient records were conducted to evaluate treatment modalities and outcomes across six different clinical scenarios based on AF presentation (acute/chronic) stratified by sphincter function (normal/hypertonic/hypotonic).

RESULTS

Analysis of data from 17 principal investigators and 22,016 patients revealed significant variability in treatment approaches, influenced by factors such as symptom duration, anal tone, and surgeon preference. Conservative treatments were commonly utilized, while surgical interventions were reserved for refractory cases. Specifically, pharmaceutical treatment was administered to 66-75% of patients in cases of acute AF and 63-67% for chronic AF, while 10-15% underwent anal dilation, and < 2% received botulinum toxin injection. Among medical treatments, nifedipine with lidocaine and glycerin film-forming ointments were the most utilized. The most performed surgical techniques were fissurectomy and anoplasty, except for patients with chronic AF and hypertonic sphincter where sphincterotomy prevailed. Trends in treatment utilization varied depending on the clinical scenario, with notable shifts observed over time.

CONCLUSIONS

This study provides insights into the evolving landscape of AF management, highlighting the need for further research to elucidate optimal treatment strategies and improve patient outcomes.

Caffeine intake from foods and beverages and trends among Chinese children and adolescents: 2004-2018

BACKGROUND

The popularity of caffeinated foods and beverages poses risks of high caffeine exposure among Chinese children and adolescents. Nevertheless, there is a lack of national assessments on their caffeine consumption.

OBJECTIVE

To estimate daily caffeine intake and analyze time trends among Chinese children and adolescents.

METHODS

The study subjects were participants of the China Health and Nutrition Survey in 2004, 2006, 2009 and 2011, and the National Food and Beverage Consumption Survey in 2014 and 2018. Caffeine content was determined using chromatographic instrument. The Monte Carlo simulation was utilized to estimate daily caffeine intake and the Kruskal-Wallis test was used to analyze differences between population characteristics. To examine yearly trends in caffeine intake from 2004 to 2018, the partial Mann-Kendall test was applied.

RESULTS

The median daily caffeine intake of Chinese children and adolescents was 0.17 (95%CI: 0.15-0.20) mg/kg BW/day. Main contributors were tea (55.52%), sodas (19.52%) and tea beverages (10.37%). Approximately 4.68% of individuals consumed caffeine exceeding 2.5 mg/kg BW/day. Higher caffeine intake was observed in adolescents aged 12-17 years, males, and consumers residing in northeastern China. While no significant overall yearly trends in caffeine intake were detected from 2004 to 2018, there was an increase in intake driven by beverage consumption between 2006 and 2014.

CONCLUSION

This study provided a national assessment of caffeine consumption among Chinese children and adolescents. Caffeinated beverages like tea, soda, and tea beverages emerged as major contributors to caffeine intake. These findings could contribute to the regulation of caffeine consumption and the promotion of healthy habits among children and adolescents.

Trends in utilization patterns of newer glucose-lowering drugs in US adults with type 2 diabetes and a history of coronary heart disease or heart failure: 2005-2019

BACKGROUND

The newer glucose-lowering drugs (GLDs), including Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i), have demonstrated superior cardio- and renal protective benefits compared to older GLDs in individuals with type 2 diabetes (T2D) at high risk for cardiovascular disease (CVD).

OBJECTIVE

This study examined the trends of the newer GLDs use in people with T2D who had a history of coronary heart disease or heart failure in the United States.

METHOD

We used 2005-2019 data from the Medical Expenditure Panel Survey (MEPS). Individuals with self-reported diabetes and CVD history were identified.

RESULTS

There was a steady increase in the use of GLP-1RA only from 2008 (3 %) to 2019 (21 %) and SGLT2i only from 2014 (5 %) to 2019 (12 %). Individuals with dual use of both newer GLD classes increased from 0.62 % in 2015 to 6 % in 2019. The overall uptake of these two newer drugs in 2019 was less than 40 %. In other words, 60 % of individuals who can substantially benefit from these newer treatments did not use the treatments.

CONCLUSION

The use of GLP-1RA and SGLT2i among individuals with T2D and a history of CVD was low and varied by insurance type. Policy-level interventions are needed to improve the use of these newer treatments further.

SUMMARY

We examined how newer glucose-lowering drugs are used among individuals with type 2 diabetes and at high risk for coronary heart disease or heart failure in the US. We found that 60 % of individuals who can substantially benefit from these newer treatments did not use the treatments due to the variation of insurance type.

Heart disease and heart failure: Trends and disparities in mortality rates in the United States from 2000 to 2020

Study objective

To describe the age, sex and racial disparities in mortality rates for heart disease (HD) and heart failure (HF) in the United States (US) between 2000 and 2020.

Design

This was an ecological study with trend analysis of mortality rates.

Setting

United States.

Participants

Adults aged 18 years and above.

Main outcomes measures

Mortality rates per 100,000 for HD and HF.

Results

There was a significant decrease in the age-standardized mortality rate for HD over the past two decades (from 343.5 per 100,000 cases to 215.1 per 100,000 cases, p < 0.001). HD mortality rates were significantly higher in males (p < 0.001), non-Hispanic blacks (p < 0.001) and in adults aged 65+ (p < 0.001) and 75+ (p < 0.001). There was no significant change in the age-standardized mortality rate for HF (from 26.9 per 100,000 cases to 25.7 per 100,000 cases (p = 0.706)) due to a reversal in the trend beyond 2011. Though the HF mortality rates were significantly lower in males (p = 0.001), and not significantly different in non-Hispanic blacks and non-Hispanic whites, there were shifts in trends beyond 2016, with higher rates in males and in non-Hispanic blacks compared to non-Hispanic whites.

Conclusions

In summary, this study underscores significant reductions in heart disease mortality rates over the past two decades, alongside persistent disparities among different demographic groups. It also highlights emerging trends in heart failure mortality rates in particular population subgroups in recent years, necessitating further exploration to inform targeted interventions and policies.

A surveillance study of cancer incidence and mortality among young adults in Costa Rica

Background

There has been an increase in certain cancers among young adults (YA) aged 20-39, particularly in Latin America. This is the first study to examine cancer incidence and mortality in YA in Costa Rica, focusing on sex-specific patterns.

Methods

Invasive cancer cases (excluding non-melanoma skin cancer) in YA from 2006 to 2015 were obtained from the Costa Rican National Registry of Tumors. Utilising SEER∗Stat software, age-standardized incidence rates (IRs) and incidence rate ratios (IRRs) were calculated. Trends and annual percent changes (APCs) in IRs were estimated using the Joinpoint regression analysis program. Cancer deaths from 2000 to 2021 were obtained from the Costa Rican National Institute of Statistics and Census. Age-standardised mortality rates were calculated using STATA®17.

Findings

YA comprised 10.7% of all invasive cancer cases diagnosed from 2006 to 2015. The age-standardized incidence rate (ASIR) of invasive cancer in YA was 50.9/100,000 person-years. The ASIR was twofold higher for females compared to males (IRR = 2.03, 95% CI:1.94, 2.13). This difference increased with age, peaking in the 35-39-year age group (IRR = 2.84, 95% CI:2.62, 3.10). Thyroid, breast, and cervical cancer were the most common in females. Testicular cancer was the most common in males. Leading causes of cancer-related deaths included cervical and breast cancer in females and stomach and brain/nervous system cancer in males.

Interpretation

The study highlights sex-specific patterns in cancer incidence and mortality among YA in Costa Rica to increase understanding and improve cancer outcomes in this age group.

Funding

This study was funded by the Intramural Research Program of the National Cancer Institute.