Association of Medicaid Expansion with In-Hospital Outcomes After Abdominal Aortic Aneurysm Repair

OBJECTIVES

Multiple studies have shown improved outcomes and higher utilization of care with the increase of insurance coverage. This study aims to assess whether Medicaid expansion (ME) has changed the utilization and outcomes of abdominal aortic aneurysm (AAA) repair in the United States.

DESIGN

Retrospective observational study.

MATERIALS

Data of patients undergoing AAA repair in the Vascular Quality Initiative (2010-2017).

METHODS

Interrupted time-series (ITS) analysis was utilized to evaluate changes in annual trends of postoperative outcomes after elective AAA repair before and after 2014. We also assessed if these trend changes were significant by comparing the changes in states which adopted ME in 2014 versus nonexpansion states (NME), and conducting a difference-in-difference analysis. Primary outcomes included in-hospital mortality and adverse events (bowel and leg ischemia, cardiac, renal, respiratory, stroke and return to the OR).

RESULTS

A total of 19,143 procedures were included (Endovascular: 85.8% and open: 14.2%), of which 40.9% were performed in ME States. Compared to preexpansion trends (P1), there was a 2% annual increase in elective AAA repair in ME states (P1: -1.8% versus P2: +0.2%, P< 0.01) with no significant change in NME (P1: +0.3% versus P2: +0.2%, P = 0.97). Among elective cases, annual trends in the use of EVAR increased by 2% in ME states (95% confidence interval (CI) = -0.1, 4.1, P = 0.06), compared to a 3% decrease in NME States [95%CI = -5.8, -0.6, P = 0.01) (P_MEversusNME < 0.01]. There was no association between ME and in-hospital mortality. Nonetheless, it was associated with a decrease in the annual trends of in-hospital complications (ME: -1.4% (-2.1,-0.8) versus NME: +0.2% (-0.2, +0.8), P < 0.01).

CONCLUSIONS

While no association between ME and increased survival was noted in states which adopted ME, there was a significant increase of elective AAA cases and EVAR utilization and a decrease in in-hospital complications in ME States.

11-Year Study of Fentanyl in Driving Under the Influence of Drugs (DUID) Casework

Prior to 2017, heroin and other prescription opioids were the most prevalent opioids implicated in driving under the influence of drugs (DUID) investigation cases and fentanyl was rarely included in the scope of toxicological analysis. Fentanyl has become the most frequently identified opioid in DUID cases with many suspected heroin cases turning out to be only fentanyl. A review of fentanyl positive DUID cases at NMS Labs was performed to provide prevalence information, change in concentration, patterns of combined drug use, indicators of impairment, and driving behavior in order to assist with toxicological interpretation of DUID scenarios involving fentanyl. Fentanyl positive DUID cases received between January 2010 and December 2020 were examined. Blood results were confirmed and quantitated for fentanyl, norfentanyl and acetylfentanyl using a liquid chromatography-tandem mass spectrometry (LC-MS-MS) analysis with a limit of quantitation (LOQ) of 0.10, 0.20 and 0.10 ng/mL, respectively. Of 153,234 blood cases examined for DUID over 11 years, fentanyl confirmed positive in 6,779 (4.4%) cases. However, there were significant changes in positivity over time. Fentanyl percent positivity increased from 0.60% in 2010 to 12% in 2020. Of 5,976 confirmed fentanyl positive cases in 2018 through 2020, blood concentrations greater than 4.0 ng/mL were observed in 44% (2018), 55% (2019), and 59% (2020) of cases. Polypharmacy was common with 87% of blood samples confirming positive for fentanyl and at least one other compound. Stimulants was the most commonly identified drug class in cases where at least one additional drug class was present. This study illustrates the importance of including fentanyl in a routine blood DUID panel.

No improvement in survival of older women with cervical cancer-A nationwide study

AIM

This study aims to report trends in primary treatment and survival in cervical cancer (CC) to identify opportunities to improve clinical practice and disease outcome.

METHODS

Patients diagnosed with CC between 1989 and 2018 were identified from the Netherlands Cancer Registry (N = 21,644). Trends in primary treatment and 5-year relative survival were analysed with the Cochran-Armitage trend test and multivariable Poisson regression, respectively.

RESULTS

In early CC, surgery remains the preferred treatment for ages 15-74. Overall, it was applied more often in younger than in older patients (92% in 15-44; 64% in 65-74). For 75+, surgery use was stable over time (38%-41%, p=0.368), while administration of radiotherapy decreased (57%-29%, p < 0.001). In locally advanced CC, chemoradiation use increased over time (5%-65%, p < 0.001). It was applied least often for 75+, in which radiotherapy remains most common (54% in 2014-2018). In metastatic CC, chemotherapy use increased over time (11%-28%, p < 0.001), but varied across age groups (6%-40% in 2014-2018). In patients treated with primary chemoradiation, regardless of stage, brachytherapy use increased over time (p ≤ 0.001). Full cohort 5-year survival increased from 68% to 74% (relative excess risk 0.55; 95% confidence interval [0.50-0.62]). Increases were most significant in locally advanced CC (38%-60%; 0.55 [0.47-0.65]). Survival remained stable in 75+ (38%-34%; 0.82 [0.66-1.02]).

CONCLUSION

Relative survival for cervical cancer increased over the last three decades. The proportion of older patients receiving preferred treatment lags behind. Consequently, survival did not improve in the oldest patients.

[Age-specific trends in risky drinking in Germany: collectivity or polarisation?]

Einleitung

Nach der Collectivity-of-Drinking-Cultures-Theorie von Skog finden Veränderungen des Alkoholkonsums in allen Bevölkerungsgruppen und -schichten als parallele Verschiebungen statt. Ziele des vorliegenden Beitrags sind (1) die Darstellung zeitlicher Trends des riskanten Konsums und des episodischen Rauschtrinkens nach Altersgruppen und Geschlecht und (2) die Prüfung, ob die Trends in allen Altersgruppen parallel verlaufen („Kollektivität“) oder zwischen Altersgruppen divergieren („Polarisierung“).

Methoden

Datengrundlage sind 9 Erhebungen des Epidemiologischen Suchtsurveys (ESA) zwischen 1995 und 2018. Als Schwellenwert für riskanten Alkoholkonsum wurde ein täglicher Konsum von mehr als 12 g Reinalkohol bei Frauen beziehungsweise 24 g bei Männern herangezogen. Episodisches Rauschtrinken wurde als Konsum von 5 oder mehr Gläsern Alkohol (ca. 70 g Reinalkohol) an mindestens einem Tag in den letzten 30 Tagen definiert. Lineare Regressionen wurden für die Vorhersage des zeitlichen Effekts auf riskanten Konsum bzw. Rauschkonsum nach Altersgruppen (18–29, 30–39, 40–49 und 50–59 Jahre) und Geschlecht getrennt berechnet und auf Unterschiede geprüft.

Ergebnisse

Die Entwicklungen riskanten Alkoholkonsums nach Altersgruppen verlaufen bei Männern weitgehend parallel, bei Frauen gegenläufig. Die Trends des episodischen Rauschtrinken weisen bei beiden Geschlechtern keine parallele Entwicklung auf: Während in der jüngsten und ältesten Altersgruppe die Prävalenz im Zeitverlauf anstieg, sank sie in den übrigen Altersgruppen.

Diskussion

Vor dem Hintergrund einer generellen Abnahme spricht die Zunahme in den Trends risikoreichen Alkoholkonsums in bestimmten Gruppen für einen Ausbau verhaltenspräventiver Maßnahmen. Zur Fortsetzung der positiven Entwicklung und der Vermeidung einer Trendumkehr sollten zudem auf die Gesamtbevölkerung ausgerichtete Präventionsanstrengungen intensiviert werden, beispielsweise durch Erhöhung der Alkoholsteuer oder Reduktion der Verfügbarkeit von Alkohol.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-021-03328-7) enthalten.

Firearm-Related Injuries: A Single Center Experience

INTRODUCTION

Firearm-related injuries (FRI) are an important public health crisis in the US. There is relatively less city level data examining the injury-related trends in Tucson, Arizona. Our study aims to examine FRI, in Southern Arizona's only Level I trauma center.

METHODS

We conducted a (2014-2019) review of our Level-I trauma center registry. We selected all patients who were evaluated for a FRI. We collected patient and center related variables. Our outcomes were the trends of FRI, injury-related characteristics, and mortality. Cochran-Armitage trend analysis was performed.

RESULTS

A total of 1012 FRI patients were identified. The majority of patients were teenagers (32%) and young adults (30%), and 88% were male. Greater than 80% of patients belonged to the low/low-middle socioeconomic class, and 18.5% completed college. The most common firearm utilized was the handgun (45%). The prevalence of FRI increased significantly (2014:15%; 2019:21%; P< 0.01). The most common injury intention was assault (75%). The median ISS was 17(9-25) with most injuries sustained to the extremities (23%). Also, 25% required emergent operative intervention. There is a significant rise in the number of severely injured patients (ISS≥25) (2014:12.1%, 2019:20%; P< 0.01), self-inflicted injuries (2014:10%, 2019:17%; P < 0.01), unintentional injuries (2014:6%, 2019:12%; P< 0.01), and mortality (2014:11%; 2019:19%; P< 0.01). A high prevalence of substance abuse was noted (73% alcohol, 64% drugs).

CONCLUSIONS

The prevalence of FRI at our center has been rising over the past decade with a shift towards more severe injuries and higher mortality rates. Addressing these alarming changes requires targeted interventions on multiple frontiers.

Effluent treatment using activated carbon adsorbents: a bibliometric analysis of recent literature

Agricultural practices and industrial and human discharges play an important role in the generation of highly contaminated effluents, which becomes a threat to the environment. The persistence of many of these compounds to conventional treatments in recent years has meant that numerous efforts have been devoted to the proposal of new selective materials that allow the removal of these contaminants by adsorption. In addition, bibliometric studies have grown as powerful tools to indicate trends in innovation. In this way, the present study consisted of evaluating the potential interest to use activated carbon as adsorbent through a prospection study in scientific and technological databases. The number of records obtained for the use of activated carbon in effluent remediation processes is equivalent to 4898, which corresponds to approximately 2.5% of the total documents (articles/patents) found for the use of carbon with no defined purpose. A total of 2275 works that used the adsorptive property of activated carbon were recovered. According to the data recovered, Brazil is the leader in scientific publications among Latin American countries and the 12th worldwide, according to the SciELO and Scopus databases, respectively. In general, a significant number of patents have been recovered for this theme, in the Derwent database, 1167 documents were recovered. The results obtained in this work evidenced the growing interest in developing technologies in this area.

Trends of Diabetes and Prediabetes Prevalence among Korean Adolescents From 2007 to 2018

BACKGROUND

To provide updated prevalence data and to estimate changes in the prevalence of diabetes among Korean adolescents by sex and age between 2007 and 2018.

METHODS

We used the data of children and adolescents (8,718 subjects aged 10 to 18 years) from the Korea National Health and Nutrition Examination Survey IV-VII (KNHANES 2007-2018). The recent prevalence of diabetes and pre-diabetes was estimated by using the latest KNHANES VII. The linear trends were estimated by comparing 3-year KNHANES cycles according to sex and by using logistic regression.

RESULTS

The prevalence of diabetes and pre-diabetes was 0.298% (95% confidence interval [CI], 0.289-0.308) and 7.914% (95% CI, 0.43-0.49). The prevalence of diabetes significantly increased from 0.189 to 0.430 during KNHANE IV and VII. A positive linear trend is significant for diabetes (P trends = 0.006) in only male subjects. The prevalence of pre-diabetes significantly increased from 5.86 to 12.08 in both sexes. During KNHANES IV and VII, the prevalence of obesity increased significantly.

CONCLUSION

Between 2007 and 2018, the prevalence of diabetes among Korean adolescents increased. Further studies are required to determine the causes of these increases.

Global-scale massive feature extraction from monthly hydroclimatic time series: Statistical characterizations, spatial patterns and hydrological similarity

Hydroclimatic time series analysis focuses on a few feature types (e.g., autocorrelations, trends, extremes), which describe a small portion of the entire information content of the observations. Aiming to exploit a larger part of the available information and, thus, to deliver more reliable results (e.g., in hydroclimatic time series clustering contexts), here we approach hydroclimatic time series analysis differently, i.e., by performing massive feature extraction. In this respect, we develop a big data framework for hydroclimatic variable behaviour characterization. This framework relies on approximately 60 diverse features and is completely automatic (in the sense that it does not depend on the hydroclimatic process at hand). We apply the new framework to characterize mean monthly temperature, total monthly precipitation and mean monthly river flow. The applications are conducted at the global scale by exploiting 40-year-long time series originating from over 13 000 stations. We extract interpretable knowledge on seasonality, trends, autocorrelation, long-range dependence and entropy, and on feature types that are met less frequently. We further compare the examined hydroclimatic variable types in terms of this knowledge and, identify patterns related to the spatial variability of the features. For this latter purpose, we also propose and exploit a hydroclimatic time series clustering methodology. This new methodology is based on Breiman's random forests. The descriptive and exploratory insights gained by the global-scale applications prove the usefulness of the adopted feature compilation in hydroclimatic contexts. Moreover, the spatially coherent patterns characterizing the clusters delivered by the new methodology build confidence in its future exploitation. Given this spatial coherence and the scale-independent nature of the delivered feature values (which makes them particularly useful in forecasting and simulation contexts), we believe that this methodology could also be beneficial within regionalization frameworks, in which knowledge on hydrological similarity is exploited in technical and operative terms.

The Changing Burden of Alcoholic Hepatitis: Rising Incidence and Associations with Age, Gender, Race, and Geography

Alcoholic hepatitis is a major cause of morbidity and mortality. However, there are limited population-based data on its incidence, demographics, and temporal trends. We performed a retrospective cohort study using the State Inpatient Databases from Florida, Massachusetts, New York, and Washington from 2010 to 2014. We included patients aged 20-79 years admitted with alcoholic hepatitis and calculated incidence using population denominators obtained from the Centers for Disease Control and Prevention WONDER database. We fit multivariable Poisson regression models to explore interactions between alcoholic hepatitis incidence rates and several predictors including state, calendar year, age, race/ethnicity, and gender. Among 56,973 unique individuals with alcoholic hepatitis, the majority were male (39,702; 69.7%) and white non-Hispanic (40,934; 72.0%). In multivariable Poisson models, there was a significant interaction between calendar year and age group (p < 0.001), with the highest incidence rates in those ages 40-49 and 50-59 across all years. The absolute increase in incidence rate across calendar years was highest in the 20-29 and 30-39 age groups in every state. Female gender was associated with a lower rate (incidence rate ratio (IRR) 0.42, 95% confidence interval (CI) 0.41-0.42, p < 0.001). Compared to white non-Hispanics, black non-Hispanics (IRR 0.79, CI 0.77-0.81, p < 0.001) and Hispanics (0.66, CI 0.65-0.68, p < 0.001) had lower incidence rates. The incidence of alcoholic hepatitis in the USA varies by age, gender, race/ethnicity, and state of residence. The group with the fastest rising incidence is those aged 20-39. More work is needed to evaluate the reasons for the temporal trends for admissions for alcoholic hepatitis.

Trends in cannabis views and use among American adults: Intersections with alcohol consumption, 2002-2018

PURPOSE

The present study aims to examine trends in cannabis views and use among US adults who are alcohol abstainers, non-binge drinkers, and binge drinkers.

METHODS

We used data from the 2002-2018 National Survey on Drug Use and Health (US adults ages 18 and older, n = 664,152). Consistent with the Centers for Disease Control and Prevention guidelines, we conducted survey-adjusted logistic regression analyses to examine the significance of survey year in relation to cannabis views/use while controlling for demographic factors.

RESULTS

Between 2002 and 2018, the proportion of adults reporting strong disapproval of cannabis use initiation decreased significantly (AOR = 0.947, CI = 0.945-948). While the prevalence of cannabis use increased significantly for non-binge (AOR = 1.070, CI = 1.065-1.076) and binge drinkers (AOR = 1.039, CI = 1.035-1.042), the trend increase was greatest among abstainers (OR = 1.099, CI = 1.088-1.111). The association between disapproval and cannabis use did not change between 2003 and 2018 among alcohol abstainers, but weakened among both non-binge (2003-2006: AOR = 0.154, CI = 0.135-0.176; 2014-2018: AOR = 0.221, CI = 0.200-0.246) and binge drinkers (2003-2006: AOR = 0.297, CI = 0.275-0.321; 2014-2018: AOR = 0.361, CI = 0.333-0.391).

CONCLUSION

Cannabis disapproval has decreased and cannabis use increased among alcohol abstainers, non-binge drinkers, and binge drinkers between 2002 and 2018. The impact of cannabis disapproval on use attenuated during the study period among drinkers but not among abstainers, suggesting that the effect of anti-cannabis attitudes may be weakening among those most likely to use cannabis.

Analysis of trends in lumbar disc degeneration using kinematic MRI

OBJECTIVE

The aim of the current study was to classify and analyze trends in lumbar disc degeneration across age, sex, and disc level using weightbearing kinematic MRI.

MATERIALS AND METHODS

Between January 2019 and July 2019, 1198 cases were retrospectively analyzed with kinematic MRI. Patients were divided into 5 groups based on age (20-29, 30-39, 40-49, 50-59, and 60+) and evaluated using the Pfirrmann classification to assess for disc degeneration at 5 vertebral levels: L1/2, L2/3, L3/4, L4/5, and L5/S1. Trends in degeneration were analyzed with regression and time series.

RESULTS

The L5/S1 vertebral disc had the highest prevalence of severe degeneration across all age groups. The most common multi-level degeneration combinations were L4/5 and L5/S1 for two levels and L3/4, L4/5, and L5/S1 for three levels. All vertebral levels showed significant difference in mean Pfirrmann grade among the age groups (p < 0.001 at all levels). Statistically significant differences in mean Pfirmmann grade among males and females were found only in ages 20-29 and 30-39, in which males showed more degeneration.

CONCLUSION

Our findings using kinematic MRI demonstrate that degeneration increases with age and is most severe in the L5/S1 disc. In multi-level degeneration the most prevalent combinations are those that are contiguous and include L5/S1. Young males were more likely to have degeneration than young females, but there was no significant difference from the fifth decade of life on.

The effect of climate change on depression in urban areas of western Iran

Objective

Human is accustomed to climatic conditions of the environment where they are born and live throughout their lifetime. The aim of this study is to examine mood swings and depression caused by sudden climate changes that have not yet given the humans a chance to adapt.

Results

Our results showed that depression could be affected by climate change and as a result, the behavior of climatic elements and trends has damaged mental health in the western regions of Iran. By investigating the trends and changes of climatic time series and their relationship with the rate of depression in urban areas of western Iran, it can be said that climate change is probably a mental health challenge for urban populations. Climate change is an important and worrying issue that makes the life difficult. Rapid climate changes in western Iran including rising air temperature, changes in precipitation, its regime, changes cloudiness and the amount of sunlight have a negative effects on health. The results showed that type of increasing or decreasing trend, as well as different climatic elements in various seasons did not have the same effect on the rate of depression in the studied areas.

Birth cohort-specific trends of sun-related behaviors among individuals from an international consortium of melanoma-prone families

BACKGROUND

Individuals from melanoma-prone families have similar or reduced sun-protective behaviors compared to the general population. Studies on trends in sun-related behaviors have been temporally and geographically limited.

METHODS

Individuals from an international consortium of melanoma-prone families (GenoMEL) were retrospectively asked about sunscreen use, sun exposure (time spent outside), sunburns, and sunbed use at several timepoints over their lifetime. Generalized linear mixed models were used to examine the association between these outcomes and birth cohort defined by decade spans, after adjusting for covariates.

RESULTS

A total of 2407 participants from 547 families across 17 centers were analyzed. Sunscreen use increased across subsequent birth cohorts, and although the likelihood of sunburns increased until the 1950s birth cohort, it decreased thereafter. Average sun exposure did not change across the birth cohorts, and the likelihood of sunbed use increased in more recent birth cohorts. We generally did not find any differences in sun-related behavior when comparing melanoma cases to non-cases. Melanoma cases had increased sunscreen use, decreased sun exposure, and decreased odds of sunburn and sunbed use after melanoma diagnosis compared to before diagnosis.

CONCLUSIONS

Although sunscreen use has increased and the likelihood of sunburns has decreased in more recent birth cohorts, individuals in melanoma-prone families have not reduced their overall sun exposure and had an increased likelihood of sunbed use in more recent birth cohorts. These observations demonstrate partial improvements in melanoma prevention and suggest that additional intervention strategies may be needed to achieve optimal sun-protective behavior in melanoma-prone families.

Trends in body mass index among ever-married Bangladeshi women, 2004-14: evidence from nationally representative population-based surveys

Both high and low body weight are associated with adverse health risk for both mother and children. Studies evaluating trends in the coverage of undernutrition and overnutrition among ever-married Bangladeshi women are limited. The objective of the present study is to assess the trends and develop future projections of body weight status among Bangladeshi women and to estimate the smoothed mean BMI by women's age for the national level and across urban and rural areas. Data from Bangladesh Demographic and Health Surveys conducted between 2004 and 2014 were used. The annual rate of change in the prevalence of underweight, overweight, and obesity, and smoothed age-specific mean BMI was estimated. During 2004–14, the prevalence of underweight reduced with an annual rate of 5⋅9 % at the national level, while the prevalence of overweight and obesity increased with an annual rate of 8⋅6 and 9⋅6 %, respectively. With the recent trends, the prevalence of underweight is expected to reduce from 11⋅9 % in 2020 to 6⋅5 % by 2025. In 2020, the prevalence of overweight and obesity were 30⋅0 and 6⋅9 %, respectively, which are projected to increase to 38⋅5 and 9⋅0 %, respectively, by 2025, if present trends continue. By 2030, the prevalence of overweight was predicted to be much higher in urban areas (44⋅7 %) compared with rural areas (36⋅5 %). Multifaceted nutrition programme should be introduced for rapid reduction of undernutrition and to halt the rise of the prevalence of overweight and obesity.

Atmospheric nitrogen deposition in the Chesapeake Bay watershed: A history of change

The Chesapeake Bay watershed has been the focus of pioneering studies of the role of atmospheric nitrogen (N) deposition as a nutrient source and driver of estuarine trophic status. Here, we review the history and evolution of scientific investigations of the role of atmospheric N deposition, examine trends from wet and dry deposition networks, and present century-long (1950-2050) atmospheric N deposition estimates. Early investigations demonstrated the importance of atmospheric deposition as an N source to the Bay, providing 25%-40% among all major N sources. These early studies led to the unprecedented inclusion of targeted decreases in atmospheric N deposition as part of the multi-stakeholder effort to reduce N loads to the Bay. Emissions of nitrogen oxides (NO_x) and deposition of wet nitrate, oxidized dry N, and dry ammonium ( NH 4 + ) sharply and synchronously declined by 60%-73% during 1995-2019. These decreases largely resulted from implementation of Title IV of the 1990 Clean Air Act Amendments, which began in 1995. Wet NH 4 + deposition shows no significant trend during this period. The century-long atmospheric N deposition estimates indicate an increase in total atmospheric N deposition in the Chesapeake watershed from 1950 to a peak of ~15 kg N/ha/yr in 1979, trailed by a slight decline of <10% through the mid-1990s, and followed by a sharp decline of about 40% thereafter through 2019. An additional 21% decline in atmospheric N deposition is projected from 2015 to 2050. A comparison of the Potomac River and James River watersheds indicates higher atmospheric N deposition in the Potomac, likely resulting from greater emissions from higher proportions of agricultural and urban land in this basin. Atmospheric N deposition rose from 30% among all N sources to the Chesapeake Bay watershed in 1950 to a peak of 40% in 1973, and a decline to 28% by 2015. These data highlight the important role of atmospheric N deposition in the Chesapeake Bay watershed and present a potential opportunity for decreases in deposition to contribute to further reducing N loads and improving the trophic status of tidal waters.

An Evaluation of the Modern North American Bariatric Surgery Landscape: Current Trends and Predictors of Procedure Selection

PURPOSE

The last 5 years have produced a dramatic transformation in the landscape of bariatric and metabolic surgery. Yet, while the landscape of bariatric procedures is changing, little is known about these trends or which factors are responsible for their evolution.

METHODS

All primary elective laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) cases were extracted from the comprehensive Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry from 2015 to 2018.

RESULTS

A total of 590,971 patients were identified, with 79.6% being female. Overall, 73.4% of patients underwent LSG. The mean age was 44.5 ± 12.0 years and mean BMI was 45.3 ± 7.9 kg/m². An increase in proportion of LSG cases was observed and associated with a decrease in LRYGB cases from 2015 to 2018. Multivariable analysis identified dialysis dependence as the greatest predictor of LSG (OR 2.67; 95% CI 2.34-3.04), whereas insulin-dependent diabetes (OR 2.27; 95% CI 2.23-2.32) and gastroesophageal reflux disease (OR 1.52; 95% CI 1.51-1.55) were the two greatest predictors of LRYGB, respectively. Patients offered LSG in 2018 had a near 1.3-fold increase in odds of receiving sleeve gastrectomy vs. those offered surgery in 2015.

CONCLUSION

The overall numbers of bariatric cases have increased from 2015 to 2018 and are associated with an increase in proportion of LSG cases and a decrease in proportion of LRYGB cases over time. Factors other than patient comorbidities alone are responsible for the current trends and modern landscape of bariatric surgery.

Rising burden of multimorbidity and related socio-demographic factors: a repeated cross-sectional study of Ontarians

OBJECTIVE

This study aimed to provide population-level data regarding trends in multimorbidity over 13 years.

METHODS

We linked provincial health administrative data in Ontario, Canada, to create 3 cross-sectional panels of residents of any age in 2003, 2009, and 2016 to describe: (i) 13-year trends in multimorbidity prevalence and constellations among residents and across age, sex, and income; and (ii) chronic condition clusters. Multimorbidity was defined as having at least any 2 of 18 selected conditions, and further grouped into levels of 2, 3, 4, or 5 or more conditions. Age-sex standardized multimorbidity prevalence was estimated using the 2009 population as the standard. Clustering was defined using the observed combinations of conditions within levels of multimorbidity.

RESULTS

Standardized prevalence of multimorbidity increased over time (26.5%, 28.8%, and 30.0% across sequential panels), across sex, age, and area-based income. Females, older adults and those living in lower income areas exhibited higher rates in all years. However, multimorbidity increased relatively more among males, younger adults, and those with 4 or 5 or more conditions. We observed numerous and increasing diversity in disease clusters, namely at higher levels of multimorbidity.

CONCLUSION

Our study provides relevant and needed population-based information on the growing burden of multimorbidity, and related socio-demographic risk factors. Multimorbidity is markedly increasing among younger age cohorts. Also, there is an increasing complexity and lack of common clustering patterns at higher multimorbidity levels.

Trends and patterns in sugar-sweetened beverage consumption among children and adults by race and/or ethnicity, 2003-2018

OBJECTIVE

Sugar-sweetened beverage (SSB) consumption has declined steadily. This study uses the latest national data to examine trends in SSB consumption among children and adults by race and/or ethnicity and to document whether long-standing disparities in intake remain.

DESIGN

Trend analyses of demographic and dietary data measured by 24-h dietary recall from the National Health and Nutrition Examination Survey (NHANES).

SETTING

Data from the 2003-2004 through 2017-2018 NHANES survey cycles were analysed in 2020.

PARTICIPANTS

The study sample included 21 156 children aged 2-19 years and 32 631 adults aged 20+ years.

RESULTS

From 2003-2004 to 2017-2018, the prevalence of drinking any amount of SSB on a given day declined significantly among all race and/or ethnicity groups for children (non-Hispanic (NH) White: 81·6 % to 72·7 %; NH Black: 83·2 % to 74·8 %, Hispanic: 86·9 % to 77·2 %) and most race and/or ethnicity groups for adults (NH White: 72·3 % to 65·3 %; Hispanic: 84·6 % to 77·8 %). Consumption declined at a higher rate among NH Black and Hispanic children aged 12-19 years compared with their NH White peers; among NH Black children aged 6-11 years, the rate of decline was lower. Despite significant declines in per capita SSB energy consumption from soda and fruit drinks, consumption of sweetened coffee/tea beverages increased among older children and nearly all adults and consumption of sweetened milk beverages increased among NH White and Hispanic children.

CONCLUSIONS

SSB consumption has declined steadily for children and adults of all race and/or ethnicity groups, but disparities persist, and overall intake remains high.

Catheter ablation in adults with congenital heart disease: A 15-year perspective from a tertiary centre

BACKGROUND

With the growing adult congenital heart disease (ACHD) population, the number of catheter ablation procedures is expected to dramatically increase. Data reporting experience and evolution of catheter ablation in patients with ACHD, over a significant period of time, remain scarce.

AIM

We aimed to describe temporal trends in volume and outcomes of catheter ablation in patients with ACHD.

METHODS

This was a retrospective observational study including all consecutive patients with ACHD undergoing attempted catheter ablation in a large tertiary referral centre over a 15-year period. Acute procedural success rate and freedom from recurrence at 12 and 24 months were analysed.

RESULTS

From November 2004 to November 2019, 302 catheter ablations were performed in 221 patients with ACHD (mean age 43.6±15.0 years; 58.9% male sex). The annual number of catheter ablations increased progressively from four to 60 cases per year (P<0.001). Intra-atrial reentrant tachycardia/focal atrial tachycardia was the most common arrhythmia (n=217, 71.9%). Over the study period, acute procedural success rate increased from 45.0% to 93.4% (P<0.001). Use of irrigated catheters (odds ratio [OR] 4.03, 95% confidence interval [CI] 1.86-8.55), a three-dimensional mapping system (OR 3.70, 95% CI 1.72-7.74), contact force catheters (OR 3.60, 95% CI 1.81-7.38) and high-density mapping (OR 3.69, 95% CI 1.82-8.14) were associated with acute procedural success. The rate of freedom from any recurrence at 12 months increased from 29.4% to 66.2% (P=0.001). Seven (2.3%) non-fatal complications occurred.

CONCLUSIONS

The number of catheter ablation procedures in patients with ACHD has increased considerably over the past 15 years. Growing experience and advances in ablative technologies appear to be associated with a significant improvement in acute and mid-term outcomes.

What a mesh! An Australian experience using national female continence surgery trends over 20 years

PURPOSE

To review the evolution of female continence surgical practice in Australia over the last 20 years and observe whether vaginal mesh controversies impacted these trends.

MATERIALS AND METHODS

From January 2000 to December 2019, medicare benefit schedule codes for female continence procedures were identified and extracted for: mesh sling, fascial sling, bulking agent, female urethral prosthesis, colposuspension, and removal of sling. Population-adjusted incidences per 100,000 persons were calculated using publicly available demographic data. Three discrete phases were defined over the study time frame for analysis: 2000-2006; 2006-2017, and 2017-2019. Interrupted time-series analyses were conducted to assess for impact on incidence at 2006 and 2017.

RESULTS

There were 119,832 continence procedures performed in Australia from 2000 to 2019, with the mid-urethral sling (MUS) the most common (72%). The majority of mesh (n = 63,668, 73%) and fascial sling (n = 1864, 70%) procedures were in women aged < 65 years. Rates of mesh-related procedures steeply declined after 2017 (initial change: -21 cases per 100,000; subsequent rate change: -12 per 100,000, p < 0.001). Non-mesh related/bulking agents increased from + 0.34 during 2006-2017 to + 2.1 per 100,000 after 2017 (p < 0.001). No significant change in mesh extraction was observed over 2006-2017 (+ 0.06 per 100,000, p = 0.192). There was a significant increase in mesh extraction procedures after 2017 (0.83 per 100,000, p < 0.001).

CONCLUSION

Worldwide, controversy surrounding vaginal mesh had a significant impact on Australian continence surgery trends. The most standout trends were observed after the 2017 Australian class-action lawsuit and Senate Inquiry.

Geographic variability in homicide rates following the COVID-19 pandemic

It has been demonstrated in a number of communities that the rates of serious crimes such as homicides and intimate partner violence have increased as a result of lockdowns due to COVID-19. To ascertain whether this is a universal trend the electronic autopsy files at Forensic Science South Australia, Adelaide, Australia, were searched for all homicides occurring between January 2015 and December 2020. There were 92 cases with 17 homicides in 2015 out of a total of 1356 cases (1.3%),18 in 2016 (18/1340 = 1.3%), 23 in 2017 (23/1419 = 1.6%); 14 in 2018 (14/1400 = 1.0%), 15 in 2019 (15/1492 = 1.0%) but in 2020 there were only 5 (5/1374 = 0.4%) (p < 0.02). Thus the incidence of homicides has fallen significantly in South Australia since the beginning of the pandemic. As the occurrence of serious crimes of violence and homicide has not followed a standard pattern in different communities it will be important to evaluate specific populations and subgroups rather than merely relying on accrued national data or extrapolating from one country to another. Pathologists, epidemiologists and health officials will need to specifically monitor local trends to understand more clearly what effects, if any, the pandemic has had on particular subgroups of deaths in order to more clearly understand causal relationships.

Trends in Molecular Testing of Lung Cancer in Mainland People's Republic of China Over the Decade 2010 to 2019

INTRODUCTION

Lung cancer is the leading cause of cancer-related morbidity and mortality in the People's Republic of China. Targeted therapies for patients with lung cancer, which depend on accurate identification of actionable genomic alteration, have improved survival compared with previously available treatments. However, data on the types of molecular testing often used in the People's Republic of China, and how they have changed over time, are scarce. We explored the overall landscape of molecular testing of lung cancer in mainland People's Republic of China in the past decade.

METHODS

We distributed a stratified random sampling survey of molecular testing to 49 hospitals from members of the Molecular Pathology Collaboration Group of Chinese Anti-Cancer Association which was weighted by the numbers of lung cancer cases in seven different geographic regions in mainland People's Republic of China from 2010 to 2019. The questionnaire contained four parts for all respondents. The questionnaire ascertained the use of approved in vitro diagnostic (IVD) devices published by the Center for Medical Device Evaluation, National Medical Products Administration of the People's Republic of China.

RESULTS

A total of 226,227 NSCLC specimens were tested from 2010 to 2019 in the selected hospitals. The annual number of initiated molecular tests increased over time (p < 0.0001), with an average annual growth rate of 31.8%. A notable increase in the number of molecular tests occurred during 2014 and 2016, which coincided with the approval of the National Medical Products Administration to IVD devices. For the diagnosis of molecular subtypes, EGFR mutation testing was first conducted in year 2007, followed by ALK translocation testing in 2010 and ROS1 in 2011. For other rare genetic variations in NSCLC, BRAF mutation testing was first launched in 2012, MET exon 14 skipping mutation in 2014, HER2 exon 20 mutations in 2017, and RET translocation in 2015. A markedly uneven distribution was also observed in the geography of leading units with the largest number of leading units located in east People's Republic of China (34.7%, 17 of 49) and the smallest number located in northwest People's Republic of China (6.1%, 3 of 49). The growth trends we observed illustrate the progress and increasing capability of molecular testing of lung cancer achieved in mainland People's Republic of China in the decade from 2010.

CONCLUSIONS

In the decade 2010 to 2019, progress and increased capability of molecular testing of lung cancer were achieved in mainland People's Republic of China. Further efforts should address the clinical application of next-generation sequencing technology, rare genomic aberrations, and the balance between novel genomic testing techniques and the approval of IVD products.

New Trends of Cervical Cancer Incidence in Kazakhstan

OBJECTIVE

The epidemiological features of the cervical cancer (CC) incidence and its spatial and temporal assessment in Kazakhstan were studied.

METHODS

The retrospective study was done for the period 2009-2018. Descriptive and analytical methods of oncoepidemiology were used.

RESULTS

During the study period, 16,441 new cases of CC were registered. The average annual crude and age-standardized incidence rate were 18.6±0.5 and 17.7±0.4 cases per 100,000 population of female, respectively, and their trends tended to increase (Тup=+2.3%; R2=0.708 and Тup=+1.9%; R2=0.615, respectively). The analysis of ASIR showed unimodal growth with a peak at 50-54 years - 45.3±1.1 cases per 100,000 population of female. Trends of ASIR decreased up to 30 years (Tdown=-1.8%; R2=0.111) and 35-59 years (Tdown=-0.9%; R2=0.103), in other age groups the trends increased, and were most pronounced in 40-44 (Тup=+4.1%; R2=0.878) and 65-69 years (Тup=+4.4%; R2=0.537). Trends in ASR of СС tended to grow in almost all regions, with higher levels in Mangystau (Тup=+4.1%; R2=0.482) and Aktobe (Тup=+6.3%; R2=0.846) regions. The cartograms of ASR per 100,000 population of female were allocated according to the following criteria: low - up to 16.3, average - from 16.3 to 19.2, high - above 19.2. The results of the spatial analysis showed the regions with a higher levels of CC incidence rate per 100,000 population of female: East Kazakhstan (19.8), Aktobe (20.0), Almaty (20.1), Kostanay region (20.9), Atyrau (21.7) regions and Almaty city (22.0).

CONCLUSION

The study of trends of the cervical cancer incidence has the theoretical and practical value:  monitoring and evaluation of screening programmes, which are implemented in the country, and conduction of secondary prevention of cervical pathology. Health authorities should consider the obtained results in the in the organization of anti-cancer activities.

Stage-specific incidence trends of renal cancers in the East of England, 1999-2016

OBJECTIVES

To determine stage-specific time-trends in renal cancer incidence.

METHODS

We used population-based East Anglia data 1999-2016 (population ∼2 million) on 5,456 primary renal cancer diagnoses, estimating stage-specific annual incidence using Poisson regression, allowing for changing time-trends, and adjusting for sex, age, and socioeconomic deprivation.

RESULTS

Renal cancer incidence increased from 9.8-16.4 cases per 100,000 during 1999-2016. Incidence of Stage I, II, and III cases increased over time, most steeply for Stage I, with annual Incidence Rate Ratio [IRR] for Stage I of 1.09 (95 % CI 1.07-1.12) during 1999-2010; and 1.03 (1.00-1.05) during 2011-2016. In contrast, the annual incidence of Stage IV renal cancer decreased during most years, IRR of 0.99 (0.98-1.00) during 2003-2016.

CONCLUSION

The findings are consistent with both earlier detection of symptomatic renal cancer and increasing identification of asymptomatic lesions. However, the decreasing incidence of late-stage disease suggests genuine shifts towards earlier diagnosis.

Trends in sleep problems and patterns among Japanese adolescents: 2004 to 2017

BACKGROUND

Sleep problems in adolescence, such as insomnia and short sleep duration, are associated with physical and mental health problems. However, little is known about the recent trends in sleep problems among adolescents. Therefore, this study examined trends in sleep problems among Japanese adolescents.

METHODS

Using data from the Lifestyle Survey of Adolescents collected in 2004 (n = 102,451), 2008 (n = 95,680), 2010 (n = 98,867), 2012 (n = 101,134), 2014 (n = 85,931), and 2017 (n = 64,417), we calculated the trends of insomnia, shorter sleep duration, late bedtimes, and poor sleep quality. Multivariable logistic regression analysis models were used to examine the association of each sleep problem and survey years.

FINDINGS

We analyzed data from 545,285 Japanese adolescents. Results indicated that, since 2004, the odds ratio for insomnia have decreased (Adjusted odds ratio [AOR] 0•85, 95% CI 0•82-0•87), as have the odds ratio for poor sleep quality (AOR 0•92, 95% CI 0•88-0•95). However, the odds ratio for shorter sleep duration (AOR 1•13, 95% CI 1•10-1•17) and late bedtimes tended to increase (AOR 1•06, 95% CI 1•03-1•08) during this period.

INTERPRETATION

The prevalence of insomnia symptoms and poor sleep quality among adolescents decreased from 2004 to 2017. However, there were increasing trends toward shorter sleep duration and late bedtimes. These changes are both relieving and concerning. Teachers, parents, and health professionals should consider educating adolescents regarding sleep hygiene, adjusting schedules of extracurricular activities, and enhancing time management to improve their sleep quantity.

FUNDING

This study received funding from Japan's Ministry of Health, Labour and Welfare.