Wastewater-based estimation of diabetes mellitus prevalence in 237 cities: A cross-China study

Diabetes mellitus, a metabolic disease characterized by hyperglycemia, has been witnessed as a rapidly escalating worldwide health crisis. China currently had 140.9 million diabetic population in 2021, which was the largest globally. DM has witnessed a significant surge in the past few decades, leading to an alarming rise in the overall burden caused by this disease. To monitor the near real-time DM prevalence and the consumption of first-line anti-diabetic drugs, a wastewater-based epidemiology (WBE) approach based on the back-calculation of metformin concentration was implemented in 237 cities in China. The quantitative analysis of metformin in wastewater was conducted by LC-MS/MS with satisfactory results of method validation. The average concentration of metformin in wastewater was 14.07 ± 13.16 μg/L, and the per capita consumption was 5.16 ± 2.08 mg/day/inh, ranging from 0.90 to 10.36 ± 4.63 mg/day/inh. The calculated metformin prevalence was found to be 0.52 % ± 0.28 %, and the final estimated DM prevalence was 11.33 % ± 4.99 %, which was nearly consistent with the result of the International Diabetes Federation survey of 9.98 %. The results suggested that metformin might be one of the suitable WBE biomarkers in DM monitoring and WBE strategy could potentially enable the estimation of DM prevalence in most of Chinese cities after reasonable correction of associated parameters.

Trends and regional differences in antidiabetic medication use: a nationwide retrospective observational study

BACKGROUND

The prevalence of diabetes is increasing, and several new drug groups have been authorized and used successfully in the treatment of diabetes, while older drug groups are still in use. Our aim was to assess the utilization tendencies and regional differences in antidiabetic medication consumption in Hungary between 2015 and 2021 and to identify the possible determinants of regional differences in antidiabetic medication use.

METHODS

For this retrospective drug utilization study, yearly wholesale database was used, which provides total coverage for ambulatory antidiabetic drug sales in Hungary, including both reimbursed and non-reimbursed medications. Data were expressed as Defined Daily Dose per 1000 inhabitants per day (DDD/TID), percentage of total use and the ratio of the highest and lowest utilization values among the counties (max/min ratio). To assess the potential reasons for regional differences in antidiabetic drug use, we analyzed the associations between regional drug utilization data and possible determinants.

RESULTS

The total national antidiabetic medication use has increased by 7.6% and reached 94.8 DDD/TID in 2021. Regarding antidiabetic subgroups, the use of metformin and novel antidiabetics (DPP4Is, GLP1As and SGLT2Is) and their combinations increased in all counties, while sulfonylurea consumption decreased, and insulin use was stable. In 2021, 19.2-24.1% of the total antidiabetic medication consumption was novel antidiabetics, 39.1-47.2% metformin, 14.8-25.8% sulfonylureas and 23.6-30.5% were insulins. Regional differences in antidiabetic medication consumption were considerable mainly in the case of GLP1As (max/min ratio:3.00), sulfonylureas (2.03) and SGLT2Is (1.92) in 2021. The association between antidiabetic medication use and possible determinants was confirmed in the case of unemployment rate and sulfonylurea use, the number of public medical card holders per ten thousand inhabitants and human insulin and sulfonylurea use. GLP1As were the only antidiabetic drug group that did not correlate with any of the investigated factors.

CONCLUSIONS

Although novel antidiabetic drug use was growing dynamically in Hungary, sulfonylurea use is still considerable. Differences in antidiabetic drug consumption were substantial between the regions.

[Regional differences and trends in healthy life expectancy in Germany]

BACKGROUND

Against the background of increasing life expectancy, the question arises in which state of health the additional years of life are spent. The aim of this study is to assess for the first time regional differences in healthy life expectancy for Germany.

METHODS

The concept of healthy life expectancy allows for the combination of regional differences in health status and mortality in a single measure. This article uses the concept of partial healthy life expectancy. We use official data on deaths and population numbers to calculate abridged life tables. Data from the Socio-Economic Panel (SOEP) are used to determine the age- and sex-specific prevalences of health status. Regional differences are analyzed from 2002 to 2019 by dividing Germany into four regions (North, South, East, West).

RESULTS

The regional differences in healthy life expectancy in Germany are greater than differences in life expectancy, and trends in healthy life expectancy partly differ from the corresponding trends in mortality. These differences over time also vary according to age: while healthy life expectancy has tended to stagnate and, in some cases, decline among the population aged between 20 and 64, the number and proportion of years in good health has increased among older adults up to the age of 79.

CONCLUSION

There are striking regional differences and trends in the distribution of expected years in good health in Germany. The timely identification of regionally divergent developments could facilitate the implementation of targeted health-promoting measures.

Secular trends and regional pattern in body height of Austrian conscripts born between 1961 and 2002

The human growth process is influenced not only by genetic factors but also by environmental factors. Therefore, regional differences in mean body heights may exist within a population or a state. In the present study, we described and evaluated the regional trends in mean body heights in the nine Austrian provinces over a period spanning more than four decades. Body height data of 1734569 male conscripts born in Austria with Austrian citizenship between 1961 and 2002 were anonymized and analyzed. From 1961 to 2002 birth cohorts, an overall increase in the mean body height of Austrian recruits was observed, although regional differences were evident. Regions with shorter body heights in the 1961-1963 birth cohorts showed a particularly pronounced increase in mean body heights. Meanwhile, the course of body height growth in the capital city, Vienna, was striking, where the highest body heights were documented for the 1961-1963 birth cohorts. In Vienna, mean body heights continued to decline until the 1984 birth cohort and increased again from the 1988 birth cohorts. In addition to economic factors, increased stress factors in an urban environment and a form of urban penalty are discussed as causes.

Taste preferences, cardiometabolic diseases and mild cognitive impairment: a prospective cohort analysis of older Chinese adults

Taste preference is a pivotal predictor of nutrient intake, yet its impact on mild cognitive impairment (MCI) remains poorly understood. We aimed to investigate the association between taste preferences and MCI and the role of cardiometabolic diseases (CMD) in this association. The study included older adults, aged 65-90 years, with normal cognitive function at baseline who were enrolled in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018. MCI was measured by the Mini-Mental State Examination, and multivariable Cox regression models were applied. Among 6423 participants, 2534 (39·45 %) developed MCI with an incidence rate of 63·12 - per 1000 person-years. Compared with individuals with insipid taste, those preferring sweetness or spiciness had a higher MCI risk, while saltiness was associated with a lower risk. This association was independent of objective dietary patterns and was more pronounced among urban residents preferring sweetness and illiterate participants preferring spiciness. Notably, among sweet-liking individuals, those with one CMD experienced a significant detrimental effect, and those with co-occurring CMD had a higher incidence rate of MCI. Additionally, regional variations were observed: sweetness played a significant role in regions known for sweet cuisine, while the significance of spiciness as a risk factor diminishes in regions where it is commonly preferred. Our findings emphasize the role of subjective taste preferences in protecting cognitive function and highlight regional variations. Target strategies should focus on assisting individuals with CMD to reduce excessive sweetness intake and simultaneously receiving treatment for CMD to safeguard cognitive function.

Analysis of affordability differences for rare diseases in China: a comparison across disease types and regions

BACKGROUND

China has implemented policies to make rare diseases more affordable. While previous studies evaluated overall affordability, few have examined affordability differences across regions and disease types. Given the vastness of China and varying medical policies across cities, this study assesses the affordability of rare diseases based on China's First List of Rare Diseases (CFLRD), National Reimbursement Drug List (NRDL), and outpatient chronic and special disease policies in each prefecture.

METHOD

Six rare diseases were selected and the average annual treatment cost of all relevant drugs in NRDL was calculated for each disease. Based on the WHO/HAI standardized approach, the study analyzed 289 cities with outpatient chronic and special disease policies, measured the security levels by the actual reimbursement ratio of Basic Medical Insurance (BMI) and affordability by the ratio of individual expenses after reimbursement to the annual disposable income of urban residents in the province. The security levels and affordability differences across disease types and provinces were analyzed using the Mann-Whitney U test and the K-W test.

RESULT

The affordability of rare diseases varied significantly on the disease types and annual treatment cost. Diseases with an annual treatment cost below 100 000 yuan are affordable to all prefectures even with low reimbursement rates, while those with a higher treatment cost were not affordable in at least 80% of prefectures even though the reimbursement ratio is high. The affordability of the same disease varies significantly across provinces and municipalities. Outpatient chronic and special diseases insurance and critical illness insurance, and the inconsistencies between them, result in regional differences.

CONCLUSION

Although China has made progress in improving the affordability of rare diseases, significant differences persist between cities and diseases. The study suggests the optimization of the BMI system and explores independent funds and innovative insurance models to enhance the affordability of rare diseases, particularly those with extremely high treatment costs.

Spatiotemporal differences, dynamic evolution and trend of cultivated land use efficiency: Based on three food functional areas

China's agricultural development has entered a period of transition, and improving the cultivated land use efficiency (CLUE) is of great significance for guaranteeing national food security. Based on the province panel data in China from 2000 to 2021, this research calculates the cultivated land use efficiency, and uses the Dagum-Gini coefficient, Kernel density estimation, and Markov chain to conduct an in-depth analysis of CLUE's regional variations and distribution dynamics in three food functional areas (TFA) of China. The study results showed that the trend of CLUE was characterized by "increasing levels and decreasing absolute differences," not only in the whole country but also in the TFA. The inter-regional variation among TFA is gradually narrowing, and the cross-group degree of inter-regional variation is on the rise. The upward probability of CLUE was more effective than the probability of a transitionary change, and the mutual influence of CLUE between neighboring cities would lead to spatial convergence in the level of CLUE in the long term. Therefore, improving CLUE in China's TFA should not only grasp the regional differences in CLUE but also actively utilize the spatial spillover effects among functional regions to realize the cross-regional synergistic development of cropland utilization efficiency in China.

Effects of social capital and technology cognition on farmers' adoption of soil and water conservation tillage technology in the Loess Plateau of China

From the aspect of regional differences, this paper investigated the impact of social capital and technology cognition on the adoption of soil and water conservation tillage technology in the Loess Plateau in China. We find social networks and social trust had significant impact on the adoption of contour tillage technology by farmers in Shanxi and Shaanxi. Social participation had a significant impact in Shaanxi, whereas social prestige had a significant impact in Gansu, and social norms had a significant impact on the adoption of contour tillage technology in the three provinces. Technology cognition played an intermediary role in the effects of social networks, social trust, and social norms on technology adoption in Shaanxi and Shanxi, and on the impact of social norms on technology adoption in Gansu. Considering social networks, the frequency of communication between farmers and villagers had the greatest impact on technology adoption in Shanxi and Shaanxi, while farmers' trust in villagers had the greatest impact on technology adoption in these two provinces. The participation in collective activities in the village had the greatest impact on technology adoption in Shaanxi. Furthermore as for social prestige there was little difference in the degree of impact of observation variables on technology adoption by farmers in Gansu. Finally, regarding social norms, the attitudes and behaviors adopted by relative's friends, and villagers in the village had the greatest impact.

Are There Regional Differences in Mental Health among Black Americans? An Exploration of Explanatory Mechanisms

Using data from the National Survey of American Life (NSAL) (2001-2003), we examine regional differences in past-year anxiety disorder and past-year major depressive episodes among a geographically diverse sample of Black Americans (N = 3,672). We find that Black Americans residing in the South experience a mental health advantage over Black Americans living in other parts of the country, experiencing lower rates of both anxiety disorder and past-year major depression. We also examine the extent to which stress exposure, religious involvement, and neighborhood contexts help explain any regional differences. We find that stress exposure helps to explain much of the differences observed across regions, while religious involvement and neighborhood contexts help explain observed regional differences to a lesser extent. These findings highlight the importance of considering regional contexts in understanding intra-racial differences in mental health.

Regional differences, dynamic evolution, and spatial-temporal convergence of green finance development level in China

Green finance has great potential for supporting environmental improvement, combating climate change, and the economical and efficient use of resources. In this study, based on the panel data of 30 provinces in China from 2010 to 2020, we used the weighted TOPSIS model to measure the green finance development level (GFDL) in China and its three major regions. The Dagum's Gini coefficient, kernel density estimation, Markov chain, and the convergence model are used to analyze the regional differences, dynamic evolution, and spatial-temporal convergence of GFDL in China. The results show that, in general, the GFDL shows an upward trend, but the GFDL in various regions is unbalanced, which is characterized by the spatial distribution of "high in the southeast and low in the northwest" and "high in the coast and low in the inland". The overall difference of GFDL is showing an expanding trend, which is mainly caused by inter-regional difference. The absolute differences of GFDL between the overall country, the eastern region, and the western region are on a widening trend, while that in the central region is on a narrowing trend. In addition, the GFDLs between the overall country, the eastern region, and the western region have no significant σ convergence, while there is an obvious σ convergence trend in the central region. Further, the GFDLs in China and its three major regions have obvious absolute β convergence trends and conditional β convergence trends.

Multicenter study of seasonal and regional airborne allergens in Chinese preschoolers with allergic rhinitis

This study is nationwide multicenter epidemiological research, aimed at investigating the distribution changes and seasonal patterns of various airborne allergens among preschool children with allergic rhinitis (AR) in different regions of China, and analyzing the clinical correlation between sensitization to various airborne allergens and AR symptoms in children. Information on children was collected through standard questionnaires, and total IgE (tIgE) and specific IgE (sIgE) for 11 inhalant allergens were tested. The results showed that dust mites are the primary allergens for preschool AR children (39%). Among pollen allergens, Amb a had the highest positivity rate (8.1%), followed by Art v (7.8%). The sensitization rates for two mites peaked in May (46.9% and 40.6%). Art v peaked in August (21.5%), while Amb a had peaks in May (12.7%) and August (17.8%). The sensitization peaks for various tree pollens mainly occurred in August. In the Eastern monsoon region, the sensitization rate to mites was significantly higher than in the Northwest arid and semi-arid regions; whereas, for pollen allergens, the sensitization rates to Amb a, Pla a, Pin a, Pop d, and Bet v were significantly higher in the Northwest arid and semi-arid regions than in the Eastern monsoon region. The correlation among various tree pollens, specifically between Pla a, Pin r, Pop d, and Bet v was strong (0.63 ~ 0.79), with a cross-overlapping percentage of 53.9%. Children with multiple pollen sensitizations had higher cumulative nasal symptom scores than those negative for pollen (P < 0.01). Children with only pollen sensitization had higher cumulative rhinitis symptom scores than the all-negative group (P < 0.0001) and the mite-only sensitization group [P < 0.05], while the mite-only sensitization group also had higher scores than the all-negative group [P < 0.05], and the group sensitized to both pollen and mites had lower scores than the pollen-only group [P < 0.05]. This study indicates that sensitization to mites and grass pollens exhibits significant regional differences, with grass pollen allergies primarily occurring in autumn, sensitization to pollens in general exhibits a pronounced seasonal pattern. Moreover, pollen sensitization aggravates nasal and ocular symptoms in AR children.

The impact of carbon trading on the "quantity" and "quality" of green technology innovation: A dynamic QCA analysis based on carbon trading pilot areas

To study the multi-factor linkage effect of carbon trading on green technology innovation, this paper employs the dynamic QCA analysis method and uses panel data from China's carbon trading pilot areas. The aim is to explore the causal path considering the time effect. Additionally, the Kruskal-Wallis rank sum test is applied to investigate the provincial coverage difference of the configuration and reveal the variation in configuration preferences between regions from a spatial dimension. The results indicate that a single factor alone does not constitute the necessary conditions for the "quantity" and "quality" of high-green technology innovation. However, the necessity of carbon trading price exhibits a declining trend over the years, demonstrating the presence of a time effect. Regarding the sufficiency analysis of conditional configuration, it mainly includes a "price-market scale" dual effect model and a single market scale effect model, with three configuration paths for each model. Among them, the "price-market scale" dual effect model can drive the increase in the quantity of green technology innovation through carbon trading price, market scale, government intervention degree, and other factors. The single market scale effect model can promote the high-quality development of green technology innovation, but the impact of carbon trading price on the quality of green technology innovation is relatively insignificant. In terms of the time dimension, the three configurations still maintain good applicability to green technology innovation under normal conditions. However, when considering the spatial dimension, the coverage distribution of the three configurations exhibits evident regional differences. This study introduces the dynamic panel QCA method into the research field for the first time. It addresses the limitations of the traditional QCA method, which is constrained by cross-section data and lacks the ability to explore the linkage effect between factors over time. Additionally, the study analyzes the effects of carbon trading price and market size on the "quantity" and "quality" of green technology innovation, considering both time and space dimensions, from a configuration perspective.

Microarchitecture Alternations of Osteochondral Junction in Patients with Osteonecrosis of the Femoral Head

The study was aimed to investigate microarchitecture of osteochondral junction in patients with osteonecrosis of the femoral head (ONFH). We hypothesis that there were microarchitecture alternations in osteochondral junction and regional differences between the necrotic region (NR) and adjacent non-necrotic region(ANR) in patients with ONFH. Femoral heads with ONFH or femoral neck fracture were included in ONFH group (n = 11) and control group (n = 11). Cylindrical specimens were drilled on the NR/ANR of femoral heads in ONFH group and matched positions in control group (CO.NR/ CO.ANR). Histology, micro-CT, and scanning electron microscope were used to investigate microarchitecture of osteochondral junction. Layered analysis of subchondral bone plate was underwent. Mankin scores on NR were higher than that on ANR or CO.NR, respectively (P < 0.001, P < 0.001). Calcified cartilage zone on the NR and ANR was thinner than that on the CO.NR and CO.ANR, respectively (P = 0.002, P = 0.002). Tidemark roughness on the NR was larger than that on the ANR (P = 0.002). Subchondral bone plate of NR and ANR was thicker than that on the CON.NR and CON.ANR, respectively (P = 0.002, P = 0.009). Bone volume fraction of subchondral bone plate on the NR was significantly decreasing compared to ANR and CON.NR, respectively (P = 0.015, P = 0.002). Subchondral bone plate on the NR had larger area percentages and more numbers of micropores than ANR and CON.NR (P = 0.002/0.002, P = 0.002/0.002). Layered analysis showed that bone mass loss and hypomineralization were mainly on the cartilage side of subchondral bone plate in ONFH. There were microarchitecture alternations of osteochondral junction in ONFH, including thinned calcified cartilage zone, thickened subchondral bone plate, decreased bone mass, altered micropores, and hypomineralization of subchondral bone plate. Regional differences in microarchitecture of osteochondral junction were found between necrotic regions and adjacent non-necrotic regions. Subchondral bone plate in ONFH had uneven distribution of bone volume fraction and bone mineral density, which might aggravate cartilage degeneration by affecting the transmission of mechanical stresses.

Regional differences in clinical phenotype of axial spondyloarthritis: results from the International Map of Axial Spondyloarthritis (IMAS)

OBJECTIVES

To explore differences in axial spondyloarthritis (axSpA) clinical phenotype around the world in a large sample of patients included in the International Map of Axial Spondyloarthritis (IMAS).

METHOD

IMAS was a cross-sectional online survey (2017-2022) of 5,557 unselected axSpA patients from 27 countries. We analysed across five geographic regions the age at symptom onset, diagnostic delay, gender, HLA-B27, family history, extra-musculoskeletal manifestations, presence of comorbidities, disease activity (BASDAI), level of spinal stiffness, and treatments.

RESULTS

Of 5,557 IMAS participants, 3,493 were from Europe, 770 from North America, 600 from Asia, 548 from Latin America, and 146 from South Africa. Age at symptom onset ranged between 25-30 years and was higher in Latin America. Diagnostic delay was longest in South Africa and lowest in Asia. The lowest HLA-B27 positivity was observed in Latin America and the highest in Asia. Extra-musculoskeletal manifestations were the lowest in Europe. Mean disease activity (BASDAI) was 5.4, with highest values in South Africa and lowest in Asia. Most of the patients had used NSAIDs for their condition and less than half had ever taken csDMARDS; both were more frequent in Latin America and South Africa. Almost half of the patients had ever taken bDMARDs, more frequent being in the Americas.

CONCLUSIONS

There is great heterogeneity of axSpA clinical phenotype presentation around the world. AxSpA manifests differently in different regions, so further understanding of these differences of phenotypes is needed to achieve early diagnosis and initiation of optimal disease treatment in axSpA in the different regions.

Regional differences in spatial determinants of land urbanization in China

China has entered a critical stage of urbanization transition but still faces unbalanced regional development and uncoordinated urban-rural integration. Studying the regional differences in spatial determinants of land urbanization (LU) is crucial to achieving coordinated regional development of urbanization. However, the spatial determinants of LU remain unclear, especially in terms of their regional differences. Therefore, this study introduced dynamic distribution and spatial analysis to measure regional differences in spatial determinants of LU in China. During 1990-2020, the imbalance of LU in China was constantly decreasing, and the differences in LU among different regions were also decreasing. LU in China had significant spatial dependence and spatial spillover effects, and the trend of group development was gradually becoming obvious. LU in eastern region was more affected by natural factors than in central and western regions, while central and western regions were more affected by socioeconomic factors than in eastern region. This study can provide a scientific reference for understanding the spatial disequilibrium of LU and promoting the regional implementation of LU coordinated development.

Evaluating Spatial, Cause-Specific and Seasonal Effects of Excess Mortality Associated with the COVID-19 Pandemic: The Case of Germany, 2020

BACKGROUND

Evaluating mortality effects of the COVID-19 pandemic using all-cause mortality data for national populations is inevitably associated with the risk of masking important subnational differentials and hampering targeted health policies. This study aims at assessing simultaneously cause-specific, spatial and seasonal mortality effects attributable to the pandemic in Germany in 2020.

METHODS

Our analyses rely on official cause-of-death statistics consisting of 5.65 million individual death records reported for the German population during 2015-2020. We conduct differential mortality analyses by age, sex, cause, month and district (N = 400), using decomposition and standardisation methods, comparing each strata of the mortality level observed in 2020 with its expected value, as well as spatial regression to explore the association of excess mortality with pre-pandemic indicators.

RESULTS

The spatial analyses of excess mortality reveal a very heterogenous pattern, even within federal states. The coastal areas in the north were least affected, while the south of eastern Germany experienced the highest levels. Excess mortality in the most affected districts, with standardised mortality ratios reaching up to 20%, is driven widely by older ages and deaths reported in December, particularly from COVID-19 but also from cardiovascular and mental/nervous diseases.

CONCLUSIONS

Our results suggest that increased psychosocial stress influenced the outcome of excess mortality in the most affected areas during the second lockdown, thus hinting at possible adverse effects of strict policy measures. It is essential to accelerate the collection of detailed mortality data to provide policymakers earlier with relevant information in times of crisis.

Regional differences, dynamic evolution, and spatial spillover effects of carbon emission intensity in urban agglomerations

Taking three major urban agglomerations in China as examples, this paper uses the Dagum Gini coefficient and its decomposition method, a Kernel density estimation method, and Markov chain and spatial Markov chain to study the regional differences, dynamic evolution characteristics, and spatial spillover effects of carbon emission intensity (CEI) of urban agglomerations, and accordingly, it proposes differentiated emission reduction and carbon reduction policies. The following results were obtained: (1) The overall CEI of the three major urban agglomerations and each individual urban agglomeration were found to have declined significantly over time, with an overall spatial pattern of "high in the north and low in the south," with inter-group differences being the main source of the overall differences. (2) The imbalance in CEI between cities was more obvious within the Beijing-Tianjin-Hebei (BTH) urban agglomeration, while the synergistic emission reduction effect of the Yangtze River Delta (YRD) and Pearl River Delta (PRD) urban agglomerations increased over the study period. (3) The probability of a city maintaining a stable level of CEI was much higher than the probability of a state shift, and there was a spatial spillover effect of carbon emissions between neighboring cities. This study can provide theoretical support for the global response to greenhouse gas emissions, promoting green development and carbon reduction in various countries and urban agglomerations and providing a quantitative basis for the formulation of relevant policies.

Association between quality of governance, antibiotic consumption, and antimicrobial resistance: an analysis of Italian regions

BACKGROUND

Emerging research has provided evidence suggesting the potential influence of governance on the development and spread of antimicrobial resistance (AMR), accounting for significant disparities observed both between and within countries. In our study, we conducted an ecological analysis to investigate the relationship between governance quality, antibiotic consumption, and AMR across Italian regions.

METHODS

By leveraging data from three distinct sources at the regional level, we compiled a comprehensive dataset comprising: AMR proportions for three specific pathogen-antibiotic combinations in the year 2021, antibiotic consumption data for systemic use in the year 2020, and the 2021 European Quality of Government Index (EQI) and its corresponding pillars. Employing mediation analysis, we investigated the potential mediating role of antibiotic consumption in the association between the EQI and an average measure of AMR.

RESULTS

Our analysis revealed substantial variation in the percentages of AMR across different regions in Italy, demonstrating a discernible North-to-South gradient concerning both antibiotic usage and governance quality. The EQI exhibited a statistically significant negative correlation with both antibiotic consumption and AMR percentages, encompassing both specific combinations and their average value. Regions characterized by higher levels of governance quality consistently displayed lower values of antibiotic consumption and AMR, while regions with lower governance quality tended to exhibit higher levels of antibiotic use and AMR. Furthermore, we observed a significant total effect of the EQI on average AMR (β = - 0.97; CI - 1.51; - 0.43). Notably, this effect was found to be mediated by antibiotic consumption, as evidenced by a significant indirect effect (β = - 0.89; CI - 1.45; - 0.32).

CONCLUSIONS

These findings draw attention to the regional disparities observed in AMR levels, antibiotic consumption patterns, and governance quality in Italy. Our study also highlights the mediating role of antibiotic consumption in the relationship between governance quality and AMR. This underscores the significance of implementing focused interventions and policies aimed at improving governance quality and promoting responsible antibiotic use.

The nonlinear effect of new urbanization on water pollutant emissions: Empirical analysis based on the panel threshold model

Rapid urbanization has led to a significant increase in water consumption and wastewater discharge. Balancing the relationship between urbanization development and water pollutants emissions is crucial for the sustainable development of the country. Given the uneven regional economic development and resource distribution in China, exploring the relationship between new urbanization and water pollution emissions cannot be limited to a single perspective such as population urbanization. This study developed a comprehensive evaluation index system for new urbanization level. Based on data from 30 provincial-level regions in China from 2006 to 2020, a Panel Threshold Regression Model (PTRM) was used to explore the nonlinear relationship between the new urbanization level and water pollution discharge. The research results show that China's new urbanization level (NUBL) and its subsystems, including population urbanization (P-NUBL), economic urbanization (E-NUBL), and spatial urbanization (SP-NUBL), all have a double threshold effect on chemical oxygen demand (COD) emissions. The promoting effect of NUBL and E-NUBL on COD emissions gradually increased in the later stage of the study. P-NUBL and SP-NUBL show a trend of inhibiting COD emissions after crossing the dual threshold values. Social urbanization (S-NUBL) and ecological urbanization (EL-NUBL) had no threshold effect, but they also had a promoting effect on COD emissions. In addition, the speed of new urbanization in eastern China was significantly faster than that in central and western China, with provinces such as Beijing, Shanghai, and Jiangsu being the first to enter the high threshold stage. The central region began to gradually enter the middle threshold stage, but provinces such as Hebei, Henan, and Anhui are still in the high pollution and high emission stage. The level of new urbanization in western China is relatively low, and future development should prioritize economic construction. Provinces with high thresholds and low water pollution emissions still need to be developed. The results of this study have important implications for promoting the harmonious development of water-saving and sustainable urban development in China.

Research on the dynamic evolution and convergence of collaborative capacity of pollution control and carbon reduction: from the perspective of whole-process governance

Under the strategic goals of achieving peak carbon neutrality, deepening the battle against pollution, and building a beautiful China, improving the collaborative capacity of pollution control and carbon reduction is an important means to achieve comprehensive green and low-carbon transformation of the social economy. Starting from the essential requirements of improving the collaborative capacity of pollution control and carbon reduction, based on the whole-process governance perspective of "source-process-end-of-pipe," build an evaluation index system, measure the collaborative capacity, quantify the spatial differences, analyze the evolution characteristics, and explore the improvement path. The study found that China's collaborative capacity of pollution control and carbon reduction is characterized by homogeneous agglomeration and unbalanced regional development. Intra-regional differences are the main source of the differences, sorting by contribution is "Eastern > Western > Central > Northeast." After taking into account the factors of green transformation of industry, the input of scientific and technological elements, and opening to the outside world, the differences have gradually narrowed. Among them, the green transformation of industry is instrumentally in bridging the gap in eastern, central, and northeastern, the input of scientific and technological elements is instrumentally in bridging the gap between regions and the eastern and northeast, and opening to the outside world is instrumentally in bridging the gap between regions and the western. The scientific measurement and improvement of this capacity will provide the factual basis and path choice for achieving the task goal of "significantly improving China's collaborative capacity of pollution control and carbon reduction by 2030," which is of great practical significance for building a higher-quality, more sustainable, and greener pattern of the collaborative capacity of pollution control and carbon reduction.

Regional differences in annual prevalence of sustainable working life in Swedish twin cohort

The global rise in life expectancy transforms age structure consequently having impact to the sustainability of social protection systems and working life. This descriptive study aimed to illustrate the annual prevalence of sustainable working life across Swedish residential regions, and investigate differences between age groups, sex, or being identical or fraternal twin. The study sample included 81,231 twins with linkage to national register data on sickness absence, disability pension, unemployment, and residential regions. Regions were classified by Swedish municipalities into nine groups. Sustainable working life were then followed in 1998, 2003, 2008, and 2013. Annual prevalence and Generalized Estimating Equation (GEE) with log linear models for interaction test were used. Medium to large size municipalities (15-24%) had higher annual prevalence of sustainable working life than smaller municipalities (1-7%). Young adults in medium to large size municipalities had high annual prevalence of sustainable working life. We found no differences for sexes or being identical or fraternal twin. To conclude, annual prevalence of sustainable working life in 1998, 2003, 2008 and 2013 differed by region being highest in medium to large size municipalities which may have importance for targeting policies, regulations, and practices in a region-specific way. Further studies on residential regions and sustainable working life would be merited to confirm associations and other influential factors.

Differences in prevalence and management of chronic kidney disease among T2DM inpatients at the grassroots in Beijing and Taiyuan: a retrospective study

PURPOSE

Chronic kidney disease (CKD) has been one of the most common complications in type 2 diabetes mellitus (T2DM) patients. This retrospective study aimed to investigate the regional differences in the prevalence and management of CKD in T2DM inpatients from two grassroots hospitals in Beijing and Taiyuan.

METHODS

The sociodemographic status, health history, lifestyle information, biochemical parameters and drug choices of the patients were collected from the Diabetes Care Information System using a retrospective cross-sectional analysis. The presence of CKD was defined as albuminuria (urine albumin-to-creatinine ratio of ≥ 30 mg/g) and/or as a reduced estimated glomerular filtration rate (< 60 ml/min/1.73 m²).

RESULTS

858 patients with T2DM in Beijing and 1,085 patients with T2DM in Taiyuan were included, with a median age of 61.0 and 61.9 years, respectively. The duration of diabetes was 10.5 and 10.3 years, respectively. The prevalence of CKD in Beijing (39.2%) was significantly higher than in Taiyuan (22.4%). The overall ABC control (A = haemoglobin A_1c; B = blood pressure; C = cholesterol) in both the Beijing and Taiyuan groups were not ideal. Patients with CKD tended to use insulin, renin-angiotensin-aldosterone system (RAAS) inhibitors, sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and dyslipidaemia therapy in Taiyuan than in Beijing. The actual proportion of carbohydrate, fat and protein in calories was 49.6%:35.4%:14.4% in Beijing and 61.5%:27.8%:10.8% in Taiyuan.

CONCLUSIONS

The higher prescription rates of RAAS inhibitors, SGLT-2i and dyslipidaemia therapy may underlie the fluctuations in the prevalence of CKD in Beijing or Taiyuan. Intensive insulin therapy and personal nutritional guidance, along with the extensive use of RAAS inhibitors, SGLT-2i and dyslipidaemia therapy during follow-up, can all play a positive role in the management of CKD in patients with T2DM in both Beijing and Taiyuan.

Factors related to the frequent use of emergency department services in Korea

BACKGROUND

Frequent Emergency Department (ED) visitors are identified by the policymakers to reduce avoidable ED visits and lessen the financial and operational burden. This study aimed to identify the factors related to the frequent use of ED services.

METHODS

This nationwide, cross-sectional observational study was conducted using information obtained from the 2019 National Emergency Department Information System (NEDIS) database. Frequent ED users were defined as patients with four or more ED visits a year. We performed multiple logistic regression analyses to verify the relationship among sociodemographic characteristics, residential characteristics, clinical characteristics, and frequency of ED visits.

RESULTS

Among 4,063,640 selected patients, 137,608 patients visited the ED four or more times a year (total number of visits = 735,502 times), which accounted for 3.4% and 12.8% of the total number of ED users and ED visits, respectively. A high ED visit frequency was associated with male sex, age < 9 or ≥ 70 years, Medical Aid (based on the insurance type), lower number of medical institutions and beds compared with that of the national average, and conditions, such as cancer, diabetes, renal failure, and mental illness. A low ED-visit frequency was associated with residence in regions vulnerable to emergency medical care and regions with high income. The possibility of frequent ED visits was high for patients with level 5 severity (non-emergent) and those with an increased need for medical treatment, including older patients and patients with cancer or mental illness. The possibility of frequent ED visits was low for patients aged > 19 years with level 1 severity (resuscitation).

CONCLUSIONS

Health service accessibility factors, including low income and medical resource imbalance, were associated with frequent ED visits. Future large-scale prospective cohort studies are warranted to establish an efficient emergency medical system.

Regional Disparities in Transvenous Lead Extraction for Cardiac Implantable Electronic Device Infection in Japan - A Descriptive Study Using the National Database Open Data

BACKGROUND

Because the penetration of transvenous lead extraction (TLE) for cardiac implantable electronic device (CIED) infection has not been investigated in Japan, we conducted a population-based, retrospective, descriptive study to evaluate regional disparities in the use of TLE for CIED infection and the potential undertreatment of CIED infection using a nationwide insurance claims database.Methods and Results: Patients who underwent CIED implantation or generator exchange and TLE between April 2018 and March 2020 were identified. Moreover, the penetration ratio of TLE for CIED infection in each prefecture was estimated. CIED implantation and TLE were most prevalent in the age categories of 80-89 years (40.3%) and 80-89 years (36.9%), respectively. There was no correlation between the number of CIED implantations and that of TLE (rho=-0.087, 95% confidence interval -0.374 to 0.211, P=0.56). The median penetration ratio was 0.00 (interquartile range 0.00-1.29). Of the 47 prefectures, 6, comprising Okinawa, Miyagi, Okayama, Fukuoka, Tokyo, and Osaka, showed a penetration ratio ≥2.00.

CONCLUSIONS

Our study data indicated great regional disparities in the penetration of TLE and potential undertreatment of CIED infection in Japan. Additional measures are needed to address these issues.

Regional differences in susceptibility to spinosyn insecticides registered for Colorado potato beetle management in Canada

The Colorado potato beetle (CPB) is the most economically important pest of Canadian potato, and if left uncontrolled, it can completely consume the crop. In the past decade, the control of CPB has relied heavily on systemic insecticides, principally the neonicotinoids thiamethoxam and clothianidin. Resistance to neonicotinoids in CPB has been well documented in the past 2 decades and mechanisms underlying the resistance better understood. In contrast, resistance to other insecticide classes, including spinosyns (spinosad and spinetoram) and anthranillic diamides (chlorantraniliprole and cyantraniliprole), have not been studied to the same degree in CPB. Spinosyns are the only insecticide certified for organic potato growers in Canada and are frequently applied as a mid-season foliar spray by conventional growers when seed treatments with neoniconitoid or diamide experience control breaks. Improved knowledge on resistance to spinosyns in CPB would allow for the development of regional management strategies. A survey of insecticide susceptibility in CPB populations from 6 potato growing regions between 2018 and 2022 observed: 1) spatial and temporal resistance trends; 2) cross-resistance; and 3) evidence of regional differences in susceptibility to spinosyns. The proportion of populations within each province considered resistant to spinosyns was, in descending order: Québec (16%) > Ontario (14%) > Manitoba (13%) > New Brunswick (9%) > Prince Edward Island (2%) > Alberta (0%). There was a significant change in CPB mortality at the diagnostic concentration (DC = LC₉₀) for spinosad and spinetoram in the 6 provinces but only for year 5 relative to the previous 4 years. Moderate cross-resistance was determined between spinosad and spinetoram with the DC mortality for all populations based on a positive and significant correlation (adjusted R² = 0.3758; P = 1.263e^-13). There was also a positive relationship observed between the number of spinosyn applications (years applied at the sampling location) and declining susceptibility to spinosad (R² = 0.0927; P < 0.002). Cross-resistance was observed between spinosyns and insecticides in the other two classes, the more significant correlation was between spinosad and tetraniliprole (R² = 0.3025; P < 0.0002). In Québec, the greater spinosad use in organic potato farms led to resistance in those CPB populations, but spinosyn resistance at conventional farms was not related to greater application of neonicotinoids and diamides. Spinosyns remain relatively effective, nevertheless growers should be concerned over the increasing cases of reduced susceptibility in conventional potato farms and resistance where organic production occurs. Resistance management should continue to encourage rotation with products from the other classes in season and between years in order to extend spinosyn use for CPB control.

Regional differences and driving forces of ecosystem health in Yangtze River Basin, China

Ecosystem health in the Yangtze River basin (YRB) shows significant regional differences. Analysis of regional differences and drivers of ecosystem health in YRB is of practical significance for sustainable basin ecological management. However, existing studies lack research on regional differences and driving forces of ecosystem health, especially in big basin regions. Based on multi-source data, this study adopted spatial statistics and distribution dynamics models to quantitatively analyze the regional differences of ecosystem health in the YRB during 2000-2020 and employed the spatial panel model to reveal the driving forces of ecosystem health in the YRB. The ecosystem health index of the upper, middle, and lower reaches of YRB and the entire basin in 2020 was 0.753, 0.781, 0.637, and 0.742, respectively, while they all decreased during 2000-2020. Regional differences in YRB ecosystem health increased during 2000-2020. From the perspective of dynamic evolution, low-level and high-level ecosystem health units evolved to high-level, while medium-high-level ecosystem health units evolved to low-level. High-high (accounting for 30.372% in 2020) and low-low (accounting for 13.533% in 2020) were the main cluster types. Regression result showed that urbanization was the main reason for ecosystem health deterioration. The findings can provide enlightenment to further understand the regional differences of ecosystem health in YRB and provide theoretical reference for the coordinated management of ecosystem at macro-level and the differential regulation of local ecosystem at micro-level in the basin region.

Regional differences and driving factors of carbon emission intensity in China's electricity generation sector

As an industry with immense decarbonization potential, the low-carbon transformation of the power sector is crucial to China's carbon emission (CE) reduction commitment. Based on panel data of 30 provinces in China from 2000 to 2019, this research calculates and analyzes the provincial CE intensity in electricity generation (CEIE) and its spatial distribution characteristics. Additionally, the GTWR model based on the construction explains the regional heterogeneity and dynamic development trend of each driving factor's influence on CEIE from time and space. The main results are as follows: CEIE showed a gradual downward trend in time and a spatial distribution pattern of high in the northeast and low in the southwest. The contribution of driving factors to CEIE has regional differences, and the power structure contributes most to the CEIE of the power sector, which promotes regional CE. Concurrently, most provinces with similar economic development, technological level, geographic location, or resource endowment characteristics show similar spatial and temporal trends. These detections will furnish broader insights into implementing CE reduction policies for the regional power sector.

Characteristics, regional differences, and influencing factors of China's water-energy-food (W-E-F) pressure: evidence from Dagum Gini coefficient decomposition and PGTWR model

Water, energy, and food security are global concerning issues especially in China. To promote regional environmental management cooperation as well as find resource security influencing factor differences among regions, this paper calculates the water-energy-food (W-E-F) pressure, find W-E-F pressure's regional differences, and the influencing factors by Dagum Gini coefficient decomposition and geographically and temporally weighted regression model for panel data (PGTWR). First, the temporal trend of W-E-F pressure is decreasing and then increasing during 2003-2019; pressure in the eastern provinces is significantly higher than in other provinces and structurally energy pressure is the dominant resource pressure in W-E-F in most provinces. Besides, inter-regional differences are the main source of regional differences in China's W-E-F pressure, particularly for the inter-regional differences between eastern regions and other regions. In addition, there are obvious spatio-temporal heterogeneity effects of population density, per capita GDP, urbanization, energy intensity, effective irrigated area, and forest cover on W-E-F pressure. Balancing regional development gaps and developing differentiated resource pressure mitigation strategies based on the characteristics of different regional drivers are of great importance.

Rapid Pacing Decreases L-type Ca2+ Current and Alters Cacna1c Isogene Expression in Primary Cultured Rat Left Ventricular Myocytes

The L-type calcium current (I_CaL) is the first step in cardiac excitation-contraction-coupling and plays an important role in regulating contractility, but also in electrical and mechanical remodeling. Primary culture of cardiomyocytes, a widely used tool in cardiac ion channel research, is associated with substantial morphological, functional and electrical changes some of which may be prevented by electrical pacing. We therefore investigated I_CaL directly after cell isolation and after 24 h of primary culture with and without regular pacing at 1 and 3 Hz in rat left ventricular myocytes. Moreover, we analyzed total mRNA expression of the pore forming subunit of the L-type Ca²⁺ channel (cacna1c) as well as the expression of splice variants of its exon 1 that contribute to specificity of I_CaL in different tissue such as cardiac myocytes or smooth muscle. 24 h incubation without pacing decreased I_CaL density by ~ 10% only. Consistent with this decrease we observed a decrease in the expression of total cacna1c and of exon 1a, the dominant variant of cardiomyocytes, while expression of exon 1b and 1c increased. Pacing for 24 h at 1 and 3 Hz led to a substantial decrease in I_CaL density by 30%, mildly slowed I_CaL inactivation and shifted steady-state inactivation to more negative potentials. Total cacna1c mRNA expression was substantially decreased by pacing, as was the expression of exon 1b and 1c. Taken together, electrical silence introduces fewer alterations in I_CaL density and cacna1c mRNA expression than pacing for 24 h and should therefore be the preferred approach for primary culture of cardiomyocytes.

Regional Differences in Procedural Care of Hemorrhoid Management in Medicare Patients; Unwarranted Variation in Clinical Practice for a Medical-First Problem

INTRODUCTION

Hemorrhoid disease is very common problem in the Medicare population. Prior work has shown significant variation in county-level practices of hemorrhoidectomy; however, regional variation of rubber band ligation (RBL) has yet to be assessed. This is important as many different practitioners from different specialties can perform this procedure repeatedly in an office-based setting. We aim to evaluate the variation of RBL and hemorrhoidectomy over a 7-y period.

METHODS

Using Medicare part B claims data, we identified all beneficiaries >65 y seen for hemorrhoid disease between 2006 and 2013. Current Procedural Terminology (CPT) codes were used to identify all events for hemorrhoidectomy (46083, 46250, 46255, 46257, 46260, and 46261) or RBL (46221) by hospital referral region (HRR). We determined HRR-level rates of hemorrhoidectomy and RBL per 1000 beneficiaries adjusted for age, sex, and race. We calculated annual coefficients of variation (SD × 100/mean) for hemorrhoidectomy and RBL.

RESULTS

1.2 to 1.3 million fee-for-service Medicare beneficiaries were seen annually for evaluation of hemorrhoid disease. Mean-adjusted annual rates for hemorrhoidectomy by HRRs varied from 4.34 to 63.03 per 1000 beneficiaries. Mean-adjusted rates of RBL by HRRs varied from 7.06 to 163 per 1000 beneficiaries. Annual procedural coefficients of variation over the study period were 41-48 (high) for hemorrhoidectomy and 69-74 (very high) for RBL.

CONCLUSIONS

While continued high variation exists for hemorrhoidectomy, there is very high variation for RBL between HRRs in treating hemorrhoid disease among Medicare beneficiaries. There are substantial Medicare expenditures in this high-volume population that are likely unwarranted.

North-south regional differential decomposition and spatiotemporal dynamic evolution of China's industrial green total factor productivity

"Green development" has become the way for countries around the world to strengthen industries, and it is an important part of China's high-quality economic development. The key for China to strike a balance between economic growth and environmental management is to optimize green total factor productivity (GTFP). This paper measures the GTFP of industry in 30 provinces of China from 2003 to 2019, based on the perspective of energy and carbon emission constraints. It empirically examines the spatial disequilibrium and dynamic evolution of industrial GTFP in China using Dagum Gini coefficients, Kernel density estimation, and Markov chain analysis. The study finds that, (1) although China's industrial GTFP is not high, it shows an increasing trend. The industrial GTFP in the southern region is higher than that in the northern region. (2) Technical efficiency is the shortcoming of China's industrial GTFP improvement. Technological progress is the main driving force of China's industrial GTFP improvement. (3) The relative and absolute differences in China'' industrial GTFP, technical efficiency, and technological progress have all shown a widening trend. Regional differences between the southern and northern regions are the main source of relative differences in industrial GTFP, technical efficiency, and technological progress. (4) China's industrial GTFP shows a clear "club convergence" phenomenon and the "Matthew effect." However, after the introduction of the spatial factor, the "club convergence" phenomenon and the "Matthew effect" have weakened. The driving effect of industrial GTFP on neighboring provinces is stronger in the south than in the north. This paper enriches the analysis of industrial GTFP and provides an important basis for the coordinated regional development of Chinese industry.

The difference in thermal comfort between southern and northern Chinese living in the Xi'an cold climate region

A year-long longitudinal survey regarding perceptions of outdoor thermal conditions and thermal comfort was conducted in Xi'an, a City in a Chinese cold region. The survey included micrometeorological measurements and a longitudinal questionnaire. The thermal comfort and adaptability of southern Chinese (people from Changsha and Guangzhou) and northern Chinese (people from Xi'an) in Xi'an were studied from the three aspects of psychological, physiological, and behavioral differences. The results of similar studies in other regions were compared with those of this study. Regarding psychological differences, northerners were more adapted to Xi'an's climate than southerners, with an expected temperatures of 20.7℃ and 24.1℃ for northerners and for southerners, respectively. Regarding physiological differences, the neutral temperature of the northern population was 22.12℃, while that of the southern population was 21.12℃. The neutral temperature for the southern population in Xi'an is similar to that of northern people living in Xi'an. Regarding behavioral differences, northerners were more likely than southerners to maintain their thermal comfort by adjusting their clothing when they experienced a change in the outdoor environment. This study not only indicates that there were differences regarding the thermal comfort of people originating different regions but also provided support for fully explaining the mechanism of climate adaptation of human thermal comfort. In addition, this work provides basic data regarding formulating outdoor thermal comfort standards and provided data support for personalized thermal comfort.

Environmental decentralization, environmental regulation, and green technology innovation: evidence based on China

The reform of the environmental management system and policy optimization is key to promoting green technology innovation. However, empirical studies on environmental monitoring decentralization are limited. As a result, this paper analyzes the impacts of environmental decentralization and environmental regulation on green technology innovation using China's 30 provincial administrative panel data ranging from 2008 to 2017. The study outcome denotes that environmental decentralization is not conducive to green technology innovation. Similar effects are also found for environmental administration decentralization, environmental supervision decentralization, and environmental monitoring decentralization. Secondly, there is a U-shaped relationship between environmental regulation and green technology innovation. With the strengthening of environmental administrative decentralization and environmental supervision decentralization, environmental regulation has a significant positive role in promoting green technology innovation. Furthermore, environmental decentralization reduces the inhibitory effect of environmental regulation on green technology innovation in the eastern and central regions. Environmental decentralization does not play a regulatory role in the impact of environmental regulation on green technology innovation in economically developed areas. Lastly, the impact of environmental regulation on green technology innovation shows significant threshold characteristics with the change in environmental decentralization, in which there is an optimal threshold interval for environmental decentralization. The study concluded with an important reference value for determining reasonable levels of environmental decentralization among different regions and improving relevant environmental regulation strategies.

Unraveling the COVID-19 hospitalization dynamics in Spain using Bayesian inference

BACKGROUND

One of the main challenges of the COVID-19 pandemic is to make sense of available, but often heterogeneous and noisy data. This contribution presents a data-driven methodology that allows exploring the hospitalization dynamics of COVID-19, exemplified with a study of 17 autonomous regions in Spain from summer 2020 to summer 2021.

METHODS

We use data on new daily cases and hospitalizations reported by the Spanish Ministry of Health to implement a Bayesian inference method that allows making short-term predictions of bed occupancy of COVID-19 patients in each of the autonomous regions of the country.

RESULTS

We show how to use the temporal series for the number of daily admissions and discharges from hospital to reproduce the hospitalization dynamics of COVID-19 patients. For the case-study of the region of Aragon, we estimate that the probability of being admitted to hospital care upon infection is 0.090 [0.086-0.094], (95% C.I.), with the distribution governing hospital admission yielding a median interval of 3.5 days and an IQR of 7 days. Likewise, the distribution on the length of stay produces estimates of 12 days for the median and 10 days for the IQR. A comparison between model parameters for the regions analyzed allows to detect differences and changes in policies of the health authorities.

CONCLUSIONS

We observe important regional differences, signaling that to properly compare very different populations, it is paramount to acknowledge all the diversity in terms of culture, socio-economic status, and resource availability. To better understand the impact of this pandemic, much more data, disaggregated and properly annotated, should be made available.

Regional differences in percutaneous coronary intervention outcomes in STEMI patients with diabetes: The Asia-Pacific evaluation of cardiovascular therapies (ASPECT) collaboration

BACKGROUND

Diabetes is associated with poorer outcomes and increased complication rates in STEMI patients undergoing percutaneous coronary intervention (PCI). Data are notably lacking in the Asia-Pacific region. We report the overall association of Diabetes with clinical characteristics and outcomes in STEMI patients undergoing PCI across the Asia-Pacific, with a particular focus on regional differences.

METHODOLOGY

The Asia Pacific Evaluation of Cardiovascular Therapies (ASPECT) collaboration consists of data from various PCI registries across Australia, Hong Kong, Singapore, Malaysia, Indonesia and Vietnam. Clinical characteristics, lesion characteristics, and outcomes were provided for STEMI patients. Key outcomes included 30-day overall mortality and major adverse cardiovascular events (MACE).

RESULTS

A total of 12,144 STEMI patients (mean(SD) age 59.3(12.3)) were included, of which 3912 (32.2%) had diabetes. Patients with diabetes were likely to have a higher baseline risk profile, poorer clinical presentation, and more complex lesion patterns (all p < 0.05). Across all regions, patients with diabetes had a higher rate of 30-day mortality and MACE (all p < 0.05). After multivariable adjustment, diabetes was significantly associated with both increased 30-day mortality (9.6%vs 5.5%, OR 1.79 [95% CI 1.40-2.30]) and MACE (13.3% vs 8.6%, R 1.73 [1.44-2.08]). The association between diabetes and 30-day MACE varied by region (p_interaction = 0.041), with the association (OR) ranging from 1.34 [1.08-1.67] in Malaysia, to 2.39 [1.66-3.45] in Singapore.

CONCLUSIONS

Diabetes portends poorer clinical outcomes in STEMI patients undergoing PCI in the Asia-Pacific with regional variations noted. The development of effective preventative measures and interventional strategies targetted at this high-risk group is crucial.

Dynamic decomposition and regional differences of urban emergy ecological footprint in the Yangtze River Delta

Maintaining the balance between the economy and the environment and further realizing sustainable economic development has become an important topic. The existing research has not used the emergy ecological footprint model to calculate the ecological footprint of the Yangtze River Delta, nor have they used the factor decomposition method to analyze the influencing factors affecting the ecological footprint change. The differences in the emergy ecological footprint among different provinces and cities have not been studied. This study reported the emergy ecological footprint in the Yangtze River Delta region from 2008 to 2020. The Logarithmic Mean Divisia Index model (LMDI) was constructed to decompose the change of emergy ecological footprint into the land structure, technology, economy, and population factors to screen the main influencing factors. Gini coefficient and Theil index were used to further analyze the main influencing factors which caused the differences in the footprints at regional and intra-regional levels. The results show that: (1) The fluctuation of the per capita emergy ecological footprint in the Yangtze River Delta region has decreased, while the fluctuation of the per capita emergy ecological carrying capacity has increased. However, the per capita emergy ecological deficit is still high, where the sustainable development of the regional economy is not optimistic. (2) Technology and economy are the main factors affecting the emergy ecological footprint of the Yangtze River Delta. (3) Regional differences refer to the differences between different provinces, while intra-regional differences refer to the difference between cities within the province. In the Yangtze River Delta region, the intra-regional differences are the main reasons causing the technical differences, while the regional differences are the main reasons causing the economic differences. The significance of the study is that scientific analysis of the sustainable development status and utilization degree of resources and environment are vital for realizing the sustainable development of the Yangtze River Delta region. By decomposing the factors affecting sustainable development, the regional differences of these factors could be analyzed and serve as a theoretical basis for local governments to formulate policies to minimise the emergy ecological footprint of a targeted region.

Factors Influencing Suicidal Ideation According to the Deprivation Indices of Different Regions in Korea

OBJECTIVES

This study examined how deprivation differed by region and the effect those differences had on suicidal ideation among the local population.

METHODS

Data collected over 10 years (2012-2021) in the Korea Welfare Panel Study were organized into 3 categories: metropolitan, city, and rural. A panel analysis was conducted on the impact of deprivation indices, socio-demographic characteristics, and life satisfaction on suicidal ideation in each category.

RESULTS

Income, divorce status, family relationship satisfaction, and medical deprivation had a significant impact on suicidal ideation in metropolitan areas, whereas these variables did not have significant effects in rural areas. In other words, income, family, and medical support were more impactful in city areas.

CONCLUSIONS

Although the deprivation index was higher in rural areas than in city areas due to an aging population and reduced income levels, the mental health of rural residents was found to be generally better than that of city residents. The possibility that this is related to the strength of relationships within the respective communities should be considered in light of recent discussions on relational welfare.

Regional differences and convergence of green innovation efficiency in China

Green innovation facilitates high-quality economic development and ecological environmental protection. Herein, the minimum distance to strong efficient frontier (MinDS) model was used to measure green innovation efficiencies (GIEs) of 30 Chinese provinces over a period of 21 years (2000-2020). Gini coefficient decomposition and kernel density estimation methods were used to analyze the regional differences of GIE. Spatial correlation was estimated to analyze spatial-spillover effects and spatial convergence of the GIE. China's GIE has shown an increasing trend with significant spatial differences in GIE among provinces. Regional differences and transvariation intensity are the primary sources of spatial differences in GIE. Regional differences in GIE have decreased, except for eastern regions. The results of spatial convergence estimation suggest spatial absolute and conditional convergence in all regions. Therefore, for the GIE improvement in China, the effects of economic level, industrial structure, and environmental regulations must be considered.

Insights into the occurrence, elimination efficiency and ecological risk of antibiotics in rural domestic wastewater treatment facilities along the Yangtze River Basin, China

China is embarking on the treatment of rural domestic wastewater, but little information on the characteristics of antibiotics in the rural domestic wastewater is available. As one of the most important new-emerging pollutants, antibiotic has been explicitly proposed to be controlled and treated since the fifth plenary session of the 19th Central Committee of the Communist Party of China. Thus, the occurrence, elimination efficiency and ecological risk of antibiotics, as well as conventional wastewater quality parameters were investigated in influents and effluents from 41 rural domestic wastewater treatment facilities (RD-WWTFs) along the Yangtze River Basin. Results showed that elimination efficiencies of routinely monitored conventional pollutants in 33 RD-WWTFs (accounting for 80.5%) were effective based on conventional wastewater quality parameters. Of 39 target antibiotics selected, 26 ones were detected in the influents and effluents with a detection frequency (DF) between 2.4% and 100%. No significant decrease of antibiotics was observed in the effluents compared with that in the influents except chlortetracyclin (CTE) and tetracycline (TCs). The composition characteristics of antibiotics showed regional differences. Among the investigated antibiotics, ofloxacin (OFX), doxycycline (DOX), roxithromycin (ROX) and lincomycin (LIN) were the predominant, totally accounted for a median percentage of more than 60% of ΣAB concentrations in both influents and effluents. Ecological risk values of ΣABs showed that 11 effluents presented high risks (26.8%), 18 ones had moderate risks (43.9%), and the rest 12 ones showed low risks (29.3%). Moreover, oxytetracycline (OXY), norfloxacin (NOR), LIN and ROX was the dominant contributors to the ecological risk values. Overall, the elimination effect of antibiotics was limited in RD-WWTFs along the Yangtze River Basin, which was likely to pose potential adverse impacts on aquatic ecosystems.

Assessing climate risk related to precipitation on cultural heritage at the provincial level in China

Variation in the physical and chemical environment driven by climate change poses severe threats to the world cultural heritage. Assessing climate risk of cultural heritage is significant to their protection, especially for countries such as China which has a long history and a large amount of cultural heritage. In the study, we employ the risk assessment framework proposed by the Intergovernmental Panel on Climate Change (IPCC) to assess quantitatively the long-term precipitation-related climate risk of cultural heritage at the provincial level in China. The cultural heritage is divided into 5 categories based on material and cultural characteristics: ancient culture sites, ancient tombs, ancient architectural structures, cave temples and stone carvings, and the modern and contemporary historic sites; and the future climate is projected to 2099 under the RCP-4.5 scenario. The results show that the risk of 5 categories of heritage varies considerably. The overall risk of the ancient culture sites and ancient tombs is significantly higher than that of the other 3 categories of heritage due to the vulnerable materials and old age. Spatially, the central regions of China face the highest overall climate risk due to the high hazard and exposure, followed by the eastern regions and the western regions. There are small regional differences in the risk of the ancient tombs while significant regional differences in the risk of the ancient architectural structures. To mitigate the climate risk of cultural heritage, the study highlights the key regions and the corresponding categories of heritage as well as strategies for prioritizing cultural heritage protection.

Analysis of the Geographic Transmission Differences of COVID-19 in China Caused by Population Movement and Population Density

The coronavirus disease (COVID-19) has led to a global pandemic and caused huge healthy and economic losses. Non-pharmaceutical interventions, especially contact tracing and social distance restrictions, play a vital role in the control of COVID-19. Understanding the spatial impact is essential for designing such a control policy. Based on epidemic data of the confirmed cases after the Wuhan lockdown, we calculate the invasive reproduction numbers of COVID-19 in the different regions of China. Statistical analysis indicates a significant positive correlation between the reproduction numbers and the population input sizes from Wuhan, which indicates that the large-scale population movement contributed a lot to the geographic spread of COVID-19 in China. Moreover, there is a significant positive correlation between reproduction numbers and local population densities, which shows that the higher population density intensifies the spread of disease. Considering that in the early stage, there were sequential imported cases that affected the estimation of reproduction numbers, we classify the imported cases and local cases through the information of epidemiological data and calculate the net invasive reproduction number to quantify the local spread of the epidemic. The results are applied to the design of border control policy on the basis of vaccination coverage.

Regional disparities in SARS-CoV-2 infections by labour market indicators: a spatial panel analysis using nationwide German data on notified infections

Background

Regional labour markets and their properties are named as potential reasons for regional variations in levels of SARS-CoV-2 infections rates, but empirical evidence is missing.

Methods

Using nationwide data on notified laboratory-confirmed SARS-CoV-2 infections, we calculated weekly age-standardised incidence rates (ASIRs) for working-age populations at the regional level of Germany’s 400 districts. Data covered nearly 2 years (March 2020 till December 2021), including four main waves of the pandemic. For each of the pandemic waves, we investigated regional differences in weekly ASIRs according to three regional labour market indicators: (1) employment rate, (2) employment by sector, and (3) capacity to work from home. We use spatial panel regression analysis, which incorporates geospatial information and accounts for regional clustering of infections.

Results

For all four pandemic waves under study, we found that regions with higher proportions of people in employment had higher ASIRs and a steeper increase of infections during the waves. Further, the composition of the workforce mattered: rates were higher in regions with larger secondary sectors or if opportunities of working from home were comparatively low. Associations remained consistent after adjusting for potential confounders, including a proxy measure of regional vaccination progress.

Conclusions

If further validated by studies using individual-level data, our study calls for increased intervention efforts to improve protective measures at the workplace, particularly among workers of the secondary sector with no opportunities to work from home. It also points to the necessity of strengthening work and employment as essential components of pandemic preparedness plans.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07643-5.

Does social support prevent suicidal ideation in women and men? Gender-sensitive analyses of an important protective factor within prospective community cohorts

BACKGROUND

Suicidal ideation and behavior constitute important public mental health issues. In this study, we examined whether social integration prevents suicidal ideation over time and whether gender modifies this association.

METHODS

Data from the Gutenberg Health Study (population-based representative community sample in midwest Germany) and the Study of Health in Pomerania (population-based cohort study in northeast Germany) were used. Participants reporting low social support were compared to those receiving middle or high social support. Within a longitudinal study design, we calculated multiple logistic regression models including interaction terms and relevant covariates to test whether gender modified the association of social support and suicidal ideation.

RESULTS

Suicidal ideation was present in 7.4% (N = 982) of the pooled cohorts' 13,290 participants. More women (8.6%, N = 565) than men (6.2%, N = 417) reported suicidal ideation. Middle or high social support was associated with a lower probability to report suicidal ideation five years later after controlling for sociodemographic factors, living situation, and cohort (OR = 0.42, 95%-CI = 0.34-0.52). Male gender was negatively related to suicidal ideation, but no statistically significant interaction of gender and social support was found (ratio of ORs = 1.00, 95%-CI = 0.73-1.35).

LIMITATIONS

The number of people reporting suicidal ideation in the SHIP study was small, especially for men. Suicidal ideation was measured using a single item.

CONCLUSIONS

Social support is an important protective factor in preventing suicidal ideation for both women and men. Future research should further clarify gender-specific effects of family variables in suicidal ideation and test similar predictive models of suicidal behavior.

Does the Mortality of Individuals with Severe Disabilities Contribute to the Persistent East-West Mortality Gap Among German Men?

After three decades since reunification male life expectancy in East Germany still lags behind that of West Germany. Unlike most of the prior studies focusing on the role of socioeconomic factors, this study aims at assessing the contribution of the population with severe disabilities to the persistent East-West male mortality gap. Our analysis is mainly based on the German Pension Fund data. It is restricted to men aged 30-59 receiving disability pension (DP). We estimate mortality indicators and compare trends among populations with or without DP. We use decomposition method to quantify the effects of changes in mortality and compositional changed in the prevalence of receiving DP on the East-West mortality difference. The analysis covers the period 1995-2013. The German Socioeconomic Panel data and Cox proportional hazard models are used to evaluate the regional differences in the risk of receiving DP. Our results suggest that both the higher prevalence of receiving DP in the East and the higher mortality level among men not receiving DP in the East explain the East-West gap. The mortality difference among those receiving DP is negligible and does not contribute much to it. The observed higher prevalence in receiving DP in the East is very likely to reflect the reality as we found no regional differences in the risk of transitioning to receiving DP. The disadvantageous position of the East can be explained by the post-reunification crisis which particularly hit young men in the 1990s, selective migration from East to West after reunification, and the higher proportion of the healthier foreign population living in the West.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10680-022-09609-4.

A novel geographic evolution tree based on econometrics for analyzing regional differences in determinants of Chinese CO2 emission intensity

Recent studies have increasingly focused on China's CO₂ emission intensity (CEI). However, specific or sufficient guidance is needed with regard to China's complex regional differences and the underlying relations between drivers and CEI. Herein, we develop a novel evolution tree based on the extended Stochastic Impacts by Regression on Population, Affluence, and Technology (STIRPAT) model to spatially visualize and quantify regional development patterns and the impact of determinants on CEI in China. The results showed that China's CEI spatially decreased from the northwest inland to the southeast coast and showed an overall annual decrease. Different regions with various regional development patterns have varying impact mechanisms on local CEI. In the highly developed region, affluence and industrial structure had the greatest effect, with an elasticity coefficient of -0.63, and 0.63, respectively. In the upper-middle developed, lower-middle developed, and developing regions, the energy structure exerted the greatest effect on local CEI with elasticity coefficients of 0.98%, 2.06%, and 0.95%, respectively. In the underdeveloped region, population had the greatest promotion effect with an impact of 1.42; however, affluence exerts a pronounced inhibitory effect with an impact of -0.63. Factors affecting China's CEI have regionally varied effects. Affluence had a significant inhibitory effect on CEI in all five regions, especially in the underdeveloped region; population had a negative effect in the relatively developed regions and a positive effect in the less developed regions. Other factors exerted a positive effect in all five regions, but their significance varied regionally. These results can help policymakers adopt effective regional energy conservation and emission reduction measures.

The impact of environmental regulation on the employment of enterprises: an empirical analysis based on scale and structure effects

Whether environmental regulation policy can achieve the double dividend of pollution control and employment promotion is a problem that warrants further discussion. This paper is a study of the effect of environmental regulation on the employment scale and employment structure. Based on matching data, the empirical results show that environmental regulations enhance the employment scale of enterprises. From the perspective of the employment structure, the labor redistribution caused by environmental regulation is reflected mainly in employment creation and employment destruction effects, which lead to the optimization of the employment structure. Further research shows that environmental regulations expand the employment scale but have different impacts on the employment structure in the developed and undeveloped regions of China. In addition, internal and external factors such as enterprise innovation and the institutional environment may affect the relationship between environmental regulation and the employment of enterprises. This paper provides theoretical support to promote the construction of an ecological civilization and the alleviation of employment pressure.

IDF Diabetes Atlas: Estimation of Global and Regional Gestational Diabetes Mellitus Prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group's Criteria

AIMS

The approaches used to screen and diagnose gestational diabetes mellitus (GDM) vary widely. We generated a comparable estimate of the global and regional prevalence of GDM by International Association of Diabetes in Pregnancy Study Group (IADPSG)'s criteria.

METHODS

We searched PubMed and other databases and retrieved 57 studies to estimate the prevalence of GDM. Prevalence rate ratios of different diagnostic criteria, screening strategies and age groups, were used to standardize the prevalence of GDM in individual studies included in the analysis. Fixed effects meta-analysis was conducted to estimate standardized pooled prevalence of GDM by IDF regions and World Bank country income groups.

RESULTS

The pooled global standardized prevalence of GDM was 14.0% (95% confidence interval: 13.97-14.04%). The regional standardized prevalence of GDM were 7.1% (7.0-7.2%) in North America and Caribbean (NAC), 7.8% (7.2-8.4%) in Europe (EUR), 10.4% (10.1-10.7%) in South America and Central America (SACA), 14.2% (14.0-14.4%) in Africa (AFR), 14.7% (14.7-14.8%) in Western Pacific (WP), 20.8% (20.2-21.4%) in South-East Asia (SEA) and 27.6% (26.9-28.4%) in Middle East and North Africa (MENA). The standardized prevalence of GDM in low-, middle- and high-income countries were 12.7% (11.0-14.6%), 9.2% (9.0-9.3%) and 14.2% (14.1-14.2%), respectively.

CONCLUSIONS

The highest standardized prevalence of GDM was in MENA and SEA, followed by WP and AFR. Among the three World Bank country income groups, high income countries had the highest standardized prevalence of GDM. The standardized estimates for the prevalence of GDM provide an insight for the global picture of GDM.

Urban housing prices within a core urban agglomeration in China

To address the imbalanced development in China, this study focuses on housing prices in China's large urban areas, referred to as “agglomerations” which is distinct from the label of “tier 1” versus “tier 2” (and three and four) that is used to categorize cities in China which have been the focus of previous research. It primarily uses a dummy variable approach to analyze whether, in China, housing prices in cities within a core urban agglomeration increase faster than those in a non-core urban agglomeration. This study also makes technical contributions in using altitude and other appropriate instrumental variables to address endogeneity issues, which is useful in studying Chinese cities. Our results show that housing prices are found to grow more rapidly in cities in the Pearl River Delta urban agglomeration, at a statistically significant level, than in other regions studied. Therefore, polarization in the core urban agglomeration is now much severer than we expect. Using housing prices as an indicator, this study reveals a sharpened trend of imbalanced development in Chinese cities. In addition to its empirical findings, this study also discusses some policies that policymakers can make on coordinating economic growth and stabilizing housing prices.