Regional differences in upper tract urothelial carcinoma patients across the United States

BACKGROUND

It is unknown whether regional differences in patient, tumor, and treatment characteristics of upper tract urothelial carcinoma (UTUC) patients exist and may potentially result in regional overall mortality (OM) differences. We tested for inter-regional differences, according to Surveillance, Epidemiology, and End Results (SEER) registries.

METHODS

Using SEER database 2000 to 2016, patient (age, sex, race/ethnicity), tumor (location, grade) and treatment (nephroureterectomy, systemic therapy [ST]) characteristics of UTUC patients of all-stages were tabulated and graphically depicted in a stage-specific fashion (T1-2N0M0 vs. T3-4N0M0 vs. TanyN1-2M0/TanyNanyM1). Multivariable Cox regression (MCR) models tested for inter-regional differences in OM.

RESULTS

Regarding T1-2N0M0 patients, statistically significant differences existed for race/ethnicity (Caucasian 71 vs. 98%), location (renal pelvis: 55 vs. 67%), grade (high 60 vs. 83%) and ST (5.5 vs. 13.9%). In MCR models, registries 3 (Hazard ratio [HR]:1.39; P < 0.001) and 4 (HR:1.31; P = 0.01) independently predicted higher OM and Registry 8 (HR:0.64; P = 0.001) lower OM. Regarding T3-4N0M0 patients, statistically significant differences existed for race/ethnicity (Caucasian 70 vs. 98%), location (renal pelvis: 67 vs. 76%), grade (high 84 vs. 94%) and ST (18.7 vs. 29.5%). In MCR models, registries 3 (HR:1.42; P < 0.001) and 4 (HR:1.31; P = 0.009) independently predicted higher OM. Regarding TanyN1-2M0/TanyNanyM1 patients, statistically significant differences existed for location (renal pelvis: 63 vs. 82%), grade (high 92 vs. 98%) and ST (53.4 vs. 58.8%). In MCR models, Registry 3 (HR:1.37; P = 0.004) independently predicted higher OM and Registry 2, (HR:0.78; P = 0.02) lower OM.

CONCLUSIONS

Inter-regional differences were recorded in patients, tumor, and treatment characteristics. Even after adjustment for these characteristics, OM differences persisted which may be indicative of regional differences in quality of care or expertise in UTUC management.

A national registry-based study on uptake of the first dose of MMR vaccine in 380 administrative regions in Poland, 2013-2016-2020

INTRODUCTION AND OBJECTIVE

Regular monitoring of the measles, mumps, and rubella (MMR) vaccine uptake quickly exposes immunity gaps in the population. In Poland, the first dose of the MMR vaccine is mandatory for children between 13 and 15 months of life. This study aimed to assess the uptake of the first dose of MMR vaccine in 380 administrative counties in Poland in 2020, as well as to analyze the MMR vaccine uptake trends in 2013-2016-2020.

MATERIAL AND METHODS

This study is an epidemiological retrospective national registry-based analysis. Data on mandatory childhood vaccinations in all 380 counties in Poland were collected from the epidemiological reports of the State Sanitary Inspectorate territorial representatives. MMR vaccine uptake was calculated as the percentage of children who received the first dose of MRR vaccine to all children subject to mandatory vaccination in the county.

RESULTS

The uptake of the first dose of MMR vaccine decreased from 99.4% in 2013, to 95.5% in 2016 and 91.9% in 2020. In 2013, 93.2% of countys MMR vaccine uptake level reached the herd immunity level, followed by 77.1% of counties in 2016 and only 38.3% of countys in 2020. In 2020, two counties reached complete (100%) MMR vaccine uptake, and the lowest MMR vaccine uptake was 63.88%. Of the 380 counties in Poland, in 226 (61.1%) the MMR vaccine uptake level was lower than the herd immunity level, and a downward trend was observed. MMR vaccine uptake decreased with an increased number of residents in a county (r= -0.35; p<0.001).

CONCLUSIONS

This study revealed that in 61% of administrative regions in Poland, the MMR vaccine uptake was below the herd immunity level. Regional differences in the MMR vaccine uptake were observed. A significant decrease in MMR vaccine uptake between 2013 - 2020 poses a risk of measles outbreaks.

[Relationship between the number of public health nurses and the total number of people receiving home-visit nursing services for mental health/intractable diseases, and those numbers' regional differences]

Objectives　The primary aim of this study was to clarify the relationship between the number of public health nurses (PHNs) and the total number of people who received home-visit nursing services for mental health or intractable diseases. The secondary aim was to clarify the extent of regional differences in the number of PNHs and mental health or intractable diseases.Methods　This study used the total number of people who received home-visit nursing services for mental health or intractable diseases in 2019 from the Portal Site of Official Statistics of Japan (e-Stat) and population and area data in January 2020. Single and multiple regression analyses (covariates: population and area) were performed on the relationship between the number of PHNs per 100,000 population (abbreviated as "ratios of PHNs") and the total number of people who received home-visit nursing services for mental health or intractable diseases per 100,000 population (abbreviated as "mental health/intractable disease achievements"). Regional differences in ratios of PHNs and mental health/intractable disease achievement were examined using mean, standard deviation, maximum/minimum values, and Gini coefficients. Analyses were performed for each of the five units: the prefectures as a whole, prefectural public health centers, municipalities within the jurisdiction of prefectural public health centers, and cities in which public health centers are established (including or not including special wards).Results　Regression analyses indicated a positive relationship between the ratios of PHNs and mental health/intractable disease achievements. Multiple regression analysis indicated that both achievements were positively associated with population size and negatively associated with area size. The largest regression coefficients between the ratios of PHNs and achievements were 34.07 and 5.48 regarding mental health achievements and intractable disease achievements, respectively. For regional differences, the smallest Gini coefficient was the ratios of PHNs, and the largest was intractable disease achievements. The smallest and largest coefficient of the prefectures as a whole was 0.15 and 0.34, respectively. The maximum/minimum values of the prefectures as a whole also indicated that the smallest was 3.8 in the ratio of PHNs and the largest was 30.0 in intractable disease achievement.Conclusions　Increasing number of PHNs is needed to provide more home-visit nursing services for mental health and intractable diseases. It is particularly important to fill up the larger number of PHNs in smaller populations or larger area prefectures. Due to regional differences in the home-visit nursing service, it is important to promote the increase in the level of these activities.

Regional differences of physical fitness and overweight and obesity prevalence among college students before and after COVID-19 pandemic since the "double first-class" initiative in China

Introduction

Physical fitness has been widely recognized as a powerful marker of health in children and adolescents, and it negatively affected by the COVID-19 pandemic. The construction of world-class universities and first-class disciplines, known as the "Double First-Class" Initiative (DFC), is a major commitment made by the Chinese government to adapt to changes in the educational environment, both domestically and internationally, in order to promote the development and practice of international higher education. The aim of the study was to look deep into the regional differences of physical fitness and overweight and obesity prevalence among college students before and after the COVID-19 pandemic since the DFC.

Methods

The original physical fitness parameters of students from 10 DFC universities and colleges in Central South China were downloaded from the official website of Chinese National Student Physical Fitness Database (CNSPFD) and then divided into 3 groups based on the pandemic periods: pre-pandemic (2019), the first year after pandemic outbreak (2020), and the second year after pandemic outbreak (2021). All the data were stored in Excel 2010, analyzed by SPSS 17.0, and plotted with ArcGIS 10.4.

Results

The total "fail" percentage (from 9.19% in 2019 to 12.94% in 2021) and the prevalence of overweight and obesity in boys (from 22.53 to 29.25% in 2021) exhibited a continuous increase year by year, and among all the physical fitness indicators the score of strength in boys and endurance quality in all individuals were the lowest in overweight and obesity groups. Students with 'fail' rate developed from northern and northeastern province to southern areas from 2019 to 2021. For grade 2019th, overweight and obesity students who also failed the test had covered nationwide and the most affected areas including northeast, east, as well as central north in senior year. The distribution of overall fitness assessments in Hubei province was in accordance with the national data, and the overall scoring growths in both class of 2021st and 2022nd were measured with a negative increase (p < 0.01).

Conclusion

The government and related functional departments should take into consideration the student regional sources, especially in western and northeast regions of China, and school polices and physical education (PE) teachers should pay more attention to put training efforts on endurance for all adolescents and strength for boys and the group of overweight and obesity who also failed in the standard test, when designing specific interventions to promote physical health and counteract the negative effects of COVID-19 pandemic in college students.

Spatial and temporal analysis of China's healthcare resource allocation measurements based on provincial data: 2010-2021

Background

With the development of society, industrialization, urbanization, aging, lifestyle and social transformation, environmental degradation, global warming and other factors have had a great impact on the health of the population, and there is an urgent need to take a series of practical actions to promote the improvement of national health. Among them, healthcare resource allocation plays a key role in advancing the level of national health, treatment of chronic diseases, and leisure and healthcare.

Methods

This article collected panel data on healthcare resource allocation in all provinces of China from 2010 to 2021, and comprehensively applied Analytic Hierarchy Process, comprehensive scoring method, regional difference analysis and spatial autocorrelation analysis to reveal regional differences, spatial-temporal patterns and development characteristics of healthcare resource allocation in China.

Results

In terms of regional differences, intra-regional differences in healthcare resource allocation tend to narrow and inter-regional differences tend to widen. In terms of spatial pattern, the western provinces on the left side of the Hu Huanyong line generally have higher scores, while the central and eastern provinces on the right side of the Hu Huanyong line have lower scores, and healthcare resource allocation in the provinces on the left side of the Hu Huanyong line, such as Tibet, Xinjiang, Qinghai, Ningxia, Gansu, Inner Mongolia, Sichuan, have the spatial characteristics of HH clusters in terms of geographic location, while the southeast coastal provinces, such as Zhejiang, Fujian, Guangdong, Hainan, have the spatial characteristics of LL clusters in terms of geographic location. From the quadrant analysis, the 2010-2021 healthcare resource allocation in the first quadrant concentrates most of the provinces in the western and northeastern regions, while the third quadrant concentrates most of the provinces in the eastern region.

Conclusion

The allocation of healthcare resources in China's four major zones has undergone a process of change from "unbalanced quantity to relatively balanced quantity," but high-quality healthcare resources are highly concentrated in the eastern part of the country, and the problem of contradiction between people and doctors is prominent. It is recommended that Internet plus healthcare technology be used to reshape the regional allocation of high-quality healthcare resources.

Regional catastrophic health expenditure and health inequality in China

Background

Catastrophic health expenditures (CHE) can trigger illness-caused poverty and compound poverty-caused illness. Our study is the first regional comparative study to analyze CHE trends and health inequality in eastern, central and western China, exploring the differences and disparities across regions to make targeted health policy recommendations.

Methods

Using data from China's Household Panel Study (CFPS), we selected Shanghai, Henan and Gansu as representative eastern-central-western regional provinces to construct a unique 5-year CHE unbalanced panel dataset. CHE incidence was measured by calculating headcount; CHE intensity was measured by overshoot and CHE inequality was estimated by concentration curves (CC) and the concentration index (CI). A random effect model was employed to analyze the impact of household head socio-economic characteristics, the household socio-economic characteristics and household health utilization on CHE incidence across the three regions.

Results

The study found that the incidence and intensity of CHE decreased, but the degree of CHE inequality increased, across all three regions. For all regions, the trend of inequality first decreased and then increased. We also revealed significant differences across the eastern, central and western regions of China in CHE incidence, intensity, inequality and regional differences in the CHE influencing factors. Affected by factors such as the gap between the rich and the poor and the uneven distribution of medical resources, families in the eastern region who were unmarried, use supplementary medical insurance, and had members receiving outpatient treatment were more likely to experience CHE. Families with chronic diseases in the central and western regions were more likely to suffer CHE, and rural families in the western region were more likely to experience CHE.

Conclusions

The trends and causes of CHE varied across the different regions, which requires a further tilt of medical resources to the central and western regions; improved prevention and financial support for chronic diseases households; and reform of the insurance reimbursement policy of outpatient medical insurance. On a regional basis, health policy should not only address CHE incidence and intensity, but also its inequality.

Body mapping of skin friction coefficient and tactile perception during the dynamic skin-textile interaction

The clothing fabric and skin interact continuously across the many regions of users' bodies during wear, which can lead to both physical skin damage and discomfort. Therefore, this investigation aimed to explore the regional differences in skin friction, tactile perception, and sensitivity in both females and males during the skin-textile interaction. The static and dynamic friction coefficient and textile perception (texture, stickiness, pleasantness, and discomfort) were measured across the 36 selected testing body areas by using a friction measurement device. The results revealed there was a significant difference in skin friction, tactile perceptions, and sensitivity across the various body regions. The anterior neck had the highest skin friction in both females and males, and participants generally rated higher texture perception in their anterior aspects compared to posterior and lateral regions. There was no significant difference in skin friction, tactile perception ratings, and sensitivity between females and males. Practitioner summary: This study sought to examine regional variations in skin friction, tactile perception, and sensitivity during the skin-textile interaction. There was a significant difference in skin friction, tactile perceptions, and sensitivity across the various body regions and no significant sex effect on skin friction, tactile perception ratings, and sensitivity.

Regional differences in the assessment of depressive symptoms in the former German Democratic Republic and Federal Republic of Germany

AIM

The present study investigated regional differences in response behaviour for the Patient Health Quetionnaire-9. We tested for measurement invariance and differential item and test functioning between formerly divided East- and West-Germany: the former German Democratic Republic and Federal Republic of Germany. Diverging socialization experiences in socialist versus capitalist and collectivist versus individualist systems may affect culturally sensitive assessments of mental health.

SUBJECT AND METHODS

To test this empirically, we used factor analytic and item-response-theoretic frameworks, differentiating between East- and West-Germans by birthplace and current residence based on several representative samples of the German general population (n = 3 802).

RESULTS

Across all survey, we discovered slightly higher depression sum scores for East- versus West-Germans. The majority of items did not display differential item functioning-with a crucial exception in the assessment of self-harm tendencies. The scale scores were largely invariant exhibiting only small amounts of differential test functioning. Nonetheless, they made up on average about a quarter of the observed group differences in terms of effect magnitude.

CONCLUSION

We explore possible causes and discuss explanations for the item-level differences. Overall, analyses of East- and West-German depressive symptom developments in the wake of reunification are feasible and statistically grounded.

Risk Factors for Incident CKD in Black and White Americans: The REGARDS Study

RATIONALE & OBJECTIVE

Little information exists on the incidence of and risk factors for chronic kidney disease (CKD) in contemporary US cohorts and whether risk factors differ by race, sex, or region in the United States.

STUDY DESIGN

Observational cohort study.

SETTING & PARTICIPANTS

4,198 Black and 7,799 White participants aged at least 45 years, recruited from 2003 through 2007 across the continental United States, with baseline estimated glomerular filtration rate (eGFR)>60mL/min/1.73m2 and eGFR assessed again approximately 9 years later.

EXPOSURES

Age, sex, race (Black or White), region ("stroke belt" or other), education, income, systolic blood pressure, body mass index, diabetes, coronary heart disease, hyperlipidemia, smoking, and albuminuria.

OUTCOMES

(1) eGFR change and (2) incident CKD defined as eGFR<60mL/min/1.73m2 and≥40% decrease from baseline or kidney failure.

ANALYTICAL APPROACH

Linear regression and modified Poisson regression were used to determine the association of risk factors with eGFR change and incident CKD overall and stratified by race, sex, and region.

RESULTS

Mean age of participants was 63±8 (SD) years, 54% were female, and 35% were Black. After 9.4±1.0 years of follow-up, CKD developed in 9%. In an age-, sex-, and race-adjusted model, Black race (β =-0.13; P<0.001) was associated with higher risk of eGFR change, but this was attenuated in the fully adjusted model (β=0.02; P=0.5). Stroke belt residence was independently associated with eGFR change (β =-0.10; P<0.001) and incident CKD (relative risk, 1.14 [95% CI, 1.01-1.30]). Albuminuria was more strongly associated with eGFR change (β of-0.26 vs-0.17; P=0.01 for interaction) in Black compared with White participants. Results were similar for incident CKD.

LIMITATIONS

Persons of Hispanic ethnicity were excluded; unknown duration and/or severity of risk factors.

CONCLUSIONS

Established CKD risk factors accounted for higher risk of incident CKD in Black versus White individuals. Albuminuria was a stronger risk factor for eGFR decrease and incident CKD in Black compared with White individuals. Living in the US stroke belt is a novel risk factor for CKD.

Adult-Onset Neuroepidemiology in Finland: Lessons to Learn and Work to Do

Finland is a relatively small genetic isolate with a genetically non-homogenous population. Available Finnish data on neuroepidemiology of adult-onset disorders are limited, and this paper describes the conclusions that can be drawn and their implications. Apparently, Finnish people have a (relatively) high risk of developing Unverricht-Lundborg disease (EPM1), Multiple Sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS), Spinal muscular atrophy, Jokela type (SMAJ) and adult-onset dystonia. On the other hand, some disorders, such as Friedreich's ataxia (FRDA) and Wilson's disease (WD), are almost absent or completely absent in the population. Valid and timely data concerning even many common disorders, such as stroke, migraine, neuropathy, Alzheimer's disease and Parkinson's disease, are unavailable, and there are virtually no data on many less-common neurological disorders, such as neurosarcoidosis or autoimmune encephalitides. There also appear to be marked regional differences in the incidence and prevalence of many diseases, suggesting that non-granular nationwide data may be misleading in many cases. Concentrated efforts to advance neuroepidemiological research in the country would be of clinical, administrative and scientific benefit, but currently, all progress is blocked by administrative and financial obstacles.

Regional Differences, Dynamic Evolution and Convergence of Public Health Level in China

People's health is a necessary condition for the country's prosperity. Under the background of the COVID-19 pandemic and frequent natural disasters, exploring the spatial and temporal distribution, regional differences and convergence of China's provincial public health level is of great significance to promoting the coordinated development of China's regional public health and achieving the strategic goal of a "healthy China". Based on China's provincial panel data from 2009 to 2020, this paper constructs an evaluation index system for China's public health level from five dimensions: the popularization of a healthy life, optimization of health services, improvement of health insurance, construction of a healthy environment, and development of a health industry. In this paper, the entropy method, Dagum Gini coefficient, Kernel density function and spatial econometric model are used to analyze the spatiotemporal distribution, regional differences, dynamic evolution and convergence of China's public health level since the new medical reform. The study found that, first, China's public health level is generally low, structural contradictions are prominent and the construction of a healthy environment has become a shortcoming hindering the improvement of China's public health level since the new medical reform. The public health level of the four major regions showed a spatial distribution pattern of "high in the eastern, low in the northeastern, central and western" areas. Second, the overall Gini coefficient of China's public health level showed a "V-shaped" trend of first decreasing and then rising, but the overall decrease was greater than the increase, among which the regional difference was the main source of regional differences in China's public health level, but its contribution rate showed a downward trend. Third, except for the basic maintenance of a healthy environment, the Kernel density curves of China's public health level and its sub-dimensions have shifted to the right to a certain extent, and there is no polarization phenomenon. Finally, the level of public health in China has a significant spatial correlation. Except for the northeast region, the growth rate of low-level public health provinces in China and the other three major regions is higher than that of high-level public health provinces, showing a certain convergence trend. In addition, the impact of economic development, financial pressure, and urbanization on the convergence of public health levels in the four major regions is significantly heterogeneous.

Regional Transcriptomics and Proteomics of Pharmacokinetics-Related Genes in Human Intestine

The intestine is an organ responsible for the absorption and metabolism of orally administered drugs. To predict pharmacokinetics behavior in the small intestine, it is necessary to examine the human intestinal expression profiles of the genes related to drug absorption, distribution, metabolism, and excretion (ADME). In this study, to obtain more accurate expression profiles in various regions of the human intestine, biopsy samples were collected from endoscopically noninflamed mucosa of the duodenum, jejunum, ileum, colon, and rectum from Japanese including Crohn's disease or ulcerative colitis patients, and both RNA-seq and quantitative proteomics analyses were performed. We also analyzed the expression of drug-metabolizing enzymes (cytochromes P450 (CYPs) and non-CYP enzymes), drug transporters, and nuclear receptors. Overall, the mRNA expression levels of these ADME-related genes correlated highly with the protein expression levels. The characteristics of the expression of ADME-related genes differed significantly between the small and large intestines, including the expression levels of CYP enzymes, which were higher and lower in the small and large intestines, respectively. Most CYPs were expressed dominantly in the small intestine, especially the jejunum, but were rarely expressed in the large intestine. On the other hand, non-CYP enzymes were expressed in the large intestine but at lower expression levels than in the small intestine. Moreover, the expression levels of drug metabolizing enzyme genes differed even between the proximal and distal small intestine. Transporters were expressed most highly in the ileum. The data in the present study will enhance understanding of the intestinal ADME of drug candidates and would be useful for drug discovery research.

[Impact of Climate Change on Summer Ozone in China]

Meteorological conditions have important impacts on surface ozone (O₃) formation. To evaluate the influence of future climate change on O₃ concentrations in different regions of China, this study employed the climate data from the community earth system model provided by the CMIP5 under the RCP4.5, RCP6.0, and RCP8.5 scenarios to generate the initial and boundary conditions for the WRF model. Then, the dynamic downscaling WRF results were fed into a CMAQ model as meteorological fields with fixed emission data. Two 10-year periods (2006-2015 and 2046-2055) were selected in this study to discuss the impacts of climate change on O₃. The results showed that climate change increased boundary layer height, mean temperature, and heatwave days in China during summer. Relative humidity decreased and wind speed near the surface showed no obvious change in the future. O₃ concentration showed an increasing trend in Beijing-Tianjin-Hebei, Sichuan Basin, and South China. The extreme value of O₃ maximum daily 8-hour moving average (MDA8) showed an increasing trend, following the order of RCP8.5 (0.7 μg·m^-3)>RCP6.0 (0.3 μg·m^-3)>RCP4.5 (0.2 μg·m^-3). The number of days exceeding the standard for summer O₃ had a similar spatial distribution with the heatwave days in China. The increase in heatwave days led to the increase in O₃ extreme pollution events, and the possibility of a long-lasting O₃ pollution event will increase in China in the future.

The Allocation Change of Rural Land Consolidation Type Structure under the Influence Factors of Different Geographical and Economic Development of China

Land consolidation structure reflects land consolidation function, and studies about its spatio-temporal change and driving mechanism can serve for regional management and control land consolidation. At present, the analysis of regional differences, time changes, and driving factors of land consolidation type structure change is relatively lacking. Based on the data of provincial acceptance projects from 2000 to 2014, this paper analyzes the spatio-temporal change of rural land consolidation type structure in China, discusses the impact of relevant policies, and identifies the socio-economic driving factors in key regions by employing correlation analysis and the PLSR (partial least squares regression) method. The results showed that from 2000 to 2014, the proportional increase of land arrangement in China was significantly correlated with the proportional decrease of land reclamation (R2 = 0.93), and the proportional decrease of land development (R2 = 0.99) showed an obvious co-evolution pattern of increase and decrease; TILC (The area of land development/The area of land arrangement) decreased from 2.14 to 0.91 in 2002-2003. Since 2003, the dominant type of land consolidation in China has gradually changed from land development to land arrangement. However, the proportion of land development in QT (Qinghai-Tibet), JY (Jin-Yu), and FGH (Fujian-Guangdong-Hainan) areas is still more than 40%; the change of land consolidation type structure was influenced by policies, social and economic factors, such as urbanization rate, fixed assets investment, industrial proportion, and population density, and the regional difference was significant: the eastern section (JZS, Jiangsu-Zhejiang-Shanghai) is the industry proportion, the central area (HHAJ, Hunan-Hubei-Anhui-Jiangxi) is grain production and fixed assets investment, the western region (NW, Northwest China) has the urbanization rate, grain production, population density, and fixed assets investment. Land consolidation structure should be configured differentially in each region based on the identification of regional function orientation and comprehensive consideration of regional resource endowment and development needs and directions to improve the efficiency of land consolidation.

Analysis of the Spatial-Temporal Evolution of Urbanization Quality in Zhejiang Province, China

Taking cities in Zhejiang Province of China from 2011 to 2020 as the research object, a multi-dimensional urbanization quality evaluation index system was constructed using the comprehensive analysis method, and the urbanization quality of 11 cities in Zhejiang Province was quantitatively measured using the entropy weight method. The system classification and time-space evolution analysis were carried out using ArcGIS software (Environmental Systems Research Institute, Inc., RedLands, CA, USA) to comprehensively study the evolution characteristics and influencing factors of the urbanization quality of cities in Zhejiang Province. This study provides a reference for local governments to formulate feasible urbanization development strategies and policies to promote the high-quality development of urbanization and for the construction of new urbanization in other provinces and cities.

Spatiotemporal Dynamic Distribution, Regional Differences and Spatial Convergence Mechanisms of Carbon Emission Intensity: Evidence from the Urban Agglomerations in the Yellow River Basin

Low-carbon transition is of great importance in promoting the high-quality and sustainable development of urban agglomerations in the Yellow River Basin (YRB). In this study, the spatial Markov chain and Dagum's Gini coefficient are used to describe the distribution dynamics and regional differences in the carbon emission intensity (CEI) of urban agglomerations in the YRB from 2007 to 2017. Additionally, based on the spatial convergence model, this paper analyzed the impact of technological innovation, industrial structure optimization and upgrading, and the government's attention to green development on the CEI's convergence speed for different urban agglomerations. The research results show that: (1) The probability of adjacent type transfer, cross-stage transfer, and cross-space transfer of the CEI of urban agglomerations in the YRB is small, indicating that the overall spatiotemporal distribution type of CEI is relatively stable. (2) The CEI of urban agglomerations in the YRB has decreased significantly, but the spatial differences are still significant, with a trend of continuous increase, and regional differences mainly come from the differences between urban agglomerations. (3) Expanding innovation output, promoting the optimization and upgrading of industrial structure, and enhancing the government's attention to green development has a significant positive effect on the convergence rate of the CEI of urban agglomerations in the YRB. This paper holds that implementing differentiated emission reduction measures and actively expanding regional collaborative mechanisms will play an important role in reducing the spatial differences in carbon emissions in urban agglomerations in the YRB, realizing the goals of peak carbon and carbon neutrality.

Population-Based, Spatial Analysis of Specialised Ambulatory Palliative Care in Mecklenburg-Western Pomerania, Germany, on the Basis of Reimbursement Data

In rural areas, healthcare providers, patients and relatives have to cover long distances. For specialised ambulatory palliative care (SAPV), a supply radius of max. 30 km is recommended. The aim of this study was to analyse whether there are regional disparities in the supply of SAPV and whether it is associated with the distance between the SAPV team's site and the patient's location. Therefore, anonymised data of the Association of Statutory Health Insurance Physicians of the Federal State of Mecklenburg-Western Pomerania (M-V) were retrospectively analysed for the period of 2014-2017. Identification as a palliative patient was based on palliative-specific items from the ambulatory reimbursement catalogue. In total, 6940 SAPV patients were identified; thereof, 48.9% female. The mean age was 73.3 years. For 28.3% of the identified SAPV patients (n = 1961), the SAPV teams had a travel distance of >30 km. With increasing distance, the average number of treatment days per patient increased. It was found that there are regional disparities in the provision of SAPV services in M-V and that local structures have an important impact on regional supply patterns. The distance between the SAPV team's site and the patient's location is not the only determining factor; other causes must be considered.

Evolutionary Trends, Regional Differences and Influencing Factors of the Green Efficiency of Agricultural Water Use in China Based on WF-GTWR Model

Improving the green efficiency of agricultural water use is a key way to promote the sustainable utilization of agricultural water resources and sustainable development of economy and society. This work calculated and analyzed the evolution trend, regional differences and driving factors of the green efficiency of agricultural water use in China from the perspective of the water footprint. The results show that the green efficiency of agricultural water use in China shows a fluctuation trend of first declining and then rising from 1997 to 2020, after which the average efficiency dropped from 0.538 in 1997 to 0.406 in 2009, and then rose rapidly to 0.989 in 2020, with an average annual growth rate of about 3.6%. From a regional perspective, the green efficiency of agricultural water use in the eastern region was the highest (0.594), above the national average (0.538), followed by the western region (0.522), with the central region in last (0.491), with significant regional differences. The spatial differences in the green efficiency of available agricultural water in China shows a fluctuating downward trend. The Gini coefficient fluctuated from 0.271 in 1997 to 0.182 in 2020, with an average annual growth rate of about -1.4%. The main source of this regional difference was super-variable density, followed by the difference between the eastern and the central regions. The influence of urbanization level, water-saving level and agricultural trade on the green efficiency of agricultural water use was always positive and the influence of industrialization level was always negative; among them, the urbanization level, water-saving level and industrialization level had a greater impact on Northeast China, and agricultural trade had a greater impact on Southeast China. Therefore, this work puts forward relevant policy recommendations.

How to Evaluate the Level of Green Development Based on Entropy Weight TOPSIS: Evidence from China

Evaluating the level of green development is of great significance to better implement the concept of green development. By constructing an evaluation index system for green development, this paper comprehensively uses the entropy weight Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS) method and coefficient of variation method to evaluate the green development level of 30 provinces in China from 2010 to 2019 and analyzes the regional differences of green development in China. The research findings are as follows: First, the level of green development in China is low but shows a slow rise trend, from 2010 to 2019; China's green development level rises from 0.274 to 0.317, an increase of 15.7%. Secondly, regional differences of green development in China are obvious, with the level ranking from high to low as eastern, western, and central regions. Third, regional differences in China's green development first widen and then narrow, with the variation coefficient of green development in 30 provinces and eastern, central, and western regions of China showing an inverted U-shaped trend of first increasing and then decreasing. Fourth, the regional difference of green development in eastern China is largest, followed by western China, and the smallest is central China. Finally, based on research findings, relevant policy recommendations are put forward.

Regional Differences in Chinese Female Demand for Childcare Services of 0-3 Years: The Moderating and Mediating Effects of Family Childcare Context

There are multiple reasons to consider the use of formal childcare: parental employment, child development, fertility choices, elderly health, generational relations, etc. This study explores the relationship between regional differences (urban/rural; eastern/central/western) and demand for childcare services (quantity, price, quality) from birth to three years of age, moderated and mediated by the family childcare contexts among Chinese women. Altogether, 1770 mothers of children aged 0-3 were selected from a national survey and analyzed. There are three major findings: (1) Urban mothers show a willingness to spend on the higher monetary cost of center-based childcare compared to rural mothers, as a result of more severe work-child conflicts faced by urban women. Urban-rural gaps in individual and household income also contribute to the differences in affordability. (2) Mothers in eastern China have a more substantial need to place their infants or toddlers in nurseries before the age of three than their counterparts in central and western China, primarily due to a lack of grandparental and paternal childcare support and an expectation of higher quality programs. (3) There is no significant regional disparity in terms of care-related or education-related quality preferences. The paper proposes regional prioritized strategies and targeted services to address the "3A" problems of childcare provision.

Measurement of local government green governance efficiency based on total waste emissions and PM2.5 concentration: Evidence from China

The problem of environmental pollution is becoming more and more prominent. Making ecological governance take an effective and sustainable development path has become a complex problem for countries to think about. The proposal of green governance provides new ideas for governments to manage enterprises and local environmental governance. The DEA method is commonly used to measure the effectiveness of environmental governance, but the traditional DEA method ignores environmental factors and management factors, and the measurement error is significant. Therefore, this paper introduces the total waste discharge and PM2.5 average concentration and other unexpected outputs, using the three-stage DEA model and three-stage DEA Malmquist index model, creatively constructing the green governance measurement index system, which measures and evaluates the green governance efficiency of 30 provinces in China from 2004 to 2019 from static and dynamic perspectives. The research results show that the efficiency value obtained by the three-stage DEA model is higher than the first stage, which confirms that the external environmental factors have a specific impact on the GGE. At the same time, the comprehensive technical efficiency value presents a "U"-shaped trend with time. From the perspective of sub-regions, there is heterogeneity in the efficiency values between regions, showing a decreasing trend of "east, west, and middle." From the efficiency decomposition results, the main reason for the negative growth rate of GGE is the low efficiency of technological progress, which provides targeted suggestions for governance in various regions of China. This study will help provinces prepare to strengthen investment in technological innovation, maximize the benefits of input and output, and promote green and sustainable development.

Impact of government subsidies on innovation of Chinese biopharmaceutical firms: Based on kink threshold model

Do government subsidies achieve the goals of stimulating firm innovation and macro-regulation? Existing studies have not reached a consistent conclusion. We will study the incentive effect of government subsidies on innovation of biopharmaceutical firms, analyze the optimal interval of government subsidies, and improve the efficiency of government subsidies. Thus, based on kink threshold model using data from Chinese biopharmaceutical listed companies from 2013-2019, this study analyzes the impact of government subsidies on innovation inputs and outputs. Government subsidies can stimulate innovation inputs and outputs of biopharmaceutical firms. Meanwhile, such subsidies have a significant threshold effect on innovation inputs and outputs, and there is an optimal interval effect. Additionally, concerning enterprise ownership, government subsidies have a more significant role in promoting innovation of non-state biopharmaceutical firms. Regarding regional differences, such subsidies have a more significant role in promoting innovation of firms in the less economically developed central and western regions. This study reveals the influence pattern of government subsidies, and provides insights and suggestions to formulate subsidy policies and enhance innovation.

Shape differences in the semitendinosus following tendon harvesting for anterior cruciate ligament reconstruction

Following hamstring autograft anterior cruciate ligament reconstruction (ACLR), muscle length, cross-sectional area, and volume are reduced. However, these discrete measures of morphology do not account for complex three-dimensional muscle shape. The primary aim of this study was to determine between-limb semitendinosus (ST) shape and regional morphology differences in young adults following tendon harvest for ACLR and to compare these differences with those in healthy controls. In this cross-sectional study, magnetic resonance imaging was performed on 18 individuals with unilateral ACLR and 18 healthy controls. Bilaterally, ST muscles were segmented, and shape differences assessed between limbs and compared between groups using Jaccard index (0-1) and Hausdorff distance (mm). Length (cm), peak cross-sectional area (cm² ), and volume (cm³ ) were measured for the entire muscle and proximal, middle, and distal regions, and compared between limbs and groups. Compared to healthy controls, the ACLR group had significantly (p < 0.001, Cohen's d = -2.33) lower bilateral ST shape similarity and shape deviation was significantly (p < 0.001, d = 2.12) greater. Shape deviation was greatest within the distal region of the ACLR (Hausdorff: 23.1 ± 8.68 mm). Compared to both the uninjured contralateral limb and healthy controls, deficits in peak cross-sectional area and volume in ACLR group were largest in proximal (p < 0.001, d = -2.52 to -1.28) and middle (p < 0.001, d = -1.81 to -1.04) regions of the ST. Overall, shape analysis provides unique insight into regional adaptations in ST morphology post-ACLR. Findings highlight morphological features in distal ST not identified by traditional discrete morphology measures. Clinical significance: Following ACLR, risk of a secondary knee or primary hamstring injury has been reported to be between 2-to-5 times greater compared to those without ACLR. Change in semitendinosus (ST) shape following ACLR may affect force transmission and distribution within the hamstrings and might contribute to persistent deficits in knee flexor and internal rotator strength.

Study on regional differences and influencing factors of energy consumption in China

Energy is becoming more and more important in the process of development. Through cluster analysis, 30 provinces chosen from the Chinese mainland are divided into high, medium, and low energy consumption regions, and the Theil index is used to analyze the characteristics of total energy consumption and other characteristics of regional differences. Based on this, an enhanced Panel-STIRPAT model is constructed. Through data and model inspection, panel models suitable for each region are selected for comprehensive analysis. The results show that: there are regional differences in energy consumption in China, and the total regional differences mainly come from within each region. The factors affecting energy consumption in different regions are the same, but due to differences in geographical environment and stress levels, the influence of these factors on energy consumption in different regions is different. Based on this, reasonable measurements to control energy consumption in different regions are presented.

Spatio-temporal evolution of the resilience of Chinese border cities

In China, border cities are developing in the direction of trade, investment, tourism, and regional diversification and becoming crucial for the national opening-up strategy and inter-regional exchange. In this study, we construct a comprehensive system for measuring and evaluating the resilience of border cities in China that also reveals the spatial and temporal characteristics of resilience. Three representative sample zones (Northeast, Northwest, and Southwest) are selected within the three major regions of China to analyze the regional differences in border city resilience and propose targeted coping strategies. The findings of this study are as follows. First, the spatial distribution of resilience in Chinese border cities varies significantly, with the overall resilience decreasing in the following order: Northeast China > Southwest China > Northwest China > North China > Tibetan China. Higher resilience of border cities is predominantly related to better economic foundations and advantages in border trade. Second, the resilience of China's border cities has increased significantly over the past decade, with highly resilient border cities concentrated in the northeastern part of China, the northern part of Xinjiang, and Guangxi Province. Moreover, high resilience generally spreads to surrounding low-resilience cities over time. Third, the spatial distribution and development trends of resilience levels differ among the three sample zones. Therefore, it is crucial to improve urban resilience according to the regional characteristics of each border city and its specific developmental stage.

Coupling Coordination Measurement and Evaluation of Urban Digitalization and Green Development in China

The coordinated promotion of urban digitalization and green development is an inevitable requirement for sustainable development in the digital age. Based on the coupling mechanism of urban digitalization and green development, in this study, we took 282 cities at the prefecture level and above in China from 2011 to 2019 as the research object, and we constructed the evaluation index system and calculated the coupling coordination degree (CD&GDD) of the two through the coupling coordination degree model. We further used the Dagum Gini coefficient, kernel density estimation, Markov chain and Moran's I to assess the spatial effects of the regional differences, dynamic evolution trends and degree of coupling coordination. The results show the following: (1) The level of urban digitalization and green development show a fluctuating upward trend, and the interaction between the two is obvious. (2) Although the CD&GDD of most cities is continuously improving, it is still at a low level. There are large differences in the levels between the regions. (3) The inter-regional differences are the main source of the large overall differences in the CD&GDD in China, and these are mainly composed of the hypervariable density and net differences between the regions. (4) The phenomenon of "club convergence" exists in the CD&GDD. (5) The coupling coordination relationship between cities has a substantial spatial effect, and the spatial effect has obvious regional heterogeneity. The results and conclusions provide a reference for developing countries to promote green and low-carbon urban development.

Case Fatality of Hospitalized Patients with COVID-19 Infection Suffering from Acute Respiratory Distress Syndrome in Germany

Aims: Patients suffering from viral pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are at risk of developing acute respiratory distress syndrome (ARDS). ARDS is a serious complication of COVID-19 that requires early recognition and comprehensive management. Little is known about the concomitant prevalence of both entities in Germany. Thus, we sought to analyze predictors and regional trends of case fatality in patients with COVID-19 and ARDS in Germany. Methods: We analyzed data on the characteristics, comorbidities and in-hospital outcomes for all hospitalized patients with COVID-19 and compared those with and without ARDS in Germany in 2020. Results: Overall, 176,137 hospitalized patients with confirmed COVID-19 were included in this analysis; among these, 11,594 (6.6%) suffered from ARDS. Most patients with ARDS were treated in hospitals in urban areas (n = 6485); proportion rate of mechanical ventilation was higher (45.9%) compared to those treated in hospitals of suburban (36.1%) or rural areas (32.0%). Proportion of ARDS grew exponentially with age until the sixth decade of life. Case-fatality rate was considerably higher in COVID-19 patients with ARDS compared to those without (48.3% vs. 15.8%; p < 0.001). Independent predictors of in-hospital case fatality with an OR > 3 were age ≥ 70 years, severe ARDS, severe liver disease, acute renal failure, stroke, dialysis treatment, shock and necessity of ECMO. Conclusions: The case fatality of COVID-19 patients with ARDS is dramatically high and shows relevant regional disparities. Our findings may help to draw more attention to predictors for in-hospital case fatality in patients hospitalized with COVID-19 and suffering from ARDS.

Guillain-Barré Syndrome in Northern China: A Retrospective Analysis of 294 Patients from 2015 to 2020

Objectives: Acute motor axonal neuropathy (AMAN) was first reported to be the main subtype of Guillain−Barré syndrome (GBS) in northern China in the 1990s. About 30 years has passed, and it is unknown whether the disease spectrum has changed over time in northern China. We aimed to study the epidemiological, clinical, and electrophysiological features of GBS in northern China in recent years. Methods: We retrospectively analyzed the medical records of GBS patients admitted to the Second Hospital of Hebei Medical University in northern China from 2015 to 2020. Results: A total of 294 patients with GBS were enrolled, with median age 53 years and 60.5% of participants being male, and a high incidence in summer and autumn. AMAN was still the predominant subtype in northern China (40.1%). The AMAN patients had shorter time to nadir, longer hospitalization time, and a more severe HFGS score at discharge than acute inflammatory demyelinating polyneuropathies (AIDP) (p < 0.05). With SPSS multivariable logistic regression analysis, we found the GBS disability score (at admission), dysphagia, and dysautonomia were independent risk factors for GBS patients requiring MV (p < 0.05). In comparison with other regions, the proportion of AMAN in northern China (40.1%) was higher than in eastern (35%) and southern (19%) China. Conclusions: AMAN is still the predominant subtype in northern China after 30 years, but there have been changes over time in the GBS spectrum since the 1990s. There are regional differences in GBS in China.

The Spatiotemporal Evolution and Influencing Factors of the Chinese Cities' Ecological Welfare Performance

In the "full world" where natural capital is scarce, within the limits of the ecological environment, the improvement of welfare is a fundamental requirement for sustainable development. The ecological wellbeing performance (EWP) of 284 cities in China from 2007 to 2020 was measured by the superefficient SBM-DEA model, considering undesirable output, and analyzing the evolutionary trends of overall comprehensive technical efficiency, pure technical efficiency, and scale efficiency. The Theil index was used to explore the source and distribution of the Chinese cities' EWP differences. Exploratory spatial data analysis (ESDA) and the spatial Durbin model (SDM) were applied to analyze the spatial distribution characteristics and driving factors of cities' EWP. The results showed the following: (1) Regarding spatial and temporal distribution, the EWP of Chinese cities showed a fluctuating upward trend, in which pure technical efficiency > scale efficiency. (2) Considering regional differences, the differences in cities' EWP were mainly intraregional rather than interregional. The contribution rates of distinct regions to the differences in EWP varied, i.e., western region > eastern region > central region > northeastern region. (3) In terms of spatial correlation, China's EWP showed positive spatial correlation, i.e., high-high agglomeration and low-low agglomeration. (4) Concerning influencing factors, the level of financial development, the structure of secondary industries, the level of opening-up, and the degree of urbanization significantly improved EWP. Decentralization of fiscal revenue significantly inhibited improvement of EWP. Decentralization of fiscal expenditure and technological progress had no significant impact on the EWP. In the future, to improve cities' EWP, China should focus on reducing differences in intraregional EWP, overcoming administrative regional limitations, encouraging regions with similar locations to formulate coordinated development plans, promoting economic growth, reducing levels of environmental pollution, and paying attention to the improvement of social welfare.

Trends in the Use of Home LTC Services in Large, Medium and Small Municipalities in Italy: Lessons for the Post-COVID-19 Reappraisal

Italian Long-Term Care is considered largely inadequate, and the recent COVID-19 pandemic has dramatically exposed its limitations. Public Home Care Services in particular were revealed as under-financed and unable to cover the potential demand for care from the older population. But does the type of municipality and its geographic location play a role in creating or mitigating unmet demand? This is the first study addressing this research question in Italy. Our hypothesis is that older people's care preferences and care possibilities may vary between small, medium and metropolitan areas, as will the organisation, funding and availability of services, and the combination will influence (unmet) demand for public home care services. In this paper, using nationally representative survey data collected by the Italian National Statistical Institute in 2003 and 2016, we investigate changes and differences in the use of public and private home care services among people aged 75 or older in Italy by size of the municipality. Our results reveal inequalities in service use between Northern and Southern areas of the country and in particular between metropolitan areas, medium and small municipalities. Such differences reinforce post-pandemic calls for new investment and changes in the design of the Italian Long-Term Care system.

Temporal development in survival, and gender and regional differences in the Swedish population of patients with synchronous and metachronous metastatic colorectal cancer

BACKGROUND

Survival in patients with metastatic colorectal cancer (mCRC) has markedly improved in patients included in clinical trials. In population-based materials, improvements were seen until about a decade ago, but it is unclear if survival has continued to improve. It is also unclear if regional or gender differences exist.

MATERIAL AND METHODS

All patients with mCRC (N = 19,566) in Sweden between 2007 and 2016 were identified from the national quality register, SCRCR, with almost complete coverage. Overall survival (OS) from diagnosis of metastatic disease was calculated in two calendar periods, 2007-2011 and 2012-2016. Differences between groups were compared using Cox regression.

RESULTS

Median age was 72 years, 55% were males, synchronous presentation was seen in 13,630 patients and metachronous in 5936. In synchronous disease, the primary tumour was removed more often during the first than the second period (51% vs 41%, p < 0.001). Median OS (mOS) was 14.0 months. It was longer in those with metachronous than synchronous disease (17.6 vs 13.1 months, p < 0.001) and in males (15.0 vs 12.8 months, p < 0.001), and markedly influenced by age and primary location. It was longer in patients diagnosed during the second period than during the first (14.9 vs 13.1 months, HR 0.89 (95% CI 0.86-0.92), p < 0.001). This difference was seen in all subgroups according to sex, age, presentation, and sidedness. mOS was about one month shorter in 1/6 healthcare regions, most pronounced during the first period. Differences in median of up to 5 months were seen between the region with the shortest and longest mOS.

CONCLUSIONS

Overall survival in Swedish patients with mCRC has improved during the past decade but is still substantially worse than reported from clinical trials/hospital-based series, reflecting the selection of patients to trials. Regional differences were seen, but they decreased with time. Women did not have a poorer prognosis in multivariable analyses.

Evaluation of Common Prosperity Level and Regional Difference Analysis along the Yangtze River Economic Belt

Common prosperity is the essential requirement of socialism as well as the common aspiration of social people. This article constructed an evaluation index system of 25 indicators for common prosperity, covering four dimensions of material wealth, harmonious social life, rich spiritual life, and livable ecological environment. The TOPSIS method was used to comprehensively rank nine provinces and two municipalities in the Yangtze River Economic Belt. The results show that the level of common prosperity along the Yangtze River Economic Belt increased significantly from 2010 to 2019, and the level of common prosperity in the lower reaches of the Yangtze River Economic Belt is much higher than that in the middle and upper reaches. According to the differences in common prosperity levels among regions, provinces and cities are divided into three categories: high, unbalanced, and low. Combined with the characteristics of each type of region, policy suggestions were put forward from the perspectives of strengthening the regional industrial cooperation mechanism, deepening the construction of regional livelihood infrastructure and basic public services, and improving the ability of regional environmental coordination.

Evaluation of the Results of China's Fiscal Medical and Health Expenditure

Purpose

To evaluate the resulting level of fiscal medical and health expenditure in China, and to provide the scientific basis for further improving fiscal medical and health service capacity in China.

Patients and Methods

The data envelopment method and Gini coefficient method were used to analyze the efficiency and regional fairness of fiscal medical and health expenditure results by using the relevant provincial and municipal data of China from 2007 to 2019.

Results

1.Overall, from 2007 to 2019, the total expenditure continued to increase, the expenditure efficiency increased first and then decreased, and the expenditure fairness continued to improve. 2. From the perspective of subregions, there are apparent differences between regions in terms of total expenditure, expenditure efficiency, and expenditure fairness, showing a better situation in the central, western, northeast and a lower situation in the east.

Conclusion

The overall level of fiscal medical and health expenditure in China shows an upward trend, but there is still much room for improvement. At the same time, there are pronounced regional differences, and the problems of efficiency and fairness coexist among regions. Therefore, in the future, we should increase medical and health investment and enhance the government’s close attention; Improve the expenditure performance appraisal system; Formulate policies according to local conditions and avoid “one size fits all.”.

Spatiotemporal Differences, Dynamic Evolution and Trend of the Coupled Coordination Relationship between Urbanization and Food Security in China

Scientific assessment of the coupled coordination degree between urbanization and food security (CDUFS) revealed regional differences and sources. Dynamic evolution and trends are important references for achieving a coordinated interaction between high-quality urbanization and ensuring food security. Specifically, the CDUFS was measured using prefectural panel data in China from 2000 to 2019 and the coupling coordination degree model, which revealed its spatial correlation and differentiation. On this basis, in order to examine the spatiotemporal differences and evolution of the CDUFS, the Dagum-Gini coefficient and Kernel density estimation were innovatively used to analyze its regional differences and evolution distribution. The spatial Markov chain was further employed to examine the evolution trend of the CDUFS. The study found that the CDUFS showed a downward trend in fluctuation within the low coordination interval. There was a positive spatial correlation, with a more stable distribution pattern of high-high and low-low clusters. The regional differences in the CDUFS were obvious and the overall difference has expanded. The main source of regional differences among different food functional areas was inter-regional differences, followed by intra-regional differences. The regional difference between food main producing areas and food main marketing areas was the highest. The CDUFS shows a single-peak distribution; the imbalance between regions was still prominent with a left trailing phenomenon and no convergence. The CDUFS has the stability of maintaining the original state, and the probability of leapfrogging evolution is low in the short term. Finally, the geospatial effect plays an important role in the dynamic evolution of the CDUFS.

Forecasting China's energy demand post-COVID-19 pandemic: Insights from energy type differences and regional differences

As the first country to restart the economy after the COVID-19 pandemic, China's fast-growing energy consumption has brought huge challenges to the energy system. In this context, ensuring a stable energy supply requires accurate estimates of energy consumption for China's post-Covid-19 pandemic economic recovery. To this end, this study uses multiple panel regression model to explore the relationship between energy consumption and economic growth from the perspective of energy sources (total energy, coal, oil, natural gas) and regional difference. The data from 30 provinces in China from 2000 to 2017 were selected. Our findings indicate that China economic growth has led to the largest increase for oil consumption, followed by natural gas consumption, and finally coal consumption. That is, China economic growth has led to the largest increase for oil consumption, followed by natural gas consumption, and finally coal consumption. In addition, the coefficients of regional energy consumption equations are heterogeneous. Among them, energy consumption growth in provinces with high energy consumption is most affected by economic growth, followed by provinces with low energy consumption, and finally provinces with middle energy consumption.

How to Evaluate Investment Efficiency of Environmental Pollution Control: Evidence from China

Clarifying the efficiency of investment in environmental pollution control is conducive to better control of environmental pollution. Based on panel data of 30 provinces and cities in China from 2008 to 2017, this study combines the three-stage super-efficient SBM-DEA model and the Global-Malmquist-Luenberger index to measure the efficiency of investment in environmental pollution control in China and analyze regional differences. The results show that: First, the investment efficiency of environmental pollution control in China shows a rising trend year by year, but there are significant differences among provinces and regions; the presence of random factors and environmental variables makes the control efficiency underestimated. Second, excluding the effects of both, the national investment efficiency of environmental pollution control has improved significantly, but still has not reached the optimal effect; the gap between provinces and regions has narrowed while the investment efficiency of environmental pollution control has improved, and there is still an unbalanced situation. Third, the main driver of the year-on-year improvement in China’s environmental pollution control efficiency is technological progress; compared with northeastern China, technological progress has a more significant role in promoting eastern, central, and western China. Finally, based on the results, this paper focuses on making suggestions to promote environmental pollution control in China in terms of making regional cooperation, making good environmental protection investment and strengthening environmental protection technology research and development.

COVID-19 Pandemic in Dialysis Patients: The Swiss Experience

Background

Chronic dialysis patients are classified as patients with increased risk for COVID-19. Knowledge about the incidence and survival of chronic dialysis patients infected with SARS-CoV-2 in Switzerland - a high-income country with high density of relatively small dialysis centers - is scarce. We present the findings regarding incidence, survival and regional differences, compared to those of the general population in Switzerland.

Methods

Information on chronic dialysis patients who tested positive for SARS-CoV-2 between February 24, 2020 and February 28, 2022 were reported to the Swiss dialysis registry by all 94 Swiss dialysis centers. Hereafter, these results were linked with clinical characteristics from the Swiss dialysis registry.

Results

Throughout the study period 1,120 out of ~4,700 dialysis patients tested positive for SARS-CoV-2 in Switzerland: 96 cases occurred in the first wave, 472 in the second wave and 5 in between. During the first wave, Italian-speaking Ticino was most severely affected, with a 7-fold higher incidence of dialysis patients compared to the general Swiss population. In the second wave, the majority of cases were found in the French-speaking part of Switzerland, with a 2.5 times higher incidence vs. non-dialysis patients. A total of 123 deaths were recorded in the first two waves, of which COVID-19 was the main cause of death in 100 patients. This corresponds to a highly increased overall mortality rate of 17.5% compared to 1.7% in the general population. Age was identified as the only risk factor for mortality in dialysis patients. During the third, fourth and fifth wave, 61, 43 and 443 cases, respectively, were recorded, resulting in 6 (mortality rate 9.8%), 1 (mortality rate 2.3%) and 13 deaths (mortality rate 2.9%).

Conclusion

Chronic dialysis patients in Switzerland were more likely to be infected by SARS-CoV-2 during the first and second wave than the rest of the population, but an inverse trend was observed during the third, fourth and fifth wave, probably thanks to vaccination. In addition, mortality is significantly increased compared to non-dialysis patients. In Swiss dialysis patients, age is the strongest risk factor for death.

Are We Ready for a New Approach to Comparing Coverage and Reimbursement Policies for Medical Nutrition in Key Markets: An ISPOR Special Interest Group Report

OBJECTIVES

Healthcare policy makers should ensure optimal patient access to medical nutrition (MN) as part of the management of nutrition-related disorders and conditions. Questions remain whether current healthcare policies reflect the clinical and economic benefits of MN. The objective of this article is to characterize coverage and reimbursement of MN, defined as food for special medical purposes/medical food for a diverse set of countries, including Australia, Belgium, Brazil, Canada, China, France, Germany, Hong Kong, Italy, Japan, The Netherlands, Singapore, Spain, United Kingdom, and United States.

METHODS

Data sources included published literature and online sources. ISPOR's Nutrition Economics Special Interest Group developed a data collection form to guide data extraction that included reimbursement coverage, years that reimbursement policies were established, and presence of a formal health technology assessment (HTA) for MN technologies.

RESULTS

Reimbursement coverage of MN technologies varied across the countries that were reviewed. All but 3 countries limited coverage to specific formulations of products, regardless of demonstrated clinical benefit. The year that reimbursement policies were established varied across countries (ranging from 1984 to 2017), and only 4 countries regularly update policies. France and Brazil are the only countries with a formal HTA process for MN technologies.

CONCLUSIONS

Most countries have limited MN reimbursement, have not updated reimbursement policies, and lack HTA for MN technologies. These limitations may lead to suboptimal access to MN technologies where they are indicated to manage nutrition-related disorders and conditions, with the potential of negatively affecting patient and healthcare system outcomes.

How Symbols and Social Interaction Influence the Experienced Utility of Sustainable Lifestyle Guiding Policies: Evidence from Eastern China

As the key to mitigating climate change, a sustainable lifestyle has become a focus of environment policy. Past studies have largely neglected the symbols of sustainable lifestyle guiding policies and failed to capture its effect on the experienced utility of sustainable lifestyle guiding policies (EUSLGP). To address this drawback, symbolic value was incorporated into a model consisting of social interaction and the EUSLGP. With data collected from 3257 respondents in Eastern China, ordinary least squares were applied to examine hypotheses and two-stage least squares based on the instrumental variable to verify the results. Results show that symbolic value combines self-expression value, relationship consolidation value, group identification value, and status-showing value, and is positively associated with EUSLGP. Social interaction plays a moderating role in the association between symbolic value and EUSLGP. Moreover, significant regional differences are discovered in the identified relationships. Consequently, policy suggestions, covering symbolic value, social interaction, and regional conditions, are proposed to enhance the EUSLGP for other countries and regions.

Low Adherence to the Mediterranean Diet Is Associated with Poor Socioeconomic Status and Younger Age: A Cross-Sectional Analysis of the EpiDoC Cohort

The Mediterranean diet (MD) is recognized as one of the healthiest dietary patterns as it has been consistently associated with several beneficial health outcomes. Adherence to the MD pattern has been decreasing in southern European countries for the last decades, especially among low socioeconomic groups. The aim of this study was to assess the adherence to the MD in Portugal, to evaluate regional differences, and explore associated factors (sociodemographic, economic, and lifestyles behaviors). This study used the third data collection wave of the Epidemiology of Chronic Diseases Cohort Study (EpiDoC 3). MD adherence was assessed using the Portuguese-validated MD adherence score (MEDAS) questionnaire. Non-adjusted and adjusted logistic regression models were used to assess the risk factors for low MD adherence and individual MEDAS items. In this cross-sectional evaluation of the EpiDoC 3 cohort study (n = 5647), 28.8% of the Portuguese population had low adherence to a MD. Azores and Madeira had lower adherence to the MD than the rest of the country. Younger individuals in lower income categories (e.g., OR_{finding it very difficult} = 1.48; 95% CI 1.16-1.91) and with a lower educational level (e.g., OR_{0-4 years} = 2.63; 95% CI 2.09-3.32) had higher odds of having a lower adherence to the MD. Portuguese adults have a high prevalence of low adherence to the MD, especially among those who are younger and have lower socioeconomic status. Public health policies to promote adherence to the MD should pay special attention to these groups.

Institutions matter: The impact of the covid-19 pandemic on the political trust of young Europeans

In this paper, we study the short-run evolution of political trust during the recent covid-19 pandemic using survey data for a sample of young individuals living in Germany, France, Italy, and Spain. In particular, we analyze whether pre-pandemic perceptions and experiences of citizens about various dimensions of local governments and institutional quality had any mediating effect on the evolution of political trust after the outbreak of the covid-19 pandemic. The results show a relative increase in political trust of about 9% in regions with high institutional quality (75th percentile) compared with regions with low institutional quality (25th percentile) over the period 2019-2020. This divergence can be associated with either a better performance of policymakers in high-quality institutions regions, or to more positive attitudes toward politicians by citizens that, before the pandemic, believed to live in regions with efficient institutions. Overall results are not affected by the inclusion of regional fixed effects or by possible differential evolution of political trust according to a large set of observable regional characteristics.

Regional variations in Sweden over time regarding the surgical treatment of acute cholecystitis: a population-based register study

OBJECTIVE

To provide optimal health care for patients with acute cholecystitis in need of acute cholecystectomy, resource allocation has to be optimized. The aim of this study was to assess possible regional inequity regarding the treatment of acute cholecystitis and explore regional differences in the management of acute cholecystitis.

METHODS

Data were retrieved from the Swedish National Register for Gallstone Surgery and Endoscopic Retrograde CholangioPancreatography. Between January 2010 and December 2019, 22,985 patients who underwent cholecystectomy for acute cholecystitis and without prior history of acute cholecystitis were included in the study. The ratio of cholecystectomies with acute cholecystitis performed within two days of admission to hospital compared to population density was studied. Furthermore, the proportion of acute performed cholecystectomies within two days of admission in regions, with or without tertiary care centers, was also examined.

RESULTS

No correlation between population density and proportion of acute performed cholecystectomies was found. Regions without tertiary care centers had a higher proportion of acute cholecystectomies performed within two days (5-10%). The difference in the ratio of acute cholecystectomies within two days of admission was significant for all years investigated except 2010.

CONCLUSIONS

The presence of a tertiary referral center within the region had a greater influence than the population density on the chance of undergoing acute cholecystectomy for patients with acute cholecystitis. There are several potential explanations for this, one being an interference of the needs of patients requiring tertiary referral center care with the needs of patients in need of acute care surgery.

A cross-sectional analysis of 2017 stroke symptoms recognition at the US regional level

OBJECTIVES

Stroke symptom recognition is critical in reducing time to treatment, but it is not known whether the increased support for stroke education programs during the last several years has led to an improvement in regional stroke symptom recognition levels since they were last assessed in the mid-2010s.

METHODS

We used the most current estimates of recognition from the 2017 National Health Interview Survey to examine regional recognition levels for individual stroke symptoms and correct identification of all five stroke symptoms.

RESULTS

Recognition of individual stroke symptoms was ≥76% in all regions, but correct identification of all stroke symptoms was lower ranging from 68.8 to 70.2%. Recognition of sudden numbness or weakness of face, arm, or leg, especially on one side (Northeast: 94.9%, Midwest: 95.8%, South: 93.8%, West: 94.5%) was the highest and recognition of sudden headache with no known cause (Northeast: 77.6%, Midwest: 76.4%, South: 77.7%, West: 76.5%) was the lowest for all regions.

DISCUSSION

We observed similar stroke symptom recognition levels in each US region with little improvement since the mid-2010s. Additional effort should be made to increase recognition of sudden headache with no known cause in US regions with current high prevalence of stroke risk factors.

Families' Worries during the First and Second COVID-19 Wave in Germany: Longitudinal Study in Two Population-Based Cohorts

This study aimed to compare worries related to the Coronavirus disease 2019 (COVID-19) in families with young children in two regions in Germany differently affected by the pandemic (Regensburg in Southeast Germany, Leipzig in Eastern Germany) during the first and the second waves of the COVID-19 pandemic. 720 parents participating in the KUNO Kids health study in Regensburg (n = 507) or the LIFE Child study in Leipzig (n = 213) answered questions regarding COVID-19-related worries and trust in anti-pandemic policy measures during the first wave (spring 2020) and during the second wave (winter 2020/2021) of the pandemic. Ordinal mixed-effects models were performed to assess differences depending on region and time, adjusting for education and migration background. Participants worried most about the general economic situation and their family and least about their own health or financial situation. Worries about oneself, family, friends, hometown, and country were stronger during the second than during the first wave. In regional comparisons, worries about family, friends, and hometown increased more pronouncedly from wave 1 to wave 2 in Leipzig (OR ranging from 2.67 (95% CI 1.71−4.19) to 3.01 (95% CI 1.93−4.71), all p < 0.001) than in Regensburg (OR ranging from to 1.38 (95% CI 1.08−1.78) to 1.72 (95% CI 1.33−2.21), all p < 0.05), running parallel with the increase in SARS-CoV-2 infections. Trust in anti-pandemic policy measures, in contrast, decreased significantly between wave 1 and wave 2, with a stronger decrease in Regensburg (OR = 0.30 (95% CI 0.22−0.39), p < 0.001) than in Leipzig (OR = 0.91 (95% CI 0.59−1.41), n.s.). The degree of families’ COVID-19-related worries differs by region and time, which might be related to differences in infection rates and public interest. Regional differences should be taken into account when developing communication strategies and policy measures during the COVID-19 pandemic.

Study on Regional Differences and Convergence of Green Development Efficiency of the Chemical Industry in the Yangtze River Economic Belt Based on Grey Water Footprint

Grey water footprint is included in the green development efficiency evaluation index system of the chemical industry. From 2002 to 2016, the super efficiency Slack Based Measure (SBM) model was used to measure the green development efficiency of the chemical industry in the Yangtze River Economic Belt. Dagum Gini coefficient and its decomposition method were used to decompose the regional differences of green development efficiency of the chemical industry in the Economic Belt, and the coefficient of variation method and panel data regression model were used to test the convergence characteristics. The following results were obtained. (1) The total grey water footprint of the chemical industry in the Yangtze River Economic Belt showed a fluctuating downward trend from 2002 to 2016. (2) The green development efficiency of the chemical industry in the Yangtze River Economic Belt was significantly improved, and the spatial differentiation law of gradient decline in the upper, middle, and lower reaches of the Economic Belt was shown. (3) The regional difference of green development efficiency of the chemical industry in the Yangtze River Economic Belt initially showed an expanding trend and then a narrowing trend. Regional differences in the upper reaches of the Yangtze River increased while those in the middle reaches first increased and then decreased, whereas those in the lower reaches decreased significantly. The variance in green development efficiency of the chemical industry is the main cause of regional differences. (4) From 2012 to 2016, the Yangtze River Economic Belt had obvious convergence in its whole region, middle reaches, and lower reaches and an inconspicuous convergence in the upstream area. Regional difference of green development efficiency of the chemical industry in the Economic Belt was the combined effect of the results of environmental regulation, industrial structure, foreign investment intensity, and scientific and technological advancements. Our results have high theoretical reference values and practical guiding significance for implementing the green efficiency promotion strategy of the chemical industry in Yangtze River Economic Belt by region and classification.

COVID-19: Regional Differences in Austria

In the turbulent year 2020, overshadowed by the global COVID-19 pandemic, Austria experienced multiple waves of increased case incidence. While governmental measures to curb the numbers were based on current knowledge of infection risk factors, a retrospective analysis of incidence and lethality at the district level revealed correlations of relative infection risk with socioeconomic, geographical, and behavioral population parameters. We identified unexpected correlations between political orientation and smoking behavior and COVID-19 infection risk and/or mortality. For example, a decrease in daily smokers by 2.3 percentage points would be associated with an increase in cumulative incidence by 10% in the adjusted model, and an increase in voters of the right-wing populist party by 1.6 percentage points with an increase in cumulative mortality by 10%. While these parameters are apparently only single elements of complex causal chains that finally lead to individual susceptibility and vulnerability levels, our findings might have identified ecological parameters that can be utilized to develop fine-tuned communications and measures in upcoming challenges of this and other pandemics.

Regional Differences in School-Based Physical Therapy: Examination of Therapist and Student Characteristics, Service Delivery, Activities, Interventions, and Outcomes

AimsThe aim of this study was to examine regional differences in school-based physical therapy practice focusing on the attributes of the school-based physical therapists and students; service delivery approaches, activities, and interventions; and student outcomes. Recognition of regional practices may decrease unnecessary variations, and assist with therapist clinical decision making and efforts to implement evidence-informed practice.MethodsA secondary data analysis of the PT COUNTS data was performed to compare physical therapist and student attributes; service delivery, activities, and interventions; and student outcomes across the Northeast, Southeast, Central, and Northwest regions of the United States.ResultsDifferences in the physical therapist and student characteristics, service delivery, activities, and interventions existed across the regions. There were no regional differences in outcomes when controlling for student functional level.ConclusionRegional differences in school-based practices may be expected and indicative of the influence of contextual factors including state and local policies and procedures that shape school-based service delivery and the characteristics of the therapists and students. Regional differences in practices may not have been of sufficient clinical magnitude to alter outcomes. Physical therapists can use the findings to reflect upon their individual decision making and practices.

The driving effect of informal economies on urbanization in China

This paper examines the rise of informal economies in China, a hidden driving force overlooked in studies on China’s urbanization. Estimating the size of informal economies using the multiple indicators multiple causes model, the paper employs mathematical models to examine the driving effect of informal economies on urbanization and to reveal the paths by which such effect works. The results were as follows. (1) In 2018, the size of the informal economy in China accounted for 23.5% of GDP with an output value of 21.16 trillion yuan. (2) The informal economy had a driving effect on China’s urbanization, and every 1-percentage-point increase in its share of the GDP led to an increase of 0.291 percentage points in the urbanization rate. (3) The informal economy’s effect on urbanization showed regional differences, decreasing in size from the eastern to the central to the western regions. (4) The informal economy drives urbanization through four paths — by promoting foreign direct investment (FDI), fixed asset investment (FAI), social consumption (SC), and secondary sector employment (SSE). Their effect sizes are ranked in descending order as follows: FDI > FAI > SC > SSE. This paper contributes to theories on urbanization dynamics and process in China by highlighting the role of the informal economy as a hidden economic power lurking in the city.