[Key Issues and Challenges in Establishing Regionally Differentiated Water Quality Standard in China].

The goal of environmental management in China is transitioning from pollution control to the improvement of ecological quality. The establishment of regional differential water quality standards can better adapt to the ecological characteristics and development needs of different regions. Given the shortcomings of current water quality standards and the needs of technological development, this study analyzed the causes and influencing factors of regional differences in water quality standards and summarized China's regional variations in areas such as the characteristics of receiving water bodies, social attributes, climate conditions, physicochemical properties of water, and aquatic biotic populations. It also examined the impact of regional characteristics on the assessment of biological toxicity. Based on these analyses, the study identified key scientific questions that may arise in the development of regional differential water quality standards in China and outlined future critical research directions in this field. These directions include developing theories and methods for determining the effluent dilution coefficient, establishing methods for identifying regional key water quality indicators and assessing their impact on water quality standards, determining regional characteristic species and their influence on water quality standards, and formulating theories and methods for categorizing different regions across the country. The aim of the study was to provide a reference for the scientific establishment of water quality standards in China.

Socio-economic factors and rural-urban differences in patients undergoing emergency laparotomy.

Background: Emergency laparotomy (EL) is a common surgical procedure with high rates of mortality and complications. Socio-economic circumstances and regional differences have an influence on the utilization of care and outcomes in many diagnostic groups, but there are only a few studies focusing on their effect in EL population. The aim of this study was to examine the socio-economic and regional differences in the rate of EL within one tertiary care hospital district. Methods: Retrospective single-center study of 573 patients who underwent EL in Oulu University Hospital between May 2015 and December 2017. The postal code area of each patient's home address was used to determine the socio-economic status and rurality of the location of residence. Results: The age-adjusted rate of EL was higher in patients from low-income areas compared to patients from high-income areas [1.46 ((95% CI 1.27-1.64)) vs. 1.15 (95% CI, 0.96-1.34)]. The rate of EL was higher in rural areas compared to urban areas [1.29 (95% CI 1.17-1.41 vs. 1.42 (1.18-1.67)]. Peritonitis was more common in patients living in low-income areas. There were no differences in operation types or mortality between the groups. Conclusions: The study findings suggest that there are socio-economic and regional differences in the need of EL. The patients living in low-income areas had a higher rate of EL and a higher rate of peritonitis. These differences cannot be explained by patient demographics or comorbidities alone.

Assessing and gauging the carbon emission efficiency in China in accordance with the sustainable development goals.

In light of the growing urgency of climate change, carbon emissions reduction has emerged as a pivotal concern within global governance. In this paper, we take carbon emission efficiency (CEE) as the research object to characterize the relationship between economic, social, and environmental development in the context of the Sustainable Development Goals (SDGs). According to the regional division standard of eight comprehensive economic zones in China, this paper analyzed the spatial differences, evolutionary characteristics, and influencing factors of CEE in 257 Chinese cities over the period 2003-2019. The analysis conducted the Dagum Gini Coefficient, Markov Transition Probability Matrix, and geographically and temporally weighted regression model (GTWR). The results demonstrate that: (1) The CEE of Chinese cities exhibits an upward trajectory. (2) The inter-differences among the eight comprehensive economic zones represent the primary spatial source of CEE divergence. (3) The CEE of Chinese cities is a staged process of gradual enhancement with spatial spillover effects. (4) Environmental regulation, energy consumption intensity, and green finances are significant factors affecting CEE, and the direction and intensity of their influence have distinct spatial heterogeneity. Ultimately, this paper proposes measures to narrow the development gap between regions and enhance the CEE across the region. Meanwhile, implementing regional refinement management and formulating differentiated regional sustainable development planning.

An estimation of future county-level cement production and associated air pollutant emissions in China through artificial neural networks.

Cement production and its air pollutant and carbon dioxides (CO2) emissions in China will be relocated greatly as a joint effect of diverse development of industrial economy and implementation of environmental policies for different regions. The future pathway and spatial pattern of emissions are important for policy making of air quality improvement and CO2 emission abatement, as well as coordinating regional development. In this study, we developed an artificial neural network (ANN) model to predict cement production at the county level and to calculate the associated emissions of air pollutants and CO2 at the county level till 2060. Results show that the cement production will decline from 2327 million metric tons (Mt) in 2015 to 704 Mt. in 2060 under the Shared Socioeconomic Pathways 1 (SSP1). Counties closer to provincial capital will experience greater retirement of cement industry. Likewise, the emissions of air pollutants and CO2 will experience a steady downward trend driven by the declining cement production and the improvement of pollution control technologies. There will be a more significant regional heterogeneity in the reduction of production and emissions at city level compared to the province level. With the clearance for nearly two-thirds of counties, future cement production and emissions will be more intensively distributed in a few cities. The shares of emissions in southwestern regions will grow from 2015 to 2060 while those of eastern regions will continue decreasing. The comparison between the changing spatial distributions of emissions and gross domestic product (GDP) indicates a positive effect of existing policies in reconciling regional economic development and air pollution controls. The outcome could support the analyses on the impact of industrial development on air quality and public health, and the method can be applied widely for other industrial sectors for a more comprehensive understanding of future emission relocation.

Unnoticed antimicrobial resistance risk in Tibetan cities unveiled by sewage metagenomic surveillance: Compared to the eastern Chinese cities.

Sewage surveillance is a cost-effective tool for assessing antimicrobial resistance (AMR) in urban populations. However, research on sewage AMR in remote areas is still limited. Here, we used shotgun metagenomic sequencing to profile antibiotic resistance genes (ARGs) and ARG-carrying pathogens (APs) across 15 cities in Tibetan Plateau (TP) and the major cities in eastern China. Notable regional disparities in sewage ARG composition were found, with a significantly higher ARG abundance in TP (2.97 copies/cell). A total of 542 and 545 APs were identified in sewage from TP and the East, respectively, while more than 40 % carried mobile genetic elements (MGEs). Moreover, 65 MGEs-carrying APs were identified as World Health Organization (WHO) priority-like bacterial and fungal pathogens. Notably, a fungal zoonotic pathogen, Enterocytozoon bieneusi, was found for the first time to carry a nitroimidazole resistance gene (nimJ). Although distinct in AP compositions, the relative abundances of APs were comparable in these two regions. Furthermore, sewage in TP was found to be comparable to the cities in eastern China in terms of ARG mobility and AMR risks. These findings provide insights into ARGs and APs distribution in Chinese sewage and stress the importance of AMR surveillance and management strategies in remote regions.

Health care policy and arthroscopic rotator cuff repair prices in the United States.

BACKGROUND: Arthroscopic rotator cuff repair (ARCR) is one of the most common orthopedic procedures in the general population. Despite its prevalence, the price of ARCR varies significantly across regions, hospital models, and settings. The purpose of this study was to examine the effect of Geographic Region, Certificate of Need (CON) laws, and Medicaid expansion on ARCR pricing. METHODS: This cross-sectional observational study used hospital payer-specific ARCR prices from the Turquoise Health Database using Current Procedural Terminology code 29827. These prices are negotiated rates or charges that hospitals establish with various payers, including insurance companies, Medicare, Medicaid, and self-pay patients, for medical services and treatments provided. Outliers below the 10th percentile and above the 90th percentile were excluded. State policies, including CON status and Medicaid expansion, were obtained from public sources, whereas additional socioeconomic and demographic data were sourced from the US Census. The state's region classification was determined based on 1 of 4 Geographic Regions defined by the US Census Bureau. A detailed analysis was also conducted for North Carolina, examining county-level data on urbanization and the Area Deprivation Index. RESULTS: There were 57,270 ARCR prices from 2503 hospitals across the United States, with a median interquartile range listed price of $6428.17 (interquartile range: $2886.88). States with CON regulations had significantly lower ARCR prices than those without ($6500 vs. $8000, P < .0001). Multivariable analysis indicated that hospitals in the Northeast and West Regions listed significantly higher prices for ARCR than those in the Midwest Region (P < .0001). In contrast, hospitals in the South Region listed lower prices for ARCR than those in the Midwest Region (P < .0001). Medicaid expansion was associated with increased ARCR prices (P < .0001), whereas CON laws were linked to reduced prices (P < .0001). In North Carolina, Area Deprivation Index and urbanization status did not significantly affect ARCR prices. CONCLUSION: The prices listed for ARCR varied significantly depending on the Geographic Region where hospitals were located. In addition, CON laws were associated with reduced ARCR prices, whereas Medicaid expansion correlated with increased prices. These findings highlight the complex interplay between health care policy, regulatory frameworks, and socioeconomic factors in determining surgical prices.

[Characteristics of applicants with first-time determination of need for long-term care-A nationwide analysis of care assessments of applicants insured with the AOK aged 60 years and above]. / Charakteristika von Antragstellenden bei erstmaliger Feststellung einer Pflegebedürftigkeit ­ eine bundesweite Analyse von Pflegebegutachtungen von AOK-Versicherten ab 60 Jahren.

BACKGROUND: The increasing number of care-dependent individuals requires approaches to prevent care dependency or reduce the loss of independence. Long-term care assessments can provide valuable insights into this. OBJECTIVE: The aim of this article is to describe initial applicants with an identified need for long-term care as well as to provide a differentiated analysis of care-related diagnoses by age, gender, care level and federal state. MATERIAL AND METHODS: The nationwide database consists of long-term care assessments conducted by the Medical Service (MD) of individuals insured with the AOK aged 60 years and above who received a care level (PG) for the first time in 2021. Information relevant to long-term care was analyzed descriptively. RESULTS: In this study 339,486 individuals with an average age of 79.6 years (±8.4 years) and a female proportion of 59.0% were analyzed. Approximately one half received care level 2 and 32.4% received care level 1. Care levels 3-5 were assessed less frequently (16.2% vs. 4.8% vs. 1.7%, respectively). Individuals living alone were represented more strongly in lower care levels, while individuals not living alone had a higher proportion in care levels 3-5. The most frequent care-relevant diagnoses were senility (R54), polyarthritis (M15) and dementia (F03) with significant differences observed between federal states (ICD-10 R chapter: 0.8% Berlin and Brandenburg vs. 37.9% Saxony; M chapter: 13.6% Bavaria and Hamburg vs. 39.9% Mecklenburg-Western Pomerania). CONCLUSION: Social determinants, such as age, gender, living alone, and region can play a role in the classification into a care level. Significant differences in care-related diagnoses between federal states warrant further investigation in future research.

High socioeconomic impact on prescription behavior despite unrestricted access to disease-modifying therapies in people with multiple sclerosis.

Background: Economic and health care restraints strongly impact on drug prescription for chronic diseases. We aimed to identify potential factors for prescription behavior in chronic disease. Multiple sclerosis was chosen as a model disease due to its chronic character, incidence, and high socioeconomic impact. Methods: Germany was used as a model country as the health-care system is devoid of economic and drug availability restraints. German statutory health insurance data were analyzed retrospectively. The impact of number of university hospitals and neurologists as well as the gross domestic product (GDP) as potential factors on prescriptions of platform and high-efficacy disease-modifying therapies (DMTs) was analyzed. Results: Prescription of platform DMTs increased over time in almost all federal states with varying degree of increase. Univariate regression analysis showed that the prescription volume of platform DMTs positively correlated with the number of university hospitals and neurologists, as well as the GDP per federal state. Stepwise forward regression analysis including all potential factors indicated a statistically significant model for platform DMT (R2 = 0.55; 95%-CI [0.28, 0.82]; p=0.001) revealing GDP as the main contributor. This was confirmed in the independent analysis. Conclusion: This study illustrates that even without overt drug prescription inequity, access to medication is not evenly distributed and depends on economic strength and regional medical care density.

Sex differences in gray matter, white matter, and regional brain perfusion in young, healthy adults.

Cerebrovascular and neurological diseases exhibit sex-specific patterns in prevalence, severity, and regional specificity, some of which are associated with altered cerebral blood flow (CBF). Females often exhibit higher resting CBF, but understanding the impact of sex per se on CBF is hampered by study variability in age, comorbidities, medications, and control for menstrual cycle or hormone therapies. A majority of studies report whole brain CBF without differentiating between gray and white matter or without assessing regional CBF. Thus fundamental sex differences in regional or whole brain CBF remain unclarified. While controlling for the above confounders, we tested the hypothesis that females will exhibit higher total gray and white matter perfusion as well as regional gray matter perfusion. Adults 18-30 yr old (females = 22 and males = 26) were studied using arterial spin labeling (ASL) magnetic resonance imaging (MRI) scans followed by computational anatomy toolbox (CAT12) analysis in statistical parametric mapping (SPM12) to quantify CBF relative to brain volume. Females displayed 40% higher perfusion globally (females = 62 ± 9 and males = 45 ± 10 mL/100 g/min, P < 0.001), gray matter (females = 75 ± 11 and males = 54 ± 12 mL/100 g/min, P < 0.001), and white matter (females = 44 ± 6 and males = 32 ± 7 mL/100 g/min, P < 0.001). Females exhibited greater perfusion than males in 67 of the 68 regions tested, ranging from 14% to 66% higher. A second MRI approach (4-dimensional flow) focused on large arteries confirmed the sex difference in global CBF. These data indicate strikingly higher basal CBF in females at global, gray, and white matter levels and across dozens of brain regions and offer new clarity into fundamental sex differences in global and regional CBF regulation before aging or pathology.NEW & NOTEWORTHY MRI used to measure cerebral blood flow (CBF) in gray matter, white matter, and 68 regions in healthy men and women. This study demonstrated that CBF is 40% higher in women, the highest sex difference reported, when controlling for numerous important clinical confounders like age, smoking, menstrual cycle, comorbidities, and medications.

[Loneliness in Germany-prevalence, development over time, and regional differences]. / Einsamkeit in Deutschland ­ Prävalenz, Entwicklung über die Zeit und regionale Unterschiede.

BACKGROUND: Loneliness is widespread and has negative health consequences. The present study seeks to answer the following questions: (1) how many people in Germany are highly lonely, (2) how has loneliness changed in Germany over time-in particular with regard to the COVID-19 pandemic, and (3) how is loneliness distributed regionally in Germany today? METHODS: The present study uses data from the 2013, 2017, and 2021 waves of the Socio-Economic Panel, a population representative panel study from Germany. Based on the University of California, Los Angeles (UCLA) loneliness scale, we estimate prevalences for high loneliness for different risk groups in Germany. Further, using multi-level models, we estimate the changes in loneliness from 2013 to 2021. Finally, we generate regional maps to display the relative regional distribution of loneliness in Germany over the three assessment waves. RESULTS: The results show that around 2% of all people living in Germany are highly lonely, and this proportion has not changed during the COVID-19 pandemic. However, mean overall loneliness in Germany increased in the last decade, particularly during the pandemic. Additionally, the regional distribution of loneliness also changed. While eastern Germany was particularly affected by loneliness in 2013, western Lower Saxony, Rhineland-Palatine, and Hesse were the most affected regions during the pandemic. DISCUSSION: Reasons for these changes could be structural changes in the German society over the past 10 years or the COVID-19 pandemic and the different measures implemented to combat the spread of the COVID-19 virus. However, since the latest representative data on loneliness stems from 2021, further data collection is urgently needed to depict the current state of loneliness in Germany.

[Loneliness in Bavaria before and during the COVID-19 pandemic]. / Einsamkeit in Bayern vor und während der COVID-19-Pandemie.

BACKGROUND: Loneliness represents a significant health risk and is associated with numerous mental and physical conditions. The aim of this paper was to describe the prevalence of loneliness in Bavaria before and during the COVID-19 pandemic with respect to socio-demographic attributes. METHODS: Data sources were the German Ageing Survey (DEAS) and the Socio-Economic Panel (SOEP). Univariate statistical analyses were carried out for different socio-demographic attributes, such as age, gender, type of household, education, and financial resources. RESULTS: According to the SOEP, the proportion of adults who are often or very often lonely increased from 2.3% in 2017 to 16.2% in 2021. In 2021, women had a higher prevalence of loneliness than men (21.0% vs. 11.3%), and younger adults had the highest prevalence of loneliness (18 to 25 years: 31.7%) compared to the other age groups. DISCUSSION AND CONCLUSIONS: During the COVID-19 pandemic, loneliness increased in almost every population subgroup in Bavaria. Further studies are needed to examine whether this development is temporary or represents a long-term effect even after the measures to prevent the spread of COVID-19 have been lifted.

Regional differences in frailty among older adults with type 2 diabetes: a multicenter cross-sectional study in Japan.

BACKGROUND: Social environment may broadly impact multifaceted frailty; however, how environmental differences influence frailty in older adults with diabetes remains unclear. This study aimed to investigate regional differences in frailty in urban and rural areas among older adults with diabetes. METHODS: This cross-sectional study was conducted as part of the frailty prevention program for older adults with diabetes study. Older adults aged 60-80 years who could independently perform basic activities of daily living (ADLs) were enrolled sequentially. Trained nurses obtained patient background, complications, body weight, body composition, blood tests, grip strength, frailty assessment, and self-care score results. Regional differences in frailty were evaluated using logistic and multiple linear regression analyses. RESULTS: This study included 417 participants (269 urban and 148 rural). The prevalence of robustness was significantly lower in rural areas than in urban areas (29.7% vs. 43.9%, p = 0.018). Living in rural areas was associated with frailty (odds ratio [OR] 2.55, 95% confidence interval [CI] 1.38-4.71) and pre-frailty (OR 2.10, 95%CI 1.30-3.41). Lower instrumental ADL (B 0.28, standard error [SE] 0.073) and social ADL (B 0.265, SE 0.097) were characteristics of rural residents. CONCLUSIONS: Regional differences in frailty were observed. Older adults with diabetes living in rural areas have a higher risk of frailty owing to a decline in instrumental and social ADLs. Social environment assessment and intervention programs that include communication strategies to enable care and social participation across environments are crucial to the effective and early prevention of frailty.

[Life expectancy for the regions of the Northwestern Federal District. Part 2: Dynamics of old age threshold.]

The paper continues the study of the population ageing in the regions of the Northwestern Federal District. It characterized population ageing based on prospective ageing indicators that take into account remaining life expectancy. The dynamics of life expectancy (LE) at birth was analyzed. A computation and comparative analysis of the old age threshold for the regions that are part of the Northwestern Federal District have been carried out. A comparative analysis of ageing indicators - traditional and prospective (the proportion of the elderly and the share of the population above the old age threshold) was carried out. It has been found that there are no fundamental differences in the dynamics of life expectancy in older ages, as well as in the of old age threshold, between the regions considered. It is shown that for the male population in almost all regions in 2021, the value of the old age threshold is below 60 years, while for the female population the opposite inequality is observed. Thus, in 2021, the share of men over the old age threshold exceeds the proportion of the elderly in almost all regions considered, and for the female population, the share of the elderly is expected to be higher than the values of the prospective indicator.

The impact of anti-COVID measures on accommodation performance.

Background: This article analyses mass accommodation facilities to examine the development of Czech tourism during the COVID-19 pandemic of 2020 and 2021. Methods: The questionnaire survey was carried out in March 2021 in mass accommodation facilities. 131 responses were received from hotels and guesthouses throughout Czechia, which represents a return rate of 20%. Data were processed using Pearson's chi-square test to determine the effect of changes in facility type and category, quality, location, and primary focus before the outbreak of the pandemic. A statistical analysis of data on overnight stays was also used with data from the public database of the Czech Statistical Office. Results: The study confirmed the increasing importance of domestic tourism and the greater sensitivity of destinations dependent on foreign tourists. Future strategies should be associated with destination rather than corporate management. The challenges are linked to the strengthening of environmentally friendly and sustainable tourism. To what extent the post-covid situation will return to the original model and to what extent it will at least partially reflect the changes that took place during the crisis period is a question for future research. Conclusions: Moving from operational to strategic measures would be advisable.

Efficiency evaluation, regional technological heterogeneity and determinant of total factor productivity change in China's healthcare system.

Enhancing efficiency and productivity in countries' healthcare systems is a global challenge. The Chinese government invested huge resources to improve the efficiency and productivity of the healthcare system across the country. To assess the success of the mission above, this research utilized DEA-SBM Meta frontier analysis alongside the Malmquist Productivity Index. These methodologies were employed to gauge Efficiency, production technology heterogeneity, and productivity of healthcare systems change across 31 mainland Chinese provinces and four distinct geographical regions throughout the study period spanning from 1997 to 2022. Results revealed that the mean efficiency score of China's healthcare system is 0.7672. It indicates a growth potential of 23.28 percent in the operational efficiency of healthcare systems. The eastern region's efficiency level (0.86917) is higher among all four regions. Zhejiang, Shandong, and Guangdong are the top three healthcare-efficiency performers. The technology gap ratio indicates that eastern regions witnessed a high TGR (0.9909), showing the country's attainment of superior healthcare technologies. Beijing, Guangdong, Shanghai, Tianjin, and Zhejiang witnessed higher TGR values among all 31 mainland Chinese provinces. The total factor productivity index of the healthcare system witnessed a slight growth of 0.33%, with an average MI score of 1.0033. Efficiency change (EC) was found to be the main determinant of TFPC as technology change TC is less than EC. Moreover, the MI score of the Western region (1.033) is higher than the corresponding Eastern, northeastern, and central regions. Guizhou, Anhui, and Yunnan were found to be the top three performers in TFPC growth. Finally, the Kruskal-Wallis test confirmed the statistically significant difference among 4 Chinese regions for the healthcare system's efficiency, TFPC, and TGR.

Geriatric syndrome awareness and its determinants in China: a cross-sectional study.

BACKGROUND: This study aims to investigate the awareness rate of six common geriatric syndromes and related influencing factors among the older adults aged 65 and above in China. METHODS: This is a multicenter cross-sectional study involving 6,653 participants aged 65 and older from four regions who completed a questionnaire on geriatric syndrome awareness. The questionnaire covered demographic data, health information, medication usage, and an assessment scale for knowledge of six geriatric syndromes (GS Awareness Scale). RESULTS: A total of 6,653 respondents were surveyed, with 5,318 valid questionnaires collected (79.93%), including 1,311 from Zhejiang (24.7%), 1,356 from Beijing (25.5%), 1,373 from Sichuan (25.8%), and 1,278 from Fujian (24.0%). The highest awareness was for falls, with 3,295 individuals (62.0%), followed by dementia with 2,929 individuals (55.1%), malnutrition with 2,907 individuals (54.7%), frailty with 2,156 individuals (40.5%), urinary incontinence with 2,006 individuals (37.7%), and sarcopenia with 1,914 individuals (36.0%). Univariate analysis showed that factors such as region, age, marital status, living situation, educational level, source of respondents, income status, and smoking had statistically significant differences in awareness rates (P < 0.05). Multivariate logistic regression results indicated that the source of respondents significantly affected the awareness rates (P < 0.05), with the older adults from rural areas having an increased risk of lower awareness compared to urban areas; age also significantly influenced the awareness rates (P < 0.05), with older age groups (76-85, 86-95 years) having a higher risk of reduced awareness compared to those aged 65-75 years. CONCLUSIONS: The awareness of common geriatric syndromes among the older adults population aged 65 years and older in China is notably low. Consequently, there exists a critical need to enhance the formulation of policies regarding geriatric syndromes across various regions, aiming to elevate health literacy among this demographic.

[Medicinal plant biodiversity in Jilin province based on big data of the fourth national survey of traditional Chinese medicine resources].

Using Origin2022Pro, PAST4.09, GraphPad, and ArcGIS, this study analyzed the big data of the fourth national survey of traditional Chinese medicine resources in Jilin province from five dimensions: differences in resource quantity, taxonomic group, family, and genus, regional distribution, and spatiotemporal distribution, aiming to fully elucidate the biodiversity of medicinal plants in Jilin province. The results indicated that 2 241 species of medicinal plants existed in Jilin province, belonging to 881 genera of 243 families, with 20 dominant families and 3 dominant genera. There were 1 901 species of medicinal plants(belonging to 778 genera of 227 families) in the eastern mountainous region, 1 503 species(belonging to 690 genera of 225 families) in the mid-mountainous areas of the central mountainous region, and 811 species(belonging to 436 genera of 136 families) in the western plain region. The biodiversity of medicinal plants in Jilin province was high and presented a trend of high in the east and low in the west. The medicinal plant resources were mainly concentrated in the eastern mountainous region, and the number of medicinal plant groups had significant diffe-rences between regions, following the trend of western region > central region > eastern region. The species richness was in the order of eastern region > western region > central region. The species diversity structure in the central region was similar to that in the eastern and western regions, while it was significantly different between the western and eastern regions. Compared with the third national survey of traditional Chinese medicine resources, the fourth survey showed an increase of 1 417 species, a decrease of 580 species, and 824 common species, indicating significant changes in the biodiversity of medicinal plants in Jilin province. The reasons for these changes need to be further explored. This article elucidates the background and biodiversity changes of medicinal plant resources in Jilin province, laying a foundation for the protection, utilization, and industrial development of traditional Chinese medicine resources in Jilin province.

Prevalence and Mortality of Life-Threatening and Life-Shortening Diseases in Children and Adolescents in Germany.

This study provides prevalence and mortality data for 0- to 19-year-old children and adolescents with medically documented life-threatening and life-shortening diagnoses in Germany. A secondary data analysis of more than 12 million insured persons documented by the statutory health insurance funds in Germany from 2014 to 2019 was conducted in collaboration with the German Association of Statutory Health Insurance Funds (GKV-SV) and the Institute for Applied Health Research Berlin (InGef), whose data sets vary in collection methods. Diagnosis prevalence and mortality were calculated based on selected International Classification of Diseases, 10th Revision (ICD-10) codes reported in inpatient and outpatient care settings. In Germany, the diagnosis prevalence of life-threatening and life-shortening diseases in children and adolescents ranges between 319 948 (InGef-adapted Fraser list) and 402 058 (GKV-SV). These diagnoses can be differentiated into different disease groups (Together-for-Short-Lives [TfSL] 1-4). The TfSL-1 group in which curative treatment can be feasible represents the largest one, with 190 865 persons. In 2019, approximately 1458 children and adolescents with life-threatening and life-shortening diseases died. The current diagnostic and mortality data of affected children and adolescents in Germany serve as the essential foundation for further research into the health care of the target group.

Regional Differences in Hepatitis C-Related Hospitalization Rates, United States, 2012-2019.

OBJECTIVES: In the United States, hepatitis C is the most commonly reported bloodborne infection. It is a leading cause of liver cancer and death from liver disease and imposes a substantial burden of hospitalization. We sought to describe regional differences in hepatitis C virus (HCV)-related hospitalizations during 2012 through 2019 to guide planning for hepatitis C elimination. METHODS: We analyzed discharge data from the National Inpatient Sample for 2012 through 2019. We considered hospitalizations to be HCV-related if (1) hepatitis C was the primary diagnosis or (2) hepatitis C was any secondary diagnosis and the primary diagnosis was a liver disease-related condition. We analyzed demographic and clinical characteristics of HCV-related hospitalizations and modeled the annual percentage change in HCV-related hospitalization rates, nationally and according to the 9 US Census Bureau geographic divisions. RESULTS: During 2012-2019, an estimated 553 900 HCV-related hospitalizations occurred in the United States. The highest hospitalization rate (34.7 per 100 000 population) was in the West South Central region, while the lowest (17.6 per 100 000 population) was in the West North Central region. During 2012-2019, annual hospitalization rates decreased in each region, with decreases ranging from 15.3% in the East South Central region to 48.8% in the Pacific region. By type of health insurance, Medicaid had the highest hospitalization rate nationally and in all but 1 geographic region. CONCLUSIONS: HCV-related hospitalization rates decreased nationally and in each geographic region during 2012-2019; however, decreases were not uniform. Expanded access to direct-acting antiviral treatment in early-stage hepatitis C would reduce future hospitalizations related to advanced liver disease and interrupt HCV transmission.

[Analysis of Regional Differences in Cadmium Ecological Risk in Surface Waters of the Yangtze River Basin].

This study primarily focused on the regional disparities in both water quality criteria and ecological risks attributed to cadmium presence within the surface waters of the Yangtze River Basin. In the initial phase, the long-term water quality criteria for cadmium were recalibrated in accordance with the guidelines outlined in China's "Water Quality Criteria for Freshwater Aquatic Organisms-Cadmium," accounting for the prevalent hardness distribution within the Yangtze River Basin's surface water. Subsequently, a more refined revision was undertaken considering the specific characteristics of the species residing within the Yangtze River Basin. This undertaking led to a comprehensive interpretation of the regional variations in both the distribution of long-term water quality criteria values and the risk quotient distribution of cadmium throughout the Yangtze River Basin. The incorporation of hardness and species-specific attributes resulted in a revised range of long-term water quality criteria for cadmium across different urban locales within the Yangtze River Basin. Notably, the recalibrated values ranged from 0.08 µg·L-1 as the lowest threshold to 0.75 µg·L-1 as the upper limit, signifying a tenfold differentiation. Correspondingly, the urban average annual risk quotient associated with cadmium exposure demonstrated a variation from 0.035 to 1.12, marking a significant 32-fold discrepancy between the lowest and highest values. It is essential to highlight that regions of paramount importance, such as the confluence area connecting the upper and middle stretches of the Yangtze River Basin and the intricate Dongting Lake system, exhibited noteworthy ecological risks attributed to cadmium presence. Consequently, further in-depth investigations into these critical regions are imperative for a comprehensive understanding of the associated risks.