Secular Trends in Preterm Birth Rates: Uncovering the Primary Challenge for Perinatal Medicine in Greece.

INTRODUCTION: Preterm labour is a serious pregnancy complication that is the primary cause of infant mortality, with detrimental impacts on the offspring and the mother in the short as well as the long term. This study aims to comprehensively present the time trends of national preterm birth rates (PBRs) in Greece. METHODS: Official national data regarding live births in Greece were acquired from the Hellenic Statistical Authority, and the annual total PBR and rates for gestational age groups were computed per 100 total live births spanning from 1980 to 2022. Time trends were analyzed through joinpoint regression analysis, and annual percent changes (APC) and average annual percent change (AAPC) were calculated with a 95% confidence interval (95% CI). RESULTS: Following a steady decline from 4.66% in 1980 to a historic low of 2.77% in 1991 with an APC of -5.1 (-6.2 to -4.2), the PBR exhibited a dramatic increase during 1991-2011 with an APC of 7.3 (6.9 to 7.8). Subsequently, between 2011 and 2022, the rise in PBR was attenuated, showing a slight statistically non-significant upward trend (APC = 0.5, 95% CI: -0.6 to 1.5). This led to a historical high of 12.07% in 2018, 4.4 times higher than that in 1991, and eventually, the PBR reached 11.90% in 2022. From 1991 to 2022, there were sharper increases in the rates of moderate (32-33 weeks) and late (34-36 weeks) preterm births, with AAPCs of 4.9 (3.5-6.4) and 5.8 (5.3-6.3), respectively. In contrast, the rates of extremely (<28 weeks) and very (28-31 weeks) preterm births saw slower growth, with AAPCs of 2.2 (1.7-2.7) and 0.7 (0.5-1.0), respectively. CONCLUSION: The PBR in Greece more than quadrupled during 1991-2022, mainly due to increases in moderate and late preterm births. Although its rise has markedly decelerated since 2011, amidst the country's economic recession, the PBR is alarmingly higher than those in all other European and developed nations. More than one in nine neonates is born prematurely in the Greek population, posing challenges in implementing evidence-based prevention strategies and perinatal care.

Advancing biomedical applications: an in-depth analysis of silver nanoparticles in antimicrobial, anticancer, and wound healing roles.

Introduction: Silver nanoparticles (AgNPs) have gained significant attention in biomedical applications due to their unique physicochemical properties. This review focuses on the roles of AgNPs in antimicrobial activity, anticancer therapy, and wound healing, highlighting their potential to address critical health challenges. Methods: A bibliometric analysis was conducted using publications from the Scopus database, covering research from 2002 to 2024. The study included keyword frequency, citation patterns, and authorship networks. Data was curated with Zotero and analyzed using Bibliometrix R and VOSviewer for network visualizations. Results: The study revealed an increasing trend in research on AgNPs, particularly in antimicrobial applications, leading to 8,668 publications. Anticancer and wound healing applications followed, with significant contributions from India and China. The analysis showed a growing focus on "green synthesis" methods, highlighting a shift towards sustainable production. Key findings indicated the effectiveness of AgNPs in combating multidrug-resistant bacteria, inducing apoptosis in cancer cells, and promoting tissue regeneration in wound healing. Discussion: The widespread research and applications of AgNPs underscore their versatility in medical interventions. The study emphasizes the need for sustainable synthesis methods and highlights the potential risks, such as long-term toxicity and environmental impacts. Future research should focus on optimizing AgNP formulations for clinical use and further understanding their mechanisms of action. Conclusion: AgNPs play a pivotal role in modern medicine, particularly in addressing antimicrobial resistance, cancer treatment, and wound management. Ongoing research and international collaboration are crucial for advancing the safe and effective use of AgNPs in healthcare.

Global Trends in Childhood Sexual Abuse and Bullying Victimization: A Comprehensive Analysis from 1990 to 2019.

Objectives: : No comprehensive analysis has yet been published regarding global trends in childhood sexual abuse (CSA) and bullying victimization (BV). The present study offers a longitudinal perspective on their prevalence worldwide. Methods: CSA and BV rates were extracted from the Global Burden of Disease study, spanning the years 1990 to 2019 across 204 countries. Trends by gender, region, and human development index (HDI) were examined. Results: For both boys and girls, and in both high- and low-HDI countries, CSA rates did not significantly change from 1990 to 2019 (p>0.05). However, BV rates increased significantly in high- and low-HDI countries for both genders (p<0.001). Subsequently, we analyzed trends separately by gender across all countries, without considering development level. In this analysis, CSA rates among girls decreased from 1990 to 2000, followed by an increasing tendency after 2000; overall, an upward trend was evident between 1990 and 2019 (p=0.029). In contrast, no significant pattern was observed for boys. Notably, BV demonstrated an increasing trend across all regions when HDI was not considered (p<0.05), with African populations experiencing the most pronounced rise (p<0.001). Globally, boys consistently exhibited higher BV rates than girls. Conclusions: Our research indicates that, on a global scale, rates of CSA among girls have been rising. Additionally, BV rates have increased in all regions for both boys and girls. Notably, this trend in BV rates is occurring irrespective of HDI. These findings underscore the necessity for targeted interventions in areas with high rates of CSA and BV.

Leveraging the trend analysis for modeling of the greenhouse gas emissions associated with coal combustion.

In this paper, it is aimed, for the first time, at deriving simple models, leveraging the trend analysis in order to estimate the future greenhouse gas emissions associated with coal combustion. Due to the expectations of becoming the center of global economic development in the future, BRICS-T (Brazil, the Russian Federation, India, China, South Africa, and Turkiye) countries are adopted as cases in the study. Following the models' derivation, their statistical validations and estimating accuracies are also tested through various metrics. In addition, the future greenhouse gas emissions associated with coal combustion are estimated by the derived models. The results demonstrate that the derived models can be successfully used as a tool for estimating the greenhouse gas emissions associated with coal combustions with accuracy ranges from at least 90% to almost 98%. Moreover, the estimating results show that the total amount of greenhouse gas emissions associated with coal combustions in the relevant countries and in the world will increase to 14 BtCO2eq and 19 BtCO2eq by 2035, with an annual growth of 2.39% and 1.71%, respectively. In summary, the current study's findings affirm the usefulness of trend analysis in deriving models to estimate greenhouse gas emissions associated with coal combustion.

Infant, Neonatal, and Post-neonatal Mortality in Greece: A Nationwide Time-Trend Analysis.

INTRODUCTION: Infant mortality is a crucial perinatal measure and is also regarded as an important public health indicator. This study aimed to comprehensively present time trends in infant, neonatal, and post-neonatal mortality in Greece. METHODS: The annual infant mortality rate (IMR), the neonatal mortality rate (NMR), and the post-neonatal mortality rate (PNMR) were calculated based on official national data obtained from the Hellenic Statistical Authority, spanning 67 years from 1956 to 2022. The time trends of the mortality rates were evaluated using joinpoint regression analysis, and the annual percent changes (APC) and the overall average annual percent change (AAPC) were calculated with a 95% confidence interval (95% CI). RESULTS: The IMR exhibited accelerating declines over more than 50 years, with an APC of -1.9 (-2.8 to -1.0) from 1956 to 1968, -5.4 (-5.6 to -5.2) from 1968 to 1999, and -7.3 (-8.9 to -5.7) between 1999 and 2008. In 2008, IMR reached its all-time low of 2.7 per 1,000 live births, down 16.6-fold from its peak at 44.1 per 1,000 live births in 1957. This improving trend was reversed following the onset of the economic crisis in the country, leading to a 57% increase in IMR from 2008 to 2016, with an upward trend APC of 3.4 (1.2 to 5.5). In the recent period 2016-2022, there was an improvement with an APC of -3.7 (-6.2 to -1.1), resulting in an IMR of 3.1 per 1,000 live births in 2022. The decrease in IMR was estimated to have prevented 209,109 infant deaths in the country from 1958 to 2022. From 1956 to 2022, the IMR decreased with an AAPC of -3.9 (-4.3 to -3.4), while the PNMR saw a decline with an AAPC of -4.5 (-5.1 to -3.9) and the NMR with an AAPC of -3.2 (-3.7 to -2.6). CONCLUSION: Greece achieved an impressive decrease in infant mortality rates, but this progress was halted and completely reversed during the economic crisis. Although there have been some recent improvements after the country's economic recovery, the rates have yet to reach pre-crisis levels.

Twenty-year changes of adolescent mental health and substance use: a Finnish population-based time-trend study.

This time-trend study assesses changes in mental health and substance use among Finnish adolescents from 1998 to 2018. Representative samples of adolescents (N = 6,600) aged 13-16 years participated in school-based, almost identical cross-sectional studies in 1998 (n = 1,446), 2008 (n = 2,009), 2014 (n = 1,800) and 2018 (n = 1,345), respectively. The Strengths and Difficulties Questionnaire was used to assess mental health. When comparing mental health in the clinical range between 1998 and 2018, the main finding was the significant increase of emotional symptoms among females. The percentage of females in the clinical range increased from 17.5 to 30.1% during the twenty-year period. When psychopathology measures were analyzed as continuous variables, the finding of increased emotional problems was confirmed. The study clearly illustrates a linear trend, with a consistent increase in emotional problems among females and decrease in substance use among both genders. An alarming finding of steady increase of self-reported emotional problems indicates the importance of early detection and evidence-based interventions for adolescent with anxiety and depression to prevent adversities associated with these disorders.

Trends in osteoporosis prevalence at a tertiary care referral center hospital in Northeastern Thailand: a 20-year analysis (2003-2022).

The current study aimed to investigate the prevalence trends of osteoporosis from 2003 to 2022 using data from the largest tertiary care referral center hospital in Northeastern Thailand. We reviewed 36,306 bone mineral density measurements of community-dwelling individuals aged > 45 years from the medical record database of Srinagarind Hospital, Khon Kaen, Thailand, between 2003 and 2022. We observed a significant increase in the crude prevalence of osteoporosis from 2003 to 2022. Meanwhile, the age-standardized prevalence increased more gradually. PURPOSE: To investigate the prevalence trends of osteoporosis from 2003 to 2022 using data from the largest tertiary care referral center in Northeastern Thailand. METHODS: Bone mineral density (BMD) measurements of community-dwelling individuals aged > 45 years were reviewed from the medical record database of Srinagarind Hospital, Khon Kaen, Thailand, between 2003 and 2022. Osteoporosis was defined by a T-score of ≤ - 2.5. For each year, crude and age-standardized prevalence rates for osteoporosis stratified by site of measurement were calculated. Trend analysis was performed using the joinpoint regression method. RESULTS: A total of 36,306 BMD measurements were identified between 2003 and 2022. The crude prevalence of femoral neck (FN) osteoporosis increased from 2.4% to 9.2% in men and from 2.5% to 11.2% in women, while the age-standardized prevalence increased less, from 2.6% to 8.3% in men, and slightly decreased from 8.7% to 7.6% in women. Trend analysis revealed increased crude and age-standardized prevalence rates of FN osteoporosis in men, with an annual percent change (APC) of 4.0 (95%CI: - 4.1 to 14.7) and 2.3 (95%CI: - 4.9 to 10.0), respectively. In women, the crude prevalence increased significantly from 2003 to 2011 (APC: 20.8, 95%CI: 5.8-249.3) and plateaued from 2011 to 2022 (APC: 0.8, 95%CI: - 30.3 to 5.9). The age-standardized prevalence was relatively unchanged (APC: 0.1, 95%CI: - 4.2 to 5.4). CONCLUSION: We observed a significant increase in the crude prevalence of osteoporosis from 2003 to 2022 among individuals receiving BMD measurements in a tertiary care referral center in Northeastern Thailand. Meanwhile, the age-standardized prevalence increased more gradually.

The burden of non-alcoholic fatty liver disease among working-age people in the Western Pacific Region, 1990-2019: an age-period-cohort analysis of the Global Burden of Disease study.

BACKGROUND: The growing prevalence of non-alcoholic fatty liver disease (NAFLD) in younger populations, particularly those of working age (15-64 years), has become a public health concern. Being diagnosed at a younger age implies a greater likelihood of accruing disability-adjusted life years (DALYs) later in life due to potential progression to conditions such as cirrhosis or hepatocellular carcinoma. This study aims to analyze NAFLD prevalence trends over three decades globally, regionally, and nationally, with a focus on age, period, and birth cohort associations. METHODS: Global, regional, and country time trends in the prevalence of NAFLD among working-age people from 1990 to 2019: Age-period-cohort analysis based on Global Burden of Disease Study 2019 estimates and 95% uncertainty interval (UI) of NAFLD prevalence in the working age population was extracted from the Global Burden of Diseases, Injuries and Risk Factors Study 2019. Age-period-cohort models were used to estimate the prevalence within each age group from 1990 to 2019 (local drift, % per year), fitted longitudinal age-specific rates adjusted for period bias (age effect), and period/cohort relative risk (period/cohort effect). RESULTS: The global age-standardized prevalence (ASPR) of NAFLD increased significantly from 1990 (14,477.6 per 100 000) to 2019 (19,837.6 per 100 000). In the Western Pacific, there were 42,903.8 NAFLD cases in 2019, 54.15% higher than in 1990. The ASPR also increased significantly in the region over the past three decades. At the national level, Palau had the highest ASPR while Brunei Darussalam had the lowest. Age-period-cohort analysis showed that in the Western Pacific, unlike globally, the risk of NAFLD declined after age 60-64 years. Relative to 1980-1989, incidence and DALY risks decreased but prevalence increased in subsequent birth cohorts. Future predictions indicate an upward trend in NAFLD burden, especially among women and medium (SDI) regions like China. CONCLUSION: Non-alcoholic fatty liver disease imparts an immense health burden that continues to grow globally and in the Asia Pacific region. Our work highlights working age adults as an at-risk group and calls attention to socioeconomic gradients within Western Pacific countries. Upward future projections demonstrate that NAFLD prevention is an urgent priority.

Spatial-temporal analysis of hepatitis E in Hainan Province, China (2013-2022): insights from four major hospitals.

Objective: Exploring the Incidence, Epidemic Trends, and Spatial Distribution Characteristics of Sporadic Hepatitis E in Hainan Province from 2013 to 2022 through four major tertiary hospitals in the Province. Methods: We collected data on confirmed cases of hepatitis E in Hainan residents admitted to the four major tertiary hospitals in Haikou City from January 2013 to December 2022. We used SPSS software to analyze the correlation between incidence rate and economy, population density and geographical location, and origin software to draw a scatter chart and SAS 9.4 software to conduct a descriptive analysis of the time trend. The distribution was analyzed using ArcMap 10.8 software (spatial autocorrelation analysis, hotspot identification, concentration, and dispersion trend analysis). SAS software was used to build an autoregressive integrated moving average model (ARIMA) to predict the monthly number of cases in 2023 and 2024. Results: From 2013 to 2022, 1,922 patients with sporadic hepatitis E were treated in the four hospitals of Hainan Province. The highest proportion of patients (n = 555, 28.88%) were aged 50-59 years. The annual incidence of hepatitis E increased from 2013 to 2019, with a slight decrease in 2020 and 2021 and an increase in 2022. The highest number of cases was reported in Haikou, followed by Dongfang and Danzhou. We found that there was a correlation between the economy, population density, latitude, and the number of cases, with the correlation coefficient |r| value fluctuating between 0.403 and 0.421, indicating a linear correlation. At the same time, a scatter plot shows the correlation between population density and incidence from 2013 to 2022, with r2 values fluctuating between 0.5405 and 0.7116, indicating a linear correlation. Global Moran's I, calculated through spatial autocorrelation analysis, showed that each year from 2013 to 2022 all had a Moran's I value >0, indicating positive spatial autocorrelation (p < 0.01). Local Moran's I analysis revealed that from 2013 to 2022, local hotspots were mainly concentrated in the northern part of Hainan Province, with Haikou, Wenchang, Ding'an, and Chengmai being frequent hotspot regions, whereas Baoting, Qiongzhong, and Ledong were frequent cold-spot regions. Concentration and dispersion analysis indicated a clear directional pattern in the average density distribution, moving from northeast to southwest. Time-series forecast modeling showed that the forecast number of newly reported cases per month remained relatively stable in 2023 and 2024, fluctuating between 17 and 19. Conclusion: The overall incidence of hepatitis E in Hainan Province remains relatively stable. The incidence of hepatitis E in Hainan Province increased from 2013 to 2019, with a higher clustering of cases in the northeast region and a gradual spread toward the southwest over time. The ARIMA model predicted a relatively stable number of new cases each month in 2023 and 2024.

Incidence trends and spatial distribution of thyroid cancer in the Chinese female population from 1990 to 2019.

Objective: This study aimed to analyze the incidence trends and spatial distribution characteristics of thyroid cancer among Chinese females from 1990 to 2019, thereby providing a scientific foundation and data support for the development of prevention and control policies. Methods: Thyroid cancer incidence data from the Global Burden of Disease (GBD) research and the annual report from the Chinese Tumor Registration were utilized. The standardized thyroid cancer incidence rate among Chinese females 1990 to 2019 was described to understand the changes in developmental trends. The JoinPoint Regression Model was employed using Excel 2019, GraphPad Prism 8, JoinPoint Regression Program 4.8.0.1, and ArcGIS 10.2. Results: Thyroid cancer's standardized incidence among female Chinese continued to increase at 1.7% per year (annual average percentage change [AAPC] = 1.7, P < 0.001), and the spatial distribution was clustered. The main high-incidence areas were North, East, and Northwest China. Conclusions: Thyroid cancer incidence in Chinese women is rapidly increasing, and its spatial distribution is concentrated. Strengthening monitoring, prevention, and control efforts in the relevant areas is warranted.

Spatiotemporal variability identification and analysis for non-stationary climatic trends for a tropical river basin of India.

The non-stationary behavior of climatic variables has been increasingly recognized as a challenge that disrupts the equilibrium of human-defined climate-based stationary processes, including hydrological and agricultural practices, and irrigation systems. This study aims to investigate long-term trends and non-stationarity in climatic variables across 23 stations of the Krishna River basin, India. Prominent trends in rainfall, temperature, and their extreme indices were identified using the Modified Mann-Kendall (MMK), Bootstrapped Mann-Kendall (BMK), and Sen's Slope Estimator tests, while the Innovative Trend Analysis (ITA) test uncovered hidden trends and potential shifts in climatic patterns. This study addresses a critical research gap by exploring both significant and hidden trends in climatic variables, providing a better understanding of future dynamics. Traditional methods like MMK and Sen's Slope were insufficient to reveal these hidden trends, but ITA offered a more comprehensive analysis. The findings revealed an increase in total annual rainfall for almost 50% of the basin, which aligns with rising maximum temperatures, suggesting enhanced evaporation rates and subsequent fluctuations in rainfall patterns. Seasonal analysis indicated a shift towards decreased rainfall during winter and pre-monsoon seasons, contrasted by increased precipitation during the monsoon and post-monsoon periods, highlighting a clear alteration in rainfall distribution. The Simple Daily Intensity Index (SDII) and other indices suggest intensified rainfall events despite a decrease in the number of rainy days, indicating fewer but more intense events. Temperature analysis showed an overall increase in maximum temperatures, with the Diurnal Temperature Range (DTR) significantly increasing across all stations, implying greater daily temperature variations and potential for intensified water cycles and extreme climatic events. Furthermore, the study simplifies these trends by classifying them into two attributes: intensity and frequency, aiding policymakers in site-specific management of water resources and planning for future climatic scenarios. The presence of non-stationarity in extreme rainfall was confirmed by the Augmented Dickey-Fuller (ADF), Phillips-Perron (PP), and Kwiatkowski-Phillips-Schmidt-Shin (KPSS) tests. These findings are significant as they conclude how climate change is altering hydrological patterns at each station. The study emphasizes the necessity for adaptive management strategies to mitigate the adverse impacts on agriculture, infrastructure, and human safety.

Asian American sub-ethnic disparities and trends in epithelial ovarian cancer diagnosis, treatment and survival.

OBJECTIVES: Studies on ovarian cancer (OC) diagnosis, treatment and survival across disaggregated Asian sub-ethnic groups are sparse. Few studies have also conducted trend analyses of these outcomes within and across Asian groups. METHODS: Using logistic, Cox, and Joinpoint regression analyses of the 2000-2018 Surveillance, Epidemiology, and End Results (SEER) data, we examined disparities and trends in OC advanced stage diagnosis, receipt of treatments and the 5-year cause-specific survival across seven Asian sub-ethnic groups. RESULTS: There were 6491 OC patients across seven Asian sub-ethnic groups (mean [SD] age, 57.29 [13.90] years). There were 1583(24.39%) Filipino, 1183(18.23%) Chinese, and 761(11.72%) Asian Indian or Pakistani (AIP) patients. The majority (52.49%) were diagnosed with OC with at an advanced stage. AIP were more likely to have advanced stage diagnosis than other subgroups (ORs, 95%CIs: 0.77, 0.62-0.96 [Filipino]; 0.76, 0.60-0.95 [Chinese]; 0.71, 0.54-0.94 [Japanese]; 0.74, 0.56-0.98 [Vietnamese] and 0.66, 0.53-0.83 [Other Asians]). The Filipinos were least likely to receive surgery but most likely to undergo chemotherapy. Japanese patients had the worst 5-year OC cause-specific survival (50.29%, 95%CI: 46.20%-54.74%). Based on the aggregated analyses, there was a significantly decreased trend in advanced-stage diagnosis and an increased trend in receipt of chemotherapy. Trends in OC outcomes for several subethnicities differed from those observed in aggregated analyses. CONCLUSION: In this cohort study of 6491 patients, OC diagnosis, treatment, survival, and trends differed across Asian American ethnic subgroups. Such differences must be considered in future research and interventions to ensure all Asian American subethnicities equally benefit from the advancements in OC care and control.

Evidence for differences in patterns of temporal trends in meta-analyses of diagnostic accuracy studies in the Cochrane Database of Systematic Reviews.

OBJECTIVES: Temporal trends in comparative meta-analyses of interventions are well-recognised in the medical literature. For studies of diagnostic test accuracy (DTA), evidence of temporal trends is growing and the importance of assessing and reporting them has been highlighted in recent guidelines on post-market surveillance in several jurisdictions. In this study we evaluate the prevalence and patterns of time trends using a larger and more up-to-date set of DTA systematic reviews than has previously been examined, from the Cochrane Database of Systematic Reviews. STUDY DESIGN AND SETTING: Cumulative meta-analysis was conducted on bivariate random effects meta-analysis estimates of sensitivity and specificity, after ranking studies by publication date. Trends for all studies were assessed graphically using plots of summary estimates by study rank, and using ROC plots of sensitivity vs. specificity. Linear trends were also described using weighted linear regression with autocorrelated errors of summary estimates against study rank. Various patterns of non-linear trends were characterised descriptively. RESULTS: The analysis included 46 reviews (92 meta-analyses) conducted between 2017 and 2022. The total number of studies within all reviews was 1,486, with a median [IQR] 7,134 [2,782, 16,406] participants per review. Reviews had a median [IQR] time span of 19 [15,25] publication years. Time trends in at least one DTA measure were observed in 40 (87%) reviews, and statistically significant linear trends in 32 (71%) reviews. Non-linear time trends were observed in 16 (35%) reviews. There was no evidence for a trend in either DTA measure in 27 (59%) reviews. CONCLUSION: The study contributes evidence on the variety in patterns of linear and non-linear temporal DTA trends which has not previously been described. We recommended researchers check statistical assumptions of trend analysis methods, for example using graphical methods. Further research into potential reasons for time trends could contribute to the robustness of future meta-analyses.

Transition and trend analysis of the burden of depression in China and different income countries: Based on GBD database and joinpoint regression model.

BACKGROUND: Depression is a leading cause of disability and poor health worldwide and is expected to rank first worldwide by 2030. The aim of this study is to analyze the transition and trend of depression burden in China and various income-level countries by utilizing the Global Burden of Disease (GBD) database and the Joinpoint regression model. This analysis seeks to comprehend the variations in the burden of depression across different income regions and evaluate their developmental patterns. METHODS: Based on the GBD 2019 open dataset, this study extracted data on YLD (Years Lived with Disability), DALY (Disability-Adjusted Life Years), and incidence related to depression. The analysis focused on the period between 1990 and 2019, covering global data and distinguishing between high-income, upper-middle-income, lower-middle-income, low-income countries, and China. We utilized the Joinpoint regression model to fit the spatiotemporal trend changes among different income-level countries. Pairwise comparisons were conducted to examine the parallelism and to determine if the differences in trend changes among various regions were statistically significant. RESULTS: From 1990 to 2019, the age-standardized YLD and DALY for depression female were higher than that in male. The YLD total change rate of depression men was higher than that of women. China exhibited the largest disparity in total YLD change rates between genders, reaching 0.08. During 1990 to 2019, the incidence of depression in 2005-2019 increased among females in middle to high-income countries, low-income countries, and China as compare to that of 1990-2005. Notably, China shown the most increase the incidence rate of females (from -0.4 % to 0.84 %). China experienced the most significant change in the YLD of depression during this period (AAPC = 0.45, 95 % CI = 0.41, 0.48, P < 0.01). China's YLD/Incidence rate was higher compared to the global, HICs, UMCs, LMCs, and LICs. In China, the YLD/incidence rate of depression began to rise in 1994, peaking around 2010, and then gradually declining. Since 2010, the growth rate of depression DALYs in China has been higher than the global average, high-income countries, upper-middle-income countries, lower-middle-income countries, and low-income countries. The DALY's AAPC value for the HLCs was the highest (AAPC = 0.24, 95 % CI = 0.22, 0.25, P < 0.01). The UMCs, in comparison to other regions, incidence rate had the highest AAPC value (AAPC = 0.48, 95 % CI = 0.46, 0.50, P < 0.01). CONCLUSIONS: Given the significant variations in the burden of depression across countries with different income levels, future strategies aimed at reducing the burden of depression should adopt tailored and differentiated approaches according to each country's specific needs and developmental stages.

Factors Influencing Neuromuscular Blockade Reversal Choice in the United States Before and During the COVID-19 Pandemic: Retrospective Longitudinal Analysis.

BACKGROUND: Neuromuscular blockade (NMB) agents are a critical component of balanced anesthesia. NMB reversal methods can include spontaneous reversal, sugammadex, or neostigmine and the choice of reversal strategy can depend on various factors. Unanticipated changes to clinical practice emerged due to the COVID-19 pandemic, and a better understanding of how NMB reversal trends were affected by the pandemic may help provide insight into how providers view the tradeoffs in the choice of NMB reversal agents. OBJECTIVE: We aim to analyze NMB reversal agent use patterns for US adult inpatient surgeries before and after the COVID-19 outbreak to determine whether pandemic-related practice changes affected use trends. METHODS: A retrospective longitudinal analysis of a large all-payer national electronic US health care database (PINC AI Healthcare Database) was conducted to identify the use patterns of NMB reversal during early, middle, and late COVID-19 (EC, MC, and LC, respectively) time periods. Factors associated with NMB reversal choices in inpatient surgeries were assessed before and after the COVID-19 pandemic reached the United States. Multivariate logistic regression assessed the impact of the pandemic on NMB reversal, accounting for patient, clinical, procedural, and site characteristics. A counterfactual framework was used to understand if patient characteristics affected how COVID-19-era patients would have been treated before the pandemic. RESULTS: More than 3.2 million inpatients experiencing over 3.6 million surgical procedures across 931 sites that met all inclusion criteria were identified between March 1, 2017, and December 31, 2021. NMB reversal trends showed a steady increase in reversal with sugammadex over time, with the trend from January 2018 onwards being linear with time (R2>0.99). Multivariate analysis showed that the post-COVID-19 time periods had a small but statistically significant effect on the trend, as measured by the interaction terms of the COVID-19 time periods and the time trend in NMB reversal. A slight increase in the likelihood of sugammadex reversal was observed during EC relative to the pre-COVID-19 trend (odds ratio [OR] 1.008, 95% CI 1.003-1.014; P=.003), followed by negation of that increase during MC (OR 0.992, 95% CI 0.987-0.997; P<.001), and no significant interaction identified during LC (OR 1.001, 95% CI 0.996-1.005; P=.81). Conversely, active reversal (using either sugammadex or neostigmine) did not show a significant association relative to spontaneous reversal, or a change in trend, during EC or MC (P>.05), though a slight decrease in the active reversal trend was observed during LC (OR 0.987, 95% CI 0.983-0.992; P<.001). CONCLUSIONS: We observed a steady increase in NMB active reversal overall, and specifically with sugammadex compared to neostigmine, during periods before and after the COVID-19 outbreak. Small, transitory alterations in the NMB reversal trends were observed during the height of the COVID-19 pandemic, though these alterations were independent of the underlying NMB reversal time trends.

[Spatiotemporal Simulation and Prediction of Soil Organic Carbon Density in Gannan Grassland Under Future Climate Scenarios].

To study the temporal and spatial distribution characteristics of soil organic carbon density in grassland and explore the relationship between organic carbon density and influencing factors is of great significance to the management and maintenance of grassland ecosystems in Gannan Autonomous Prefecture, which is conducive to realizing the goal of "double carbon," promoting carbon sink, and mitigating climate change. Taking Gannan Tibetan Autonomous Prefecture of Gansu Province as the research object, based on data from two CMIP6 future climate scenarios (SSP126 and SSP585), the CENTURY model was used to simulate and predict the temporal and spatial changes in soil organic carbon density in grassland of Gannan during 2023-2100. The main conclusions were as follows:① From 2023 to 2100, total organic carbon density, slow organic carbon density, and inert organic carbon density all showed a downward trend, whereas active organic carbon density fluctuated first and then increased. Meanwhile, the total organic carbon density, active organic carbon density, slow organic carbon density, and inert organic carbon density under the SSP585 scenario were higher than those under the SSP126 scenario. ② Mann-Kendall mutation analysis showed that the abrupt change in the difference of soil total organic carbon density (Δsomtc) occurred in 2030. The abrupt change in the difference of soil active carbon density (Δsom1c) occurred in 2027. ③ During the study period, the average soil organic carbon density of Gannan grassland was 7 505.69 g·m-2 under the SSP126 scenario and 7 551.87 g·m-2 under the SSP585 scenario. Gannan grassland soil organic carbon density was higher in the west and lower in the east, and the coefficient of variation was relatively stable. ④ The results of partial correlation analysis showed that precipitation was positively correlated with soil organic carbon density, whereas temperature was significantly negatively correlated with soil organic carbon density under future climate scenarios. ⑤ The results of the Theil-Sen Median trend analysis and Mann-Kendall test showed that under the two climate scenarios, the soil organic carbon density in Gannan showed an overall downward trend, in which Luqu County showed the fastest downward trend and Dibe County showed the slowest.

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Understanding the spatiotemporal variations and driving factors of regional vegetation coverage is crucial for developing scientific plans for ecological environment protection and maintaining regional ecological balance. Based on the Google Earth Engine (GEE) platform and using Landsat Collection 2 data, we investigated the spatiotemporal variation and driving factors of vegetation coverage in Shanxi Province, China, from 1990 to 2020, by employing methods such as pixel-based binary model, trend analysis, zonal statistics, and geodetector. The results showed that vegetation coverage in Shanxi Province showed a fluctuating upward trend from 1990 to 2020. Vegetation coverage in 44.4% of this region had been significantly improved, and the area with significant degradation accounted for 7.4%. Vegetation coverage in Shanxi Province was positively correlated with elevation, slope, and mountain terrain relief. The area proportion of vegetation coverage growth was the highest in the plateau and hilly regions. Factor detection results showed that land use type, landform type, annual average precipitation, and soil type were the main influencing factors of the spatial differentiation of vegetation coverage in Shanxi Province. Results of the interaction detection showed that the interaction between driving factors all showed enhancement. The interaction between natural factors showed a downward trend, while the interaction results of social factors showed an upward trend, reflecting that the impacts of human activities on vegetation coverage in Shanxi Province were gradually increasing.

Evaluating trends in groundwater quality of coastal alluvial aquifers of Eastern India for sustainable groundwater management.

Groundwater is a precious natural element which ensures global water, food, and environmental security in the twenty-first century. Systematic monitoring, sustainable utilization, preservation and remediation are critical aspects of efficient groundwater resource management. This study deals with the analysis of spatial variability and trend in groundwater chemistry as well as identification of possible contamination sources in a coastal alluvial basin of eastern India. Pre-monsoon season data of 14 groundwater-quality variables measured in 'leaky confined' and 'confined' aquifers were analyzed for ten years (2012-2021). Mann-Kendall (M-K) test with the Sen's Slope Estimator, Spearman Rank Order Correlation (SROC) and Innovative Trend Analysis (ITA) tests were employed to assess decadal (2012-2021) trends. The analysis of the results indicated that the 'critical' water-quality parameters exceeding the acceptable limits for drinking are TDS, EC, TH, pH, Mg2+, Na+, K+, Fe2+, HCO3-, Cl- and NO3-. Weak negative correlations between rainfall and groundwater elevation for both the aquifers reveal poor rainfall recharge into the aquifers. Therefore, a reduction in groundwater abstraction and augmentation of groundwater recharge is recommended. Trend analysis results indicated that the concentrations of TH, Mg2+ and Fe2+ exhibit significant increasing trends in the 'leaky confined aquifer'. In contrast, significant rising trends in TH, Mg2+, Na+, Fe2+, HCO3- and NO3- concentrations are identified in the 'confined aquifer'. Further, the SROC test could not detect the trends in groundwater quality in most blocks and for many parameters. On the other hand, the ITA test revealed significant trends in most of the parameters of the two aquifers in almost all the blocks. Trend magnitudes of the groundwater-quality parameters based on the Sen's Slope Estimator and the ITA test vary from -63.7 to 58.65 mg/L/year for TDS, -14 to 39.07 mg/L/year for TH, -1.49 to 4.83 mg/L/year for Mg2+, -7.14 to 22.96 mg/L/year for Na+, -0.32 to 0.44 mg/L/year for Fe2+, -8.33 to 20.75 mg/L/year for HCO3-, -26.52 to 31.01 mg/L/year for Cl- and 1.29 to 3.76 mg/L/year for NO3- over the study area. The results of M-K and ITA tests were found in agreement in all the blocks for both the aquifers. Groundwater contamination in both the aquifers can be attributed to weathering, geogenic processes, mineral dissolution, seawater intrusion, poor recharge pattern and injudicious anthropogenic activities. It is strongly recommended that concerned authorities urgently formulate efficient strategies for managing groundwater quality in the 'leaky confined' and 'confined' aquifers which serve as vital sources of drinking and irrigation water supplies in the study area.

Evaluation of the sensitivity of meteorological drought in the Mediterranean region to different data record lengths.

The division and evaluation of data series used in monitoring drought into different time intervals is a practical approach to detecting the spatial and temporal extent of drought spread. This study aimed to determine meteorological drought's spatial and temporal distribution using overlapping and consecutive periods and cycles of the standardized precipitation index (SPI) time series in the Mediterranean region, Turkey. In the scope of the research, SPI values for the SPI12, SPI6 (1), and SPI6 (2) seasons were calculated for consecutive and overlapping hydrological years (1978-1998/21 years, 1978-2008/31 years, and 1978-2018/41 years) at 28 meteorological stations. Autocorrelation, Mann-Kendall, and Sen slope trend tests were applied at a 5% significance level for each season (SPI12, SPI6 (1), and SPI6 (2)) and different time scales (21, 31, and 41 years). For each season and period, maps of the SPI drought class, average formation of drought class, Mann-Kendall (MK) trend, and Sen's slope (SS) trend test statistics for the Mediterranean region were obtained, and the spatial distribution rate of trends was determined by drawing hypsometric curves. Changes in drought occurrence at different time scales were thoroughly evaluated with the changing length of data recording. Consequently, it was determined that the mild wet (MIW) and mild drought (MID) classes dominate the study area in the Mediterranean region. Significant and nonstationary changes detected in extreme wet and drought occurrences (extreme wet, EW; severe wet, SW; extreme drought, ED; severe drought, SD) were found to pose a risk in the study area. It was observed that there were spatially and temporally insignificant decreasing drought trends in the Mediterranean basin, considering that the time scales of these trends slowed down. Despite a nonsignificant trend from the MID drought class to the MIW drought class, it is predicted that the MIW and MID classes will maintain their dominance in the Mediterranean region. The central part of the study area (central Mediterranean basin) is the region with the highest drought risk.