Geographical variations and predictors of coronary artery disease mortality in Turkiye: an environmental and behavioral analysis.

OBJECTIVE: This study aims to analyze the geographical variations and identify key environmental and behavioral predictors of coronary artery disease (CAD) mortality in Turkiye. METHODS: A 10-year longitudinal province-level data was used to identify change trajectories of CAD mortality. Environmental determinants (such as air quality and climatic conditions) and behavioral factors of alcohol consumption and smoking were examined for their association with CAD mortality change trajectories using Ordinal Logistic Regression models. RESULTS: The study revealed significantly different trajectoriesof CAD mortality across Turkiye. Environmental factors, particularly air quality (Particulate Matter-10 variation) and climatic conditions (humidity and temperature variations), were heavily associated with the level of CAD mortality. Behavioral factors, notably alcohol consumption and smoking, also exhibited a significantly positive association. Humidity, sunlight, and temperature remained as key predictors of CAD after controlling for smoking and alcohol consumption. CONCLUSION: The study underscores the importance of addressing environmental and lifestyle factors in CAD management and prevention strategies. The findings suggest the necessity for region-specific interventions and public health policies tailored to the unique characteristics of each province in Turkiye. This research contributes to a deeper understanding of the multifactorial nature of CAD mortality, providing valuable insights for future research to investigate causal associations, healthcare planning, and policy-making. TRIAL REGISTRATION: Our study has been registered in ClinicalTrials.GOV system with a procotol ID of CAD001.

Geographical variations in long term colorectal cancer outcomes in England: a contemporary population analysis revealing the north-south divide in colorectal cancer survival.

BACKGROUND: Regional variations in healthcare outcomes in England have been historically reported. This study analyses the variations in long term colorectal cancer survival across different regions in England. METHODS: Relative survival analysis of population data obtained from all cancer registries in England between 2010 and 2014. RESULTS: Totally, 167,501 patients were studied. Regions in the southern England had better outcomes with Southwest and Oxford registries having 63.5 and 62.7% 5 year relative survival. In contrast, Trent and Northwest cancer registries had 58.1% relative survival (p < 0.01). The regions in the north fared below the national average. The survival outcomes reflected socio-economic deprivation status, the best performing regions in the south having low levels of deprivation (5.3 and 6.5% having maximum deprivation in Southwest and Oxford, respectively). The regions with worst long term cancer outcomes had high levels of deprivation with 25% and 17% having high levels of deprivation in Northwest and Trent regions. CONCLUSION: There are significant variations in long term colorectal cancer survival between different regions in England, southern England had better relative survival when compared with the northern regions. Disparities in socio-economic depravation status in different regions may be associated with worse colorectal cancer outcomes.

Increased burden of cardiovascular disease in people with liver disease: unequal geographical variations, risk factors and excess years of life lost.

BACKGROUND: People with liver disease are at increased risk of developing cardiovascular disease (CVD), however, there has yet been an investigation of incidence burden, risk, and premature mortality across a wide range of liver conditions and cardiovascular outcomes. METHODS: We employed population-wide electronic health records (EHRs; from 1998 to 2020) consisting of almost 4 million adults to assess regional variations in disease burden of five liver conditions, alcoholic liver disease (ALD), autoimmune liver disease, chronic hepatitis B infection (HBV), chronic hepatitis C infection (HCV) and NAFLD, in England. We analysed regional differences in incidence rates for 17 manifestations of CVD in people with or without liver disease. The associations between biomarkers and comorbidities and risk of CVD in patients with liver disease were estimated using Cox models. For each liver condition, we estimated excess years of life lost (YLL) attributable to CVD (i.e., difference in YLL between people with or without CVD). RESULTS: The age-standardised incidence rate for any liver disease was 114.5 per 100,000 person years. The highest incidence was observed in NAFLD (85.5), followed by ALD (24.7), HCV (6.0), HBV (4.1) and autoimmune liver disease (3.7). Regionally, the North West and North East regions consistently exhibited high incidence burden. Age-specific incidence rate analyses revealed that the peak incidence for liver disease of non-viral aetiology is reached in individuals aged 50-59 years. Patients with liver disease had a two-fold higher incidence burden of CVD (2634.6 per 100,000 persons) compared to individuals without liver disease (1339.7 per 100,000 persons). When comparing across liver diseases, atrial fibrillation was the most common initial CVD presentation while hypertrophic cardiomyopathy was the least common. We noted strong positive associations between body mass index and current smoking and risk of CVD. Patients who also had diabetes, hypertension, proteinuric kidney disease, chronic kidney disease, diverticular disease and gastro-oesophageal reflex disorders had a higher risk of CVD, as do patients with low albumin, raised C-reactive protein and raised International Normalized Ratio levels. All types of CVD were associated with shorter life expectancies. When evaluating excess YLLs by age of CVD onset and by liver disease type, differences in YLLs, when comparing across CVD types, were more pronounced at younger ages. CONCLUSIONS: We developed a public online app ( https://lailab.shinyapps.io/cvd_in_liver_disease/ ) to showcase results interactively. We provide a blueprint that revealed previously underappreciated clinical factors related to the risk of CVD, which differed in the magnitude of effects across liver diseases. We found significant geographical variations in the burden of liver disease and CVD, highlighting the need to devise local solutions. Targeted policies and regional initiatives addressing underserved communities might help improve equity of access to CVD screening and treatment.

Geographical variations and determinants of iron and folic acid supplementation during pregnancy in Ethiopia: analysis of 2019 mini demographic and health survey.

BACKGROUND: One of the packages of critical antenatal care treatments for pregnant women includes iron and folic acid (Fe/FA) supplementation. Using recently available and nationwide representative survey data, this study aimed to determine the spatial patterns and drivers of Fe/FA supplementation during pregnancy. METHOD: The data for this study was obtained from Ethiopia's 2019 Mini Demographic and Health Survey (EMDHS). We used the Kid's Record (KR) dataset, and a total weighted sample of 3926 reproductive-age women who gave birth within the previous 5 years was used as the study's final sample size. To analyze the spatial distributions (geographic variation of Fe/FA supplementation) different statistical software like Excel, ArcGIS, and Stata 14 were used. A two-level multilevel binary logistic regression model was fitted to identify both individual and community-level factors associated with Fe/FA supplementation during pregnancy. RESULT: This study found that there were significant geographical variations of iron and folic acid supplementation across Ethiopia, eastern and southern parts of the country were predicted to have low Fe/FA supplementation coverage. Advanced maternal age (AOR = 0.75: 95%CI: 0.59 0.96), resides in developing region (AOR = 0.57, 95%CI: 0.43 0.74), not attended formal education (AOR = 0.60, 95%CI: 0.39 0.92), middle (AOR = 1.51, 95%CI: 18 1.93) and rich wealth status (AOR = 1.48, 95%CI: 1.15 1.91), and four and above ANC visits (AOR = 4.35 95%CI: 3.64 5.21) were determinants of iron and folic acid supplementation among pregnant women. CONCLUSION: Our research found that there were geographical variations across the country, with low coverage seen in Ethiopia's eastern and southern regions. Iron and folic acid supplementation coverage were inadequate among pregnant women with low education, advanced maternal age, and those from underdeveloped countries. Conversely, increasing iron and folic acid uptake was associated with higher socioeconomic class and four or more ANC visits. The findings of this study highlight the importance of increasing maternal health care, such as iron and folic acid supplements, for underserved populations.

Extending the range of applicability of the semi-empirical ecosystem flux model PRELES for varying forest types and climate.

Applications of ecosystem flux models on large geographical scales are often limited by model complexity and data availability. Here we calibrated and evaluated a semi-empirical ecosystem flux model, PREdict Light-use efficiency, Evapotranspiration and Soil water (PRELES), for various forest types and climate conditions, based on eddy covariance data from 55 sites. A Bayesian approach was adopted for model calibration and uncertainty quantification. We applied the site-specific calibrations and multisite calibrations to nine plant functional types (PFTs) to obtain the site-specific and PFT-specific parameter vectors for PRELES. A systematically designed cross-validation was implemented to evaluate calibration strategies and the risks in extrapolation. The combination of plant physiological traits and climate patterns generated significant variation in vegetation responses and model parameters across but not within PFTs, implying that applying the model without PFT-specific parameters is risky. But within PFT, the multisite calibrations performed as accurately as the site-specific calibrations in predicting gross primary production (GPP) and evapotranspiration (ET). Moreover, the variations among sites within one PFT could be effectively simulated by simply adjusting the parameter of potential light-use efficiency (LUE), implying significant convergence of simulated vegetation processes within PFT. The hierarchical modelling of PRELES provides a compromise between satellite-driven LUE and physiologically oriented approaches for extrapolating the geographical variation of ecosystem productivity. Although measurement errors of eddy covariance and remotely sensed data propagated a substantial proportion of uncertainty or potential biases, the results illustrated that PRELES could reliably capture daily variations of GPP and ET for contrasting forest types on large geographical scales if PFT-specific parameterizations were applied.

Geographical variations of the associations between health interventions and all-cause under-five mortality in Uganda.

BACKGROUND: To reduce the under-five mortality (U5M), fine-gained spatial assessment of the effects of health interventions is critical because national averages can obscure important sub-national disparities. In turn, sub-national estimates can guide control programmes for spatial targeting. The purpose of our study is to quantify associations of interventions with U5M rate at national and sub-national scales in Uganda and to identify interventions associated with the largest reductions in U5M rate at the sub-national scale. METHODS: Spatially explicit data on U5M, interventions and sociodemographic indicators were obtained from the 2011 Uganda Demographic and Health Survey (DHS). Climatic data were extracted from remote sensing sources. Bayesian geostatistical Weibull proportional hazards models with spatially varying effects at sub-national scales were utilized to quantify associations between all-cause U5M and interventions at national and regional levels. Bayesian variable selection was employed to select the most important determinants of U5M. RESULTS: At the national level, interventions associated with the highest reduction in U5M were artemisinin-based combination therapy (hazard rate ratio (HRR) = 0.60; 95% Bayesian credible interval (BCI): 0.11, 0.79), initiation of breastfeeding within 1 h of birth (HR = 0.70; 95% BCI: 0.51, 0.86), intermittent preventive treatment (IPTp) (HRR = 0.74; 95% BCI: 0.67, 0.97) and access to insecticide-treated nets (ITN) (HRR = 0.75; 95% BCI: 0.63, 0.84). In Central 2, Mid-Western and South-West, largest reduction in U5M was associated with access to ITNs. In Mid-North and West-Nile, improved source of drinking water explained most of the U5M reduction. In North-East, improved sanitation facilities were associated with the highest decline in U5M. In Kampala and Mid-Eastern, IPTp had the largest associated with U5M. In Central1 and East-Central, oral rehydration solution and postnatal care were associated with highest decreases in U5M respectively. CONCLUSION: Sub-national estimates of the associations between U5M and interventions can guide control programmes for spatial targeting and accelerate progress towards mortality-related Sustainable Development Goals.

Geographical variations in patient-reported outcomes after total hip arthroplasty between 2008 - 2012.

BACKGROUND: Health care on equal terms is a cornerstone of the Swedish health care system. Total hip arthroplasty (THA) is considered a success story in Sweden with low frequency of reoperations and restored health-related quality of life (HRQoL). Administratively, health care in Sweden is locally self-governed by 21 counties. In this longitudinal nation-wide observational study we assessed the possible geographical variations in 1-year follow-up patient-reported outcomes (PROs): EQ-5D index, EQ VAS, Pain VAS and Satisfaction VAS. METHODS: Study population consisted of 36,235 Swedish THA patients, operated during 2008 to 2012 due to hip osteoarthritis. Individual data came from Swedish Hip Arthroplasty Register, Statistics Sweden and National Board of Health and Welfare. We used descriptive statistics together with multivariable regression analysis to analyse the data. RESULTS: We observed county level differences in both preoperative and postoperative PROs. The results showed that the differences observed in preoperative PROs could not fully explain the differences observed in postoperative PROs, even after adjustment for patient demographics (age, sex, BMI, Elixhauser comorbidity index, marital status, educational level and disposable income). This indicates that other factors might influence the outcome after THA. CONCLUSION: Likely, structural and process differences such as indication for surgery have an influence on PROs after surgery. Standardization of care at hospital levels may decrease geographical variations in postoperative HRQoL. Remaining differences will then possibly be associated to patient demographics.

Where is the fruit? Multidimensional inequalities in food retail environments around public elementary schools.

BACKGROUND: The increasing number of convenience and small food stores may be contributing to the rising childhood obesity rate in the United States; however, the literature assessing food environments surrounding elementary schools in this country is relatively limited. This study determines (a) whether the food environments around public elementary schools is of significantly lower quality than those of other areas in the United States and (b) how the quality of the school food environment is associated with local socio-economic factors and geographical components. METHODS: Data for 52,375 public elementary schools as well as 96,652 convenience stores, 65,044 small food stores, and 44,383 supermarkets/grocery stores were obtained from the National Center of Education Statistics and the U.S. Department of Agriculture. A two-sample t test was applied to compare the food environment within 0.5-mile buffer around schools and that in the remaining area of each county. A binomial regression model was constructed to examine the impact of socio-economic and geographical factors on unequal food environments. RESULTS: The food environment within 0.5 mile around schools is of significantly poorer quality than that of the rest of the test area (p < .001). The quality of the food environment around schools is highly associated with such socio-economic factors as median household income (OR = 1.000, p < .01) and percentage of minority population (OR = 0.989, p < .01). Quality also varies geographically, with poorer quality in the Midwest (OR = 0.722, p < .05) and northeast (OR = 0.328, p < .001) than in the south and west and lower quality in metro counties (OR = 0.627, p < .01) than in rural and nonmetro counties. CONCLUSION: Our findings stress the importance of awareness for improving food retail environments around elementary schools for the benefit of our children.

Geographical disparities in prescription practices of lithium and clozapine: a community-based study.

OBJECTIVE: To explore the socioeconomic and health resource characteristics associated with geographical variations of lithium and clozapine dispensing rates in France. METHOD: The study was performed using reimbursement data from the French Insurance Healthcare system over the period 2006-2013 in a community-based sample of persons aged 16 years and over. An ecological design was used to assess whether lithium and clozapine prescribing rates were associated with socioeconomic and health resource characteristics of the zone of residence (n = 95 French administrative subdivisions). RESULTS: Large geographical disparities were observed in dispensing rates: lithium dispensing rates by zone of residence ranged from 0 to 6.6 per 1000 (mean 2.4 per 1000) and clozapine dispensing rates ranged from 0 to 4.9 per 1000 (mean 0.8 per 1000). Higher density of GPs and regular communication between mental health services and primary care were independently associated with higher rates of lithium and clozapine dispensing and with a higher proportion of lithium users among mood-stabilizer users. CONCLUSION: A sufficient density of GPs and an effective communication and collaboration between mental healthcare services and primary care seems to favor greater access to psychotropic drugs with demonstrated efficacy but often viewed as 'risky' to prescribe.

Reproductive biology of female Norway lobster, Nephrops norvegicus (Linnaeus, 1758) Leach, in Icelandic waters during the period 1960-2010: comparative overview of distribution areas in the Northeast Atlantic and the Mediterranean.

Maturity size, reproductive cycle, sex ratio and fecundity of female Nephrops were investigated at SW, S and SE Iceland for the period 1960-2010. Time series of biological parameters and fisheries data displayed significant relationships. In addition, female biological data from 20 areas in the Atlantic and Mediterranean were compared. Fifty percentage maturity estimates had an overall range of 23.9-34.4mm CL with some anomalies in the 2000s. The reproductive cycle in Iceland has been biennial during the whole study period from mid-1960s to 2010 with minor change in phase in the 2000s. Biennial moulting retards female growth more than annual spawning, and the length of incubation and hatch time of year show significant relationships with latitude and sea temperature. Variations in sex ratio were observed and relationships found between female sex ratio and CL, CPUE and stock biomass during 1961-2010, displaying apparent fishery-induced effects on sex ratio. Potential and realized fecundity estimates in Iceland are 35-50% of those reported from more southerly waters. Biennial spawning and low fecundity limit the number of progeny in Icelandic Nephrops and necessitate lower fishing mortality. Ambient temperature in Icelandic waters has risen by 1°C since the late 1990s, generating around 30 days shorter incubation time in the 2000s, but around 3°C rise is necessary for possible annual spawning.

Examining the existing usage gap of electronic health records in the United States: A study of National Health Survey.

Background: Little is known about the extent of geographic variation in online health record usage and related demographic characteristics in the United States. Methods: In order to examine geographical variation in the usage of online e-health records (EHR) patient portals in the US, and the sociodemographic factors effects on the access and use of the EHR patient's portal. This study using data from the 2019 and 2020 Health Information National Trends Survey. Specifically, predictors associated with accessing patients' EHR portal were examined. Furthermore, geographic variation of EHR portal' availability and usage gap were examined and mapped. Results: Respondents had significantly higher likelihood to access EHR portals when they are higher educated, willing to seek health information online, insured and had regular providers (adjusted OR = 2.01, 95% CI: 1.44 - 2.80; adjusted OR = 3.51, 95% CI: 2.49 - 4.94; adjusted OR = 2.38, 95% CI: 1.05 - 5.43; adjusted OR = 2.1, 95% CI: 1.51 - 2.92, respectively). Individuals living in Central-West, South regions or other non-urban areas as well as deprived urban areas are less likely to access their EHR portals (adjusted OR = 0.6, 95% CI: 0.41 - 0.89). Furthermore, we found that people living in the Midwest, Southern regions, and Mountain rural areas are more likely to have greater difficulties to access EHR than other regions. Therefore, populations residing in these underserved (deprived urban, rural or remote) areas tend to face more considerable obstacles to e-healthcare. Conclusions: Improve the disparities, accessibility, and educational initiatives on the usage of eHealth resources and encouragement from both healthcare providers and policymakers should be implemented with a particular focus on targeting non-urban areas and underserved population.

Are adverse events following an invasive strategy in patients with non-ST-segment elevation acute coronary syndromes more frequent at US sites versus non-US sites? Analysis from the ACUITY trial.

OBJECTIVE: To compare outcomes between US and non-US (OUS) sites in patients with non ST-elevation acute coronary syndromes (NSTEACS) and to evaluate potential reasons for differences in outcomes. BACKGROUND: There are little data comparing outcomes at US versus OUS sites in patients with NSTEACS managed with an invasive strategy. METHODS: The ACUITY trial randomized 13,819 patients with NSTEACS in 17 countries to an invasive approach with one of three strategies: (1) heparin plus glycoprotein platelet inhibitors (GPI), (2) bivalirudin plus GPI, or (3) bivalirudin alone. RESULTS: US patients were more often female, were younger, heavier, and had more diabetes, prior myocardial infarction (MI), and prior bypass surgery. US patients were less often treated with percutaneous coronary intervention but had more frequent drug-eluting stent use. US patients had lower mortality and higher MI rates at 30 days and 1 year and higher composite ischemic outcome at 30 days. After adjusting for differences in baseline variables, US patients had higher rates of MI and composite ischemic outcome at 30 days and higher rates of MI at 1 year {HR [95% confidence interval (CI)] = 1.36 [1.18-1.56], P < 0.0001} with no differences in mortality. There were no differences in treatment effects comparing bivalirudin with the other strategies between US and OUS sites. CONCLUSIONS: US versus OUS patients with NSTEACS had higher adjusted rates of MI and ischemia. The reasons for these differences are not clear but may be due to unmeasured confounders, different thresholds for event reporting, or valid differences in systems of care which may impact outcomes.

Molecular detection of Bartonella species in wild small mammals in western Yunnan Province, China.

Background: Small mammals serve as the main reservoir for Bartonella and as a proxy indicator of the potential risk of Bartonella transmission from nature to humans. They offer a valuable early warning for human infection. Nevertheless, geographical variations in the impact of the host on the occurrence of Bartonella infection are underestimated. This study was designed to investigate the infection characteristics of Bartonella and explore its species diversity in wild small mammals in western Yunnan Province, China. Methods: Wild small mammals were captured from Yulong, Jianchuan, and Lianghe counties in western Yunnan Province between 2015 and 2016. Real-time quantitative PCR (qPCR) was used to detect Bartonella infection, and the Bartonella species were identified by phylogenetic analysis. The factors associated with Bartonella infection in small mammals were analyzed by the Chi-square Test. Results: The prevalence of Bartonella in small mammals was 47.85% (768/1605). Lianghe County had the highest Bartonella infection rate, with 56.27% of the samples tested positive, followed by a rate of 50.91% was tested in Yulong County, and 39.97% in Jianchuan County (p < 0.001). Bartonella was detected positive in a total 25 small mammal species, with infection rates ranging from 2.17% to 100%. Niviventer fulvescens had the highest Bartonella infection rate. In comparison with the dominant small mammal species, Eothenomys mileyus had the lowest Bartonella infection rate than that in Apodemus chevrieri, Rattus tanezumi, and Apodemus draco (p < 0.001). Male small mammals had a higher infection rate than females (p < 0.05). The prevalence of Bartonella in small mammals during the summer season was higher compared to the other three seasons (p < 0.001). Woodland landscape had the highest Bartonella infection rate (p < 0.001). Bartonella rochalimae, B. japonica, B. tribocorum, B. washoensis, B. sylvatica, and B. rattimassiliensis were obtained from infected small mammals. Conclusion: This study showed a high prevalence of Bartonella was detected with various Bartonella species in small mammals in Yulong, Jianchuan, and Lianghe counties of western Yunnan Province. These findings hold significant scientific clues, providing valuable reference points for further research of Bartonella natural foci in Yunnan or other analogues environments.

[Peculiarities of allergy to plant foods in South-Eastern Spain]. / Peculiaridades de la alergia a los alimentos vegetales en el sureste de España.

Allergy to fruits and vegetables is the most common primary food allergy in Mediterranean countries, especially the lipid transfer proteins (LTPs) syndrome. This study is the first research that studies multiple clinical, allergological and therapeutics characteristics of allergies to plants in the South-East of Spain, and assessing whether these characteristics differ in emergency room or outpatient clinic. This is a prospective study of patients who consult for the first time for allergy to vegetables at Granada, Spain. We record demographic data, symptoms, allergological study and indicated therapy. The characteristics obtained agree with the current bibliographic except the higher prevalence than other areas of positive sensitization of Pru p 3, Cor a 9 and Ara h 9, which predisposes to severe allergic reactions. We conclude: Allergy to plant food in Granada is a more severe phenotype than other geographic areas from Spain, especially in young adults sensitized by different LTPs and pollinosis to olive pollen.

La alergia a frutas y verduras es la alergia alimentaria más común en los países mediterráneos, especialmente el síndrome LTP (lipid transfer proteins). Este es el primer estudio que analiza múltiples características clínicas, alergológicas y terapéuticas de la alergia a vegetales en el sureste de España y que evalúa si difieren en urgencias o consultas externas. Se trata de un estudio prospectivo de pacientes que consultan por primera vez debido a alergia a verduras en Granada, España. Registramos datos demográficos, clínicos, alergológicos y tratamiento prescrito. Las características obtenidas concuerdan con las infomadas en la bibliografía actual, excepto en la mayor prevalencia de Pru p 3, Cor a 9 y Ara h 9, que predisponen a reacciones alérgicas graves. La conclusión es que la alergia a vegetales en Granada es un fenotipo más grave que en otras áreas de España, especialmente en adultos jóvenes sensibilizados a diferentes proteínas de transferencia de lípidos y polinosis a polen del olivo.

Machine learning-based estimation of ground-level NO2 concentrations over China.

Most current scientific research on NO2 remote sensing focuses on tropospheric NO2 column concentrations rather than ground-level NO2 concentrations; however, ground-level NO2 concentrations are more related to anthropogenic emissions and human health. This study proposes a machine learning estimation method for retrieving the ground-level NO2 concentrations throughout China based on the tropospheric NO2 column concentrations from the TROPOspheric Monitoring Instrument (TROPOMI) and multisource geographic data from 2018 to 2020. This method adopts the XGBoost machine learning model characterized by a strong fitting ability and complex model structure, which can explain the complex nonlinear and high-order relationships between ground-measured NO2 and its influencing factors. The R2 values between the retrievals and the validation and test datasets are 0.67 and 0.73, respectively, which suggests that the proposed method can reliably retrieve the ground-level NO2 concentrations across China. The distribution characteristics, seasonal variations and interannual differences in ground-level NO2 concentrations are further analyzed based on the retrieval results, demonstrating that the ground-level NO2 concentrations exhibit significant geographical and seasonal variations, with high concentrations in winter and low concentrations in summer, and the highly polluted regions are concentrated mainly in Beijing-Tianjin-Hebei (BTH), the Yangtze River Delta (YRD), the Pearl River Delta (PRD), Cheng-Yu District (CY) and other urban agglomerations. Finally, the interannual variation in the ground-level NO2 concentrations indicates that pollution decreased continuously from 2018 to 2020.

Temporal and geographical variations of thyroid cancer incidence and mortality in France during 1986-2015: The impact of overdiagnosis.

BACKGROUND: France is among the countries showing fastest growth of thyroid cancer (TC) incidence and highest incidence rates in Europe. This study aimed to clarify the temporal and geographical variations of TC in France and to quantify the impact of overdiagnosis. METHODS: We obtained TC incidence data in 1986-2015, and mortality data in 1976-2015, for eight French departments covering 8% of the national population, and calculated the age-standardised rates (ASR). We estimated the average annual percent changes (AAPC) of TC incidence, overall and by department and histological subtype. Numbers and proportions of TC cases attributable to overdiagnosis were estimated by department and period, based on the comparison between the shape of the age-specific curves with that observed prior to changes in diagnostic practice. RESULTS: During 1986-2015, there were 13,557 TC cases aged 15-84 years. Large variations of TC incidence were observed across departments, with the highest ASR and the fastest increase in Isère. Papillary subtype accounted for 82.8% of the cases, and presented an AAPC of 7.0% and 7.6% in women and men, respectively. Anaplastic TC incidence decreased annually 3.0% in women and 0.8% in men. Mortality rates declined consistently for all departments. The absolute number (and proportion) of TC cases attributable to overdiagnosis grew from 1074 (66%) in 1986-1995 to 3830 (72%) in 2006-2015 in women, and varied substantially across departments. CONCLUSIONS: Overdiagnosis plays an important role in the temporal and regional variations of TC incidence in France. Monitoring the time trends and regulating the regional healthcare practice are needed to reduce its impact.

Geographical Variations in Host Predisposition to COVID-19 Related Anosmia, Ageusia, and Neurological Syndromes.

The novel coronavirus disease (COVID-19), has become the most critical global health challenge in recent history. With SARS-CoV-2 infection, there was an unexpectedly high and specific prevalence of olfactory and taste disorders (OTDs). These high rates of hyposmia and hypogeusia, initially reported as up to 89% in European case series, led to the global inclusion of loss of taste and/or smell as a distinctive feature of COVID-19. However, there is emerging evidence that there are striking differences in the rates of OTDs in East Asian countries where the disease first emerged, as compared to Western countries (15.8 vs. 60.9%, p-value < 0.01). This may be driven by either variations in SARS-CoV-2 subtypes presenting to different global populations or genotypic differences in hosts which alter the predisposition of these different populations to the neuroinvasiveness of SARS-CoV-2. We also found that rates of OTDs were significantly higher in objective testing for OTDs as compared to subjective testing (73.6 vs. 60.8%, p-value = 0.03), which is the methodology employed by most studies. Concurrently, it has also become evident that racial minorities across geographically disparate world populations suffer from disproportionately higher rates of COVID-19 infection and mortality. In this mini review, we aim to delineate and explore the varying rates of olfactory and taste disorders amongst COVID-19 patients, by focusing on their underlying geographical, testing, ethnic and socioeconomic differences. We examine the current literature for evidence of differences in the olfactory and gustatory manifestations of COVID-19 and discuss current pathophysiological hypotheses for such differences.

C3435T Polymorphism of the ABCB1 Gene in Polish Patients with Inflammatory Bowel Disease: A Case-Control and Meta-Analysis Study.

P-glycoprotein encoded by the ABCB1 gene constitutes a molecular barrier in the small and large bowel epithelium, and its different expression may influence susceptibility to inflammatory bowel disease (IBD). We aimed to assess the contribution of the C3435T polymorphism to disease risk in the Polish population. A total of 100 patients (50 Crohn's disease (CD), 50 ulcerative colitis (UC)) and 100 healthy controls were genotyped for the single nucleotide polymorphism (SNP) C3435T by using the PCR-RFLP method. Patients were classified on the basis of disease phenotype and the specific treatment used. A meta-analysis was carried out of our results and those from previously published Polish studies. There was no significant difference in allele and genotype frequencies in IBD patients compared with controls. For CD patients, a lower frequency of TT genotype in those with colonic disease, a lower frequency of T allele, and a higher frequency of C allele in those with luminal disease were observed, whereas for UC patients, a lower frequency of CT genotype was observed in those with left-sided colitis. A meta-analysis showed a tendency towards higher prevalence of CC genotype in UC cases. These results indicate that the C3435T variants may confer a risk for UC and influence disease behaviour.

Geographical variations of early age sexual initiation among reproductive-age women in Ethiopia: evidence from EDHS 2016.

BACKGROUND: The early age of sexual initiation contribute a lot for various risks such as mistimed pregnancy followed by insecure termination, developing fistula and contracting sexually transmitted infections which are currently the major public health concerns for low-income countries. Therefore, the purpose of this study was to detect spatial clusters and identify factors associated with an early age sexual initiation of women in the reproductive age group. METHODS: We used a population-based nationwide representative Ethiopian Demographic and Health Survey (EDHS) 2016 data.. A total of 12,033 respondents of reproductive age (15-49 years) women who had at least one event of sexual intercourse was retrieved and included for the analysis. Spatial cluster detection and autocorrelation analysis were also done to explore the patterns of early age sexual initiation. RESULTS: The median age at first sexual intercourse among respondents was 16 (±3.3) years and more than half (66.2%) had their first sexual intercourse before the age of 18 years. The spatial variations of the age of sexual initiation was nonrandom and clustered with a Moran's I = 0.413 (P-value < 0.001). In addition, five significant spatial clusters were also identified. Moreover, the probability of starting sex at an earlier age was associated with the respondent's residence, marital status, educational attainment and wealth index. CONCLUSION: This study found a higher proportion of an early age sexual initiation of women. Respondent's residence, marital status, educational attainment and wealth index were significantly associated with early sexual initiation. The SaTScan analysis identified five statistical significant spatial clusters which indicate that there were geographical variations. Therefore, integrated interventions focusing on the identified high spot clustered areas are recommended to reduce early age sexual initiation.

Geographical differences in heart failure characteristics and treatment across Europe: results from the BIOSTAT-CHF study.

BACKGROUND: Geographical differences may impact the treatment of heart failure (HF) and the results of clinical trials. We have investigated the differences between geographical areas across Europe in the BIOSTAT-CHF program. METHODS: Patients with worsening HF enrolled in BIOSTAT-CHF were subdivided, according to the European geographical areas, into those from Northern countries (The Netherlands, Norway, Sweden, UK), Central countries (Germany, Poland, Serbia, Slovenia), and Mediterranean countries (France, Greece, Italy). Patients were compared for baseline characteristics, treatment, and outcomes. The primary endpoint was a composite of all-cause mortality or HF hospitalization. RESULTS: Among 2516 patients enrolled in BIOSTAT-CHF, 814 (32.3%) were from Northern European centers, 816 (32.4%) from Central European centers, and 886 (35.2%) from Mediterranean centers. Patients from Northern European centers were older, had more severe signs and symptoms of HF, and with lower incidence of non-cardiac comorbidities such as chronic kidney dysfunction, diabetes and, hypertension, compared to those from the Central and Mediterranean centers. Patients receiving ≥ 50% of the target dose of both ACE-I/ARB after the up-titration phase were higher in the Northern European centers compared with the other regions (60% versus 58.7% in the Central European centers and 46.5% in the Mediterranean ones; p < 0.001). The primary endpoint occurred at a higher rate in the Northern centers (44.3% versus 37.4% in central centers and 39.6% in Mediterranean centers; p = 0.014), this difference became non-significant after the adjustment for important confounders. Importantly, treatment up-titration reduced the event rates regardless of the geographical region (p for interaction > 0.05). CONCLUSION: The BIOSTAT-CHF study showed significant differences in the clinical features, treatment and prognosis in European patients with HF. Patients from the Mediterranean centers less often had the HF treatments up-titrated; however, the treatment up-titration benefited patients irrespective of their geographical region and should be part of the "default" clinical practice.