Geographical incidence of testosterone supplementation in total hip and knee arthroplasty.

Introduction: Prescription testosterone usage in the United States declined after 2013 following reports of its association with myocardial infarction and stroke. However, more recently there has been a documented increase in testosterone prescriptions. Recently, testosterone levels have also been hypothesized to increase infection risk in patients undergoing elective shoulder arthroplasty. Furthermore, testosterone may increase the risk of venous thromboembolism. These complications are perioperative concerns for total hip and knee arthroplasties (THA/TKA). Therefore, the purpose of our study is to identify trends in the incidence of testosterone prescriptions in patients who underwent THA/TKA with respect to geographical population data. Methods: We retrospectively reviewed 40,711 primary THAs and 50,893 primary TKAs performed in males between 1/1/2016 and 12/31/2021 using a commercial claims database. Records were reviewed for demographics, geographical location, and supplemental testosterone prescriptions within 1 year prior to surgery. Patient Metropolitan Statistical Area (MSA) was assessed with respect to United States Census Population Data. Results: We identified 91,604 males who underwent primary THA (n = 40,711) or TKA (n = 50,893). For THA/TKA, patients who were younger had a higher likelihood of having a supplemental testosterone prescription (OR = 0.99, 95 % CI [0.99-1.00], p < 0.001). TKA patients (2,507, 4.9 %) had a higher rate of testosterone prescriptions than THA patients overall (1,413, 3.4 %), (OR = 1.44 95 % CI [1.35, 1.54], p < 0.001) as well as within each year.For THA and TKA patients, patients in the Midwest (OR = 1.61, p < 0.001), South (OR = 3.04, p < 0.001), and West (OR = 2.28, p < 0.001) regions all had higher testosterone prescription rates than the Northeast. Patients living in a city (MSA population ≥200,000) were more likely to be prescribed testosterone (OR = 1.20, p = 0.002). Conclusion: Surgeons conducting TKA/THA should be aware that younger patients, those in higher population areas, and those in the Midwest, South, and West regions are more likely to be prescribed testosterone than those in the Northeast.

Regional variations in HIV diagnosis in Japan before and during the COVID-19 pandemic.

Background: The number of people undergoing voluntary HIV testing has abruptly decreased since 2020. The geographical heterogeneity of HIV infection and the impact of COVID-19 on the diagnosis of HIV at regional level are important to understand. This study aimed to estimate the HIV incidence by geographical region and understand how the COVID-19 pandemic influenced diagnosis of HIV. Methods: We used an extended back-calculation method to reconstruct the epidemiological dynamics of HIV/AIDS by geographical region. We used eight regions: Tokyo, the capital of Japan, Hokkaido plus Tohoku, Kanto plus Koshinetsu (excluding Tokyo), Hokuriku, Tokai, Kinki, Chugoku plus Shikoku, and Kyushu plus Okinawa. Four different epidemiological measurements were evaluated: (i) estimated HIV incidence, (ii) estimated rate of diagnosis, (iii) number of undiagnosed HIV infections, and (iv) proportion of HIV infections that had been diagnosed. Results: The incidence of HIV/AIDS during the COVID-19 pandemic from 2020 to 2022 increased in all regions except Kanto/Koshinetsu (51.3 cases/year), Tokyo (183.9 cases/year), Hokuriku (1.0 cases/year), and Tokai (43.1 cases/year). The proportion of HIV infections that had been diagnosed only exceeded 90% in Tokyo (91.7%, 95% confidence interval (CI): 90.6, 93.3), Kanto/Koshinetsu (91.0%, 95% CI: 87.3, 97.8), and Kinki (92.5%, 95% CI: 90.4, 95.9). The proportion of infections that had been diagnosed was estimated at 83.3% (95% CI: 75.1, 98.7) in Chugoku/Shikoku and 80.5% (95% CI: 73.9, 91.0) in Kyusyu/Okinawa. Conclusions: In urban regions with major metropolitan cities, including Tokyo, Kinki, and Kanto/Koshinetsu, the number of undiagnosed HIV infections is substantial. However, the proportion of undiagnosed infections was estimated to be smaller than in other regions. The diagnosed proportion was the lowest in Kyusyu/Okinawa (80.5%), followed by Chugoku/Shikoku and Hokkaido/Tohoku. The level of diagnosis in those regional prefectures may have been more influenced and damaged by the COVID-19 pandemic than in urban settings.

Exploring the influencing factors of scrub typhus in Gannan region, China, based on spatial regression modelling and geographical detector.

Scrub typhus is a significant public health issue with a wide distribution and is influenced by various determinants. However, in order to effectively eradicate scrub typhus, it is crucial to identify the specific factors that contribute to its incidence at a detailed level. Therefore, the objective of our study is to identify these influencing factors, examine the spatial variations in incidence, and analyze the interplay of two factors on scrub typhus incidence, so as to provide valuable experience for the prevention and treatment of scrub typhus in Gannan and to alleviate the economic burden of the local population.This study employed spatial autocorrelation analyses to examine the dependent variable and ordinary least squares model residuals. Additionally, spatial regression modelling and geographical detector were used to analyze the factors influencing the annual mean 14-year incidence of scrub typhus in the streets/townships of Gannan region from 2008 to 2021. The results of spatial1 autocorrelation analyses indicated the presence of spatial correlation. Among the global spatial regression models, the spatial lag model was found to be the best fitting model (log likelihood ratio = -319.3029, AIC = 666.6059). The results from the SLM analysis indicated that DEM, mean temperature, and mean wind speed were the primary factors influencing the occurrence of scrub typhus. For the local spatial regression models, the multiscale geographically weighted regression was determined to be the best fitting model (adjusted R2 = 0.443, AICc = 726.489). Further analysis using the MGWR model revealed that DEM had a greater impact in Xinfeng and Longnan, while the southern region was found to be more susceptible to scrub typhus due to mean wind speed. The geographical detector results revealed that the incidence of scrub typhus was primarily influenced by annual average normalized difference vegetation index. Additionally, the interaction between GDP and the percentage of grassland area had a significant impact on the incidence of scrub typhus (q = 0.357). This study illustrated the individual and interactive effects of natural environmental factors and socio-economic factors on the incidence of scrub typhus; and elucidated the specific factors affecting the incidence of scrub typhus in various streets/townships. The findings of this study can be used to develop effective interventions for the prevention and control of scrub typhus.

Trichinella findings in Germany from 2013 to 2023 indicate an increased prevalence in wild boar (Sus scrofa) population.

In Germany, Trichinella spp. are mainly detected in the sylvatic cycle. Here, the affected animal species are wild boar, fox, badger, raccoon dog, wolf, raccoon and golden jackal. The predominantly detected species are T. spiralis, followed by T. pseudospiralis and T. britovi. Due to legal requirements in Germany, all hunted wild boars and other susceptible animals must be examined for Trichinella spp. if their meat is intended for human consumption. In recent years, an increase in the number of Trichinella-positive wild boar shot in Germany has been registered and the prevalence of positive wild boar scaled up from 0.002 % to 0.005 % between 2013 and 2023. Regarding regional distribution, most Trichinella findings in wild boar have been registered in the North-Eastern part of Germany. Here, the federal states Western-Pomerania, Brandenburg and Saxony that are bordering to Poland are particularly affected. The increase in positive wild boar may be associated with the spread of raccoon dogs and wolves in these regions. Thus, measures are required to prevent the spread of Trichinella among wild animals and to follow the systematic meat inspection in susceptible wild animals intended for food especially wild boar.

Integrating mineral elements and metabolite features to distinguish Lotus seeds from different geographic origins.

The characteristics of lotus seeds (LS) are influenced by variety and environment. However, it remains unknown the difference of metabolites and elements of LS from different origins. In this study, an accurate quantification method (97-107 %) for 20 mineral elements in LS was developed, and a metabolomic method was established to identify a total of 323 metabolites in LS. Mineral composition analysis revealed significant variations in the mineral element contents among LS samples from seven geographical regions. LS were rich in potassium (14,710 mg/kg), manganese (67.19 mg/kg), with a low level of sodium (210 mg/kg). A total of 10 mineral elements and 117 metabolites (p < 0.05 and VIP > 1) were identified as the potential geographical markers of LS by integration analysis. The linear discriminant analysis model showed high prediction accuracy. This study provides strong experimental evidence to maintain the authenticity and quality of LS in the food industry.

Metabolomics and quantitative analysis to determine differences in the geographical origins and species of Chinese dragon's blood.

Objective: The aim of this study was to comprehensively analyze the differences in Chinese dragon's blood (CDB), specifically Dracaena cochinchinensis and Dracaena cambodiana, from different geographical origins. Methods: Metabolomic analysis of CDB was performed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). A reliable ultrahigh-performance liquid chromatography method with a photodiode array detector (UHPLC-PDA) was developed and applied for the quantitative analysis of 12 phenolic compounds in 51 batches of samples. Results: A total of 1394 metabolites were detected, of which 467 were identified as differentially accumulated metabolites. Multivariate analysis revealed that both origin and species had an effect on the composition of CDB, with greater variation between species. 19 phenolic compounds were selected as quality markers to distinguish D. cochinchinensis (Hdsp) from D. cambodiana (Hdca), and oppositin and spinoflavanone a were identified as quality markers to discriminate D. cochinchinensis samples from Hainan (Hdsp) and Guangxi Provinces (Gdc). Quantitative analysis indicated that four phenolic compounds, including loureirin D, 4H-1-benzopyran-4-one,2,3-dihydro-3,5,7-trihydroxy-3-[(4-methoxyphenyl)methyl]-,(R)-, loureirin B, and pterostilbene, showed significant differences between Gdc and Hdsp. Additionally, five phenolic compounds, namely resveratrol, loureirin D, pinostilbene, 4H-1-benzopyran-4-one,2,3-dihydro-3,5,7-trihydroxy-3-[(4-methoxyphenyl)methyl]-, (R)-, and loureirin B, exhibited significant differences between Hdsp and Hdca. Conclusion: There are significant differences in the quality of CDB from different geographical origins and species, which lays the foundation for the in-depth development and utilization of different sources of CDB.

Insight into the emerging insect to human pathogen Photorhabdus revealing geographic differences in immune cell tropism.

Background: Photorhabdus asymbiotica is a species of the insect pathogenic Photorhabdus genus that has been isolated as an etiological agent in human infections. Since then, multiple isolates have been identified worldwide; however, actual clinical infections have so far only been identified in North America, Australia, and Nepal. Previous research on the clinical isolates had shown that the strains differed in their behaviour when infecting cultured human cells. Methods: In this study, we investigate the differences between the pathogenic activities of P. asymbiotica isolates from different geographic locations. Pathogenicity was analysed using infection assays with both cultured cell lines (THP-1, CHO, and HEK cells) and primary immune cells, and peripheral blood mononuclear cells (PBMCs) isolated from human blood. Results: Here, we present the findings from the Australian (Kingscliff) and North American (ATCC43949) clinical isolates, and non-clinical soilborne nematode isolates from Thailand (PB68) and Northern Europe (HIT and JUN) of P. asymbiotica. We also show the first findings from a new clinical isolate of P. luminescens (Texas), the first non-asymbiotica species to cause a human infection, confirming its ability to infect and survive inside human immune cells. Conclusion: Here for the first time, we show how P. asymbiotica selectively infects certain immune cells while avoiding others and that infectivity varies depending on growth temperature. We also show that the tropism varies depending on the geographic location a strain is isolated from, with only the European HIT and JUN strains lack the ability to survive within mammalian cells in tissue culture.

No geographical differences in male mate choice in a widespread fish, Limia perugiae.

Behavior, like most other traits, can have a spatial component, and variability of behavior at the population level is predicted. In this article, we explore male mate choice at this level. Male mate choice, while maybe not as common as female choice, is expected to evolve when males respond to significant variation in female quality and, for example, prefer females with higher fecundity. In fishes, higher fecundity is associated with larger body size, an easily measured trait. In this study, we investigated the presence of male mate choice for larger females in a widespread species of livebearing fish, Limia perugiae, while comparing preferences between populations. We hypothesized that environmental variation, for example, in the form of salinity, might result in population differences. Using dichotomous choice tests, we analyzed behavioral data for 80 individuals from 7 distinct populations from Hispaniola. We found that L. perugiae males significantly preferred large females, but there was no significant statistical variation between populations.

COVID-19 vaccine coverage effectiveness among elderly with geographical information system mapping: what about Indonesia?

Background: The elderly are the next priority after health workers and public service workers get the COVID-19 vaccine to control morbidity and even mortality in the elderly who have a risk factor that is up to 60 times more severe than children. Objectives: This study aimed to spatially analyze the effectiveness of COVID-19 vaccine coverage among the elderly in Indonesia with geographic information system (GIS) mapping and to analyze the relationship between COVID-19 vaccine coverage in the elderly with the COVID-19 cure rate. Design: This quantitative study used secondary data on COVID-19 vaccination coverage in the elderly group of Central Java Province, Indonesia in 2021. Methods: Data were analyzed using a simple linear correlation test to test the relationship between variables with a 1,774,396 elderly sample size, then distributed using mapping of COVID-19 vaccination coverage using a GIS. Results: The relationship between COVID-19 vaccine dose-2 elderly coverage cure rate showed a strong relationship (r = 0.677) and a positive pattern. The coefficient value with a determination of 0.459 means that the regression line equation obtained can explain 45.90% of the variation in the COVID-19 cure rate. There was a significant relationship between COVID-19 vaccine elderly coverage and the COVID-19 cure rate (p-value = 0.005). Conclusion: Clinicians and public health workers should continue to encourage elderly vaccination at all recommended doses for eligible individuals.

COVID-19 vaccine coverage effectiveness among elderly with geographical information system mapping: what about Indonesia? This research analyzed the Effectiveness of COVID-19 Vaccine Coverage among the Elderly in Indonesia with Geographic Information System Mapping and analyzed the relationship between COVID-19 Vaccine coverage in the elderly with the COVID-19 cure rate.

High-risk spatiotemporal patterns of leprosy in the southeastern region of Yunnan province from 2010 to 2022: an analysis at the township level.

BACKGROUND: Despite being preventable and curable, leprosy remains endemic in some undeveloped regions, including China. Wenshan Zhuang and Miao Autonomous Prefecture (Wenshan prefecture) currently bears the highest leprosy burden in China. In this ecological study, we aimed to analyze the epidemiological characteristics as well as identify and visualize the high-risk townships of Wenshan prefecture using the most updated leprosy data from 2010 to 2022. METHODS: Geographical information system combined with spatial scan statistics was used for newly detected leprosy cases abstracted from the Leprosy Management Information System in China. Global Moran's I index was used to uncover the spatial pattern of leprosy at the township level. Spatial scan statistics, encompassing purely temporal, purely spatial, spatial variation in temporal trends, and space-time analysis, were implemented for detecting the risk clusters. RESULTS: Between 2010 and 2022, Wenshan prefecture detected 532 new leprosy cases, comprising 352 (66.17%) males and 180 (33.83%) females. The aggregated time primarily occurred between October 2010 and March 2014. The distribution pattern of newly detected leprosy cases was spatially clustered. We identified four high-risk spatial clusters encompassing 54.51% of the new cases. Furthermore, spatial variation in temporal trends highlighted one cluster as a potential high-risk area. Finally, two space-time clusters were detected, and the most likely cluster was predominantly located in the central and northwest regions of Wenshan prefecture, spanning from January 2010 to September 2013. CONCLUSIONS: In this ecology study, we characterized the epidemiological features and temporal and spatial patterns of leprosy in Wenshan prefecture using the most recent leprosy data between 2010 and 2022. Our findings offer scientific insights into the epidemiological profiles and spatiotemporal dynamics of leprosy in Wenshan prefecture. Clinicians and policymakers should pay particular attention to the identified clusters for the prevention and control of leprosy.

Metabolic differences in Zingiber officinale Roscoe by geographical origin determined via multiplatform metabolomics and method for simultaneous analysis of six phenolic compounds.

Ginger, which is the rhizome of Zingiber officinale Roscoe, is widely distributed and consumed. The taste and aroma of ginger differ depending on its geographical origin. To distinguish the origin of ginger, ginger extracts from Korea, Peru, and China were analyzed using ultra-performance liquid chromatography (UPLC) coupled to quadrupole time-of-flight mass spectrometry and nuclear magnetic resonance spectroscopy for metabolomics. Korean ginger contained more 10-gingerol, and Peruvian ginger contained more 6-gingerol and 8-gingerol. Several amino acids negatively correlated with gingerols, suggesting that amino acids are related to the biosynthesis of gingerols. Sugars, which are the main energy source, positively correlated with gingerols. Organic acids and gingerols were also positively correlated, indicating that both organic acids and gingerols are used for adaptation to the environment surrounding the root. We confirmed the features of the primary and secondary metabolites by verifying the correlation between metabolites and differences in metabolites according to ginger origin. We additionally optimized a simultaneous UPLC analytical method of marker compounds for the simple and rapid quality control of ginger. This method exhibits excellent linearity, sensitivity, and reproducibility. Using metabolomics, differences in origin were observed, and a low-end equipment analysis method for quality control can be used in the ginger industry.

Morpho-molecular characterization of phoma-like fungi from Morus alba in northern Thailand; a novel species (Boeremia albae) and a new host record (B. maritima).

Boeremia was established to accommodate phoma-resembling fungi. Its species occur in terrestrial ecosystems as endophytes, saprobes and pathogens, except one species reported from a marine ecosystem. Boeremia species are characterized by hyaline, thin-walled, and aseptate (occasionally 1(-2)-septate) conidia that are variable in shape, and hyaline, straight or slightly curved, thick-walled, and 1-septate ascospores that are usually constricted at the septum. In the past, host associations were used to delimit Boeremia species. However, since Boeremia taxa have overlapping morphological characters and are cryptic, it renders taxonomic identification arduous. Therefore, the use of other approaches including multi-gene phylogenetic analyses are imperative. Recommended DNA markers for species delineation are the internal transcribed spacer (ITS, nuclear rDNA consisting of ITS1-5.8S-ITS2) and large subunit (28S, D1-D2 domains of nuclear 28S rDNA) loci, and the genes for actin (ACT1), beta-tubulin (TBB1), RNA polymerase 2 (RPB2) and translation elongation factor 1α (TEF1). Here, we applied morphological and molecular phylogenetic analyses to establish a new taxon (B. albae), and a new host and geographical record for B. maritima associated with leaf spots of Morus alba (Moraceae) in northern Thailand. By providing sequence data for three additional gene regions, our phylogenetic analyses impart a stable phylogenetic placement of the ex-type strain of B. maritima, as illustrated. This is the first study that reports Boeremia species from M. alba, and B. maritima from a terrestrial habitat.

Development and evaluation of a panel of newly screened Y chromosome InDels for inferring paternal ancestry information in Southwest China.

Y-InDels (insertions/deletions) are genetic markers which are extremely understudied. It is unknown whether this type of markers can be utilized for genetic ancestry inference. We have developed an innovative Y chromosome ancestry inference system tailored for forensic applications. This panel amplifies 21 Y chromosome loci, encompassing Y-InDels and Y-SNPs (Single Nucleotide Polymorphism), utilizing the capillary electrophoresis (CE) platform. The system performed well at DNA concentrations greater than 0.125 ng/ul and produced accurate results at a 1:100 mixing ratio of male and female DNA. The Cumulative probability of matching (CPM) was between 0.95 and 0.97 in the experimental population. The system's efficacy in inferring ancestral origins was demonstrated through intercontinental population discrimination, revealing high discrimination power between African and East Asian populations. Population genetic analyses conducted on Han, Qiang and Hui populations in Southwest China, where the smallest FST value was 0.0002 between Han Chinese in Beijing (from 1000 Genomes Project) and Qiang Chinese from Sichuan (CQSC). Phylogenetic tree construction further illuminated distinct haplotypes among populations, with ethnically unique haplotypes observed in 34.6% of Hui and 7.1% of Qiang populations. K-fold cross-validation show the system's inference abilities at the intercontinental level. In addition, our investigations identified potential associations between the Y-InDel locus Y: 15,385,547 (GRCh37) and haplogroup R1a1a1b2a2- Z2124, as well as locus Y: 13,990,180 (GRCh37) and haplogroup F-M89. In conclusion, we have established a Y-chromosome inference system tailored for grassroots-level application, underscoring the value of incorporating Y-InDel markers in forensic analyses.

Serving Queensland: reflecting on geographical access to the pelvic exenteration service in Queensland.

BACKGROUND: Pelvic exenteration for rectal cancer involves a radical multi-visceral resection to improve complete surgical clearance, and access is limited within Queensland. METHODS: A retrospective review of a prospective database of the referrals to the pelvic exenteration service in the Royal Brisbane and Women's Hospital from 2009 to2023. Geographic, as well as clinical and demographic information was collected. RESULTS: One hundred and seventy six patients were referred to the pelvic exenterations service. In total 93 patients were referred from a major city, 52 from inner regional areas, and 31 from outer regional or remote areas. One hundred and three referred patients (58.5%) proceeded to surgery, significantly more of whom were referred from a major city (P < 0.001). Of the patients referred from outer regional, inner regional, and major cities, a similar proportion of patients proceeded to surgery (55%, 52%, and 63.4%). Patients not proceeding to surgery in major cities and inner regional areas were most commonly unfit to proceed, whereas in outer regional areas most patients decided against surgery (61.5%). In the 14-year period, overall referrals increased, with inner regional referrals increasing the most over time. Overall survival was not significantly impacted by remoteness. CONCLUSION: Awareness of the pelvic exenteration service in regional Queensland may have resulted in less referrals to the service. It is important to confirm a broad-reaching service to optimize patient care.

Data fusion of HS-SPME-GCMS, NIRS, and fluorescence, using chemometrics, has the potential to explore the geographical origin of gentian rhizomes.

Gentiana lutea rhizomes are known for their bitter tasting properties conferred by its unique biochemical content. They are currently of interest in phytotherapy, animal nutrition, food processing, cosmetic applications and agroecology. In this study, a NIRS, fluorescence and HS-SPME-GCMS dataset of 55 rhizomes from four different French mountains (Alpes, Jura, Massif Central and Pyrénées) was collected with the aim of assessing the variability of Gentiana lutea composition at different scales. The feasibility of data fusion strategies was demonstrated to be effective in distinguishing the geographical origin of Gentiana lutea roots over a wide area. The results suggest that data fusion methods have the potential to be more effective in the quality of separation of studied sites of Gentiana lutea roots than individual decisions obtained from individual analytical tools. However, to guarantee the geographical origin of Gentiana lutea roots within a single massif using these techniques, environmental factors must be considered.

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.

Prevalence and treatment of autism spectrum disorder in the United States, 2016-2022.

This study aims to assess the prevalence of Autism Spectrum Disorder (ASD) and its treatment. The study population was children aged 3-17 years with information on current ASD from National Survey of Children's Health, 2016-2022. Analysis of treatment was also conducted within the population of children with a current ASD diagnosis. A multivariate log-binomial regression model was used to assess the change of current ASD prevalence and ASD treatment by two study period (prior to COVID-19 pandemic: 2016-2019; during COVID-19 pandemic: 2020-22) and sociodemographic information. Compared to the current ASD at 2.5% in 2016, it increased to 3.6% in 2022. The treatment has decreased from 70.5% in 2016 to 61.6% in 2022 for any treatment and from 27.2% in 2016 to 20.4% in 2022 for medication treatment. Compared to children from 2016-2019, children from the following group were more likely to have ASD diagnosis during the pandemic (2020-2022), including those aged 3-5 years (aPR = 1.66, 95%CI 1.29-2.13), non-Hispanic white children, children from family with above national family income, and those with private insurance. However, medication treatment almost halved during the pandemic for non-Hispanic black children (aPR = 0.49, 95%CI 0.26-0.93) and children born overseas. In conclusion, higher prevalence of ASD might indicate a better awareness of ASD. The reduction in treatment correlates to the health service disruption caused by the pandemic, highlighting the needs of policy efforts to improve treatment for ASD.

Ethnic, geographical and altitude considerations and maternal mortality associated with HELLP syndrome in Ecuador: a population-based cohort study.

BACKGROUND: Eclampsia and pre-eclampsia rank as the third leading causes of maternal death in Ecuador, following pre-existing chronic diseases and postpartum haemorrhage, as reported by the Ecuadorian National Institute of Statistics and Census (INEC). In contrast, HELLP (Haemolysis, Elevated Liver enzymes, Low Platelet count) syndrome remains underexplored epidemiologically, not only in Latin America but globally. This study marks the first population-based investigation into HELLP syndrome incidence and mortality in Ecuador, examining geographical variations, altitude influences and ethnic backgrounds. METHODS: Conducted as a retrospective population-based cohort study from 2015 to 2017, this research delves into the incidence, risk factors and maternal mortality associated with HELLP syndrome in Ecuador. Utilising data from INEC and the Ecuadorian Ministry of Health, we identified HELLP syndrome cases through ICD-10 (International Classification of Diseases, tenth revision) coding in hospitalised individuals. Logistic regression analysis was employed to explore association, whilst geospatial statistical analysis focused on cantons to identify significant spatial clusters. Primary outcome measures include HELLP syndrome incidence and maternal mortality, supplying crucial insights into the syndrome's impact on maternal health in Ecuador. RESULTS: The incidence of HELLP syndrome is 0.76 (0.69-0.84)/ 1000 deliveries. Afro-Ecuadorian communities have a higher risk (Odds Ratio (OR) = 2.18 (1.03-4.63)) compared to Indigenous Ecuadorian communities. Living at mid-level or high altitude is a significant risk factor OR of 2.79 (2.19-3.55) and an OR 3.61 (2.58-5.03), respectively. Being an older mother was also identified as a risk factor. Women living more than 20 km from the obstetric unit have an OR of 2.55 (2.05-3.18). Moreover, we found that cantons with higher crude HELLP syndrome incidence also have lower numbers of physicians (R = 0.503, p-value < 0.001). The mortality incidence of women with HELLP syndrome is 21.22 (12.05-20.59)/1000 deliveries with HELLP syndrome diagnoses. CONCLUSIONS: High altitude, advanced maternal age and geographical distance between residence and health centres are risk factors for HELLP syndrome. Maternal mortality in women with HELLP syndrome is higher than pre-eclampsia and eclampsia but comparable with previous reports in other countries.

The selectivity of internal movers: An analysis of the relationship between education, social origin, and geographical mobility in Europe.

This paper aims to analyse the social selectivity of internal movers in six European countries, by examining the influence of education and social origin on the likelihood of moving. The study, using ShareLife data, reveals country-specific variations in social selectivity. France and Poland show a skilled selection of internal movers, where education is the primary factor affecting the likelihood of moving, with no additional effect of social origin. In Germany and Sweden, internal movers are selected based on their social origin as well as education, but this double selection differs between the two countries, with a boosting scenario in Germany and a systematic effect of social origin in Sweden, regardless of educational level. Finally, in Spain and Italy, the social selectivity of movers is less evident. Overall, the study highlights the importance of considering the interplay of education and social origin in understanding the social selectivity of internal movers.

Exploration of Geographical Environmental Factors Influencing Regional Population Mortality Patterns in China.

OBJECTIVES: The regional population mortality patterns in China exhibit substantial geographical distribution characteristics. This paper aims to explore the impact and mechanisms of geographical environmental factors on regional population mortality patterns. METHODS: This study first utilized the data from China's Seventh Population Census to obtain mortality patterns for the 31 provincial-level administrative regions. Subsequently, a functional regression method was employed to explore the geographical environmental driving factors of regional mortality patterns. RESULTS: The study provides a detailed explanation of the mechanisms and marginal contributions of key geographical environmental factors at different age groups. CONCLUSIONS: (1) The impact of geographical environmental factors on mortality patterns shows distinct phased characteristics. Mortality patterns before the age of 40 years are hardly influenced by geographical environmental factors, with a noticeable impact beginning at ages 40-69 years and reaching the maximum influence after the age of 70 years. (2) In mortality patterns at ages 40-69 years, average altitude have the most substantial impact, followed by extreme low-temperature days and PM2.5 concentration. In mortality patterns at ages 70-94 years, high-temperature days have the greatest influence, followed by the impact of SO2 concentration. (3) In comparisons based on gender, socioeconomic factors, and geographical environmental factors, gender and urban-rural differences have the most significant impact on regional population mortality patterns, followed by the influence of other socioeconomic factors, with geographical environmental factors having a relatively smaller impact.