10-year Trends Research Articles

Exploring 12-Year trends in childhood obesity prevalence for the Republic of Ireland – a national study using survey data from 2002 and 2014

Background: The prevalence of overweight and obesity among children may have reached a plateau in some developed countries, including Ireland. The aim of this study was to examine 12-year trends in the prevalence of overweight and obesity among primary-school-aged children in the Republic of Ireland between 2002 and 2014. Methods: Two large-scale oral health cross-sectional surveys of primary-school-aged children aged 4–13 years were conducted 12 years apart in 2002 (n=14,055; response rate=68%) and 2014 (n=5,223; response rate=67%). Both surveys included standardised and calibrated height and weight measures. Ownership of a means-tested medical card determined economic status. Standard International Obesity Task Force criteria were applied to determine the prevalence of overweight and obesity. Results: The overall prevalence of overweight/obesity among 4–13-year-olds significantly decreased from 26% (95% CI: 25.1%–26.5%) in 2002 to 24% (95% CI: 22.4%–24.7%) in 2014. Among boys and girls aged 4–13 years, the significant decrease was from 23% (95% CI: 22.1%–24.1%) to 20% (95% CI: 18.9%–22.0 and 28% (95% CI: 27.4%–29.5%) to 27% (95% CI: 25.0%–28.4%), respectively. Among 5-year-old children, the overall prevalence of overweight and obesity significantly decreased from 25% (95% CI: 23.7%–26.2%) to 22% (95% CI: 19.9%–23.4%). In 2002, the estimated prevalence of overweight/obesity was similar in children with and without medical cards, whereas in 2014, overall prevalence was higher in those with medical cards. Conclusions: Results suggest a fall in the prevalence of overweight/obesity between 2002 and 2014, and may suggest a favourable cohort effect. Despite this fall, the overall prevalence remains high and socioeconomic disparities have increased.

Amphetamine use and psychiatric admissions: a 10-year perspective

We aimed to (i) describe the 10-year trend in admissions associated with amphetamine use, (ii) describe the distinguishing characteristics of people with an amphetamine-related diagnosis (ARD) and (iii) examine predictors of repeated admissions among people with an ARD. We conducted a retrospective cohort study. We (i) counted the number of admissions with an ARD and evaluated any trends, and using univariate and multivariate tests, (ii) compared those who had an ARD with those who did not and (iii) compared those with an ARD who had one, two to four, and five or more admissions. Admissions associated with amphetamine use increased between 2009 and 2015. Those with an ARD had significant differences in demographics, diagnosis and pattern of service use relative to those without an ARD. Amongst those with an ARD, a higher number of admissions was positively associated with a schizophrenia diagnosis but inversely associated with a transient psychotic disorder diagnosis. The increase in admissions associated with amphetamine use indicates that people with an ARD posed major demands on inpatient services. Targeting amphetamine treatment to those with psychotic disorders, both schizophrenia and transient psychotic disorders, may reduce hospital-related costs and re-admissions.

Comparison of 20-Year Obesity-Associated Cancer Mortality Trends With Heart Disease Mortality Trends in the US

Heart disease and cancer are the 2 major diseases associated with mortality risk in the United States. Four decades of improvements in heart disease mortality slowed after 2011; this slowing has been associated with the obesity epidemic. The same pattern has not been observed for total cancer mortality. However, trends in total cancer mortality may obscure patterns specific to obesity-associated cancers. To investigate whether trends in obesity-associated cancer mortality mirror the slowed mortality improvements observed for heart disease associated with the obesity epidemic. This cross-sectional study compared US mortality trends for International Statistical Classification of Diseases and Related Health Problems, Tenth Revision-defined cancer (total cancer, obesity-associated cancer, and cancer not associated with obesity) and heart disease deaths from January 1, 1999, to December 31, 2018. Data were included on decedents with complete information on the underlying cause of death, age, sex, race, and ethnicity. Changes in age-adjusted cause-specific mortality rates between 1999-2011 and 2011-2018 were compared. Annual relative rates of change in age-adjusted mortality rates (AAMRs) in the overall population and stratified by sex, race, and ethnicity were estimated using Poisson regression. Differences in AAMR annual relative rates of change before and after 2011 were evaluated using Wald tests. A total of 50 163 483 decedents met the inclusion criteria (50.1% female decedents, 79.9% non-Hispanic White decedents, and 11.7% non-Hispanic Black decedents; mean [SD] age, 72.8 [18.5] years). In contrast with heart disease mortality, for which improvements slowed between 1999-2011 and 2011-2018, decreases in total cancer AAMR relative change accelerated between 1999-2011 (-1.48 [95% CI, -1.43 to -1.52]) and 2011-2018 (-1.77 [95% CI, -1.67 to -1.86]) (P < .001). For obesity-associated cancer mortality, which accounted for approximately 33% of total cancer deaths annually, decreases in annual AAMR relative change decelerated from -1.19 (95% CI, -1.13 to -1.26) in 1999-2011 to -0.83 (95% CI, -0.70 to -0.96) in 2011-2018 (P < .001). The largest decelerations in obesity-associated cancer mortality were observed for female decedents (-1.45 [95% CI, -1.36 to -1.53] in 1999-2011 and -0.91 [95% CI, -0.75 to -1.07] in 2011-2018; P < .001) and non-Hispanic White individuals (-1.16 [95% CI, -1.09 to -1.22] in 1999-2011 and -0.68 [95% CI, -0.55 to -0.81] in 2011-2018; P < .001). Slowing improvements in obesity-associated cancer mortality were obscured when considering total cancer mortality. These findings potentially signal a changing profile of cancer-associated mortality that may parallel trends previously observed for heart disease as the consequences of the obesity epidemic are understood.

PSVI-2 Rising 10-year Trend in Piglet Pre-weaning Mortality in Breeding Herds Associated with Sow Herd Size and Number of Piglets Born Alive

Abstract The objectives of the present study were to explore the trend in preweaning mortality (PWM) and related measurements such as piglets born alive (PBA), stillborn piglets, herd productivity and herd size in sow herds over a 10-year period; and 2) to examine the relationships between PWM and the related measurements. Herd-level annual data from 2007–2016 for 91 herds in Spain were abstracted from a sow database compiled by a veterinary consultancy firm. The database software automatically calculated herd-level PWM (%) as follows: the total number of piglets born alive to a sow completely weaned during a year (TPBA) minus the total number of piglets weaned by the completely weaned sow during the year divided by TPBA x 100. All the statistical analyses were performed using SAS University Edition. A growth curve model was applied to incorporate correlations for all of the observations arising from the same farm. Herd means of PWM (SD) increased from 11.9 (4.1) % to 14.4 (3.2) %, and mean PBA increased by 1.9 pigs. Mean age of piglet death during lactation increased by 3.8 days, and there was a significant effect of increased year on herd size and the number of piglets weaned per sow per year (PSY; P &amp;lt; 0.05). Higher PWM was associated with more PBA, more stillborn piglets and small herds (lower than the median size: &amp;lt; 570 sows; P &amp;lt; 0.05). Also, as PBA increased from 9 to 14 pigs, PWM in large herds (&amp;gt; 570 sows) increased by only 6.6%, compared with 9.6% in small herds. Furthermore, as PWM decreased from 18 to 8%, herd productivity measured as PSY increased by 2.2 pigs in large herds, but only by 0.6 pigs in small herds. In conclusion, the effect of increased PBA on PWM was alleviated more in large herds than in small herds. Also, the impact of decreased PWM on herd productivity was greater in large herds than in small herds.

U.S. Infant Mortality Rates: An Exploration of Black/White Disparities, Current Trends, and Social Inequalities

The purpose of this paper is to explore 10-year trends in infant mortality rates (IMRs) from 2007 to 2016 for non-Hispanic (NH) blacks and NH whites by levels of sociodemographic characteristics such as maternal age, marital status, education, and access to prenatal care. Using data from the Centers for Disease Control and Prevention (CDC) Wonder Online database, descriptive statistics were performed, and a measure of disparity was calculated to illustrate racial differences in IMRs. Between 2007 and 2016, IMRs for NH blacks have declined at a faster rate (15.8%) compared to NH whites (13.5%). As for the selected sociodemographic indicators, reductions were observed for both racial groups for most age categories assessed, married and unmarried women, and for women with early or no access to prenatal care. For educational attainment levels, declines were observed for both racial groups for all levels except for high school graduate or GED and some college, in which increases were observed for NH white women. The measure of disparity illustrates the large racial gap in IMRs persists between NH blacks and NH whites. More structural and systemic mechanisms, including research and policies, are needed to address the disparities in IMRs.

12-year Trends in Lipid Levels in Korean Children and Adolescents: A Cross-sectional Study Based on the Korea National Health and Nutrition Examination Survey

Background: Dyslipidaemia at a young age is one of the risk factors of adulthood cardiovascular disease. However, investigations on the trends in lipid levels among the youth are scarce. Thus, we aimed to analyse the trends in lipid levels in Korean youth from 2007 through 2018. Methods: This cross-sectional study investigated the lipid profiles of 10,734 youths aged 10-18 years using data from the four phases of the Korea National Health and Nutritional Examination Survey: IV (2007-2009), V (2020-2012), VI (2013-2015), and VII (2016-2018). We assessed the age-, sex-, and body mass index (BMI)-adjusted mean levels of lipids at each survey. Findings: The mean levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (non-HDL-C) levels increased from phase IV to VII. Among boys, the prevalence of subjects with acceptable levels of TC, LDL-C, and non-HDL-C decreased, whereas that of subjects with adverse levels increased from phase VI to VII. In BMI- and sex-specific analysis, adverse trends in TC, LDL-C, and non-HDL were more apparent among boys with normal BMI than among those who were overweight and obese. Among girls, the mean TC, LDL-C, and triglycerides levels increased in subjects with normal BMI and overweight. Interpretation: Our results suggest worsening trends in lipid levels and dyslipidaemia among Korean youth. These adverse trends were seen even in youth with normal BMI. These findings indicate the need for more concern about lipid levels in youth with normal BMI as well as those with overweight and obesity.

Trends in disability-free life expectancy at age 50 years in Australia between 2001 and 2011 by social disadvantage

BackgroundThe aims of this study were (1) to estimate 10-year trends in disability-free life expectancy (DFLE) by area-level social disadvantage and (2) to examine how incidence, recovery and mortality transitions...

Ecological Correlates of 20-Year Population Trends of Wintering Waterbirds in Deep Bay, South China

Along the East Asian-Australasian flyway (EAAF), waterbirds are threatened by a wide range of human activities. Studies have shown that wintering populations of many species have declined in Australia and Japan; however, long term data along China’s coast are limited. In this study, we analyzed data collected from monthly bird surveys to quantify population trends of wintering waterbirds from 1998 to 2017 in the Deep Bay area, South China. Of the 42 species studied, 12 declined, while nine increased significantly. Phylogenetic comparative analysis revealed that population trends were negatively correlated to reliance on the Yellow Sea and body size. Further, waterbird species breeding in Southern Siberia declined more than those breeding in East Asia. These findings, coupled with a relatively high number of increasing species, support the continual preservation of wetlands in the Deep Bay area. This study provides another case study showing that data collected from wintering sites provide insights on the threats along migratory pathway and inform conservation actions. As such, we encourage population surveys in the EAAF to continue, particularly along the coast of China.

Nationwide Trends in Body Mass Index, Underweight, Overweight and Obesity Among Korean with Disabilities from 2008 to 2017

Background: The maintenance of optimal body weight is a crucial component in health and quality of life. However, little is known about weight distribution and trends among people with disabilities. This study in South Korea examined the 10-year trends of weight and prevalence of underweight, overweight and obesity according to disability grade and types compared with those without disabilities. Methods: We linked national disability registration data with national cancer screening program data. Age-standardized prevalence of underweight and obesity were analyzed for each year during the period 2008 to 2017, according to the presence, type, and severity of disabilities. Risk of underweight, overweight, obesity, and severe obesity were examined by multinomial logistic regression after adjusting for socio-demographic and clinical variables as of 2017. Findings: People with disabilities (both male and female) had a higher risk of underweight compared to those without disability (OR 1·41, 95% CI 1·38-1·44, and OR 1·31, 95% CI 1·28-1·34, respectively), especially in those with severe disabilities (OR 2·00, 95% CI 1·94-2·06 in male, and OR 1·83, 95% CI 1·77-1·89 in female, respectively). The age-standardized prevalence of severe obesity (BMI ≥30·0 kg/m2 ) was also higher in people with disability, and the disparity relative to people without disability widened from 1·8% in 2008 to 3·7% in 2017. Women with disabilities are more likely to be obese than those without disabilities regardless of disability severity (OR 1·40, 95% CI 1·38-1·41). The risk of severe obesity was also more prominent in women with disabilities (OR 2·08, 95% CI 2·05-2·11). Interpretation: Physical, mental and developmental disabilities were significantly associated with higher prevalence of obesity as well as underweight. The intersection of female gender, severe disability, and mental/developmental disabilities was associated with risk of severe obesity. Simultaneous efforts are needed to enhance food security as well as weight control and exercise for people with disabilities. Funding Statement: This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean Ministry of Science and ICT (MSIT) (No. 2019R1A2C1087507 and 2021R1C1C2008683) and the Korean Ministry of Education (No. 2019R1D1A3A03103862). Declaration of Interests: We declare no competing interests. Ethics Approval Statement: The study protocol was approved by the Institutional Review Board of Chungbuk National University (CBNU-201910- BMETC-946-01)

Temporal trends in the quality of deceased donor kidneys and kidney transplant outcomes in Europe: an analysis by the ERA-EDTA Registry.

BackgroundWe investigated 10-year trends in deceased donor kidney quality expressed as the kidney donor risk index (KDRI) and subsequent effects on survival outcomes in a European transplant population.MethodsTime trends in the crude and standardized KDRI between 2005 and 2015 by recipient age, sex, diabetic status and country were examined in 24 177 adult kidney transplant recipients in seven European countries. We determined 5-year patient and graft survival probabilities and the risk of death and graft loss by transplant cohort (Cohort 1: 2005–06, Cohort 2: 2007–08, Cohort 3: 2009–10) and KDRI quintile.ResultsThe median crude KDRI increased by 1.3% annually, from 1.31 [interquartile range (IQR) 1.08–1.63] in 2005 to 1.47 (IQR 1.16–1.90) in 2015. This increase, i.e. lower kidney quality, was driven predominantly by increases in donor age, hypertension and donation after circulatory death. With time, the gap between the median standardized KDRI in the youngest (18–44 years) and oldest (>65 years) recipients widened. There was no difference in the median standardized KDRI by recipient sex. The median standardized KDRI was highest in Austria, the Netherlands and the Basque Country (Spain). Within each transplant cohort, the 5-year patient and graft survival probability were higher for the lowest KDRIs. There was no difference in the patient and graft survival outcomes across transplant cohorts, however, over time the survival probabilities for the highest KDRIs improved.ConclusionsThe overall quality of deceased donor kidneys transplanted between 2005 and 2015 has decreased and varies between age groups and countries. Overall patient and graft outcomes remain unchanged.

AB063. SOH21AS223. Trends in body mass index over the past decade for primary hip and knee arthroplasty

Background: Obesity and its increasing prevalence is a pressing public health concern. Obesity is a significant risk factor for developing osteoarthritis. Pain and loss of function associated with end-stage osteoarthritis is best managed with arthroplasty. Following these procedures, there is evidence to support that obese patients are more likely to suffer complications. With the WHO projecting that Ireland will see the highest obesity incidence in Europe by 2025, we looked at 10-year trends in body mass index (BMI) of the primary arthroplasty cohort at the NOHC, aiming to discern whether the average BMI of these patients has risen over time.

Ten-Year Trend Analysis of Mortality Due to External Causes of Injury in People with Disabilities, South Korea, 2008–2017

External causes of injury are major contributors to mortality among people with disabilities. We analyzed the 10-year trend (2008–2017) of mortality attributed to external causes of injury among people with disabilities. We conducted an observational, population-based, retrospective, cross-sectional study among people with disabilities in South Korea. The database was compiled by merging two data sets: registered people with disabilities during 2008–2017 from the Ministry of Health and Welfare, and the data published by the Korea National Statistical Office. Between 2008 and 2017, the all-cause mortality among people with disabilities showed a rising trend and increased from 2641 per 100,000 in 2008 to 2751 per 100,000 in 2017. During this 10-year period, 6.5–9.2% of the total number of deaths were caused by injuries. Disabilities that were associated with a high crude mortality rate shared the same three most frequent causes of death: suicide, motor vehicle crashes, and falling. Mortality due to external causes of injury increased among older people with disabilities. Thus, effective strategies are required to decrease preventable deaths caused by unintentional injuries among people with disabilities.

10-Year Trends in Aortic Dissection: Mortality and Weekend Effect within the US Nationwide Emergency Department Sample (NEDS).

This study examined changes in aortic dissection (AD) mortality from 2006 to 2017 and assessed the impact of weekday versus weekend presentation upon mortality. This observational study analyzed all records in the Nationwide Emergency Department Sample (NEDS) database. NEDS aggregates discharge data from 984 hospitals in 36 states and the District of Columbia in the United States of America. All patients with thoracic and thoracoabdominal AD recorded as their principal diagnosis were identified via ICD codes. Patient characteristics (weekday|weekend) count: 26,759|9,640, P = 0.016; age (years): 65.2 ± 15.8|64.7 ± 16.2, P = 0.016; women: 11,318 (42.3%)|4,086 (42.4), P = 0.883; Charlson comorbidity index: 2.3 ± 1.7|2.3 ± 1.6, P = 0.025. There were 36,399 ED visits with diagnosed AD. Annual AD diagnoses increased by 70% from 2006 to 2017. From 2012-2017, patients had lower in-hospital mortality (9.9% versus 11.9%, P < 0.001) compared with 2006-2011. Patients reporting during the weekend had higher in-hospital mortality (11.8% versus 10.4%, P < 0.001) compared with weekdays. On multivariable analysis, year of presentation remained independently associated with in-hospital mortality, with 2012-2017 being associated with reduced mortality (odds ratio (OR) 0.90, 95% CI: 0.82, 0.99, P = 0.031), as compared with 2006-2011. Weekend presentation remained independently associated with worse in-hospital mortality (OR 1.17, 95% CI: 1.05, 1.29, P = 0.003) compared with weekday presentation. Although AD mortality is decreasing, the patients presenting on the weekend were 13% more likely to die in the hospital compared with patients presenting during the week.

Trends in Urine Drug Monitoring Among Persons Receiving Long-Term Opioids and Persons with Opioid Use Disorder in the United States

Practice guidelines recommend urine drug monitoring (UDM) at least annually in the setting of chronic opioid therapy as an objective assessment of substance use. However, empirical evidence on who gets tested and how often testing occurs is lacking. This study investigates 10-year UDM trends in the United States based on 2 factors: (1) the duration of prescription opioid treatment, and (2) having an opioid use disorder (OUD) diagnosis and medications for opioid use disorder (MOUD) prescriptions. Observational cross-sectional study. Research was conducted using administrative claims data from Optum's deidentified Clinformatics Data Mart Database for the period 2007 to 2016. The dataset contained information on the plan enrollment and health care claims from 50 states and the District of Columbia. To examine trends in UDM based on the duration of prescription opioid treatment, persons receiving prescription opioid analgesics were categorized into 4 groups based on the number of days covered: (a) less than 90 days, (b) 90 to 179 days, (c) 180 to 269 days, and (d) at least 270 days. To examine trends based on an OUD diagnosis and MOUD prescriptions, persons diagnosed with OUD were identified and categorized based on the presence of MOUD prescriptions as follows: (a) OUD with buprenorphine (BPN) and naltrexone (NTX) in the same year; (b) OUD with BPN only; (c) OUD with NTX only; (d) OUD with chronic prescription opioid analgesics (>= 90 days); (e) OUD without prescription opioid analgesics, BPN, or NTX; and (f) chronic prescription opioid analgesics (>= 90 days) without an OUD diagnosis. For analysis, the percent receiving UDM was estimated per group per year. Then the data were restricted to those receiving at least one UDM to estimate the average number of UDM per person. Data included an average of 364,485 persons per year receiving prescription opioid analgesics for chronic use, and 10,277 per year receiving an OUD diagnosis. Among those receiving prescription opioid analgesics, less than 50% received UDM. For those receiving at least one UDM, one additional UDM was performed per person as the duration of opioids increased by 90 days. Among persons with OUD, the percent receiving UDM was the highest for those receiving both BPN and NTX (87%), followed by those receiving BPN only (80%), chronic opioids (79%), NTX only (72%), and those not receiving any MOUD/opioids (54%). Methadone dispensing for OUD treatments was not captured in administrative claims data. Although recommended for patients with chronic pain, UDM is provided less than half of the time for these patients. However, once patients received at least one UDM, they would continue to receive it on a fairly regular basis. Compared with those with chronic pain, persons diagnosed with OUD are more likely to receive UDM at a more frequent interval.

An assessment of trends in the Iranian pharmaceutical market following domestic production of selected medications (2007‒2017) and new considerations for health policymakers

Background: Enacting national policies which empower the local production of medications is a promising way to improve the accessibility and affordability of medications, but this can also have unintended consequences. A number of such policies have been adopted by the Iranian government. This study was designed to examine the changes in the consumption of a number of selected pharmaceuticals which occurred in the years after these selected products began to be domestically produced. The implications of these changes were then evaluated for their potential to suggest possible policy changes. Method: A 10-year trend study was conducted to identify changes which occurred between 2007 and 2017 in the consumption of 28 selected, imported medications after they began to be domestically produced. Results: Six different medication consumption patterns were observed after the development of domestic medication production. In addition, a downward trend in the cost of medications was observed, specifically due to the introduction of domestic pharmaceuticals. Discussion: Examination of the observed changes in the consumption patterns revealed that various factors affect consumption patterns of imported medications. Significant increases in certain domestically manufactured medications indicated that local production might result in the irrational use of medications. In addition, the competitiveness of Iranian products, in terms of quality and accessibility should be considered. Conclusion: New considerations are needed for health policymakers to support domestic production of viable alternative medications. However, increased accessibility of domestically produced medications may result in greater unreasonable use of medications

P0306 / #590: 20 YEARS OF ADMISSION REGISTRATION AT A DUTCH PEDIATRIC INTENSIVE CARE UNIT (PICU): TIME TRENDS IN LONG DURATION ADMISSION AND READMISSIONS

Aims & Objectives: Advances in treatment options has resulted in a growing population of children who require chronic medical support that also affects the characteristics of children admitted to the PICU. To emphasize this change in the PICU population, we described 20-year time trends in long duration admission and readmissions on a Dutch PICU. Methods: All patients aged 0-17 years admitted to the PICU Academic Medical Center, Amsterdam, The Netherlands between 1997 and 2017 were extracted from the PICE registry. Main outcome measures were: number of admissions and readmissions within the first year after discharge, length of PICU stay and cumulative admission days. Results: A total of 8,234 children (42.2% female, median age at admission 2.2 years (IQR 0.4-8.4)), were admitted on 11,195 occasions and accounted for 48,964 cumulative admission days. Between 1997 and 2012 the percentage of long stayers (i.e. admission ≥30days) increased from 1.5% to 3.0% annually, and decreased to 1.9% in 2017. Subsequently, cumulative admission days for long stayers increased between 1997 and 2012 from 26% to 45% of total cumulative admission days, and decreased to 34% in 2017. Readmission occurred overall in 1,510 patients (18.3%). Frequent flyers (i.e. ≥3readmissions; n=136, 1.7%) accounted for 5,178 cumulative admission days (10.6% of total admission days); no changes in time were observed. Conclusions: Over the last 20 years significantly more patients were admitted for ≥30 days resulting in an increased burden on the PICU. This demands a new perspective to address this growing population of chronically ill patients admitted to the PICU.

Feasibility of thermal load control from electrochromic windows for ground coupled heat pump optimization

The concept of designing a ground coupled heat pump (GCHP) system as a rechargeable source of energy by implementing supplementary heating and cooling load devices to dynamically balance building energy loads has recently been introduced. This research presents a novel design of integrating electrochromic glass window controls with a GCHP system for long-term optimization and sustainability. A building energy model was developed and simulated with the solar heat gain coefficients of 0.41, 0.25, 0.15, and 0.09 to model electrochromic glass windows. The energy model outputs were used for ground heat exchanger model simulations which analyzed 20-year temperature trends and system efficiencies. The results showed the integrated GCHP system with electrochromic windows was feasible and a conceptual control sequence and design was developed. The annual cooling demand decreased by 32% between the clear glass and fully tinted state. It was recommended to increase the ground heat exchanger capacity to 200 boreholes at 45.7 m in 2040 to prevent overheating from projected climate change. The average system coefficient of performance was 7.6 for the fully tinted window state. The integrated GCHP system reduced CO2 emissions by 30% and the 30-year NPV was US$142,273.65 cheaper compared to a conventional boiler and chiller system.

Analysis of 20-Year Trends in Medicare Reimbursement for Reconstructive Microsurgery.

Microsurgery is being increasingly utilized across surgical specialties, including plastic surgery. Microsurgical techniques require greater time and financial investment compared with traditional methods. This study aimed to evaluate 20-year trends in Medicare reimbursement and utilization for commonly billed reconstructive microsurgery procedures from 2000 to 2019. Microsurgical procedures commonly billed by plastic surgeons were identified. Reimbursement data were extracted from The Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services for each current procedural terminology (CPT) code. All monetary data were adjusted for inflation to 2019 U.S. dollars. The average annual and total percentage changes in reimbursement were calculated based on these adjusted trends. To assess utilization trends, CMS physician/supplier procedure summary files were queried for the number of procedures billed by plastic surgeons from 2010 to 2018. After adjusting for inflation, the average reimbursement for all procedures decreased by 26.92% from 2000 to 2019. The greatest mean decrease was observed in CPT 20969 free osteocutaneous flaps with microvascular anastomosis (-36.93%). The smallest mean decrease was observed in repair of blood vessels with vein graft (-9.28%). None of the included procedures saw an increase in reimbursement rate over the study period. From 2000 to 2019, the adjusted reimbursement rate for all procedures decreased by an average of 1.35% annually. Meanwhile, the number of services billed to Medicare by plastic surgeons across the included CPT codes increased by 42.17% from 2010 to 2018. This is the first study evaluating 20-year trends in inflation-adjusted Medicare reimbursement and utilization in reconstructive microsurgery. Reimbursement for all included procedures decreased over 20% during the study period, while number of services increased. Increased consideration of these trends will be important for U.S. policymakers, hospitals, and surgeons to assure continued access and reconstructive options for patients.

10-Year Trends of Emergency Department Visits, Wait Time, and Length of Stay among Adults with Mental Health and Substance use Disorders in the United States.

This study examined if there was a change in the number of Emergency Department (ED) visits, wait time, and length of stay among adults with mental health and substance use disorders (MHSUD) in the United States from 2006 to 2015. From the National Hospital Ambulatory Medical Care Survey, a total of 17,488 ED visits by adults with MHSUD were identified. Linear regression and negative binomial regression analyses were conducted to assess statistically significant changes in trends of ED visits, wait time, and length of stay. Results indicated that ED visits by adults with MHSUD increased by 30.6% from 2006 to 2015. Wait time of ED visits by adults with MHSUD decreased for the same time period; however, length of stay did not change. Also, there were some differences in trends of wait time and length of stay by diagnosis. Specifically, wait time of ED visits by adults with psychotic disorders did not decrease. Length of stay of ED visits by adults with anxiety disorders statistically significantly increased from 2006 to 2015. More effort is needed to improve the quality of ED care for adults with MHSUD. In such an effort, diagnoses should be taken into consideration.

Comparison of Out-of-Hospital Cardiac Arrests Occurring in Schools and Other Public Locations: A 12-Year Retrospective Study

Objective: Out-of-hospital cardiac arrests (OHCA) in schools and universities are uncommon. However, these institutions must plan and prepare for such events to ensure the best outcomes. To evaluate their preparedness we assessed baseline characteristics, survival outcomes and 12-year trends for OHCA in schools/universities compared to other public locations. Methods: We conducted a retrospective analysis of OHCA in schools/universities and public locations between 2008 and 2019 using Victorian Ambulance Cardiac Arrest Registry data. Results: We included 9,037 EMS attended cases, 131 occurred in schools/universities and 8,906 in public locations. Compared to public locations, a significantly higher proportion of EMS treated cases in schools/universities received bystander cardiopulmonary resuscitation (CPR) (95.5% vs. 78.5%, p < 0.001), public access defibrillation (PAD) (26.1% vs. 9.9%, p < 0.001) and presented in shockable rhythms (69.4% vs. 50.9%, p < 0.001). Unadjusted survival to hospital discharge rates were also significantly higher in schools/universities (39.6% vs. 24.2%, p < 0.001). The long-term unadjusted trends for bystander CPR in schools/universities increased from 91.7% (2008–10) to 100% (2017–19) (p-trend = 0.025), for PAD from 4.2% (2008–10) to 47.5% (2017–19) (p-trend < 0.001) and for survival to hospital discharge from 16.7% (2008–10) to 57.5% (2017–19) (p-trend = 0.004). However, after adjustment for favorable cardiac arrest factors, such as younger age, bystander CPR and PAD, survival was similar between schools/universities and public locations. Conclusion: The majority of OHCA in schools and universities were witnessed and received bystander CPR, however less than half received PAD. Developing site-specific cardiac emergency response plans and providing age appropriate CPR training to primary, secondary and university students would help improve PAD rates.