Relative Annual Change Research Articles

Assessment of Management Practices to Prevent Soil Degradation Threats on Lithuanian Acid Soils

An assessment of soil characteristics pertaining to their suitability for agricultural use in general is necessary to reverse the declining trend of soil quality and to ensure sustainable agriculture. The aim of this study was to determine the soil resistance (SRI) and degradation indices (SDI) under different agrotechniques and to find out whether management-induced changes are large enough to reduce soil degradation. The study was based on the comparison of physicochemical data of 3 long-term experiments conducted in the western part of Lithuania. Changes in soil properties over the past 20 years (1999–2019) have been determined. The most commonly used measures in Lithuania, such as soil liming, manuring, residue maintenance, and tillage, were selected for the analysis. The analysis carried out showed that the soil, which was fertilized with manure, had a higher value of soil quality parameters compared to natural Retisol: organic matter (by 0.53 percentage points), total nitrogen (by 0.04 percentage points), and the available amounts of phosphorus (by 69 mg/kg) and potassium (by 6.6 mg/kg). The assessment of the relative annual change in SOC content revealed that long-term soil manuring has significant SOC sequestration capability. Among the soil management techniques examined, it appeared that the greatest relative annual change (0.47 g kg−1yr−1) in SOC content was noted in manured soil. The results indicate that the higher degradation, and resistance values were observed in acid soil (pH 4.2), where liming was applied, indicating greater sensitivity to degradation. Based on analyzed indices, the agricultural practices ranked as: manuring > residue management > reduced tillage > liming. The lowest SRI values were obtained for low level of nutrients (from −0.11 to 0.89), organic carbon (from −0.72 to −0.49), and pH (from −0.25 to –0.1), indicating that these properties are more sensitive to applied agricultural practices compared to others. All these findings provide information for promoting better soil management, soil protection, land use planning, and the planning of remedial measures, especially in the most afflicted areas.

Life Expectancy Changes and Their Consequences for Pension System in Finland and the Czech Republic

Finland and the Czech Republic are among the countries where population ageing has been the most pronounced in the last decade. The aim of the paper is to describe future development of life expectancy in the context of pension system reforms that are currently prepared by the politicians in analysed countries. One-year age-and-sex-specific mortality rates for population aged 0 to 100+ were taken from the Human Mortality Database for 1950–2021 and projected to 2050. Three stochastic models were calculated in R and compared. Suitable was Lee-Carter model modified by Li-Lee-Gerland (with rotation of bx parameter) because of low infant mortality in both populations. Projected year-on-year change of life expectancy was comparable to the Eurostat, but absolute values were too optimistic in our case. Values of temporary life expectancy between 60 and 70 years and indices of annual relative changes revealed relatively fast pace of increase in life expectancy in both populations which the pension systems should také into account.

Inner Retinal Layer Changes Reflect Changes in Ambulation Score in Patients with Primary Progressive Multiple Sclerosis.

The establishment of surrogate markers to detect disability progression in persons with multiple sclerosis (PwMS) is important to improve monitoring of clinical deterioration. Optical coherence tomography (OCT) could be such a tool. However, sufficient longitudinal data of retinal neuroaxonal degeneration as a marker of disease progression exist only for PwMS with a relapsing-remitting course (RRMS) so far. In contrast, longitudinal data of retinal layers in patients with primary-progressive MS (PPMS) are inconsistent, and the association of OCT parameters with ambulatory performance in PwMS has rarely been investigated. We aimed to investigate the relative annual rates of change in retinal layers in PwMS (RRMS and PPMS) compared with healthy controls (HC) using OCT and to evaluate their association with ambulatoryfunctionalscore (AS) worsening in PPMS. A retrospective analysis of a longitudinal OCT dataset of the retinal layers of PwMS and HC from two MS centers in Germany was performed. Walking ability was measured over a standardized distance of 500 m, and changes during the observation period were categorized using the AS and the expanded disability status scale (EDSS). 61 HC with 121 eyes and 119 PwMS (PPMS: 57 patients with 108 eyes; RRMS: 62 patients with 114 eyes) were included. The median follow-up time for PwMS was 3 years. The relative annual change of pRNFL (peripapillary retinal nerve fiber layer) and INL (inner nuclear layer) was significantly different in PwMS compared with HC. RRMS and PPMS subgroups did not differ in the annual atrophy rates. In patients with PPMS, worsening of the AS was significantly associated with increased thinning of the TMV (total macular volume), GCIP (ganglion cell and inner plexiform layer), and ONPL (outer nuclear and outer plexiform layer) (all p-value < 0.05, r > 0.30). For every -0.1% decrease in the TMV, GCIP, and ONPL, the risk of a deterioration in the AS increased by 31% (hazard ratio (HR): 1.309), 11% (HR: 1.112), and 16% (HR: 1.161), respectively. In addition, worsening EDSS in PPMS was significantly associated with the relative annual atrophy rates of pRNFL, TMV, and GCIP (all p-value < 0.05). Disability progression in PPMS can be measured using OCT, and increasing annual atrophy rates of the inner retinal layers are associated with worsening ambulation. OCT is a robust and side-effect-free imaging tool, making it suitable for routine monitoring of PwMS.

Related variations: A novel approach for detecting patterns of regional variations in healthcare utilisation rates.

Regional variations in healthcare utilisation rates are ubiquitous and persistent. In settings where an aggregate national health service budget is allocated primarily on a per capita basis, little regional variation in total healthcare utilisation rates will be observed. However, for specific treatments, large variations in utilisation rates are observed, iymplying a substitution effect at some point in service delivery. The current paper investigates the extent to which this substitution effect occurs within or between specialties, particularly distinguishing between emergency versus elective care. We used data from Statistics Norway and the Norwegian Patient Registry on eight somatic surgeries for all patients treated from 2010 to 2015. We calculated Diagnosis-Related Group (DRG) -weight per capita in 19 hospital regions. We applied principal component analysis (PCA) to demonstrate patterns in DRG-weight, annual relative changes in DRG-weight, and DRG-weight production for elective care. We show that treatments with similar characteristics cluster within regions. Treatment frequency explains 29% of the total variation in treatment rates. In a dynamic model, treatments with a high degree of emergency care are negatively correlated with treatments with a high degree of elective care. Furthermore, when considering only elective care treatments, the substitution effect occurs between specialties and explains 49% of the variation. When designing policies aimed at reducing regional variations in healthcare utilisation, a distinction between elective and emergency care as well as substitution effects need to be considered.

Managing soil organic carbon in tropical agroecosystems: evidence from four long-term experiments in Kenya

Abstract. In sub-Saharan Africa, maize is one of the most important staple crops, but long-term maize cropping with low external inputs has been associated with the loss of soil fertility. While adding high-quality organic resources combined with mineral fertilizer has been proposed to counteract this fertility loss, the long-term effectiveness and interactions with site properties still require more understanding. This study used repeated measurements over time to assess the effect of different quantities and qualities of organic resource addition combined with mineral nitrogen (N) on the change of soil organic carbon (SOC) contents over time (and SOC stocks in the year 2021) in four ongoing long-term experiments in Kenya. These experiments were established with identical treatments in moist to dry climates, on coarse to clayey soil textures, and have been conducted for at least 16 years. They received organic resources in quantities equivalent to 1.2 and 4 t C ha−1 yr−1 in the form of Tithonia diversifolia (high quality, fast turnover), Calliandra calothyrsus (high quality, intermediate turnover), Zea mays stover (low quality, fast turnover), sawdust (low quality, slow turnover) and local farmyard manure (variable quality, intermediate turnover). Furthermore, the addition of 240 kg N ha−1 yr−1 as mineral N fertilizer or no fertilizer was the split-plot treatment. At all four sites, a loss of SOC was predominantly observed, likely because the sites had been converted to cropland only a few decades before the start of the experiments. Across sites, the average decline of SOC content over 19 years in the 0 to 15 cm topsoil layer ranged from 42 % to 13 % of the initial SOC content for the control and the farmyard manure treatments at 4 t C ha−1 yr−1, respectively. Adding Calliandra or Tithonia at 4 t C ha−1 yr−1 limited the loss of SOC contents to about 24 % of initial SOC, while the addition of sawdust, maize stover (in three of the four sites) and sole mineral N addition showed no significant reduction of SOC loss over the control. Site-specific analyses, however, did show that at the site with the lowest initial SOC content (about 6 g kg−1), the addition of 4 t C ha−1 yr−1 farmyard manure or Calliandra with mineral N led to a gain in SOC contents. The other sites lost SOC in all treatments, albeit at site-specific rates. While subsoil SOC stocks in 2021 were little affected by organic resource additions (no difference in three of the four sites), the topsoil SOC stocks corroborated the results obtained from the SOC content measurements (0–15 cm) over time. The relative annual change of SOC contents showed a higher site specificity in farmyard manure, Calliandra and Tithonia treatments than in the control treatment, suggesting that the drivers of site specificity in SOC buildup (soil mineralogy, soil texture, climate) need to be better understood for effective targeting management of organic resources. Farmyard manure showed the highest potential for reducing SOC losses, but the necessary quantities to build SOC are often not realistic for smallholder farmers in Africa. Therefore, additional agronomic interventions such as intercropping, crop rotations or the cultivation of crops with extended root systems are necessary to maintain or increase SOC.

Time trends in ethnic inequalities in child health and nutrition: analysis of 59 low and middle-income countries

BackgroundAlthough ethnicity is a key social determinant of health, there are no global analyses aimed at identifying countries that succeeded in reducing ethnic gaps in child health and nutrition.MethodsWe identified 59 low and middle-income countries with at least two surveys since 2010 providing information on ethnicity or language and on three outcomes: under-five mortality, child stunting prevalence and a composite index (CCI) based on coverage with eight maternal and child health interventions. Firstly, we calculated population-weighted and unweighted measures of inequality among ethnic or language groups within each country. These included the mean difference from the overall national mean (absolute inequality), mean ratio relative to the overall mean (relative inequality), and the difference and ratio between the best- and worst-performing ethnic groups. Second, we examined annual changes in these measures in terms of annual absolute and relative changes. Thirdly, we compared trends for each of the three outcome indicators and identified exemplar countries with marked progress in reducing inequalities.ResultsFor each outcome indicator, annual changes in summary measures tended to show moderate (Pearson correlation coefficients of 0.4 to 0.69) or strong correlations (0.7 or higher) among themselves, and we thus focused on four of the 12 measures: absolute and relative annual changes in mean differences and ratios from the overall national mean. On average, absolute ethnic or language group inequalities tended to decline slightly for the three outcomes, and relative inequality declined for stunting and CCI, but increased for mortality. Correlations for annual trends across the three outcomes were inconsistent, with several countries showing progress in terms of one outcome but not in others. Togo and Uganda showed with the most consistent progress in reducing inequality, whereas the worst performers were Nigeria, Moldova, Kyrgyzstan, Sao Tome and Principe, and Burkina Faso.ConclusionsAlthough measures of annual changes in ethnic or language group inequalities in child health were consistently correlated within each outcome, analyses of such inequalities should rely upon multiple measures. Countries showing progress in one child health outcome did not necessarily show improvements in the remaining outcomes. In-depth analyses at country level are needed to understand the drivers of success in reducing ethnic gaps.

The 21-Year Trend of Stroke Incidence in a General Japanese Population: Results from the Takashima Stroke Registry, 1990–2010

Introduction: Since the 1960s, the stroke morality rate in Japan has declined significantly. Although several risk factors for stroke have become more evident due to increasingly Westernized lifestyle, there have been no population-based registry data on recent time trends in stroke incidence in Japan. The purpose of this study is to determine these trends in stroke incidence using a population-based registry. Methods: Data were obtained from the Takashima Stroke Registry, which covers approximately 50,000 residents in Takashima City, Japan. The age- and sex-standardized stroke incidence rate was estimated using the direct method. Average annual relative changes of stroke incidence were estimated using Poisson regression models. Results: We identified a total of 2,371 patients with first-ever stroke during the period 1990–2010. Crude incidence rates of total stroke (per 100,000 person-years) were 225 in the early period (1990–2001) and 187 in the late period (2002–2010), and the mean age at onset of stroke increased from 71.9 years in the early period to 74.8 years in the late period. Age- and sex-standardized incidence rates of stroke (per 100,000 person-years) decreased from 327 in the early part of this study period and 206 in the later period. During the 21-year period, age- and sex-standardized average annual relative reduction in stroke incidence was statistically significant (−3.7% per year). When stratified into early and late periods, the adjusted annual relative reduction in stroke incidence was observed during the early period (−2.1% per year), and there were no significant changes during the late period. Conclusions: In this population-based registry, there was a significant reduction in incidence of stroke from 1990 to 2010. Although the speed of reduction in stroke incidence appears to have slowed down after 2000, continuous public health measures are required to provide further protection against stroke.

Temperature and relative humidity trends in the northernmost region of South Africa, 1950–2016

The northernmost Limpopo Province is located in one of the warmest regions of South Africa, where the agricultural sector is prone to heat stress. The aim of this study was to explore air temperature and relative humidity trends for the region, which have implications for agricultural adaptation and management (amongst other sectors). In particular, we investigated seasonal, annual and decadal scale air temperature and relative humidity changes for the period 1950–2016. Positive temperature trends were recorded for this period, averaging +0.02 °C/year, with the strongest changes observed in mean maximum summer temperatures (+0.03 °C/year). Interannual temperature variability also increased over time, especially for the period 2010–2016, which presents probability densities of &lt;50% for minimum temperatures. Positive relative humidity trends (+0.06%/year) were also recorded for the period 1980–2016, but proved to be the least predictable weather parameter, with probability densities of &lt;0.5% across seasons for the study period. Considering the substantial interannual variability in temperature and relative humidity, there is clear increased risk for the agricultural sector, particularly for small-scale farmers who generally have limited capacity to adapt. Climate science focusing on the southern African region should continue to establish the impact of climate change and variability on specific small-scale farming systems and enterprises, with recommendations for strategic adaptation based on up-to-date evidence.Significance: Heat indices have increased, and variability in temperature and relative humidity has substantially increased over recent decades. Changes in air temperature and relative humidity have direct and/or indirect negative effects on sectors such as agriculture, leading to reduced productivity. The small-scale farming sector, which contributes significantly to national food security in developing countries, is the production system most exposed and vulnerable to observed changes/extremes in temperature and relative humidity. There is an urgent need to build capacity of small-scale farmers for appropriate adaptation to observed changes in climate based on up-to-date evidence.

BMI and BMI change following incident type 2 diabetes and risk of microvascular and macrovascular complications: the EPIC-Potsdam study

Aims/hypothesisStudies suggest decreased mortality risk among people who are overweight or obese compared with individuals with normal weight in type 2 diabetes (obesity paradox). However, the relationship between body weight or weight change and microvascular vs macrovascular complications of type 2 diabetes remains unresolved. We investigated the association between BMI and BMI change with long-term risk of microvascular and macrovascular complications in type 2 diabetes in a prospective cohort study.MethodsWe studied participants with incident type 2 diabetes from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort, who were free of cancer, cardiovascular disease and microvascular disease at diagnosis (n = 1083). Pre-diagnosis BMI and relative annual change between pre- and post-diagnosis BMI were evaluated in multivariable-adjusted Cox models.ResultsThere were 85 macrovascular (myocardial infarction and stroke) and 347 microvascular events (kidney disease, neuropathy and retinopathy) over a median follow-up of 10.8 years. Median pre-diagnosis BMI was 29.9 kg/m2 (IQR 27.4–33.2), and the median relative annual BMI change was −0.4% (IQR −2.1 to 0.9). Higher pre-diagnosis BMI was positively associated with total microvascular complications (multivariable-adjusted HR per 5 kg/m2 [95% CI]: 1.21 [1.07, 1.36], kidney disease 1.39 [1.21, 1.60] and neuropathy 1.12 [0.96, 1.31]) but not with macrovascular complications (HR 1.05 [95% CI 0.81, 1.36]). Analyses according to BMI categories corroborated these findings. Effect modification was not evident by sex, smoking status or age groups. In analyses according to BMI change categories, BMI loss of more than 1% indicated a decreased risk of total microvascular complications (HR 0.62 [95% CI 0.47, 0.80]), kidney disease (HR 0.57 [95% CI 0.40, 0.81]) and neuropathy (HR 0.73 [95% CI 0.52, 1.03]), compared with participants with a stable BMI; no clear association was observed for macrovascular complications (HR 1.04 [95% CI 0.62, 1.74]). The associations between BMI gain compared with stable BMI and diabetes-related vascular complications were less apparent. Associations were consistent across strata of sex, age, pre-diagnosis BMI or medication but appeared to be stronger among never-smokers compared with current or former smokers.Conclusions/interpretationAmong people with incident type 2 diabetes, pre-diagnosis BMI was positively associated with microvascular complications, while a reduced risk was observed with weight loss when compared with stable weight. The relationships with macrovascular disease were less clear.Graphical abstract

Serum 25-hydroxyvitamin D level in relation to weight change and the risk of weight gain in adults of normal weight at baseline: the Norwegian HUNT cohort study.

ObjectiveWe sought to investigate the relationship of serum 25-hydroxyvitamin D (25(OH)D) level with weight change and the risk of weight gain in an adult population who had normal weight at baseline and were followed up for 11 years.DesignA population-based prospective cohort study.SettingNord-Trøndelag, Norway.ParticipantsThe study included 1501 adults who participated in the second and third surveys of the Nord-Trøndelag Health Study (HUNT2 (1995–1997) and HUNT3 (2006–2008)) and had a normal body mass index ≥18.5 and <25.0 kg/m2 at baseline.Primary and secondary outcome measuresRelative weight change (%) was calculated as ((HUNT3 weight−HUNT2 weight)/HUNT2 weight×100). Relative annual weight change (%) was calculated as (relative weight change/follow-up years×100). Clinical weight gain was defined as relative weight change ≥5% over the 11 years, while annual weight gain was defined as relative annual weight change >1.25%.MethodsMultiple regression models were used to estimate adjusted coefficients for the relative annual weight change and risk ratios (RRs) for the risk of clinical weight gain and of annual weight gain.ResultsEach 25 nmol/L increase in season-standardised serum 25(OH)D level at baseline was associated with a reduction of 0.05% (95% CI −0.11 to 0.01) for relative annual weight change, a 10% (RR 0.90, 95% CI 0.82 to 0.97) reduced risk of clinical weight gain, and a 19% (RR 0.81, 95% CI 0.65 to 1.00) reduced risk of annual weight gain. A statistically significant trend was evident for the risk of clinical weight gain when 25(OH)D levels were treated as a categorical variable (p=0.006).ConclusionsThe findings suggested an inverse association of serum 25(OH)D level with the risk of clinical weight gain in adults who had normal weight at baseline over 11 years’ follow-up.

105-OR: Trends in Complications in Type 1 and Type 2 Diabetes in Denmark, 1996-2016

Background and aim: Both micro- and macro vascular complications represent major problems for diabetes patients and monitoring of the extent of these among diabetes patients is essential. Several studies have reported decreasing complications rates. We describe the burden and trend in 18 groups of complications in persons with diabetes in Denmark 1996-2016. Methods: We compiled a diabetes register for the entire Danish population, including reliable classification of type of diabetes. From the National Patient Register we extracted dates of recorded complications in 18 classes. Binomial regression was used to describe the prevalence of complications at diagnosis and change in these over time. Rate models based on Poisson likelihood were used to describe the incidence rates and changes in these. Analyses were conducted separately for T1D and T2D, and controlled for sex, age, duration of diabetes and including a linear term to describe the calendar time effect (date of diagnosis). Results: The prevalence at diagnosis of previous CVD was 10% in T1D and 37% in T2D, with annual relative changes of 3% in T1D and 5% in T2D. Retinopathy prevalence at diagnosis was 4.3% in T1D and 1.7% in T2D with no change in T1D, but a relative decrease of 6% in T2D. We found similar decreases in rates of complications in T1D and T2D; decrease of 2%/year in rates of CVD, 5%/year in amputations, while there were no changes in the incidence rates of retinopathy and renal disease over the period 1996-2016. For most complications we found a very high incidence during the first year after diagnosis, most likely reflecting a diagnostic catch-up and not any biological phenomenon. Conclusions: A steady decrease in incidence rates of most complications was seen, but not for microvascular complications. The pattern of complications at diagnosis was more mixed, influenced by fluctuations in diagnostic activity over the period. In general an encouraging trend in complication occurrence was seen in Denmark in the period 1996-2016. Disclosure B. Carstensen: Stock/Shareholder; Self; Novo Nordisk A/S. H. Amadid: None. M.E. Jørgensen: Research Support; Self; Amgen, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi-Aventis. Stock/Shareholder; Self; Novo Nordisk A/S.

Prevalence and trend analysis of antimicrobial resistance in clinical Escherichia coli isolates collected from diseased pigs in the USA between 2006 and 2016.

Antimicrobial resistance (AMR) is an emerging threat to both human and animal health. Antimicrobial use and resistance in food animal production, including swine, has received increased scrutiny as a source of resistant foodborne pathogens. Continuous surveillance of AMR in bacterial isolates of swine origin can guide in conservation of antimicrobials used in both human and swine medicine. The objective of this study was to evaluate the prevalence and trends of the phenotypic AMR in Escherichia coli of swine origin isolated from clinical samples at the Minnesota Veterinary Diagnostic laboratory between 2006 and 2016. The prevalence of resistance to ampicillin, tetracyclines and sulphadimethoxine remained greater than 50% throughout the period. There was a drastic change in enrofloxacin resistance, increasing from less than 1% to more than 20% between 2006 and 2016 (annual relative increase of 57% between 2006 and 2013 and 16% between 2013 and 2016). The prevalence of resistance to other antimicrobials remained constant (ceftiofur, oxytetracycline and chlortetracycline) or changed significantly (annual relative changes of less than 10%) for at least some time-period between 2006 and 2016 (ampicillin, florfenicol, gentamicin, neomycin, sulphadimethoxine, trimethoprim-sulphamethoxazole and spectinomycin). Rarefaction analysis revealed an increase in the number of unique combinations of AMRs per year. Network analysis was performed by estimating and plotting partial correlations between minimum inhibitory concentrations (MICs) of various antimicrobials. An increase in strength of these networks was observed, particularly in networks created after 2010, which can be indicative of increased multiple AMR in these isolates. These results provide valuable insight into the trends in AMR in E. coli of swine origin in the USA and act as supplementary information to the existing active AMR surveillance systems.

Disabilities in activities of daily living and in instrumental activities of daily living among older adults in China, 2011–15: a longitudinal cohort study

BackgroundWith global population ageing, the population of older adults (aged ≥60 years) is rapidly growing, and most such individuals are in need of health care and assistance. We aimed to assess changes in disability in basic activities of daily living (ADL), and in instrumental activities of daily living (IADL) among older Chinese individuals. MethodsWe used data from three surveys of the China Health and Retirement Longitudinal Study, conducted in 2011 (n=7380), 2013 (n=8328), and 2015 (n=9594). Data on six ADL measures (dressing, bathing, eating, walking, toileting, and urination and defecation) and six IADL measures (doing housework, shopping, cooking, managing money, taking medicine, and telephoning) were collected through interviews. We defined disability as need of assistance or inability to perform any of the ADLs or IADLs. Generalised estimating equation models were used to assess the time trend in the prevalence of disabilities in ADL and IADL. FindingsThe prevalence of disability in IADLs increased from 1496 (20·96%, weighted) of 7330 participants in 2011 to 2584 (26·51%, weighted) of 9348 in 2015, with a relative annual increase of 1·92% in the total sample (ptrend<0·0001). The trend was statistically significant (ptrend<0·001) in all subgroups by age, sex, and living region. The prevalence of disability in ADLs showed little change from 2011 (759 [11·40%, weighted] of 7354) to 2015 (983 [10·03%, weighted] of 9554), with a relative annual change of 0·12% in the total sample (ptrend=0·2429), and in all subgroups by age, sex, and living region (ptrend>0·10). After controlling for various confounding factors, functional capacities in ADLs and IADLs were substantially worse in women than in men. InterpretationThe prevalence of IADL disability increased among older Chinese adults during 2011–15, whereas the prevalence of ADL disability remained stable. Improvements in lifestyle, socioeconomics, and health care might reduce disabilities in ADL, but lifespan extension might expand IADL disability as more frail and older individuals survive with health problems. FundingNational Natural Science Foundation of China (grant number 81573262).

Trends in prescriptions and costs of inhaled medications in chronic obstructive pulmonary disease: a 19-year population-based study from Canada.

BackgroundThe patterns of medication use in chronic obstructive pulmonary disease (COPD) may change over time due to the availability of new medications, updates in guideline-based recommendations, and changes in patient and care provider preferences.ObjectivesTo document population-level trends of filled prescriptions and costs for major classes of inhaled COPD therapies.MethodWe used administrative health databases of the province of British Columbia, Canada, from 1997 to 2015, to create a retrospective cohort of COPD patients. We documented the percentage of patients receiving major inhaled COPD-related medications, including short-acting beta-2 adrenoreceptor agonists (SABA), long-acting beta-2 adrenoreceptor agonists (LABA), inhaled corticosteroids (ICS), short-acting muscarinic receptor antagonists (SAMA), and long-acting muscarinic receptor antagonists (LAMA). We quantified the average, and relative annual change in, dispensed quantities and costs (in 2015 Canadian dollars [$]) of medications. Combination therapy was assessed as the proportion of time covered by two or more long-acting medications of different classes.ResultsA total of 176,338 patients were included in the final cohort (mean age at entry 68.7, 48.5% female). In 2015, the most common medication was ICS (45.7% of the patients), followed by LABA (36.5%). LAMA was the least used medication (18.9%). The number of filled prescriptions per patient per year for LAMA (+7.8% per year) and LABA (+4.9%) increased, while they decreased for SAMA (−6.3%) and SABA (−3.8%), and remained relatively constant for ICS. The average annual per-patient costs of inhaled medications were $570.8 in 2015, which was double the costs from 1997. Single-inhaler ICS/LABA had the highest rate of increase (11.6% per year), and comprised 53.7% of the total costs of inhalers in 2015. In 2015, 28.5% of the patient time was on combination therapies, with 7.1% on triple ICS/LABA/LAMA therapy.ConclusionUtilization of inhaled therapies for COPD has changed significantly over time. The low utilization of LAMA and high utilization of combination therapies (particularly those containing ICS) do not seem to be aligned with COPD treatment guidelines.

Tolvaptan in Japanese patients with later-stage autosomal dominant polycystic kidney disease.

A recent study demonstrated that tolvaptan slowed estimated glomerular filtration rate (eGFR) decline in later-stage autosomal dominant polycystic kidney disease (ADPKD) patients. However, Japanese patients were not included in that trial, therefore tolvaptan's efficacy in Japanese patients with advanced chronic kidney disease (CKD) has remained unknown. In this prospective cohort study, 54 patients with ADPKD who had eGFR ≥ 15ml/min/1.73m2 and total kidney volume (TKV) ≥ 750ml were treated with tolvaptan. The primary endpoint was the change in height-adjusted total kidney volume (htTKV) and eGFR after 1-year treatment with tolvaptan. Then, we compared the primary endpoint between later CKD stage (baseline eGFR < 45ml/min/1.73m2) and earlier CKD stage (baseline eGFR ≥ 45ml/min/1.73m2). The rate of kidney growth during the 1-year treatment did not differ significantly between earlier and later CKD stages. The median and interquartile range of relative change in htTKV in later CKD stage was 8.2%/year [4.4, 26.6], as compared with 5.7%/year [1.6, 16.4] in earlier CKD stage (p = 0.17). Nor did the rate of eGFR decline between earlier and later CKD stages. The relative annual change in eGFR in later CKD stage was - 9.7%/year [- 15.9, - 2.1], as compared with - 6.8%/year[- 11.1, 0.1] in earlier CKD stage (p = 0.18). This analysis indicates that the efficacy of tolvaptan for Japanese patients with later stage ADPKD was not significantly different from that of Japanese patients with earlier stage ADPKD.

NDVI-derived forest area change and its driving factors in China.

China harbors diversified forest types, from tropical rainforest to boreal coniferous forest, and has implemented large-scale reforestation/afforestation programs over the past several decades. However, little information is available on changes in China’s forest area and the causes. In this study, we used the classified forest distribution thematic map derived from Normalized Difference Vegetation Index (NDVI) datasets and a revised IPAT model to examine China’s forest area change and the possible driving factors from 1982 to 2006. Overall, NDVI-derived forest areas were numerically consistent with those reported in the 3rd, 4th, 5th, and 6th National Forest Inventories, respectively. Over the past 25 years, China’s forest area was estimated to have an average of 169.18 million hectares with an annual increase of 0.15 million hectares (c.a. a total net increment of 3.60 million hectares), which is equivalent to 0.089% of the relative annual change rate. However, a large difference in the changing rate and direction of forest area at the province level was found; for instance, forest area has declined in 10 provinces, mainly in Northeastern and Southern China, while 21 provinces showed an increase. The changes were most likely attributed to the policy regarding the import and export of timber and affluence (per capita gross domestic product), and both contributed more than 80% of the total contribution of the six factors of the revised IPAT model.

Trends in attention-deficit hyperactivity disorder medication use: a retrospective observational study using population-based databases

The use of medications to treat attention deficit hyperactivity disorder (ADHD) has increased, but the prevalence of ADHD medication use across different world regions is not known. Our objective was to determine regional and national prevalences of ADHD medication use in children and adults, with a specific focus on time trends in ADHD medication prevalence. We did a retrospective, observational study using population-based databases from 13 countries and one Special Administrative Region (SAR): four in Asia and Australia, two in North America, five in northern Europe, and three in western Europe. We used a common protocol approach to define study populations and parameters similarly across countries and the SAR. Study populations consisted of all individuals aged 3 years or older between Jan 1, 2001, and Dec 31, 2015 (dependent on data availability). We estimated annual prevalence of ADHD medication use with 95% CI during the study period, by country and region and stratified by age and sex. We reported annual absolute and relative percentage changes to describe time trends. 154·5 million individuals were included in the study. ADHD medication use prevalence in 2010 (in children aged 3-18 years) varied between 0·27% and 6·69% in the countries and SAR assessed (0·95% in Asia and Australia, 4·48% in North America, 1·95% in northern Europe, and 0·70% in western Europe). The prevalence of ADHD medication use among children increased over time in all countries and regions, and the absolute increase per year ranged from 0·02% to 0·26%. Among adults aged 19 years or older, the prevalence of any ADHD medication use in 2010 varied between 0·003% and 1·48% (0·05% in Asia and Australia, 1·42% in North America, 0·47% in northern Europe, and 0·03% in western Europe). The absolute increase in ADHD medication use prevalence per year ranged from 0·0006% to 0·12%. Methylphenidate was the most commonly used ADHD medication in most countries. Using a common protocol and data from 13 countries and one SAR, these results show increases over time but large variations in ADHD medication use in multiple regions. The recommendations of evidence-based guidelines need to be followed consistently in clinical practice. Further research is warranted to describe the safety and effectiveness of ADHD medication in the short and long term, and to inform evidence-based guidelines, particularly in adults. None.

Impact of Chronic Opioid Therapy Risk Reduction Initiatives on Opioid Overdose

We assessed the effects of opioid dose and risk reduction initiatives on opioid overdose rates among patients on chronic opioid therapy (COT). Using an interrupted time series design, we compared trends in overdose rates. We compared patients on COT in settings that implemented a COT dose reduction initiative and then a COT risk stratification/monitoring initiative to similar patients on COT from control settings. From 2006 to 2014, 31,142 patients on COT (22,673 intervention, 8,469 control) experienced 311 fatal or nonfatal opioid overdoses. In primary analyses, changes in opioid overdose rates among patients on COT did not differ significantly between intervention and control settings with the implementation of either dose reduction or risk stratification/monitoring. In planned secondary analyses, overdose rates decreased significantly (17% per year) during the dose reduction initiative among patients on COT in intervention settings (relative annual change, 0.83; 95% confidence interval, 0.70–0.99), but not in control settings (0.98. 95% confidence interval, 0.70–1.39). We conclude that overdose rates among patients on COT were not decreased by risk stratification and monitoring initiatives. Results were inconsistent for COT dose reduction, with no significant difference between intervention and control settings (primary hypothesis test), but a significant decrease in overdose rates within the intervention setting during dose reduction (secondary hypothesis test). PerspectiveRisk stratification/monitoring interventions among patients on COT did not decrease opioid overdose rates. The effects of COT dose reduction on opioid overdose rates were inconsistent. Greater decreases in COT dose, a larger control group, or both may have been needed to identify conclusive reductions in opioid overdose rates.

Evaluation of Four Parameterization Strategies for the APEX Model

Abstract.State-of-the-art model parameterization consists of calibrating and validating the model using monitored data. When data are not available, many studies have relied on alternate strategies, including parameter sets obtained for eco-hydrologically similar watersheds and best professional judgment (BPJ). The objectives of this study were to (1) test the accuracy of four APEX parameterization strategies to predict runoff quantity and quality in a small agricultural watershed and (2) compare the effects of the different parameter sets on relative and absolute water quality outcomes for different conservation practice scenarios. A BPJ and three parameter sets obtained on nearby and more distant sites, including two fully calibrated parameter sets, i.e., for runoff, sediment, and total phosphorus (TP), and one partially calibrated parameter set, i.e., for runoff and TP only, were evaluated based on edge-of-field runoff, sediment loss, and TP loss, as well as for long-term annual predictions and relative changes for six conservation practice scenarios. Only the parameter sets that were fully calibrated met the model performance criteria on the test watershed and produced similar 30-year average annual predictions for the conservation practices. Relative changes in conservation outcomes were similar for the fully and partially calibrated parameter sets. They were different for the BPJ parameter set for at least one conservation practice. In the absence of site-specific data, the best parameterization strategy was to use parameter sets from a model calibrated for runoff, sediment, and nutrient losses from an eco-hydrologically similar site. Partial calibration of the model was sufficient to obtain consistent relative effects of the conservation practices. Keywords: Conservation practices, Hydrologic modeling, Model parameterization, Phosphorus, Sediment.

Effect of different fertilization modes on soil organic carbon sequestration in acid soils

ABSTRACTA meta-analysis of 297 treatment data from the Vezaiciai Branch of the Lithuanian Research Centre for Agriculture and Forestry long-term field experiment published from 2006 to 2015 was used to characterize the changes in SOC under different fertilization treatments and residue management practices in Lithuania’s acid soil. A meta-analysis was performed to quantify the relative annual change (RAC) of SOC content and the average RAC rate of SOC under four fertilization modes (farmyard manure (FYM) (40 t ha−1)); alternative organic fertilizers (in the manure background (40 t ha−1)); FYM (60 t ha−1); alternative organic fertilizers (in the manure background (60 t ha−1)) in two soil backgrounds (naturally acid and limed soil). The average RAC under four fertilization modes was 1.46 g kg−1 yr−1, indicating that long-term fertilization had considerable SOC sequestration potential. Incorporation of alternative organic fertilizers in unlimed soil showed negative effects (−0.39 and −0.66 g kg−1 yr−1) in the observed long-term experiment. The RAC in the limed soil with incorporated organic fertilizers (FYM and alternative organic fertilizers), compared to the control, and varied from 0.25 g kg−1 yr−1 in the treatment with incorporated alternative organic fertilizers (in the manure background (40 t ha−1)) to 0.71 g kg−1 yr−1 in the soil with FYM (60 t ha−1). In this study, the average RAC rate of SOC under organic fertilization treatments in limed soil (5.07–6.54%) was longer than organic fertilization in unlimed soil (2.11–3.49%), which might be attributed to the application of organic manure that would result in a slow release of fertilizer efficiency. Our results indicate that the application of manure (40 or 60 t ha−1) showed the greatest potential for C sequestration in agricultural soil and produced the longest SOC sequestration duration.