Baseline Year Research Articles

Climate Risks and Economic Consequences of Rising Global CO2 Emissions in Aviation, Shipping, and Heavy-Duty Transport

This study examines methods to lessen the environmental consequences of global CO2 emissions from the hard-to-abate transport sector. The paper analyzed historical and projected trends in global CO2 emissions from the hard-to-abate transport industry under two scenarios: the stated policy scenario (STEPS) and the announced pledged scenario (APS). The study covered the historical period from 2010 to 2022 and projected emissions up to 2050. The analysis revealed that the compound annual growth rate (CAAGR) of STEP exceeded that of APS in 2030 and 2050 for challenging emissions from heavy- duty vehicles, aircraft, and shipping when compared to the baseline year of 2022. The aviation industry has a higher CAAGR of 5.3% and 2.5% for 2030 and 2050, respectively, compared to heavy-duty vehicles at 1.6% and 0.9% for 2030 and 2050, respectively, and shipping at 0.7% and 0.9% for 2030 and 2050, respectively, under STEPS. Under the APS scenario, shipping showed a negative CAAGR of -0.8% and -2.8% for 2030 and 2050, respectively, and 0.4% and -1.8% for 2030 and 2050, respectively, for heavy-duty trucks. In comparison, the aviation industry had CAAGRs of 4.5% and 0.8% for 2030 and 2050, respectively. The data shows that the aviation industry is expected to see a far greater CAAGR in emissions than heavy-duty vehicles and shipping in both STEPS and APS scenarios. Targeted efforts are necessary to mitigate the environmental effects of air travel in the upcoming decades. The paper also examined 56 publicly traded international transportation companies and their corresponding carbon emission targets. Only seven companies, or 12.5%, have established goals for reducing emissions from 2023 to 2050; 10 companies, accounting for 17.9%, have committed to achieving carbon neutrality by 2040 to 2060; five corporations, representing 8.9%, have set targets for reducing emission intensity from 2025 to 2034; and 34 global corporations, making up 60.7%, have committed to achieving net zero emissions between 2040 and 2050. Despite some progress in setting emission reduction targets in the air travel industry, many companies still need to set carbon footprint reduction goals.

Effect of Delaying High School Start Time on Teen Physical Activity, Screen Use, and Sports and Extracurricular Activity Participation: Results From START.

We aimed to characterize relationships between delayed high school start time policy, which is known to lengthen school night sleep duration, and patterns in activity outcomes: physical activity, non-school electronic screen time (non-schoolwork), and sports and extracurricular activity among adolescents. We used data from the START study, a multi-site evaluation of a natural experiment, assessing the effects of a school start time policy change in high schools in the Minneapolis, Minnesota metropolitan area. The study follows students in 2 schools that shifted to a later start time (8:20 or 8:50 am) after baseline year and 3 schools that maintained a consistent, early start time (7:30 am) over the 3-year study period. Activity was measured by participant self-report on an in-school survey. The analysis used a difference-in-differences estimator, in which the changes in each outcome observed in the comparison schools estimate the changes in each outcome that would have been observed in the late-start adopting schools had they not delayed their start times after baseline. Over 2 years of follow-up, no changes emerged to suggest that later school start times either interfered with, or promoted, any activity-related outcome that was measured. Communities interested in promoting sleep by delaying start times may do so knowing that there are unlikely to be adverse effects on adolescent physical activity, electronic screen time, or organized sports and activity participation. A shift to later school start times does not appear to enhance or detract from the healthfulness of students' activity level.

Severe Acute Respiratory Infection (SARI) due to Influenza in Post-COVID Resurgence: Disproportionate Impact on Older Māori and Pacific Peoples.

Influenza reemerged after a 2020-2021 hiatus in 2022, but understanding the resurgence needs pre-COVID era surveillance. We compared age- and ethnicity-specific incidence of severe acute respiratory infection (SARI) from a hospital network in Auckland, New Zealand, in 2022 against a baseline, 2012-2019. Annual and monthly influenza SARI incidence per 1000 persons by age and ethnic group between 2012 and 2022 was calculated using resident population as the denominator. The hospitals capture most severe illness of the resident population. Influenza SARI incidence was highest among <1 year olds (2.62; 95% CI: 1.84-3.61) during 2012-2019, lowest at 6-14 years, and did not significantly increase until 50-64 years (0.35; 95% CI: 0.27-0.45), reaching 1.19 (95% CI: 0.57-1.55) in those ≥75 years. In all age groups, incidence was at least threefold higher in Māori and Pacific Peoples. No influenza SARI was identified in 2020-2021. In 2022, despite an early peak, annual incidence (<65 years) was lower than baseline in all ethnic groups, but incidence (≥65 years) in Māori (2.06; 95% CI: 1.22-3.26) and Pacific (3.94; 95% CI: 2.97-5.13) peoples was higher in 2022 than most baseline years, whereas incidence in NMNP (0.22; 95% CI: 0.14-0.32) was lower than any baseline year. After no influenza 2020-2021, Auckland had an early, high, narrow peak in 2022. Stratification by age and ethnicity revealed striking discrepancies in incidence among Māori and Pacific adults over 65 years compared with NMNP adults, with implications for targeted vaccination strategies.

The impact of diabetes pay-for-performance program on hyperglycemic hyperosmolar state (HHS)

Abstract Background To examine the effects of a diabetes pay-for-performance (P4P) program on the negative metabolic outcome: hyperglycemic hyperosmolar state (HHS) of patients in Taiwan. Methods Four years (2008∼2011) of data from the National Health Insurance Administration (NHIA) databases were examined. P4P patients included those who were newly enrolled in the P4P group in 2010, and consecutively included in 2011. Patients were never enrolled are defined as non-P4P group in these two years. The caliper matching method and a generalized estimating equation were used to estimate difference-in-differences models (baseline year 2009) and examine the effects of the P4P program on the count of the adverse outcome. Results The P4P program was associated with decreases in the incident of HHS (IRR 0.53, P = 0.02). Conclusions The disease management component of the diabetes P4P program can be beneficial for reducing the incidences of HHS. Key messages • The disease management component of the diabetes P4P program can be beneficial for reducing the incidences of HHS. • The disease management component of the diabetes P4P program is important.

Effect of the longitudinal change in anemia status on clinical outcomes for patients with nonvalvular atrial fibrillation: analysis from the Hokuriku-Plus AF registry

Abstract Background Anemia is a common comorbidity in older patients with heart failure (HF)1 and atrial fibrillation (AF)2, associated with an increased risk of adverse events. This study evaluated the prognostic effects of longitudinal changes in anemia status on clinical outcomes in patients with AF, as limited data are available on this aspect. Methods and Results We prospectively evaluated data of 1,388 patients with AF obtained from the Hokuriku-Plus AF registry (1,010 men, 72.3±9.7 years) and recorded the incidence of cardiovascular death (CVD), HF, thromboembolism, and major bleeding. Finally, 1,233 patients with AF with baseline and first year of follow up hemoglobin levels were evaluated. Patients were categorized into 3 groups based on the longitudinal changes in 1-year anemia status: AF without anemia (group 1), AF with improved anemia (group 2), and AF with sustained or new-onset anemia (group 3). During 1–5-year follow up, the incidences of CVD, HF, thromboembolism, and major bleeding were significantly higher in patients with AF and anemia than in those without (Figure1). Additionally, the incidence of CVD or HF was significantly higher in group 3 than in groups 1 and 2 (Figure 2). Multivariate analysis revealed no anemia or improvement from anemia in 1 year as an independent predictor for reducing CVD and HF. Conclusions Recovery from anemia may be associated with a favorable clinical course in AF.

Changes in the prevalence of intellectual disability among 10-year-old children in Sweden during 2011 through 2021: a total population study

BackgroundRecent studies have suggested an increasing prevalence of intellectual disability diagnoses in some countries. Our aim was to describe the trend in the prevalence of intellectual disability diagnoses in Sweden and explore whether associated sociodemographic and perinatal factors can explain changes in the prevalence.MethodsWe used a register-based nationwide cohort of residents in Sweden born between 2001 and 2011. We calculated the prevalence of intellectual disability diagnoses by age 10 for each birth cohort and the prevalence ratios in relation to the baseline year 2011, overall and by severity of intellectual disability, and comorbidity of autism and attention-deficit/hyperactivity disorder. The prevalence ratios were stratified and adjusted for associated sociodemographic and perinatal factors.ResultsAmong 1,096,800 individuals, 8,577 were diagnosed with intellectual disability by age 10. Among these, 3,949 (46%) and 2,768 (32%) were also diagnosed with autism and attention-deficit/hyperactivity disorder, respectively, and 4% were diagnosed with profound, 8% severe, 20% moderate, 52% mild, and 16% other/unspecific intellectual disability. The recorded age-10 prevalence of intellectual disability diagnoses increased from 0.64% (95% confidence interval 0.59–0.69%) in 2011 to 1.00% (0.94–1.06%) in 2021, corresponding to an annual prevalence ratio of 1.04 (1.04–1.05). The increase was, however, restricted to mild, moderate, and other/unspecific intellectual disability diagnoses, while the trends for profound and severe intellectual disability diagnoses were stable. The increasing trend was perhaps less pronounced among females and children with diagnosed attention-deficit/hyperactivity disorder, but independent of the co-occurrence of autism. The prevalence ratios did not change with stratification or adjustment for other associated demographic and perinatal factors.ConclusionThe recorded prevalence of diagnosed mild and moderate intellectual disability among 10-year-olds in Sweden has increased over the recent decade. This increase could not be explained by changes in associated sociodemographic or perinatal factors, including birth weight, gestational age, and parental age, migration status, and education at the child’s birth. The increase instead may be due to changes in diagnostic practices in Sweden over time.

A Study on Ambient Air Quality and Management inCommercial Areas of Gorakhpur City

The current study evaluates the city of Gorakhpur's ambient air quality using an air quality index. For the period January 2018 to November 2022, the 24-hour average concentration of the three primary pollutants SO2, NO2, andPM10 in a commercial area close to Jalkal Bhawan in Gorakhpur city was measured. Pollutant measurements were made between January 2018 and November 2022. The IND-AQI technique was implemented to calculate the Air Quality Index. In July, the highest monthly average concentrations of PM10, SO2, and NO2 were recorded at 401.13, 36.41, and 54.02, respectively. The yearly average SO2 concentration was found to be within the CPCB- recommended limit, while NO2 was found to be slightly above the maximum allowable level. However, PM10 wasconsistently found to be above the CPCB-recommended limit. The average monthly concentration of NO2 is higherthan SO2, and the overall AQI rating was determined to be moderate. The global experiences clearly demonstratedthat international action had been city specific rather than country oriented, and as a result, statistics show a reductionin PM2.5 of 35%–40% in five years for cities like Beijing and Seoul, whereas cities like Santiago and Mexico Cityhave shown reductions in PM2.5 and PM10 concentration of 73% and 61% in 20 to 25 years, respectively. Recent research published in the Lancet found that over the past five years, CO and Sulphur dioxide levels decreased by 28.2% and 54.1%, respectively, while NO2 and O3 concertation showed no considerable improvement. The August2018 TERI and ARAI report examined several interventions and predicted their possible effects. PM2.5 and PM10 levelsin Delhi and the NCR are above average. A different scenario has been developed in light of the intervention that can improve air quality the most. The NCAP produces an estimated national level target of 20%-30% decreasesin PM2.5 and PM10 concentration by 2024 after taking into consideration the existing international and national studies. This keeps 2018 as the baseline year for concentration comparisons. Gorakhpur City has recently experienced an increase in development activity, which has led to particulate matter.

A century of variability of heatwave-driven streamflow in melt-driven basins and implications under climate change

Abstract Meltwater runoff from snow and glaciers in high mountain regions supports the water needs of hundreds of millions of people, but extreme events such as heatwaves modify the timing and magnitude of water available for downstream communities and ecosystems. The streamflow response to heatwaves depends strongly on heatwave timing and temperature, and the amount of snow and glacier ice available to melt. However, as ongoing climate change continues to alter both seasonal melt patterns and the frequency and intensity of heatwaves, it is not well understood how such streamflow responses will evolve relative to the seasonal cycle of streamflow. We address this knowledge gap by using long-term meteorological and hydrological datasets to characterize spatial and temporal heterogeneity in the streamflow sensitivity to heatwaves at six basins with &gt;80 years of observations in Western Canada. We use years with earlier freshets and less snowfall as proxies of anticipated climate change, and apply a metric to describe how the streamflow sensitivity to heatwaves varies across years with different hydro-climatological characteristics. We find that in future proxy years relative to baseline years, nival streamflow is more sensitive to early spring heatwaves but less sensitive to late spring and summer heatwaves. Relative to baseline years, late spring heatwaves in future proxy years generate a smaller fraction of peak streamflow that is diminished as the freshet progresses. Our findings imply that future heatwave-driven peak flows in spring may be lessened by the diminished streamflow sensitivity to heatwaves in late spring, but this may be partially offset by excess melt during future heatwaves that are longer and hotter.

Does Dialysis Therapy Cause Cognitive Impairment in Older Adults? A Propensity Score Matching Retrospective Study From a Japanese Long-Term Care Insurance Certification Survey.

This study explored the longitudinal connection between dialysis therapy in older adults and the incidence of cognitive impairment, and trends of general abilities. We conducted a retrospective propensity score matching (PSM) analysis of data from the care-needs certification survey in City A, Japan, spanning 2017 to 2021. Our sample comprised 11 443 initially cognitively intact older adults from the baseline year 2017. Among them, individuals had received dialysis therapy at baseline, and 216 individuals were included after PSM. The dialysis group had a significantly lower incidence of cognitive impairment during follow-up than the control group (P = 0.02). The competing risk of death was significantly higher in the dialysis group than in the control group (P < .001). Both groups showed a decline in their comprehensive ability over the time. There have been several reports of a negative association between dialysis and cognitive impairment, but more detailed investigation of the longitudinal relationship may be needed. Comprehensive support remains critical for both dialysis and non-dialysis older adults.

Fit for 2030? Possible scenarios of road transport demand, energy consumption and greenhouse gas emissions for Italy

Decarbonizing the transportation sector is one of the key challenges to reduce greenhouse gas (GHG) emissions and meet EU Green deal 2030 targets. Road transport decarbonization requires a holistic approach encompassing various strategies and interventions aimed at fostering the sustainable transition of this sector. This challenge is crucial given that road is responsible for over 90% of the overall transport GHG emissions.Within this framework, this study aims, for the Italian case, to: a) estimate the national passenger and freight road travel demand with respect to three different time periods: 2005 (reference year for EU “fit for 55” target); 2019 (last consolidated pre-covid year); 2022 (base-line year); b) define possible road transport scenarios to 2030 following the Avoid-Shift-Improve (ASI) approach; c) estimate the GHG and energy consumption inventory related to national road transport for the 2005, 2019; 2022 and 2030 scenarios. Due to the current “deep uncertainty” regarding key economic and social variables in this period, two forecasting scenarios – named “moderate decarbo” and “high decarbo” – were designed and based on different and somewhat opposite hypotheses on exogenous variables (e.g., GDP) and penetration rates of measures and policies promoting sustainable transportation (e.g., subsidies for electric vehicles) already in place. Although the current European legislation refers only to Tank-to-Wheel (TtW) objectives, this study included also the Well-to-Wheel (WtW) evaluation, which is more accurate in assessing the GHG impact of different policies, energy carriers, and technologies. As for the past, results suggest that GHG reductions over the period 2005–2022 are mostly due to crises and stagnation of the Italian economy. “Moderate decarbo” forecasts for 2030 lead to a 12% reduction of TtW (and 15% for WtW) GHG emissions compared to 2005 levels, with ASI policies compensating for the assumed economic growth. In any case these values are far from the EU “Fit for 55” goal setting a 43.7% reduction of TtW emissions. Even under very favourable hypotheses (“high decarbo” scenario), GHG emissions might be reduced by only 28% for TtW and 33% for WtW, still well below EU objectives. Furthermore, passengers and freight show very different behaviour, with the latter contributing to emissions more than proportionally, and “shift-to-rail” policies, although very useful in some market segments, contribute moderately at the overall national level. The main conclusion of this study is that the pathway towards road transport decarbonization in Italy (and possibly in other EU Countries) is very uncertain, and the ambitious 2030 target is unlikely to be met with currently planned policies alone. The transportation system needs to be constantly monitored, and new policies have to be implemented to reach higher emissions reduction goals.

Mapping the patient journey and treatment patterns in early-stage (stage I-III) non-small cell lung cancer

IntroductionWe map the patient journey from symptom onset to intervention and describe primary treatment in a retrospective population-based cohort study of patients in a large healthcare-provider. MethodsNewly diagnosed adult patients diagnosed with stages I-III non-small cell lung cancer (NSCLC) between 2016 and 2019 were identified from the Israel National Cancer Registry and chart review was performed to extract de-identified data. The following timelines were constructed: from symptom onset to imaging, imaging to biopsy, and biopsy to primary treatment initiation. Cutoff: 31st December 2021. The initial symptom was captured up to one year prior to biopsy. ResultsAmong 302 patients (41 % female, 70 % >=65 years, 79 % former or current smoking, 62 % adenocarcinoma), 34.1 % stage I, 10.3 % stage II, 42.1 % stage III and 13.6 % unknown (AJCC ver. 8). In the baseline year, 80.5 % of patients reported at least one symptom to their physician, and 12.3 % reported four or more symptoms. The most common symptoms reported were cough (29.8 %), pneumonia (24.2 %), chest pain (18.5 %), bronchitis (17.5 %) and wheezing (17.2 %). For patients with an initial symptom (n=243) median time from symptom onset to imaging was 5.5 months (95% CI:4.8–6.3), and time from imaging to primary treatment initiation was 2.6 (2.3–2.9) months in all patients. Total duration from symptom to intervention was 8.5 months (7.6–9.3). Over 93 % of stage I patients underwent surgery and 4.9 % received definitive radiation. Over 83 % of stage II patients underwent surgery; of these, 54.8 % received adjuvant/neoadjuvant chemotherapy. Of stage III patients, 68.5 % received definitive chemoradiation (half received durvalumab), and the remaining underwent surgery with adjuvant/neoadjuvant treatment. ConclusionA total of 80.5 % of patients were symptomatic and the median duration from symptom onset to treatment initiation was 8.5 month long. Improving patient and physician awareness to lung cancer symptoms, and the introduction of screening programs are essential for reducing those delays.

Ecological Effects of the Huge Invasive Species Removal Project in Coastal China.

Saltmarsh wetlands are recognized as some of the most ecologically valuable yet vulnerable ecosystems globally. However, since the 1970s, saltmarsh wetlands in coastal China have been seriously threatened by the invasive Spartina alterniflora. Although the Chinese government has initiated a nationwide S.alterniflora removal project, the potential benefits and risks of this project remain unknown. Here, we focus on the Yangtze River Estuary Saltmarsh Wetland (YRESW) and simulate its future ecosystem structure, function, and quality under three scenarios based on remote sensing and field investigation data. The simulation scenarios include the absence of a removal project, natural regeneration postproject (NRP), and planted restoration postproject. The results show that the removal project will reverse the escalating invasion trend of S.alterniflora in the YRESW. Compared to the baseline year of 2022, there is a remarkable increase in ecosystem structure (composition: +107%, configuration: +27%) and ecosystem quality (+10.5%) under the NRP scenario. Although blue carbon storage sharply decreases under both scenarios involving project implementation, planted restoration can restore YRESW's carbon sequestration capacity to 0.19 Tg C per year, achieving 87% of the carbon storage present before the project. This study underscores the necessity of comprehensive and detailed risk assessments in ecological projects, particularly when dominant species are involved. Our findings hold significant implications for stabilizing coastal wetland ecosystems and promoting sustainable development in coastal areas.

Impact of construction activities on agricultural land use for sustainable food production in Ile-Ife

The construction industry is a key player in global economic development and assumes a critical position in multifaceted demand for land resources through urbanisation process such as housing and infrastructure development. This pressure plays significant role in decimating available land resources for agricultural activities and has great implication for sustainable food production. This study examined land use change process in Ile-Ife using Landsat Image at 32m resolution over a period of 2002 to 2023. The features were classified into Baresurface, Built-up, Cultivation, Vegetation, and Waterbody with respective area of coverage of 0.9%, 21.0%, 30.3%, 47.4% and 0.3% at the baseline Year 2002. Findings showed that there was significant percentage increase from 2002 to 2023 of 166.7% for Baresurface (2.4%) and 106.2% for Built-up (43.3%). On the contrary, Cultivation area reduced to 22.2%, with a percentage decimation of 26.7%, Vegetation was reduced to 31.9% with a percentage reduction of 32.7% and Waterbody to 0.2% with a percentage reduction of 33.3%. Notably, majority of the percentage differences occurred between 2002 and 2014, which is largely attributable to increase in minimum wage. By implication, substantial arable land areas for cultivation and vegetation towards food production have been overtaken by built-up area and construction activities without any visible effort at exploring alternatives for agricultural practices towards food production. A concerted effort is required to stem the tide in ensuring sustainable food production.

Abstract A024: Exploring liver cancer risk factors by birth cohort: An electronic health record (EHR)-based epidemiologic cohort study

Abstract Background: Most hepatocellular carcinoma (HCC) cases in the U.S. have been attributed to chronic hepatitis B (HBV) and hepatitis C virus (HCV) infections, though burden of alcoholic liver disease and metabolic-dysfunction associated fatty liver disease (MAFLD) is rising. Individuals born between 1945-1965 (“the baby boomers”), comprise 25% of the U.S. population but account for 81% of chronic HCV infections and thus bear a disproportionate burden of HCC compared to younger or older cohorts. We examined the association of HCV and other risk factors to liver cancer incidence within liver cancer birth cohorts. Methods: Adults with at least one visit from 2000-2017 to San Francisco Health Network (SFHN), Sutter Health Northern California, and Kaiser Permanente Hawai’i (KPH) were linked to data on incident HCC from the California (SFHN/Sutter) and Hawai’i (KPH) cancer registries through 2017. The three birth cohorts were defined as 1)1895-1944 (“pre-baby boomer”); 2)1945-1965 (“baby boomer”); 3)1966-1999 (“post-baby boomer”). We used Cox proportional hazards regression with age as the timescale to examine association of each risk factor (i.e., HBV, HCV, metabolic syndrome, MAFLD, alcohol use, smoking history) with incident HCC stratified by sex and birth cohort; models were adjusted for site, baseline year, number of encounters, length of active follow-up, race/ethnicity, and cirrhosis. For next steps, we plan to calculate the population attributable fraction for each of these risk factors. Results: From the pooled cohort of 4,248,553 individuals, 2,916 had incident HCC. 15% were born between 1895-1944; 32% from 1945-1965; and 53% from 1966-1999; 55% were females; 39% identified as non-Hispanic (NH) White; 14% as Asian American; 11% as Hispanic; 5% as NH Black. Across all birth cohorts, males and females with active chronic hepatitis B had higher HCC risk compared to those with inactive status. Males and females in the pre-baby boomer and baby boomer cohorts (but not post baby-boomers) with active chronic hepatitis C had higher HCC risk. Males and females in the pre-baby boomer cohort (Hazard Ratio [HR]=2.58, 95% Confidence Interval [CI] 2.01-3.31); HR=2.85, 95% CI 2.03-4.00, respectively) and females in the baby boomer cohort (HR=1.55, 95% CI 1.03-2.32) with metabolic syndrome had higher HCC risk. Having MAFLD was associated with increased HCC risk among males from all three birth cohorts and females in the pre-baby boomer and baby-boomer cohort. Alcohol use was associated with higher HCC among pre-baby boomer males (HR=1.23, 95% CI 1,04-1.46) and baby boomer females (HR=1.39, 95% CI 1.10-1.76). Conclusion: In this racially, ethnically, and socioeconomically diverse cohort, HBV is a significant risk factor in HCC risk across birth cohorts for both males and females, while HCV is among older birth cohorts. Consistent with recent studies, MAFLD is a growing cause across birth cohorts. Understanding the contribution of these risk factors and for whom they are most relevant can help identify targets for intervention to reduce liver cancer burden. Citation Format: Janet N. Chu, Aly Cortella, Alison J. Canchola, Pushkar Inamdar, Sixiang Nie, Mai Vu, Ma Somsouk, Michele M. Tana, Caroline A. Thompson, Chanda Ho, Hashem B. El-Serag, Mi-Ok Kim, Mark Segal, Yihe G. Daida, Su-Ying Liang, Scarlett L. Gomez, Mindy C. Derouen, Salma Shariff-Marco. Exploring liver cancer risk factors by birth cohort: An electronic health record (EHR)-based epidemiologic cohort study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A024.

Five-year trend analysis of drug use among individuals 16 years of age and older injured in non-fatal motor vehicle crashes in the US

Objective To examine the prevalence of drug use among individuals (age 16+) injured in non-fatal motor vehicle crashes (MVCs) from 2019 to 2023 and assess regional differences based on US Census regions (i.e., West, Midwest, Northeast, and South), and thereby contribute to a comprehensive understanding of drug-related MVCs. Methods We examined emergency medical services data from 19 US states (January 2019 to December 2023) to determine the annual mean drug use prevalence among individuals (age 16+) injured in non-fatal MVCs. Differences in drug use prevalence were assessed using ANOVA with the Tukey-Kramer test for year-to-year comparisons. Adjusted Poisson regression models with random effect for states were used to compare trends to the baseline (i.e., 2019) and to assess regional differences. Results Among individuals (age 16+) injured in non-fatal MVCs, 62,310 had reported drug use. ANOVA results showed significant year-to-year differences in the prevalence of drug use among individuals injured in non-fatal MVCs, with an increase from 2019 to 2020 and a subsequent decrease from 2020 to 2023 (p < 0.05). Compared to the baseline year of 2019, the prevalence in 2020 was 1.34 times (95% confidence interval [CI]: 1.12, 1.61) the prevalence in 2019. The prevalence in 2022 and 2023 were similar to the 2019 prevalence. Although no significant associations were found between US regions and the overall mean prevalence from 2019 to 2023; there was a difference in the average annual rate of change in prevalence by region, with a 4.0% lower rate in the Midwest compared to the Northeast (p < 0.001). This signifies a need to monitor future trends for potential regional differences. Conclusions Drug use prevalence among individuals (age 16+) injured in non-fatal MVCs increased from 2019 to 2020; then decreased to levels reflecting baseline prevalence in 2019; with no significant regional differences in the overall mean crash-related drug use prevalence. These findings highlight the need for continuous surveillance across the US over an extended period. They also underscore the potential impact of environmental risk factors, such as the COVID-19 pandemic, and the necessity to monitor how drug use prevalence related to non-fatal MVCs changes in the coming years.

Firearm Injuries Are on the Rise: The Results of a Pediatric Trauma Center Review

IntroductionFirearm injury is the leading cause of death in children. The recent rise has coincided with the COVID-19 pandemic. The purpose of this study was to evaluate the trends of pediatric firearm injury over a 6-y period, to include the COVID-19 pandemic, at our pediatric trauma center. MethodsA retrospective review of the trauma registry at a free-standing children’s hospital from January 2018 to December 2023 was performed. The variables evaluated included year of injury, age of injury, race, gender, admission requirements, need for blood products, need for operation, mortality, insurance type, and reason for injury. ResultsThere were 397 firearm injury presentations identified over the 6-y period. The median age of injury was 13 y with an interquartile range of 6-15 y. Most were male (72.3%) and of Black race (74.6%). A majority of children who sustained a firearm injury had Medicaid (77.8%). During the years of 2018 and 2019, we evaluated 40 and 39 patients, respectively. Over the next 2 y, there was a dramatic increase in pediatric firearm injuries with an increase of 65% (N = 66) in 2020 and 102.5% (N = 81) in 2021. Although there was less of an increase above baseline in 2022, there was still an elevation of 82.5% (N = 73). By the end of 2023, there had been a 145% rise (N = 98) in pediatric firearm injuries above the baseline year of 2018. The mortality rate was 7.6% (N = 30), which is 2.5 times higher than the all-cause trauma mortality of 3.1% at our facility. ConclusionsThe number of firearm injuries dramatically increased during the COVID-19 pandemic and these increases have been sustained. Most of the victims have been male, of Black race, and publicly insured. While the state population of Alabama is 26.4% Black race, Black children account for 74.6% of all firearm-injured pediatric patients in our trauma registry. The reason for this disparity is not well-understood. Through ongoing research, we hope to gain insight into the reasons behind pediatric firearm injury and the best ways to mitigate them through both the medical and public health arenas.

Neighborhood Safety Concerns and the Onset of Depressive Symptoms Among Women: A Population-based Prospective Cohort Study in South Korea.

Neighborhood safety is crucial for the well-being of residents; however, longitudinal evidence is scarce. This study explored the association between neighborhood safety concerns and depressive symptoms among women. A nationally representative sample of 10,008 women was surveyed in 2016. Six dimensions of neighborhood safety concerns were assessed: crime, food, safety at night, traffic accidents, building and facility, and general safety. The total score for neighborhood safety concerns ranged from 6 to 24, with higher scores indicating greater concerns. Depressive symptoms were assessed using the 10-item version of the Center for Epidemiologic Studies Depression. For cross-sectional analyses, we explored how neighborhood safety concerns were associated with concurrent depressive symptoms at baseline. For the longitudinal analyses, we explored how they were associated with depressive symptom onset at the 2-year follow-up (2018) among women without depressive symptoms at baseline (n = 7,643). Logistic regressions were employed. The mean (standard deviation [SD]) of the neighborhood safety concern score was 12.7 (3.3). In the cross-sectional analysis, a 1-SD increase in neighborhood safety concern score was associated with 1.23-fold (95% CI: 1.13-1.35) increase in the odds of concurrent depressive symptoms at the baseline year. In the longitudinal analysis, a 1-SD increase in neighborhood safety concern score was associated with 1.15-fold (95% CI: 1.03-1.29) increase in the odds of experiencing the onset of depressive symptoms at the follow-up year. This study suggests that neighborhood safety concerns are risk factors for the development of depressive symptoms of female residents. Policy efforts are necessary to ensure community safety.

Clinical characteristics of women with HIV in the RESPOND cohort: A descriptive analysis and comparison to men.

Women with HIV are globally underrepresented in clinical research. Existing studies often focus on reproductive outcomes, seldom focus on older women, and are often underpowered to assess sex/gender differences. We describe CD4, HIV viral load (VL), clinical characteristics, comorbidity burden, and use of antiretroviral therapy (ART) among women with HIV in the RESPOND study and compare them with those of the men in RESPOND. RESPOND is a prospective, multi-cohort collaboration including over 34 000 people with HIV from across Europe and Australia. Demographic and clinical characteristics, including CD4/VL, comorbidity burden, and ART are presented at baseline, defined as the latter of 1 January 2012 or enrolment into the local cohort, stratified by age and sex/gender. We further stratify men by reported mode of HIV acquisition, men who have sex with men (MSM) and non-MSM. Women account for 26.0% (n = 9019) of the cohort, with a median age of 42.2 years (interquartile range [IQR] 34.7-49.1). The majority (59.3%) of women were white, followed by 30.3% Black. Most women (75.8%) had acquired HIV heterosexually and 15.9% via injecting drug use. Nearly half (44.8%) were receiving a boosted protease inhibitor, 31.4% a non-nucleoside reverse transcriptase inhibitor, and 7.8% an integrase strand transfer inhibitor. The baseline year was 2012 for 73.2% of women and >2019 for 4.2%. Median CD4 was 523 (IQR 350-722) cells/μl, and 73.6% of women had a VL <200 copies/mL. Among the ART-naïve population, women were more likely than MSM but less likely than non-MSM (p < 0.001) to have CD4 <200 cells/μL and less likely than both MSM and non-MSM (p < 0.001) to have VL ≥100 000 copies/mL. Women were also more likely to be free of comorbidity than were both MSM and non-MSM (p < 0.0001). RESPOND women are diverse in age, ethnicity/race, CD4/VL, and comorbidity burden, with important differences relative to men. This work highlights the importance of stratification by sex/gender for future research that may help improve screening and management guidelines specifically for women with HIV.

Assessment of rural sustainable development and analysis and prediction of obstacles and coupled coordinated development: A case study of Zaozhuang City

In China, the Innovation Demonstration Zone for the National Sustainable Development Agenda is a key initiative for executing the United Nations (UN) 2030 Agenda for Sustainable Development. The Zone also plays critical roles in addressing the developmental bottlenecks that China faces and sharing Chinese insights into global sustainable development efforts. On July 15, 2022, the State Council endorsed the Zone’s establishment in Zaozhuang City, Shandong Province, where it focuses on innovation-led sustainable development in rural areas. Research into the levels, impediments, interdependencies, and evolutionary trends of rural sustainable development is crucial. Therefore, this research aimed to assist in comprehensively assessing developmental challenges and facilitating the harmonious advancement of social, economic, and environmental aspects in rural areas. In pursuit of the three fundamental dimensions of the UN’s Sustainable Development Goals (SDGs), namely development’s drivers, quality, and equity, this study was grounded in China’s national Rural Revitalization Strategy and the demands of sustainable development strategies. It also aligns with the UN 2030 Agenda for Sustainable Development and the associated SDG indicators. Focusing on four key areas, namely production elements, natural elements, social elements, and rural governance, this study developed an evaluation index system for assessing the level of rural sustainable development. It employed a range of analytical models, including the game theory-based combination empowerment method, barrier degree model, coupling degree model, coupling coordination degree model, and gray prediction GM(1,1) model, to analyze the status and evolving trends of rural sustainable development in Zaozhuang City from 2015 to 2022. The key findings were as follows: ① Relative to the baseline year 2015, the sustainable development level in Zaozhuang’s rural areas has shifted toward an improved state overall. ② The primary barrier to achieving rural sustainable development in Zaozhuang is the city’s rural governance system. ③ While the components of rural sustainable development in Zaozhuang are in the early stages of both basic and moderate coordination, an overall enhancement has occurred in their integrative coordination. ④ Between 2023 and 2025, the level of integrative coordination in Zaozhuang is expected to rise steadily. However, reaching a state of advanced coordination will require additional time for development.

Benzodiazepine receipt in adults with psychogenic non-epileptic seizures in the USA

BackgroundCharacterising benzodiazepine (BZD) prescribing to individuals with psychogenic non-epileptic seizures (PNES) is important for optimising PNES outcomes, but existing data is lacking.MethodsUsing a nationwide administrative claims database (2016–2022), incident PNES...