Baseline Year Research Articles

Using a crime prevention framework to evaluate tiger counter-poaching in a Southeast Asian rainforest

Tigers are a conservation-reliant species, as multiple populations face the risk of local extinction due to poaching arising from the continued demand for their body parts. Preventing tiger poaching poses a challenge for the rangers responsible for their protection, particularly in Southeast Asia, where the protected areas are typically large, mountainous tropical forests guarded by small teams of rangers. Improving counter-wildlife crime tactics is hindered without robust evaluations, and inefficient approaches are perpetuated. We evaluate an eight-year project aiming to recover a tiger population in Peninsular Malaysia. Three distinct poaching problems by Vietnamese, Thai and Cambodian groups, differing by organisation, target species and tactics, were prioritised, and ranger counter-poaching tactics were tailored to reduce these. Applying a framework developed to evaluate crime prevention known by the acronym EMMIE, here we: (1) examine evidence our intervention was Effective in reducing the poaching threat; (2) resolve the Mechanisms by which our intervention caused a reduction in harm from poaching and how intervention effectiveness is Moderated by the three poaching types; (3) define the elements necessary for Implementation and the Economic costs involved. We found poaching incursion frequency fell 40% from baseline years to treatment years across all poaching types while poaching incursion depth declined, with disrupted incursions on average, 2.6 km (Thai) and 9.1 km (Cambodian) closer to the forest edge. However, wire snares increased from baseline to treatment years as Vietnamese poachers increased the number of snares per incursion eightfold. No poaching incursions were observed during the Covid-19 pandemic. Tiger density remained below recovery potential (0.48/100km2 in 2014 to 0.53/100 km2 in 2021) but stabilised as key females survived and were detected breeding. Leopard, sun bear, muntjac and wild boar densities remained stable. Disarming active snares and seizing an increased proportion of snares before being deployed directly reduced the potential risk of mortality to medium-large mammals once a poaching incursion began. Attributing the decline in poaching attempts to our intervention is supported for Cambodian poachers via three plausible mechanisms: increased cost of reoffending by repatriated poaching team leaders; reduction of detailed knowledge sharing and imitation by peers; general deterrence at community level from increased awareness of the elevated risk of arrest and low likelihood of enjoying rewards. We found ranger performance enhancements at three critical stages of counter-poaching were instrumental in increasing arrest certainty, this was made possible by institutionalising a learn-and-adapt cycle underpinned by a dedicated site analyst. This study highlights how investing in problem analysis and going beyond simple assumptions of deterrence can greatly enhance the effectiveness and efficiency of small wildlife protection teams.

The impact of allergen-specific immunotherapy with house dust mite allergens on the quality of life in children with bronchial asthma

Controlled studies of the impact of allergen-specific immunotherapy on the quality of life of patients provide mixed results. Purpose. To evaluate the quality-of-life dynamics in children with bronchial asthma during 3 years of treatment with allergen immunotherapy with house dust mite allergens and one year after its completion.Material and methods. In an open-label, five-year prospective study, the clinical efficacy of allergen immunotherapy and quality of life were assessed using a validated PAQLQ(S) questionnaire at the end of the baseline year (before starting allergen immunotherapy), at the end of each of allergen immunotherapy year, and at the end of the follow-up year. The study was completed by 25 patients of the main group (16 boys, 9 girls aged 8.3 [6.7; 11.5] years at inclusion) with moderate bronchial asthma in 17 children (68%), mild bronchial asthma in 8 children (32%), and 25 children of the comparison group (who received a similar amount of pharmacological therapy but not allergen immunotherapy), matched as pairs-copies to the children of the main group.Results. During the first two years of allergen immunotherapy, changes in the level of quality of life were multidirectional. By the end of the third year of allergen immunotherapy, there was a trend towards an improvement in overall quality of life and a decrease in the effect of bronchial asthma symptoms upon quality of life. A year after allergen immunotherapy completion in the main group, a significant increase in overall quality of life was noted, in comparison with the level of quality of life before the start of treatment (p=0.03) and in comparison with the level in the comparison group (p=0.046).Conclusion. The data obtained objectively indicate an increase in quality of life in children with asthma as a result of a full course of allergen immunotherapy. The achieved positive results were maintained for at least 1 year after the end of treatment.

Trends in Acute Care Use for Mental Health Conditions Among Youth During the COVID-19 Pandemic

Understanding how children's utilization of acute mental health care changed during the COVID-19 pandemic is critical for directing resources. To examine youth acute mental health care use (emergency department [ED], boarding, and subsequent inpatient care) during the second year of the COVID-19 pandemic. This cross-sectional analysis of national, deidentified commercial health insurance claims of youth mental health ED and hospital care took place between March 2019 and February 2022. Among 4.1 million commercial insurance enrollees aged 5 to 17 years, 17 614 and 16 815 youth had at least 1 mental health ED visit in the baseline year (March 2019-February 2020) and pandemic year 2 (March 2021-February 2022), respectively. The COVID-19 pandemic. The relative change from baseline to pandemic year 2 was determined in (1) fraction of youth with 1 or more mental health ED visits; (2) percentage of mental health ED visits resulting in inpatient psychiatry admission; (3) mean length of inpatient psychiatric stay following ED visit; and (4) frequency of prolonged boarding (≥2 midnights) in the ED or a medical unit before admission to an inpatient psychiatric unit. Of 4.1 million enrollees, 51% were males and 41% were aged 13 to 17 years (vs 5-12 years) with 88 665 mental health ED visits. Comparing baseline to pandemic year 2, there was a 6.7% increase in youth with any mental health ED visits (95% CI, 4.7%-8.8%). Among adolescent females, there was a larger increase (22.1%; 95% CI, 19.2%-24.9%). The fraction of ED visits that resulted in a psychiatric admission increased by 8.4% (95% CI, 5.5%-11.2%). Mean length of inpatient psychiatric stay increased 3.8% (95% CI, 1.8%-5.7%). The fraction of episodes with prolonged boarding increased 76.4% (95% CI, 71.0%-81.0%). Into the second year of the pandemic, mental health ED visits increased notably among adolescent females, and there was an increase in prolonged boarding of youth awaiting inpatient psychiatric care. Interventions are needed to increase inpatient child psychiatry capacity and reduce strain on the acute mental health care system.

The impact of transition of Spina Bifida Care: A retrospective population-based cohort study comparing outcomes and health care costs longitudinally from adolescence into adulthood.

Transition from multidisciplinary paediatric to adult care results in a significant change in the intensity of care provided to patients with spina bifida (SB). To compare planned and unplanned health care utilization and costs of care of transitioning SB patients. Through a retrospective population-based cohort study, patients with SB born in Ontario between 1988 and 1999 were studied using routinely collected data analysed at ICES. Patients were followed longitudinally from age 16 to 22 years with comparisons made between the paediatric baseline year (age 16) to the first 3 years of adulthood (ages 19 to 21). A composite primary outcome of unplanned emergency room (ER) visits, hospitalizations and emergency surgical procedures, was compared before and after transition. Secondary outcomes included these variables individually and estimated health care costs. In the 299 patients, no significant differences were identified in the composite primary outcome between periods (P = 0.09). Unplanned ER visits (P = 0.004) and emergency surgical procedures (P = 0.02) increased after transition. Despite this, the estimated individual total cost of care declined after transition (P = 0.03). Further, multivariable analysis identified rural residence (RR 1.78, confidence interval [CI] 1.30 to 2.44) and previous urologic surgery (RR 1.91, CI 1.41 to 2.57) as significant predictors of increased need for emergent care and health care costs, respectively. Patients with SB in Ontario have higher rates of ER usage and unplanned surgery after the transition to adult care. While this does not drive an increase in health care costs, improvements in the care of transitioned SB patients, particularly rural patients and those with prior urologic surgery, may decrease the requirement for acute care.

Pharmacogenomics and the Concept of Personalized Medicine for the Management of Hypertension

Pharmacogenomics and the Concept of Personalized Medicine for the Management of Hypertension

Scenarios of maternal mortality reduction by 2030 in the Americas: insights from its tempo

BackgroundThe enduring threat of maternal mortality to health worldwide and in the Americas has been recognized in the global and regional agendas and their targets to 2030. To inform the direction and amount of effort needed to meet those targets, a set of equity-sensitive regional scenarios of maternal mortality ratio (MMR) reduction based on its tempo or speed of change from baseline year 2015 was developed.MethodsRegional scenarios by 2030 were defined according to: i) the MMR average annual rate of reduction (AARR) needed to meet the global (70 per 100,000) or regional (30 per 100,000) targets and, ii) the horizontal (proportional) or vertical (progressive) equity criterion applied to the cross-country AARR distribution (i.e., same speed to all countries or faster for those with higher baseline MMR). MMR average and inequality gaps –absolute (AIG), and relative (RIG)– were scenario outcomes.ResultsAt baseline, MMR was 59.2 per 100,000; AIG was 313.4 per 100,000 and RIG was 19.0 between countries with baseline MMR over twice the global target and those below the regional target. The AARR needed to meet the global and regional targets were -7.60% and -4.54%, respectively; baseline AARR was -1.55%. In the regional MMR target attainment scenario, applying horizontal equity would decrease AIG to 158.7 per 100,000 and RIG will remain invariant; applying vertical equity would decrease AIG to 130.9 per 100,000 and RIG would decrease to 13.5 by 2030.ConclusionThe dual challenge of reducing maternal mortality and abating its inequalities will demand hefty efforts from countries of the Americas. This remains true to their collective 2030 MMR target while leaving no one behind. These efforts should be mainly directed towards significantly speeding up the tempo of the MMR reduction and applying sensible progressivity, targeting on groups and territories with higher MMR and greater social vulnerabilities, especially in a post-pandemic regional context.

1291-P: Participants in Annual Workplace Health Evaluation Program Had Lower Risk for Developing Diabetes

Background: We asked whether the risk of developing diabetes would be reduced in individuals who participated in annual employer-sponsored workplace health evaluations compared to those not participating in the program. Methods: We studied a cohort of all employees with 5 years of administrative claims data (2017-2021) and no diabetes-related pharmacy claims in the baseline year (2017). The health evaluation group was defined as individuals who participated in annual workplace health assessments for 5 consecutive years. The non-health evaluation group did not participate in workplace assessments in any year. The association between health evaluation status and incident diabetes was assessed in Cox regression models that adjusted for variables that differed between the 2 groups at baseline (Table). Incidence of diabetes was defined as any diabetes-related pharmacy claims during follow-up (2018 to 2021). Results: Of 9,021 participants, 67.8% were female; mean baseline age (standard deviation) was 46.1 (10.4) years. After adjustment (Table footnote), annual workplace health evaluation participants (n=7,957) had a 33% lower in risk of developing diabetes compared to the non-health evaluation group (n=1,064) (Table). Conclusions: Individuals participating in annual health evaluations in a workplace setting had lower risk of developing diabetes than non-participants. Disclosure C.H.Tong: None. M.Jalandoni-bustamante: Employee; Quest Diagnostics. M.S.Fragala: Employee; Quest Diagnostics, Stock/Shareholder; Quest Diagnostics. C.E.Birse: Employee; Quest Diagnostics.

Serum folate and risk of disabling dementia: a community-based nested case–control study

ABSTRACT Purpose The aim of this study was to examine associations between serum folate levels and risk of disabling dementia that required care under the national insurance (disabling dementia). Methods We performed a nested case–control study in a community-based cohort, the Circulatory Risk in Communities Study, involving 13,934 Japanese individuals aged 40–84 years at the baseline period of 1984–2005. Serum folate was measured in 578 cases of incident disabling dementia, and in 1,156 controls whose age (±1 years), sex, area of residence, and baseline year were matched with the cases. The diagnosis of disabling dementia was performed by attending physicians under the National Long-Term Care Insurance System in Japan. Conditional odds ratios of disabling dementia according to quintiles of serum folate were calculated using conditional logistic regression models. Results After a 20.8-year follow-up, serum folate was inversely associated with risk of disabling dementia. The respective multivariable odds ratios (95% CIs) were 0.71 (0.51–0.99), 0.76 (0.54–1.06), 0.70 (0.49–1.00), and 0.62 (0.43–0.90) for persons with the second, third, fourth, and highest quintiles of serum folate as compared with the lowest quintile (P for trend = 0.03). A similar association was observed for dementia with or without stroke. Conclusion In this nested case–control study with a long follow-up, low serum folate levels were associated with an increased risk of disabling dementia among Japanese individuals.

Assessing Climate-Driven Salinity Intrusion through Water Accounting: A Case Study in Ben Tre Province for More Sustainable Water Management Plans

This scientific paper delves into sustainable water management strategies for Ben Tre Province of the Vietnamese Mekong Delta (VMD) in light of water-infrastructure plans that have been impacted by climate change-induced salinity intrusion. Specifically, we aim to mitigate the effects of salinity intrusion for the province while promoting long-term environmental sustainability. In doing so, a water accounting framework was applied, mostly based on the MIKE11 hydrodynamic modeling and water balance calculations, to determine current and future water stress issues based on two main scenarios of extreme drought year 2016 (baseline) and the future year 2030 under climate change for a medium-low emission scenario (RCP4.5). The study found that salinity intrusion significantly causes severe water stress in the future year 2030 compared to the baseline year 2016, while the existing water management methods are relatively inadequate to control salinity intrusion, leading to over 57% of the area affected by medium to critical water stress levels, although it will go along with planned water infrastructures. Additionally, a system of triple rice cropping converted two rice cropping and upland cropping with 40% water demand cutoff was found to be the most suitable measure for 2030. Particularly, water-saving and water demand reduction should be incorporated into infrastructural planning for sustainable water management. Our study provides valuable insights for policymakers and stakeholders, not only for the province and the VMD, but also other regions facing similar challenges.

Economic burden of nonadherence to standards of diabetes care.

To evaluate the effect of nonadherence to American Diabetes Association (ADA) guidelines on health care expenditures for patients with type 2 diabetes (T2D). Retrospective cross-sectional cohort design, utilizing 2016-2018 Medical Expenditure Panel Survey data. Patients with a diagnosis of T2D who completed the supplemental T2D care survey were included in the study. Participants were categorized based on adherence to the 10 processes in the ADA guidelines into adherent (≥ 9 processes) and nonadherent (≤ 6 processes) categories. Propensity score matching was employed using a logistic regression model. After matching, total annual health care expenditure change from baseline year was compared using a t test. Further, imbalanced variables were controlled for in a multivariable linear regression model. A total of 1619 patients representing 15,781,346 (SE = 438,832) individuals met the inclusion criteria, among whom 12.17% received nonadherent care. After propensity matching, those who received nonadherent care had $4031 higher total annual health care expenditures compared with their baseline year, whereas patients who received adherent care had $128 lower total annual health care expenditures compared with their baseline year. Further, multivariable linear regression adjusted for the imbalanced variables indicated that nonadherent care was associated with a mean (SE) $3470 ($1588) increase in the change from baseline health care expenditure. Nonadherence to the ADA guidelines results in a significant increase in health care expenditures among patients with diabetes. The economic impact of nonadherent care for T2D is a significant and extensive issue that needs to be addressed. These findings emphasize the importance of providing care based on ADA guidelines.

ASSOCIATION BETWEEN PEAK EXPIRATORY FLOW AND INCIDENT HEART FAILURE AND MORTALITY IN MIDDLE-AGED AND OLDER CHINESE ADULTS

Objective: Previous studies have suggested that pulmonary dysfunction predicts incident cardiovascular disease, posing the question of whether peak expiratory flow, one of the most direct measurements of lung function, could present a modifiable risk factor. In the present study, we aimed to evaluate associations of peak expiratory flow with incident heart failure, cardiovascular death, and all-cause death. Design and method: This study included 93,161 participants from the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project in Southern China who had lung function measurements at baseline (year 2016-2017) and were annually followed-up to December 2020. The composite endpoints included hospitalization for heart failure, cardiovascular death, and all-cause death. Hospitalization for heart failure were ascertained by linking to the Inpatient Registry and confirmation of death was based on information from local government vital statistics offices. The relationship between peak expiratory flow and all outcomes was assessed using multivariable Cox regression adjusting for age, sex, education, annual income, insurance, residence, occupation, current smoking, current drinking, body mass index, hypertension, diabetes, coronary heart disease, and stroke at baseline. Results: The mean age was 54.2 years, and 60.7% were women. At 3.4 ± 0.9 years of follow-up, heart failure occurred in 1361 (1.5%), cardiovascular death in 365 (0.4%), all-cause death in 1346 (1.4%), and the composite in 2490 (2.7%). Compared with the lowest quartile, the HR (95% CI) of the highest quartile in peak expiratory flow was 0.66 (0.55 - 0.78) for incident heart failure, 0.70 (0.51 - 0.95) for cardiovascular death, 0.54 (0.46 - 0.64) for all-cause death, and 0.54 (0.47 - 0.61) for the composite. The restricted cubic spline showed significantly negative relationships of peak expiratory flow with all outcomes. In addition, the association between peak expiratory flow and incident heart failure was not significantly changed after mortality was treated as competing risks in the Fine–Gray proportional sub-distribution hazards models (HR [95% CI]: 0.87 [0.81 - 0.93]). Conclusions: Higher peak expiratory flow was significantly associated with decreased risks of incident heart failure, cardiovascular death, and all-cause death in middle aged and elderly Chinese adults, independent of and to a similar extent as major known cardiovascular risk factors.

Patient and provider factors associated with colorectal cancer screening among average risk health plan enrollees in the US, 2015–2018

BackgroundTo assess patient and primary care provider (PCP) factors associated with adherence to American Cancer Society (ACS) and United States Preventive Services Task Force (USPSTF) guidelines for average risk colorectal cancer (CRC) screening.MethodsRetrospective case-control study of medical and pharmacy claims from the Optum Research Database from 01/01/2014 − 12/31/2018. Enrollee sample was adults aged 50 − 75 years with ≥ 24 months continuous health plan enrollment. Provider sample was PCPs listed on the claims of average-risk patients in the enrollee sample. Enrollee-level screening opportunities were based on their exposure to the healthcare system during the baseline year. Screening adherence, calculated at the PCP level, was the percent of average-risk patients up to date with screening recommendations each year. Logistic regression modelling was used to examine the association between receipt of screening and enrollee and PCP characteristics. An ordinary least squares model was used to determine the association between screening adherence among the PCP’s panel of patients and patient characteristics.ResultsAmong patients with a PCP, adherence to ACS and USPSTF screening guidelines ranged from 69 to 80% depending on PCP specialty and type. The greatest enrollee-level predictors for CRC screening were having a primary/preventive care visit (OR = 4.47, p < 0.001) and a main PCP (OR = 2.69, p < 0.001).ConclusionsIncreased access to preventive/primary care visits could improve CRC screening rates; however, interventions not dependent on healthcare system contact, such as home-based screening, may circumvent the dependence on primary care visits to complete CRC screening.

Effect of Hypertonic Saline on Lung Function as Add-on Treatment in People With Cystic Fibrosis Receiving Dornase Alfa: A Cystic Fibrosis Foundation Patient Registry Analysis

Introduction of novel therapies for cystic fibrosis (CF), raises the question whether traditional treatments can be withdrawn. Nebulized hypertonic saline (HS) could potentially be discontinued in patients receiving Dornase alfa (DA). In the pre-modulator era, did people with CF who were F508del homozygous (CFF508del) and received DA and HS have better preserved lung function than those treated with DA only? Retrospective analysis of CF Foundation Patient Registry data (2006-2014). Among 13,406 CFF508del with data for at least 2 consecutive years, 1,241 CFF508del had spirometry results and were treated with DA for 1-5 years without DA or HS during the preceding (baseline) year. Absolute percent predicted FEV1 (ppFEV1) change while on DA and HS relative to DA only was the main outcome. A marginal structural model was applied to assess the effect of 1-5 years of HS while controlling for time-dependent confounding. Of 1,241 CFF508del, 619 (median baseline age 14.6 years; IQR 6-53) received DA only and 622 (14.55 years; IQR 6-48.1) were treated with DA and HS for 1-5 years. After 1 year, subjects receiving DA and HS had ppFEV1 that averaged 6.60% lower than ppFEV1 in those treated with DA only (95%CI: -8.54% to -4.66%; P<.001). Lower lung function in the former relative to the latter persisted throughout follow-up, highlighting confounding by indication. After accounting for baseline age, sex, race, DA use duration, baseline and previous year's ppFEV1 and time-varying clinical characteristics, DA and HS for 1-5 years were similar to DA only regarding ppFEV1 (year 1: mean ppFEV1 change +0.53% [95%CI: -0.66% to +1.71%; P=.38]; year 5: -1.82% [-4.01% to +0.36%; P=.10]. In the pre-modulator era, CFF508del had no significant difference in lung function when nebulized HS was added to DA for 1-5 years.

Nutritional status, body image satisfaction, and self-esteem in adolescents from the SI program for secondary school trial

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): 1. SHE Foundation and "la Caixa" 2. Fondo de Investigación Sanitaria - Instituto de Salud Carlos III. Background/Introduction Adolescence is a sensitive period regarding self-esteem and body image. In particular, nutritional status could affect self-esteem levels and body image satisfaction. Purpose To evaluate the distribution of body image satisfaction by nutritional status, and to assess the relationship between body image satisfaction and self-esteem over adolescence. Methods 1315 adolescents from the SI! Program for Secondary Schools trial were assessed at baseline (12.5 (0.4) years, 48.2% girls), first follow-up (1-FU) (13.9 (0.4) years, 47.6% girls) and second follow-up (2-FU) (15.8 (0.4) years, 48.4% girls). Adolescents were classified as having underweight, normal weight or overweight/obesity according to Center for Disease Control (CDC) standards for body mass index (BMI). Body image satisfaction and self-esteem were assessed with Stunkard's figure rating scale and self-esteem domain of the Child Health and Illness Profile-Adolescent Edition (CHIP-AE) questionnaire, respectively. The association between both variables was estimated using linear and logistic mixed models. Results Overall, only 14.6% of adolescents were systematically satisfied with their body image. Most adolescents with overweight/obesity desired to lose weight (89.7% at baseline, 84.9% at 1-FU, and 83.9% at 2-FU), while most adolescents with underweight desired to gain weight (76.3% baseline, 80.0% 1-FU, 84.0% 2-FU). The percentage of girls with normal weight desiring to lose weight increased from 33.4% at ~12 years of age to 45.9% at ~16 years of age, while the desire to gain weight increased in boys with normal weight (32.3% at baseline vs 38.2% at 2-FU) (Figure 1). Satisfied adolescents consistently presented higher self-esteem over time compared to unsatisfied adolescents, especially girls (Table 1). Conclusion(s) Body image satisfaction was consistently related to nutritional status over adolescence. The desire to lose weight in girls with normal weight increased over time, while the desire to gain weight increased in boys with normal weight. Data suggests that body image satisfaction could determine self-esteem levels. These results show how gender stereotypes may affect body image and self-esteem, and therefore eating and exercise behaviors, highlighting the importance to reinforce body acceptance through school-based health promotion interventions.

Gender differences in cardiovascular health over adolescence using the novel Life's Essential 8 score

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): 1. Fondo de Investigación Sanitaria - Instituto de Salud Carlos III 2. SHE Foundation and “la Caixa” Foundation. Background/Introduction The evidence for gender differences in overall cardiovascular health (CVH) score and individual health metrics over adolescence is conflicting. Purpose To study gender differences in overall CVH status and its individual metrics in a large cohort of adolescents aged 12 to 16 years in Spain. Methods This study collected longitudinal data from 1324 adolescents at baseline (48.4% girls; 12.5 (0.4) years), 1211 (47.9% girls; 13.9 (0.4) years) at first follow-up and 1095 at second follow-up (48.2% girls; 15.8 (0.4) years) attending 24 secondary schools enrolled in the SI! Program for Secondary Schools trial in Spain. Eight individual metrics (nicotine exposure, diet, physical activity (PA), sleep health, body mass index (BMI), blood glucose, non-high-density lipoprotein cholesterol, and blood pressure (BP)) were measured and scored from 0 to 100 points according to the Life’s Essential 8 (LE8) criteria established by the American Heart Association. An overall CVH score was constructed summing the metrics described above, ranging from 0 to 100 points. Low, moderate, or high overall CVH score was defined as 0-49, 50-79, or 80-100 points, respectively. Differences in CVH over time were analyzed in individuals with CVH score available at three time-points (n=1077) using generalized linear mixed adjusted models. Results At approximately 12 years of age, most individuals had a moderate or high LE8 CVH score and CVH was slightly higher (healthier) in girls than boys (77.2 vs. 76.0 points) (Figure 1). LE8 CVH score increased significantly in boys and girls between 12 and 14 years of age (1.78 and 1.95 points, respectively), without gender differences (Figure 2). LE8 CVH score decreased significantly in boys and girls between 14 and 16 years of age; however, this decline was higher in boys than in girls (-3.17 versus -1.62 points, p value=0.007). Regarding individual metrics, mean scores were lowest for the diet, and sleep health and highest for BP. The highest declines over time were observed in PA, especially in boys, and nicotine exposure, especially in girls. Conclusions Most adolescents had a moderate or high overall CVH status, although boys showed slightly unhealthier scores and greater decline over time. Gender differences in individual CVH metrics were also found. This information is helpful for tailoring health promotion programs in adolescence.

Social and physical neighbourhood characteristics and 10-year incidence of depression and anxiety in older adults: Results from the Longitudinal Aging Study Amsterdam

ObjectiveA growing literature suggests that neighbourhood characteristics are associated with mental health outcomes, but the evidence in older adults is inconsistent. We investigated the association of neighbourhood characteristics, pertaining to demographic, socio-economic, social and physical environment domains, with the subsequent 10-year incidence of depression and anxiety, in Dutch older adults. MethodsIn the Longitudinal Aging Study Amsterdam depressive and anxiety symptoms were assessed four times between 2005/2006 and 2015/2016, using the Center for Epidemiological Studies Depression Scale (n = 1365) and the Anxiety subscale of the Hospital Anxiety and Depression Scale (n = 1420). Neighbourhood-level data on urban density, percent population over 65 years of age, percent immigrants, average house price, average income, percent low-income earners, social security beneficiaries, social cohesion, safety, proximity to retail facilities, housing quality, percent green space, percent water coverage, air pollution (particulate matter (PM2.5)), and traffic noise, were obtained for study baseline years 2005/2006. Cox proportional hazard regression models, clustered within neighbourhood, were used to estimate the association between each neighbourhood-level characteristic and the incidence of depression and anxiety. ResultsThe incidence of depression and anxiety was 19.9 and 13.2 per 1000 person-years, respectively. Neighbourhood characteristics were not associated with the incidence of depression. However, various neighbourhood characteristics were associated with an increased incidence of anxiety, including: higher urban density level, higher percent immigrants, greater proximity to retail facilities, lower housing quality score, lower safety score, higher PM2.5 levels and less green space. ConclusionOur results indicate that several neighbourhood characteristics are associated with anxiety but not with depression incidence in older age. Several of these characteristics have the potential to be modifiable and thus could serve as a target for interventions at the neighbourhood-level in improving anxiety, provided that future studies replicate our findings and provide further evidence for a causal effect.

Factors associated with persistent multiyear frequent emergency department use

BackgroundAlthough frequent emergency department (ED) users have been widely studied in cross-sectional settings, there is some evidence suggesting that most frequent ED users do not remain frequent users over multiple...

Effects of being eligible for specific health guidance on health outcomes: A regression discontinuity analysis using Japan's data on specific health checkups

The significance of general health checkups and guidance is controversial. To examine the effectiveness of Japan's specific health checkup (SHC) and specific health guidance (SHG) programs, this study applied a regression discontinuity design (RDD) using the SHC results database collected by a private company. We applied a sharp RDD with a cutoff body mass index (BMI) of 25 kg/m2 for those with a waist circumference (WCF) of <85 cm in men and < 90 cm in women, with risks of hypertension, dyslipidemia or diabetes, and aged between 40 and 64 years. Study outcomes were differences in BMI, WCF, and major cardiovascular risk factors between the baseline year and the following year. We analyzed the data of baseline years of 2015, 2016, and 2017 separately and their pooled data. We judged the results to be robust significant when significant results in the same direction were found in all four analyses. A total of 1,041,607 observations out of 614,253 people were analyzed. We found robust significant results that those eligible for SHG in the baseline year had a lower BMI (both men and women) and lower WCF (men only) in the following year than those not eligible for SHG: BMI for men (−0.12 kg/m2, 95% CI [confidence interval]: −0.15 to −0.09); BMI for women (−0.09 kg/m2, 95% CI: −0.13 to −0.06); and WCF for men (−0.36 cm, 95% CI: −0.47 to −0.28) in the pooled data. Robust significant results were not found in WCF for women or in major cardiovascular risk factors.

Lung cancer mortality in the wake of the changing smoking epidemic: a descriptive study of the global burden in 2020 and 2040

ObjectivesLung cancer (LC) is the leading cause of cancer death in 2020, responsible for almost one in five (18.0%) deaths. This paper provides an overview of the descriptive epidemiology of...

Trend and spatial pattern of stable cropland productivity in China based on satellite observations (2001−2020)

Sustained productivity growth of China's stable cropland is crucial for meeting the food and nutritional needs of the 1.4 billion population amid global food market volatility, limited uncultivated land, and urban and ecological land squeezing agricultural space. Despite this, research on trend tracking and spatial pattern identifying in productivity of China's stable croplands at a national scale is currently lacking. Here, we attempted to fill this gap based on satellite observation data and cloud computing platform, using the crop growth index, quadratic regression model, and indicator-based spatial overlay analysis. Results show the productivity of China's stable cropland rose by ∼31.07% from 2001 to 2020 but will fall to ∼78.89% to ∼85.78% of the 2015 level (baseline year of SDGs) by 2030. The declining trends can be attributed to three main factors: (1) 69.15% of cropland that previously exhibited significant productivity growth has started to decline; (2) the productivity of cropland with the highest agricultural suitability (Level 4–5) has been long-term declining, showing no signs of reversing; (3) 44.12% of stable cropland's productivity was volatile over the research period, leading to high uncertainty in productivity growth. The large-scale spatial overlap between high agricultural suitability and human activity intensity determined the spatial pattern of stable cropland productivity. Therefore, comprehending and mitigating urbanization's indirect and off-site detrimental impacts on cropland productivity are critical to ensuring China's future food security.