Impact Of Changes Research Articles

AI in customer feedback integration: A data-driven framework for enhancing business strategy

The integration of artificial intelligence (AI) into customer feedback systems has emerged as a transformative approach for businesses seeking to enhance their strategies and maintain a competitive edge. This review presents a data-driven framework that leverages AI to analyze, interpret, and act upon customer feedback, providing actionable insights for business decision-making. AI techniques such as natural language processing (NLP), machine learning (ML), and sentiment analysis allow companies to automate the feedback collection process and analyze vast amounts of data from diverse sources, including surveys, reviews, social media, and customer support interactions. The proposed framework facilitates real-time feedback analysis, enabling businesses to identify trends, customer preferences, and potential pain points more efficiently. By integrating AI with existing customer relationship management (CRM) systems, businesses can automate the categorization and prioritization of feedback, allowing for timely responses and more effective problem-solving. Furthermore, predictive analytics tools within the framework can forecast customer needs, allowing businesses to tailor products and services to meet evolving expectations. This framework also supports continuous improvement by enabling businesses to track the impact of changes implemented based on customer feedback. Additionally, AI’s ability to personalize the customer experience by recognizing patterns and individual preferences plays a crucial role in increasing customer satisfaction and loyalty. The data-driven insights generated through AI integration can guide businesses in refining their marketing, product development, and customer service strategies, leading to improved operational efficiency and better alignment with customer expectations. In conclusion, the integration of AI into customer feedback mechanisms represents a significant advancement for data-driven business strategy development. This framework not only enhances feedback accuracy and speed but also empowers businesses to deliver more personalized and customer-centric solutions.

The impact of climate change on the reproductive biology and population dynamics of fishes: Implications for fisheries and food security

The purpose of this paper is to review and evaluate published literature on the impact of climate change on the reproductive biology and population dynamics of fishes. A systematic method was utilized to access published literature on “Impacts of Climate Change on fishes and fisheries”. A total of fifty-two (52) research papers published between the years 1973 to 2024 were accumulated and used for this review. A subjective approach was used to select the topics: impact of climate change and fishes and fisheries. The physical and biological impacts of climate change on fisheries were evaluated. In addition, the role of fisheries in food security to combat the global hunger index of human beings was assessed in this review paper. Strategies to be implemented by fisheries to mitigate the effect of climate change was also presented in this review. The literature accessed revealed that fish is an important resource to the economies of many countries and a source of natural protein. As the average per capita food supply from fish and fisheries products continue to rise in developing nations, it is falling in underdeveloped nations. The published works of literature established that the global fisheries and fish population dynamics, reproductive biology, abundance and distribution are all affected by climate change. This review highlights the fact that more extensive studies on the impact of climate change on fishes and fisheries should be done in neotropical countries since there are gaps of such information on research and published data in these biodiversity rich regions.

The impact of climate change on the ecology, reproduction and distribution of marine mammals and the possible legislation, conservation and management approaches to protect these marine mammal species: A systematic review

The impact of climate change on the ecology, reproduction and distribution of marine mammals and the possible legislation, conservation and management approaches to protect these marine mammal species: A systematic review

Literature review on sustainable development in bali province through the lens of financial aspects

This literature review discusses the relationship between regional financial performance, capital expenditure, and environmental expenditure and their role in sustainable development. Sustainable development is defined as development that is able to meet current needs without sacrificing the ability of future generations to meet their needs. Previous studies have shown that the allocation of regional spending, especially environmental spending, is still low despite having an important contribution to preserving ecosystems and reducing the impact of climate change. This review emphasizes that regional financial performance plays a significant role in determining capital expenditure and environmental allocation. Unbalanced spending policies can hinder the achievement of sustainable development. In addition, effective allocation of environmental spending is key to supporting various climate change mitigation programs and maintaining environmental quality in the future. The results of this study conclude that improving financial performance needs to be accompanied by appropriate budget policies, especially in capital expenditure and the environment. Efforts to ensure sustainable development require synergy between economic growth and environmental concern so that long-term development goals are achieved.

Neuroinflammatory Pathways Associated with Chronic Post-Thoracotomy Pain: A Review of Current Literature.

Chronic post-thoracotomy pain (CPTP) is a major clinical problem that affects up to 35-55% of patients undergoing thoracic incisions. Evidence suggests that multiple cellular signaling pathways and neuro-inflammatory mediators may play an essential role in the pathogenesis of CPTP. In this comprehensive review, we present the current evidence on the cellular signaling pathways and inflammatory changes associated with the initiation and maintenance of CPTP, focusing on the potential application of these findings in the clinical setting. An electronic search of Medline, EMBASE, Cochrane, Google Scholar, and ClinicalTrials.gov was performed, and 3652 abstracts were identified. After an initial abstract screening, 131 studies underwent a full-text review, and nine papers were eventually included in this review. Studies were included if they assessed the cellular signaling pathways or inflammatory processes associated with the induction and/or maintenance of CPTP. All the identified studies were pre-clinical studies conducted on animal models. Our search identified seven cellular pathways (NK-1 receptor (NK-1), Glutaminase 1, Toll-like receptor 4 (TLR4), Resolvins, Ror-2, Sonic hedgehog signaling (Shh), and Wnt5a/Wnts) and six cytokines (IL-1β, IL-6, IL-8, IL-10, IFN-γ, and TNF-α) that were investigated in the context of CPTP. Multiple cellular signaling pathways and inflammatory cytokines may play an important role in the neuroinflammatory changes associated with the induction and maintenance of chronic post-thoracotomy pain in animal models. However, the clinical impact and therapeutic utility of these neuroinflammatory changes in routine clinical practice have yet to be demonstrated.

A Research of the Integrated Circuit Design and Optimization

With the scientific and technical revolution going on, integrated circuit has been playing a vital role in our daily life ever since. In IC (Integrated circuit) design and manufacturing, layout of the integrated circuit determines its success or failure. However, the constantly decreasing characteristic size and progressive process bring about some new issues. That is why in post-Moore’s Law period, the design and optimization of layouts deserves attention of the whole industry. A properly designed and optimized layout not only results in better performance while using, but also cut out the cost of manufacture. In this paper, the methodology of integrated circuit layout design and optimization are discussed. For design, the author presented the whole flow of how the layout is generated and principles in integrated circuit design. For optimization, two approaches are analyzed. One is shorting out the critical area. Based on critical area theory and methodology of image processing, layouts can be improved in configuration. The method discussed here makes a modification on the previous way to make the optimization more accurate and efficient. The other method is inserting auxiliary polysilicon, which can counteract the impact of channel length change of MOSFETs and focus error as a unavoidable result of the process improvement.

Interaction between alcohol intake and employment status changes on mortality among young workers

Abstract Background To investigate the impact of changes in employment status and their interaction with alcohol consumption on health outcomes among young workers. This study aims to explore how employment fluctuations, periodic unemployment, and economic activity levels influence the health of economically active individuals, focusing particularly on the synergistic effects that these employment changes may have when combined with alcohol consumption. Methods We conducted a retrospective cohort study using data from the Korean National Health Insurance Service database. The study included individuals aged 25-44 years who underwent health check-ups between 2009 and 2010. We categorized changes in employment status into three groups: continuously employed, economically active with employment fluctuations, and periodically unemployed. We estimated adjusted hazard ratios and 95% confidence intervals using multivariable Cox proportional hazard models to assess the impact of changes in employment status on the risk of all-cause mortality. The relative excess risk due to interaction, a widely accepted indicator of additive interaction, was used to assess the interaction between alcohol consumption and changes in employment status. Results Changes in employment status significantly increased the risk of all-cause mortality in both men and women in the economically active with employment fluctuations and periodically unemployed groups compared with the continuously employed group. The synergistic effect of alcohol consumption and changes in employment status on the risk of all-cause mortality was significant only among men. Conclusions The findings of this study indicate that changes in employment status, particularly when combined with alcohol consumption, significantly affect all-cause mortality among young workers. Key messages • Employment status fluctuations combined with alcohol consumption significantly increase all-cause mortality risks among young workers, especially men. • This study emphasizes the urgent need for targeted interventions that address the combined impact of employment and lifestyle factors on public health.

Impact of changes of Achilles tendon thickening on cardiovascular events among patients with familial hypercholesterolemia

Abstract Backgrounds Achilles tendon thickening (ATT) can be regressed through LDL-lowering in patients with familial hypercholesterolemia (FH). The Japan Atherosclerosis Society (JAS) determined the threshold of ATT as ≥8.0 mm in male and ≥7.5 mm in female. Purpose We aimed to determine clinical impact of changes of ATT in development of major adverse cardiovascular events (MACE). Methods Patients with clinically diagnosed FH (N=1,273, male/female=614/659) with ATT data using X-ray were assessed. We divided the patients into 4 groups (group 1: patients without ATT from baseline to their follow-up, group 2: patients without ATT at baseline, but developed ATT at follow-up, group 3: patients with ATT at baseline, but regressed at follow-up, group 4: patients with ATT from baseline to their follow-up). Cox proportional hazards models were used to assess factors associated with MACE, including cardiovascular death and any coronary events. Results The median follow-up period was 10.9 years. During the follow-up period, 142 MACEs were observed, and median ATT was regressed from 7.8 to 7.6 mm. We found that there was more significant positive correlation between cholesterol-year score and ATT among patients with and without MACE (p <0.001; Spearman’s r=0.33, and p <0.001; Spearman’s r=0.35, respectively). Under these circumstances, changes of ATT were significantly associated with the occurrence of MACE (hazard ratio (HR): 2.73; 95% confidence interval (CI): 1.33–4.13; p<0.001, HR: 2.18; 95% CI: 1.08–3.28; p<0.001, HR: 6.34; 95% CI: 3.10–9.58; p<0.001, in group 2, group 3, and group 4, respectively when group 1 was considered as reference). Conclusion Assessments of ATT condition represent diagnostic values and risk stratification information among patients with FH.

Impact of changes in left heart geometry on predicting new-onset atrial fibrillation in patients with hypertension

Abstract Background Hypertension-induced left ventricular hypertrophy (LVH) increases end-diastolic LV pressure and contributes to left atrial enlargement (LAE), which are associated with development of atrial fibrillation (AF). However, the impact of LVH and LAE and their regression following antihypertensive therapy on AF incidence remains unclear. Purpose This study aimed to investigate the impact of changes in the LVH and LAE status on the occurrence of new-onset AF (NOAF). Methods This retrospective analysis included patients with sinus rhythm who underwent echocardiography at hypertension diagnosis and after 6–18 months. LVH was defined as LV mass index >115 g/m2 (men) and >95 g/m2 (women), and LAE was defined as LA volume index >42 ml/m2. LVH and LAE regression was defined as the absence of LVH and LAE on follow-up echocardiography, respectively. The occurrence of NOAF was assessed in relation to changes in LVH and LAE status. Results Among the 1,464 patients included in the study, 163 (11.1%) patients developed NOAF during a median follow-up of 63.8 months (interquartile range, 35.9–128.5 months). On average, 12 electrocardiograms per patient were reviewed for AF detection. New-onset LVH (adjusted HR 1.88, 95% CI 1.20–2.94, P=0.006) and LAE (adjusted HR 1.89, 95% CI 1.05–3.40, P=0.034) were significant predictors of NOAF. Conversely, regression of LVH (adjusted HR 0.51, 95% CI 0.280.91, P=0.022) or LAE (adjusted HR: 0.30, 95% CI 0.15–0.63, P=0.001) after antihypertensive therapy was associated with a reduced risk of NOAF. The risk of NOAF was higher in patients with LVH and LAE together (adjusted HR 4.30, 95% CI 2.81–6.56, P<0.001) than in those with either LVH or LAE, or those with neither, as determined by follow-up echocardiography. Conclusion In patients with hypertension and sinus rhythm, regression of LVH and LAE following antihypertensive therapy is associated with a decreased incidence of NOAF, whereas newly developed LVH or LAE is associated with a higher risk of NOAF. The changes in left heart geometry can serve as a predictive marker for NOAF in patients with hypertension.

6.F. Scientific session: Understanding the impact of climate change on health: the latest reports from EEA and NPHIs

Abstract Climate change poses a significant threat to human life and wellbeing worldwide. Extreme weather events like heatwaves, storms or floods can have adverse impacts on health, as can many other factors influenced by climate change, such as allergens, UV radiation and vector-borne diseases. In order to support the action needed to protect and promote health and wellbeing, many National Public Health Institutes (NPHIs) aim to keep relevant stakeholders informed on the scientific evidence of the impacts of climate change on health. Reports that synthesise the evidence can help in the development of suitable and health-relevant climate change adaptation and mitigation measures. In this workshop, European Environment Agency assessments on climate and health are presented, including the European Climate Risk Assessment Report and recent outputs of the European Climate and Health Observatory. Next, three NPHIs introduce their recent national reports on the impact of climate change on health, sharing lessons learned and valuable insights into their content, process and reception, highlighting similarities and differences. The workshop will feature presentations by NPHIs from the United Kingdom (UK Health Security Agency), Germany (Robert Koch Institute), and the Netherlands (National Institute for Public Health and the Environment) as well as the European Climate and Health Observatory. The perspective of the European Climate and Health Observatory offers Europe-wide insights as a provider of tools and knowledge that support actions from NPHIs and other health actors. Our aim is to highlight the value of such reports, and inform and inspire NPHIs and other stakeholders that may be considering the publication of similar reports. The format of the workshop will be informative and interactive, with opportunity for Q&A, discussion, and engagement with the audience. By showcasing the recent reports, the workshop aims to increase awareness of climate change as a public health issue and establish NPHIs as key climate actors. Furthermore, it aims to highlight the importance of having a national, up-to-date evidence base to drive climate measures and enhance resilience. Key messages • National evidence-based reports on climate change and health are a useful tool for informing health-relevant climate change adaptation and mitigation measures. • Through the public health functions of surveillance, monitoring, responding and evaluating, NPHIs play a crucial role in collating and assessing the evidence on the health effects of climate change.

Climate change and its health effects - an optional subject for medical students

Abstract The Standing Committee of European Doctors urged to include training on the impact of climate change on health for health professionals. Currently, in the curriculum of most medical schools, the health-related impacts of climate change represent a peripheral part. The teaching of health effects of climate change should be made part of the training of health professionals and should be introduced in the curriculum of medical schools. ClimateMed is an Erasmus project that improves the curriculum and expands knowledge about the health effects of climate change at medical universities. The World Café method, based on round table discussions, was applied to assess the needs, summarize the proposals, and develop the necessary strategy. At the same time, a questionnaire was applied to those medical students from UMFST Targu Mureș who chose this subject as an optional subject. Students related the importance of understanding the diseases caused directly or indirectly by climate change, and reported what kind of topics should be included in a new course, in which semester/module and in what format it would be appropriate to teach it. The most frequently reported topics were: excessive heat and heat-related illnesses, extreme weather, vector-borne diseases, food safety, air pollution, and mental health. According to the goals of the project and students’ opinions, since 2023 medical students can choose Climate Change and Health Effects as an elective course. Based on the demand for medical universities to include in their curriculum knowledge related to the health effects of climate change, ClimateMed project can facilitate this integration and can promote the increase of teacher motivation and the development of methodological guidelines for university teachers. The project contributes to the preparation of some educational materials and the introduction of an optional subject in the training curriculum of the students of the Faculty of Medicine, UMFST Targu Mureș. Key messages • There must be made efforts to include training on the impact of climate change on health for health professionals, to introduce this subject in the curriculum of medical schools. • ClimateMed project can facilitate the integration of knowledge about the health effects of climate change into curriculum and can promote the practical use.

The prevalence and impact of changes in the severity of secondary TR during hospitalization in acute heart failure

Abstract Background Secondary tricuspid regurgitation (TR) is a prevalent entity in patients hospitalized for acute heart failure (AHF), and concomitant moderate or severe TR at admission has been demonstrated to be associated with a poor prognosis. However, no study has described the trajectories of the severity of secondary TR during admission, and the prognostic implications of changes in the severity of secondary TR. Purpose This study aimed to investigate the dynamism of secondary TR observed during hospitalization due to worsening heart failure, and its prognostic impact in patients with AHF. Methods A post-hoc analysis of 1,061 consecutive patients hospitalized with AHF was performed, enrolled in the prospective, multicenter Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure (REALITY-AHF). Patients included in the study underwent a comprehensive echocardiographic examination within 24 hours of admission and again prior to discharge. Patients were divided into four groups based on the TR severity at admission and discharge: none to mild TR at both admission and discharge (no/no group), moderate to severe TR at admission but improved to none to mild TR at discharge (resolution group), none to mild TR at admission but moderate to severe TR at discharge (worsening group), and moderate to severe TR at both admission and discharge (persistent group). The primary endpoint was the composite of 1-year all-cause mortality and HF re-hospitalization after discharge. Results The no/no, resolution, worsening, and persistent groups included 479 (45%), 275 (26%), 85 (8%), and 222 patients (21%), respectively. The no/no group and the resolution group had significantly lower tricuspid regurgitant pressure gradients prior to discharge compared to the worsening and persistent groups (P<0.001). Also, right ventricular dysfunction evaluated at discharge, defined by tricuspid annular plane systolic excursion <17 mm, was more prevalent in the worsening (65.7%) and persistent groups (66.4%) compared to the no/no (43.7%) and resolution (53.2%) groups (P<0.001). Compared to the no/no group, the worsening and persistent groups, but not the resolution group, were associated with a higher incidence of the primary endpoint (Log-rank: P<0.001). This association remained significant in an adjusted Cox regression analysis, with the worsening group (hazard ratio: 1.48, 95% confidence interval [CI]: 1.01–2.20) and persistent group (hazard ratio: 1.35, 95% CI: 1.01–1.83) independently associated with the primary endpoint, but not the resolution group (hazard ratio: 1.10, 95% CI: 0.81–1.49). Conclusions In patients hospitalized for AHF, the severity of secondary TR is dynamic, and changes in the severity of TR are significantly associated with prognosis. Our study results underscore the importance of repetitive evaluation of TR in hospitalized patients with AHF.

Impact of changes in proteinuria on the risk of atrial fibrillation in patients with diabetes mellitus: a nationwide population-based study

Abstract Background Diabetes mellitus (DM) is a well-known risk factor for atrial fibrillation (AF). Proteinuria is also considered as an independent predictor for AF. However, there is limited data on whether the changes in proteinuria severity can impact the risk of AF among patients with DM. Purpose We aimed to evaluate the association between changes in proteinuria over time detected using a urine dipstick test and the risk of AF among patients with DM. Methods A total of 1,605,495 patients with DM who underwent two biennial health checkups provided by the National Health Insurance Service (NHIS) between January 2013 and December 2016 were included. All patients had two consecutive urine dipstick tests during the checkups. We divided the study population into four groups based on their glomerular filtration rate (GFR): > 90 ml/min, 60-90 ml/min, < 60 ml/min, and those with end-stage renal disease (ESRD). We evaluated the association between the changes in proteinuria over time detected using a urine dipstick test and the risk of AF and their changes by GFR. Results During a median 4.0-year follow-up, AF occurred in 32,391 persons (5.22 per 1,000 person-years). Among 1,605,495 patients who underwent two consecutive urine dipstick tests, 1,453,116 (90.51%) patients had a negative proteinuria on both tests (negative or trace result on both urine dipstick tests), and 68,979 (4.3%) patients had an aggravated proteinuria (from negative to more than 1+ result on subsequent urine dipstick test). While 48,357 (3.01%) patients had a resolved proteinuria (from positive to negative results on subsequent tests) and 35,043 (2.18%) patients had a persistent proteinuria (positive result on both tests). Those with aggravated or resolved or persistent proteinuria showed an increased risk of AF (HR 1.39, 95% CI 1.33-1.46; HR 1.37, 95% CI 1.30-1.45; HR 1.95, 95% CI 1.85-2.06) compared with most subjects who showed subsequent negative results on proteinuria. This result was consistent within every GFR group. However, the tendency of increment of AF risk by changes in proteinuria was more prominent in lower GFR groups (Table). In subgroup analysis, there was no significant difference between male and female. However, the younger aged (< 65 years) group had a more prominent tendency of increased AF risk by changes in proteinuria. Conclusion Changes in proteinuria showed a significant association with the risk of AF in patients with DM. This tendency was prominent in patients with lower GFR. Therefore, careful monitoring of AF risk based on proteinuria changes could be beneficial for those with DM.

Impacts of long-term climate change on human health: a global scoping review

Abstract Introduction Research output on climate change and human health is growing rapidly. This can make it difficult to find and use relevant information to develop public health action. Methods We present a global scoping review of the rapidly growing quantitative research output on long-term climate change and human health. We searched Scopus, Embase, and PubMed for quantitative, English language literature published between January 2000 and June 2021 that referenced climate change and human health in titles, abstracts, or keywords. Results From 36,956 publications we identified 754 relevant studies. Europe, the Americas, and the Western Pacific were studied much more often than other WHO regions. Research on temperature and vectors accounted for 70% of all included publications. Malaria, diarrheal diseases, and cardiovascular diseases were the most studied specific health outcomes. We found very few studies on non-communicable diseases in low- and middle-income countries. Retrospective publications (153) showed effects of climate change are already occurring worldwide. Most studies on tick-borne encephalitis, malaria, and lower respiratory infections associated with air pollution found impacts caused by climate change have increased. The strongest attribution of climate change was found for heat-related impacts. In prospective publications (626) diarrheal diseases, and impacts associated with heat and chemical air pollution were most consistently projected to increase. Future vector-borne disease impacts were projected to be highly location specific. Some studies demonstrated adaptation can effectively reduce impacts, while noting that capacity to adapt differs greatly between population groups. Conclusions Our findings underline climate change impacts are diverse and complex. Future research should prioritize the relatively understudied regions most vulnerable to climate change, such as Africa, and impacts beyond those related to temperature and vector-borne diseases.

Hydrological dichotomy: Streamflow drought in dammed vs. undammed regions of the largest Indian Peninsular basin

Recurring streamflow drought is a significant problem, and it is necessary to comprehend the spatiotemporal patterns and driving factors of historical droughts in order to manage future water supplies effectively. Drought has significant and often severe effects on semi-arid and arid zones due to the already limited availability of water in these regions. Therefore, this research examines streamflow drought fluctuations in India's second-largest basin, the Godavari. The Godavari Basin experiences diverse climatic conditions ranging from humid in the Western Ghats to semi-arid in central and western regions. Frequent hydrological droughts have plagued the Godavari basin. Still, the impact of human activities and climate change on the streamflow drought characteristics in the Godavari basin has not been thoroughly investigated. Further, assessing the regional control of streamflow drought deficit and intensity in a large river basin like Godavari is crucial. The findings show that streamflow drought is worst in central and eastern Godavari. Additionally, dammed and undammed locations have different streamflow drought characteristics. Droughts have lengthened in dam-affected areas. However, regions without dams have seen more deficit and intensity. Thus, different sustainable water management techniques are needed for the dammed and undammed regions of the Godavari basin.

Effects of legal age change on adolescents’ perception of access to alcohol in Portugal

Abstract Background Adolescents and young adults are a group particularly vulnerable to the effects of alcohol consumption. In Portugal, legislative changes in 2013 and 2015 prohibited the sale of alcoholic beverages to under-18s. This study aimed, first, to evaluate the impact of these policy shifts on the perceived access to alcohol among Portuguese adolescents, and second, to assess the different impacts across gender and socioeconomic strata. Methods Data from the ESPAD survey, spanning 1995-2019, was used. A quasi-experimental difference-in-differences study design was employed, using Finland, Norway, and Sweden as controls. The perceived access to beer, wine, and spirits among 16-year-old adolescents was used as outcomes, adjusted for gender and parental education. Results were also stratified by gender and by parental education status. Results After the increase in the minimum age for alcohol sales, there was a higher perceived easiness of access to beer (coef=0.018, p = 0.001) and a decline in spirits (coef=-0.088, p = 0.022), with no changes in wine. Male adolescents exhibited a decrease in the perception of access to spirits (coef=-0.100, p = 0.007) and wine (coef=-0.049, p = 0.049), while changes in the perception of access to beer were non-significant. Similar patterns were observed in female adolescents, yet non-significant for wine or spirits. These positive impacts on beer and negative impacts on spirits were observed in the different socioeconomic groups; wine was the exception, with only the highest-education group showing a decrease in the perception of access (coef=-0.056, p = 0.011). Conclusions In this study, the effect of raising the minimum age for alcohol sales in Portugal varied according to the alcoholic beverage, gender, and, for wine, according to the socioeconomic group. These findings suggest limitations in the policy’s effectiveness and equity. Future research should delve into the underlying causes to optimize health-promoting policies. Key messages • Portugal’s alcohol policy changes led to differential impacts on the perception of access to alcohol, with an impact in higher alcohol content beverages. • The impact of alcohol policy changes also differed across gender and socioeconomic status, with a stronger effect on male adolescents and higher socioeconomic strata.

Development of health care expenditures in Finland up to 2040

Abstract Background Increasing health care expenditures are threatening public health by complicating the supply of adequate health services. Exploration of possible future developments of the expenditures is needed to understand how to prepare for future or to change an unwanted course of development. We provided projections by health care sectors taking into account demographic and other developments. Methods We used national data on the realized expenditures per capita by age group, sex and health care sectors from 2017 to 2020, and official forecasts of the population in Finland up to 2040. Future per capita expenditures were projected with Bayesian linear regression models incorporating a priori dependency structure for the slope parameters of the age groups such that the time trends of adjacent groups would be more similar than other groups. These projections were then combined with the population forecasts to estimate the total expenditures. Results The greatest increase (164%) was estimated for the total costs of the primary outpatient healthcare: from 2153 to 5677 million euros in 2020-2040, such that 7% of the growth was attributed to demographic developments. The estimated growths were 68% for the primary inpatient healthcare, 14% for the specialised somatic healthcare, and 52% for the urgent and emergency health services, of which 91%, 98% and 21% were attributed to demographic developments, respectively. Conclusions Notable increases in expenditures are expected in all considered health care sectors, but there are great differences in the proportions of the growth attributed to demographic developments. Due to the limited role of demographic changes, it is worth focusing on controlling the impacts of other developments by, e.g., improving the population health and the efficiency of the health care system. Key messages • Notable increases are expected in health care expenditures up to 2040. • Impacts of demographic changes varies markedly between health care sectors.

Impact of land-use change on coupling coordination degree of regional water–food–carbon system

IntroductionThe objective of this study is to investigate the impact of land use changes on the coupling coordination of the regional water-food-carbon system in Hebei Province. Moreover, the findings aim to offer insights for achieving comprehensive and coordinated development of regional resources.MethodsBy constructing an evaluation index system of the coupled coordinated development of the water-food-carbon system, using the coupled coordination model to study the coupled coordination of the water-food-carbon (WFC) system in Hebei Province from 2010 to 2020, and applying the Pearson correlation coefficient and ArcGIS to analyze the impacts of land-use changes on the degree of coupled coordination.ResultsThe results show that: (1) The most notable characteristics of land type changes include a decrease in cropland and an increase in construction land, primarily driven by the conversion of cropland to construction sites. The total area converted amounts to 8207.20 km2. (2) The degree of coupled coordination of the water-food-carbon system in the study area as a whole shows an upward and then downward trend, and shows a spatial distribution pattern of “high in the north-east and low in the south-west”; (3) In Hebei Province, the degree of coupling coordination within the water-food-carbon system exhibits a stable positive correlation with forest land, grassland, and water area. Additionally, the transfer of forest land and grassland are significant factors influencing the delineation of cold and hot spots within the region.DiscussionTherefore, in addressing the coordinated development of the water-food-carbon system, it is essential to consider the influence of land. Resources should be allocated judiciously based on regional advantages to promote sustainable development effectively.

Prevalence, mechanisms and prognostic impact of dynamic mitral regurgitation unmasked by handgrip exercise in patients with hypokinetic non-dilated and dilated cardiomyopathy

Abstract Background Recent studies suggest that mitral regurgitation (MR) is a dynamic condition influenced by global and regional left ventricular (LV) remodeling as well as mitral valvular deformation. Exercise testing plays a substantial role in assessing the hemodynamic relevance of MR and is recommended by current guidelines. Handgrip exercise may serve as alternative exercise intervention to bicycle exercise, as it is easy to perform even bedside. However, there are no data yet, on the prevalence, mechanisms and prognostic impact of dynamic MR in patients with dilated cardiomyopathy using isometric exercise testing. Aims We aimed to assess the prevalence, hemodynamic consequences, and prognostic impact of exercise-induced changes in MR in patients with hypokinetic non-dilated and dilated cardiomyopathy. Methods Patients with hypokinetic non-dilated and dilated cardiomyopathy and at least mild MR who underwent handgrip echocardiography at the University Hospital Duesseldorf between January 2018 and September 2021 were enrolled.Patients were followed-up for one year to assess clinical outcomes. We assessed all-cause mortality, HF-associated hospitalizations, MV surgery, transcatheter edge-to-edge repair (TEER), left ventricular assist device implantation and heart transplantation during follow-up. Results Fifty-eight patients were included (mean age 70±15 years; 41% female; mean LVEF 37±10%). At rest, 28 patients (48%) presented with mild MR, and 30 patients (52%) had moderate MR. Fifteen patients (26%) with non-severe MR at rest, developed dynamic severe MR during handgrip exercise. Patients with dynamic severe MR had advanced MR at rest, larger left atrial dimensions, and increased mitral annulus diameter (all p<0.01). During exercise, LVEDVi, LVESVi and parameters of local left ventricular remodeling (tenting height, tenting area) were increased in patients with dynamic severe MR compared to those with non-severe MR (all p<0.05). During one-year follow-up, there was no difference regarding all-cause mortality and HF hospitalizations in patients with dynamic severe MR and non-severe MR (Log-rank test Chi2 0.262; p=0.609)(Figure 1). However, patients with dynamic severe MR more often underwent mitral valve surgery/intervention than patients with non-severe MR (Log-rank test Chi2 29.41; p<0.001)(Figure 1). Conclusion Our results demonstrate that the evaluation of non-ischemic MR only at rest underestimates the full severity of the lesion. Handgrip exercise unmasks severe MR in every fourth patient with non-severe MR at rest. These data may have implications for therapeutic decision-making in symptomatic patients with hypokinetic non-dilated and dilated cardiomyopathy and non-severe MR at rest. TEER might present an effective treatment option to improve clinical outcomes in patients with non-ischemic cardiomyopathy and non-severe MR at rest but dynamic severe MR during exercise.Figure 1

Temporal trends in major bleeding after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction from 2003 to 2017: the Western Denmark Heart Registry

Abstract Background Management of patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) has changed during the last two decades. Introduction of more potent platelet inhibitors may carry an increased risk of bleeding complications, while other therapeutic options, such as use of radial artery access and proton pump inhibitors may reduce bleeding risk. The combined impact of these treatment changes on bleeding risk in patients with STEMI remains unknown. Purpose To examine temporal trends in 1-year risk of major bleeding after STEMI treated with primary PCI from 2003 to 2017. Methods We used the Western Denmark Heart Registry to identify first-time PCI-treated patients undergoing primary PCI for STEMI from 2003 to 2017. Patients were divided into 4 calendar periods based on the time of STEMI. The main outcome was 1-year risk of major bleeding defined as a hospital admission for bleeding using a validated definition with high accuracy. Additionally, the 1-year risk of major bleeding in STEMI patients was compared with the risk in an age- and sex-matched general population cohort without prior coronary artery disease. Results From 2003 to 2017, we identified 18,540 patients treated with primary PCI for STEMI (median age 64 years, 75% men)and 92,700 age- and sex-matched individuals. The 1-year risk of major bleeding after STEMI was similar across the different time periods; 4.1% in 2003-2006, 3.8% in 2007-2010, 3.8% in 2011-2014, and 4.5% in 2015-2017. The adjusted HR for bleeding in STEMI patients was 1.03 (95% CI 0.83-1.26) when comparing the latest period with the earliest period. The age- and sex-matched general population exhibited a 1-year risk of major bleeding of around 1% in all time periods (Figure 1). Conclusions Despite changes in management, the 1-year risk of major bleeding remained stable around 4% after primary PCI-treated STEMI from 2003 to 2017. This risk was approximately 4 times higher than the bleeding risk observed in an age- and sex-matched general population.