Geographic Variation Research Articles

Burden of six major types of digestive system cancers globally and in China.

Digestive system cancers constitute a significant number of cancer cases, but their burden is not uniform. As Global Cancer Observatory (GLOBOCAN) 2022 has recently updated its estimates of cancer burden, we aimed to investigate the burden of six major digestive system cancers both worldwide and in China, along with geographical and temporal variations in cancer-specific incidence and mortality. We extracted data on primary cancers of the esophagus, stomach, colorectum, liver, pancreas, and gallbladder from the GLOBOCAN database for 2022. Age-standardized incidence and mortality rates were calculated and stratified by sex, country, region, and human development index (HDI). We used the 2022 revision of the World Population Prospects (United Nations) to obtain demographic data for various age groups in China from 1988 to 2012 and used the joinpoint model and the average annual percentage change (AAPC) to analyze cancer incidence trends in China. In 2022, the estimated global incidence of digestive system cancers reached 4,905,882, with an estimated 3,324,774 cancer-related deaths. Colorectal cancer was most prevalent in terms of incidence and mortality. There was a significant correlation between the burden of gastrointestinal cancers and country HDI. From 1988 to 2012, the incidence of esophageal, gastric, and liver cancers declined in China, whereas colorectal and pancreatic cancer incidences continued to increase. By 2050, colorectal and liver cancers are projected to remain the leading cancer types in China in terms of incidence and mortality, respectively. Digestive system cancers remain a significant public health challenge globally and in China. Although progress has been made in the prevention and control of some cancers, the burden of digestive system cancers persists. The implementation of tertiary prevention strategies must be intensified to reduce the incidence and mortality of digestive system cancers, mitigating their impact on public health.

P-721 Exploring the impact of geographical variation: A retrospective study examining semen phenotypes within a cohort of 19,612 men attending a fertility center in the UAE

Abstract Study question What are the epidemiological trends of semen phenotypes and their association with geographic regions among men seeking fertility treatment in the UAE? Summary answer Following covariate adjustment, UAE Nationals attending a fertility center displayed lower incidence of oligozoospermia and higher prevalence of asthenozoospermia and teratozoospermia compared to other nationalities. What is known already Conventional semen analysis remains the gold standard for diagnosing and managing male infertility. It is well documented that semen is heterogenous and can be influenced by diverse factors, including but not limited to race, ethnicity, sociocultural background, seasonality, and geographical region. Although higher infertility prevalence has been reported in regions like North Africa and the Middle East, existing estimates rely largely on data from female partners of infertile couples and studies dating back to 1988. This underscores a significant data paucity in the Middle East. Study design, size, duration In this retrospective study, the anthropometric data (age, weight, height, body mass index, nationality) and semen parameters (semen volume, semen pH, sperm concentration, total sperm count (TSC), total motility (TM), progressive motility (PM), normal morphology, viability) of 19,612 men (32,664 samples) who attended a fertility center in the UAE between 2011 and 2022 were assessed. Ethical approvals for this study were obtained from appropriate bodies (REC/2022/P27 and MBRU IRB-2021-12). Participants/materials, setting, methods Data from patients were categorized into different geographical regions (Sub-Saharan Africa, North Africa, North America, Central America, South America, Asia, Europe, Middle East, and Oceania) based on nationality. Patients were further grouped as MENA (Middle East and North Africa) and non-MENA, while data from UAE Nationals (UAE) were also compared to Other Nationalities (Global). Unadjusted analysis was performed using SPSS. While covariate adjustment and propensity score analyses were performed using R package and STATA. Main results and the role of chance All semen parameters, remained within normal WHO reference values when stratifying according to geographical regions, MENA and Non-MENA as well as UAE and Global. Interestingly, MENA displayed a significant reduction in semen volume (p < 0.0001) and sperm concentration (p = 0.017), and an increase in PM (p < 0.00001). Similarly, PM was higher in UAE versus Global. To address skewed data distribution between UAE and Global, we employed propensity score analysis and logistic regression models, with semen parameters categorized according to WHO lower reference limits. Following covariate adjustment, all models demonstrated no significant difference in PM and TM between the two subgroups. However, logistic regression indicated a non-significant increase (4%) in the prevalence of asthenozoospermia in UAE compared to Global. Categorical analysis indicated that the Global samples had significantly lower TSC compared to the UAE group (24.6% vs. 26.3%, p<.001). Modelling adjusted for propensity score and UAE Nationality further suggested that UAE were 13% less likely to have lower TSC compared to Global (p<.001). About 58% of UAE samples exhibited teratozoospermia, while it was 56% for Global. After adjusting for confounders, analysis revealed a significantly higher prevalence (12%) of teratozoospermia among UAE compared to Global, with a potential range of 9%-16% in the long term. Limitations, reasons for caution A limitation of the current study is data distribution skewness. Of the 32,664 samples from 19,612 patients (113 countries), 21,649 samples are from UAE Nationals. However, logistic regression, propensity score adjustment accounting for Nationality, propensity score matching (1:2 ratio), and inverse probability weighting were applied to mitigate this bias. Wider implications of the findings Paucity of data on male fertility in the UAE and MENA region does not allow for accurate estimation of male infertility. Owed to its sample size and statistical robustness, this study provides evidence addressing this gap, offering insights into interpretation of global data on reproductive health. Trial registration number not applicable

Geographic population structure and distinct intra-population dynamics of globally abundant freshwater bacteria.

Implications of geographic separation and temporal dynamics on the evolution of free-living bacterial species are widely unclear. However, the vast amount of metagenome sequencing data generated during the last decades from various habitats around the world provides an unprecedented opportunity for such investigations. Here we exploited publicly available and new freshwater metagenomes in combination with genomes of abundant freshwater bacteria to reveal geographic and temporal population structure. We focused on species that were detected across broad geographic ranges at high enough sequence coverage for meaningful population genomic analyses, associated to the predominant freshwater taxa acI, LD12, Polynucleobacter and Ca. Methylopumilus. Despite the broad geographic ranges, each species appeared as sequence-discrete cluster, in contrast to abundant marine taxa, for which continuous diversity structures were reported on global scale. Population differentiation increased significantly with spatial distance in all species, but notable dispersal barriers (e.g. oceanic) were not apparent. Yet, the different species showed contrasting rates of geographic divergence and strikingly different intra-population dynamics in time series within individual habitats. Change of an LD12 population over seven years was minor (FST= 0.04) compared to differentiation between lakes, whereas a Polynucleobacter population displayed strong changes within merely two months (FST up to 0.54), similar in scale to differentiation between populations separated by thousands of kilometers. The slowly and steadily evolving LD12 population showed high strain diversity, whereas the dynamic Polynucleobacter population exhibited alternating clonal expansions of mostly two strains only. Based on the contrasting population structures we propose distinct models of speciation.

Geographical variations, prevalence, and molecular dynamics of fastidious phloem-limited pathogens infecting sugar beet across Central Europe.

In Europe, two fastidious phloem-limited pathogens, 'Candidatus Phytoplasma solani' (16SrXII-A) and 'Candidatus Arsenophonus phytopathogenicus', are associated with rubbery taproot disease (RTD) and syndrome basses richesses (SBR) of sugar beet, respectively. Both diseases can significantly reduce yield, especially when accompanied by root rot fungi. This study investigates the presence, geographic distribution and genetic traits of fastidious pathogens and the accompanying fungus, Macrophomina phaseolina, found on sugar beet across four geographically separated plains spanning seven countries in Central Europe. The survey revealed variable incidences of symptoms linked to these fastidious pathogens in the Pannonian and Wallachian Plains, sporadic occurrence in the North European Plain, and no symptomatic sugar beet in the Bohemian Plain. Molecular analyses unveiled the occurrence of both 'Ca. P. solani' and 'Ca. A. phytopathogenicus' throughout Central Europe, with a predominance of the phytoplasma. These fastidious pathogens were detected in all six countries surveyed within the Pannonian and Wallachian Plains, with only a limited presence of various phytoplasmas was found in the North European Plain, while no fastidious pathogens were detected in Bohemia, aligning with observed symptoms. While 16S rDNA sequences of 'Ca. P. solani' remained highly conserved, multi-locus characterization of two more variable loci (tuf and stamp) unveiled distinct variability patterns across the plains. Notably, the surprising lack of variability of tuf and stamp loci within Central Europe, particularly the Pannonian Plain, contrasted their high variability in Eastern and Western Europe, corresponding to epidemic and sporadic occurrence, respectively. The current study provides valuable insights into the genetic dynamics of 'Ca. P. solani' in Central Europe, and novel findings of the presence of 'Ca. A. phytopathogenicus' in five countries (Slovakia, Czech Republic, Austria, Serbia, and Romania) and M. phaseolina in sugar beet in Slovakia. These findings emphasize the need for further investigation of vector-pathogen(s)-plant host interactions and ecological drivers of disease outbreaks.

T44 - Geographic Variations in Fentanyl Positive Urine Drug Screens in the United States, 2021

T44 - Geographic Variations in Fentanyl Positive Urine Drug Screens in the United States, 2021

Chronological and Geographical Variations in the Incidence and Acceptance of COVID-19-Positive Donors and Outcomes Among Abdominal Transplant Patients.

Given the importance of understanding COVID-19-positive donor incidence and acceptance, we characterize chronological and geographic variations in COVID-19 incidence relative to COVID-19-positive donor acceptance. Data on deceased donors and recipients of liver and kidney transplants were obtained from the UNOS database between 2020 and 2023. Hierarchical cluster analysis was used to assess trends in COVID-19-positive donor incidence. Posttransplant graft and patient survival were assessed using Kaplan-Meier curves. From among 38429 deceased donors, 1517 were COVID-19 positive. Fewer kidneys (72.4%vs. 76.5%, p < 0.001) and livers (56.4%vs. 62.0%, p < 0.001) were used from COVID-19-positive donors versus COVID-19-negative donors. Areas characterized by steadily increased COVID-19 donor incidence exhibit the highest transplantation acceptance rates (92.33%), followed by intermediate (84.62%) and rapidly increased (80.00%) COVID-19 incidence areas (p = 0.016). Posttransplant graft and patient survival was comparable among recipients, irrespective of donor COVID-19 status. Regions experiencing heightened rates of COVID-19-positive donors are associated with decreased acceptance of liver and kidney transplantation. Similar graft and patient survival is noted among recipients, irrespective of donor COVID-19 status. These findings emphasize the need for adaptive practices and unified medical consensus in navigating a dynamic pandemic.

Enhancing resilience: Integrating future flood modeling and socio-economic analysis in the face of climate change impacts

As climate change intensifies, future floods will become more severe in some areas with geographic variation, necessitating that local and regional governments implement systems to provide information for climate adaptation, particularly for vulnerable populations. Therefore, we aimed to develop a methodology to identify areas that are at an increased risk from future floods and independently socially vulnerable. In this study, 100-year recurrence interval flood extents and depths were estimated using an ensemble of six independent Coupled Model Intercomparison Project Phase 6 climate models for a past and future period under the highest-emissions climate scenario. The flood inundation results were related to social vulnerability for two selected study areas in the Mississippi River Basin. The range of flood extents and depths for both time periods were estimated, and differences were evaluated to determine the effects from climate change. To identify at-risk areas, the relationship between the spatial distribution of flood depths and vulnerability was then assessed. Finally, an analysis of the current and future damages on infrastructure from flooding on residential housing was performed to determine whether damages are correlated with higher vulnerability areas. Results show in every flooding scenario, flood extents and depths are increasing in the future compared with the past, ranging from an increase of 6 to 76 km2 in extent across both locations. A statistically significant relationship between spatial clusters of flooding and of vulnerability was found. The infrastructure analysis found that residential structures in the most vulnerable census tracts are 6 to 59 times more likely to experience moderate damage compared with the least vulnerable tracts depending on scenario. Overall, a framework was established to holistically understand the hydrologic and socioeconomic impacts of climate change, and a methodology was developed to use for allocating resources at the local scale.

Geographic variation in evolutionary rescue under climate change in a crop pest-predator system.

Species distribution models (SDMs) are often built upon the "niche conservatism" assumption, such that they ignore the possibility of "evolutionary rescue" and may underestimate species' future range limits under climate change. We select aphids and ladybirds as model species and develop an eco-evolutionary model to explore evolutionary rescue in a predator-prey system under climate change. We model the adaptive change of species' thermal performances, accounting for biotic interactions. Our study suggests that, without considering evolutionary adaptation, the warming climate will result in a reduction in aphid populations and the extinction of ladybirds in large parts of the United States. However, when incorporating evolutionary adaptation into the model, aphids can adapt to climate change, whereas ladybirds demonstrate geographic variation in their evolutionary rescue potential. Specifically, ladybirds in southern regions are more likely to be rescued than those in the north. In certain northern regions, ladybirds do not avoid extinction due to severe warming trends and seasonality of the climate. While higher warming trends do prompt stronger evolutionary changes in phenotype, they also lead to reduced aphid population abundance such that ecology constrains ladybird population growth. Higher seasonality induces an ecological effect by limiting the length of reproductive season, thereby reducing the capacity for evolutionary rescue. Together, these findings reveal the complex interplay between ecological and evolutionary dynamics in the context of evolutionary adaptation to climate change.

Clinical Spectrum of Dermatological Disorders at an Urban Health Center in East Delhi

Dermatological disorders constitute a significant proportion of primary health care (PHC) setups. The pattern of dermatological disorders varies among different countries and different parts of the same country owing to climatic and geographical variations, level of education, access to health care, etc. To study the clinical spectrum of patients presenting with dermatological disorders at an urban health center (UHC) in East Delhi. To identify the various risk factors associated with dermatological disorders in study subjects. A total of 1,148 patients who reported skin diseases for the first time at the Dermatology Outpatient Clinic at UHC in East Delhi were recruited. Detailed demographic data, history, and examination and potential risk factors of skin diseases (socioeconomic status, level of education, occupation, comorbidities, and addictions) were recorded on a predesigned proforma. A total of 616 (53.7%) patients had infectious dermatoses and 532 (46.3%) had non-infectious dermatoses. Among the infectious dermatoses, fungal diseases (44.8%) were the most common followed by parasitic infections (31.17%) and bacterial infections (9.74%). Among the non-infectious group, eczematous disorders (28.01%) were the most common, followed by pigmentary disorders (21.62%) and acne (19.55%). A significant association between level of education, occupation, and comorbidities with the distribution of infectious and non-infectious dermatoses was found. As a significant proportion of patients with a vivid spectrum of dermatological disorders present at the PHC setups, therefore dermatologists supervise that specialty clinics should be held regularly at these centers along with the availability of all the basic investigations to aid diagnosis and management.

Macroeconomic environment and the future performance of loans: Evidence from three peer-to-peer platforms

The literature on peer-to-peer loan market performance focuses predominantly on the microlevel variables connected to individual borrower or loan characteristics. We hypothesize that the economic environment, reflected by macroeconomic variables at the time of loan origination, should play a role in explaining loans’ future performance. Our dataset comprises two US-based platforms and one UK-based platform, which provides a rich field to verify our hypothesis with numerous loan-related variables. Specifically, we consider Lending Club with 1,169,976 individual loans and 128 variables, Prosper with 386,685 loans and 142 variables, and Zopa with 440,493 loans and 192 variables. Using linear and threshold regressions, we observe three main findings: (i) accounting for the macroeconomic environment systematically improves our understanding of the variation in the future performance of individual loans; (ii) demand-side variables, particularly the unemployment rate and industrial production, have stronger effects as supply-side and economic uncertainty variables; and (iii) the importance (effect size) of the macroeconomic environment is at least at the level of that of calendar and geographic variables but much smaller than the importance of loan or borrower characteristics. These results suggest that the economic environment might be useful in individual loan-level credit risk models.

Statistical Analysis of Moisture Sources and Quantitative Contribution of Cold Vortex Rainstorms in Northeast China during the Warm Season

Abstract The northeast cold vortex (NECV) is an essential system in the northeast region (NER) of China. Understanding the moisture source and associated transport characteristics of NECV rainstorms is the key to the knowledge of its mechanisms. In this study, we focus on two NECV rainstorm centers during the warm season (May–September) from 2008 to 2013. The Flexible Particle (FLEXPART) model and quantitative contribution analysis method are applied to reveal the moisture sources and their quantitative contribution. The results demonstrate that for the northern NECV rainstorm center (R1), Northeast Asia (35.66%) and east-central China and its coastal regions (29.14%) make prominent moisture contributions, followed by R1 (11.37%), whereas east-central China and its coastal regions (45.16%), the southern NECV rainstorm center itself (R2, 17.90%), and the northwest Pacific (10.24%) principally contribute to R2. Moisture uptake in Northeast Asia differs between R1 and R2, which could serve as one of the vital indicators to judge where the NECV rainstorm falls in NER. Moisture from the Arabian Sea, the Bay of Bengal, and the South China Sea suffers massive en route loss, although these sources’ contribution and uptake are positively correlated with the intensity and scale of NECV rainstorms in the two centers. There exists intermonth and geographical variability in NECV rainstorms when the main moisture source region contributes the most. Regulated by the atmospheric circulation and the East Asian summer monsoon, the particle trajectories and source contributions of NECV rainstorms vary from month to month. Sources’ contribution also turns out to be diverse in the overall warm season.

Delimiting species, revealing cryptic diversity, and population divergence in Qinghai-Tibet Plateau weevils through DNA barcoding.

The Leptomias group represents one of the most diverse taxonomic group of weevils in the Qinghai-Tibet Plateau and its adjacent areas. Despite the potential of hidden diversity, relatively few comprehensive studies have been conducted on species diversity in this taxonomic group. In this study, we performed DNA barcoding analysis for species of the Leptomias group using a comprehensive DNA barcode dataset that included 476 sequences representing 54 morphospecies. Within the dataset, our laboratory contributed 474 sequences, and 390 sequences were newly generated for this study. The average Kimura 2-parameter distances among morphospecies and genera were 0.76% and 19.15%, respectively. In 94.4% of the species, the minimum interspecific distances exceeded the maximum intraspecific distances, indicating the presence of barcode gaps in most species of Leptomias group. The application of Automatic Barcode Gap Discovery, Assemble Species by Automatic Partitioning, Barcode Index Number, Bayesian Poisson tree processes, jMOTU, and Neighbor-joining tree methods revealed 45, 45, 63, 54, and 55 distinct clusters representing single species, respectively. Additionally, a total of four morphospecies, Leptomias kangmarensis, L. midlineatus, L. siahus, and L. sp.9RL, were found to be assigned to multiple subclade each, indicating the geographical divergences and the presence of cryptic diversity. Our findings of this study demonstrate that Qinghai-Tibet Plateau exhibits a higher species diversity of the Leptomias group, and it is imperative to investigate cryptic species within certain morphospecies using integrative taxonomic approaches in future studies. Moreover, the construction of a DNA barcode reference library presented herein establishes a robust foundational dataset to support forthcoming research on weevil taxonomy, phylogenetics, ecology, and evolution.

Slow burn: Weak energy transition in a growing economy

Despite impressive recent gains in income (now classified by the World Bank as a “high income country”), and access to alternative heating systems, Chileans continue to have amongst the highest levels of per-capita wood consumption in the world, with serious attendant health and environmental implications. In this paper, we estimate the income elasticity of the use of firewood as a primary residential heating system in Chilean households. Our estimate accounts for the country’s climatic, geographic, and socio-demographic variation; controls for multiple levels of fixed-effects and covariates; and accounts for selection—as some households choose no heating systems whatsoever. We find that an increase of income of 10% decreases the probability of firewood use by about one-tenth of a percentage point, a statistically significant but economically trivial effect. This result, consistent across various robustness checks, provides evidence for an extremely weak income-based energy transition in Chile. It implies that passive environmental policy, expecting a reduction of firewood use exclusively from income growth will fail. If the Chilean government’s aim is to lower the detrimental health and environmental outcomes associated with firewood use, they will have to adopt more aggressive approaches.

Slow burn: Weak energy transition in a growing economy

Despite impressive recent gains in income (now classified by the World Bank as a “high income country”), and access to alternative heating systems, Chileans continue to have amongst the highest levels of per-capita wood consumption in the world, with serious attendant health and environmental implications. In this paper, we estimate the income elasticity of the use of firewood as a primary residential heating system in Chilean households. Our estimate accounts for the country’s climatic, geographic, and socio-demographic variation; controls for multiple levels of fixed-effects and covariates; and accounts for selection—as some households choose no heating systems whatsoever. We find that an increase of income of 10% decreases the probability of firewood use by about one-tenth of a percentage point, a statistically significant but economically trivial effect. This result, consistent across various robustness checks, provides evidence for an extremely weak income-based energy transition in Chile. It implies that passive environmental policy, expecting a reduction of firewood use exclusively from income growth will fail. If the Chilean government’s aim is to lower the detrimental health and environmental outcomes associated with firewood use, they will have to adopt more aggressive approaches.

Conservation-oriented management benefits the Black-faced Spoonbill, an endangered migratory waterbird

Active conservation management is crucial for maintaining and recovering populations of threatened species. Yet, there are remarkably few studies quantifying the benefits of conservation management and comparing ecological and anthropogenic influences on populations. We investigate these issues using the Black-faced Spoonbill Platalea minor as a case study. This species is an endangered migratory waterbird that garnered significant conservation attention along the East Asian-Australasian Flyway. Its global population has shown an upward trend recently, yet the speed of recovery has varied spatially. Understanding the species’ occurrence across wintering sites and the factors driving the geographical variation in recovery is vital for examining the benefits of management. In winter 2021–2022, we surveyed the occurrence and abundance of Black-faced Spoonbills and gathered data on environmental conditions across six important wintering sites in Taiwan and the Chinese mainland. Our results indicated a preference for larger wetlands with water depths of 10–20cm. Birds were more likely to be present in wetlands receiving conservation management interventions. Wetlands with vegetated bunds and fewer artificial materials tended to attract larger flocks. The contribution of wetland size and conservation management aimed at increasing spoonbill abundance varied across regions, with a more significant positive effect of conservation management observed in Taiwan. Our results serve as a valuable reference for regional conservation planning and wetland management in wintering areas, aiding their long-term conservation. In line with this, we recommend increased conservation management efforts informed by our findings, particularly in regions with relatively slow recovery rates.

Trends and levels of the global, regional, and national burden of appendicitis between 1990 and 2021: findings from the Global Burden of Disease Study 2021

Appendicitis is a common surgical emergency that poses a large clinical and economic burden. Understanding the global burden of appendicitis is crucial for evaluating unmet needs and implementing and scaling up intervention services to reduce adverse health outcomes. This study aims to provide a comprehensive assessment of the global, regional, and national burden of appendicitis, by age and sex, from 1990 to 2021. Vital registration and verbal autopsy data, the Cause of Death Ensemble model (CODEm), and demographic estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) were used to estimate cause-specific mortality rates (CSMRs) for appendicitis. Incidence data were extracted from insurance claims and inpatient discharge sources and analysed with disease modelling meta-regression, version 2.1 (DisMod-MR 2.1). Years of life lost (YLLs) were estimated by combining death counts with standard life expectancy at the age of death. Years lived with disability (YLDs) were estimated by multiplying incidence estimates by an average disease duration of 2 weeks and a disability weight for abdominal pain. YLLs and YLDs were summed to estimate disability-adjusted life-years (DALYs). In 2021, the global age-standardised mortality rate of appendicitis was 0·358 (95% uncertainty interval [UI] 0·311-0·414) per 100 000. Mortality rates ranged from 1·01 (0·895-1·13) per 100 000 in central Latin America to 0·054 (0·0464-0·0617) per 100 000 in high-income Asia Pacific. The global age-standardised incidence rate of appendicitis in 2021 was 214 (174-274) per 100 000, corresponding to 17 million (13·8-21·6) new cases. The incidence rate was the highest in high-income Asia Pacific, at 364 (286-475) per 100 000 and the lowest in western sub-Saharan Africa, at 81·4 (63·9-109) per 100 000. The global age-standardised rates of mortality, incidence, YLLs, YLDs, and DALYs due to appendicitis decreased steadily between 1990 and 2021, with the largest reduction in mortality and YLL rates. The global annualised rate of decline in the DALY rate was greatest in children younger than the age of 10 years. Although mortality rates due to appendicitis decreased in all regions, there were large regional variations in the temporal trend in incidence. Although the global age-standardised incidence rate of appendicitis has steadily decreased between 1990 and 2021, almost half of GBD regions saw an increase of greater than 10% in their age-standardised incidence rates. Slow but promising progress has been observed in reducing the overall burden of appendicitis in all regions. However, there are important geographical variations in appendicitis incidence and mortality, and the relationship between these measures suggests that many people still do not have access to quality health care. As the incidence of appendicitis is rising in many parts of the world, countries should prepare their health-care infrastructure for timely, high-quality diagnosis and treatment. Given the risk that improved diagnosis may counterintuitively drive apparent rising trends in incidence, these efforts should be coupled with improved data collection, which will also be crucial for understanding trends and developing targeted interventions. Bill and Melinda Gates Foundation.

Microbial dynamics, risk factors and outcomes of secondary pneumonia in critically ill patients with COVID-19: A multicenter retrospective cohort study

Secondary pneumonia has a significant clinical impact on critically ill patients with COVID-19. Considering potential geographic variations, this study explores the clinical implications of secondary pneumonia within East Asian populations. This multicenter, retrospective cohort study enrolled critical COVID-19 patients requiring intensive care units (ICUs) admission in Taiwan from December 31, 2020, to June 1, 2022. Among the 187 critical COVID-19 patients, 80 (42.8%) developed secondary pneumonia. The primary causative pathogens were gram-negative bacilli (GNB) (76.8%). Gram-positive cocci and fungi were mainly observed during the initial two weeks of ICU stay. Notably, the incidence of pulmonary aspergillosis was 9.2% during the first week of ICU stay and all Staphylococcus aureus were susceptible to methicillin. Multi-drug resistant organisms (MDROs) were responsible for 28.3% of the cases, exhibiting significantly longer ICU stays compared to the non-MDRO group (median, 27 vs. 14 days, P<0.001). In the multivariate analysis, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores were associated with a significantly increased risk of secondary pneumonia. In-hospital mortality was significantly higher in patients with secondary pneumonia than in those without (37.7% vs. 16.7%, P=0.02) and survival analysis demonstrated gram-negative bacilli-related secondary pneumonia contributed to a worse prognosis. Secondary pneumonia in critical COVID-19 patients significantly raised in-hospital mortality and extended hospital and ICU stays. Moreover, the presence of GNB notably predicted an unfavorable prognosis.

District-level Epidemiology and Sociodemographic Determinants of Noncommunicable Diseases (NCDs)- Results the National Family Health Survey -5 (2019-21).

BackgroundNoncommunicable diseases (NCDs) are the leading cause of adult mortality in India. However, the data regarding the prevalence of NCD risk factors at district level is scarce. This study aims to analyse and map NCD risk factors at the state and district levels, exploring sociodemographic influences on these risks in Indian males and females. MethodsWe analysed National Family Health Survey-5 database and used the prevalence estimates to create choropleth maps, enabling us to examine the geographical variations in NCD risk factors at the district level in India. ResultsDistricts in the Satluj-Yamuna plains, western Rajasthan, and the northeastern regions exhibited clusters with a prevalence of high blood pressure exceeding 30.1%. Northeastern districts showed over 40% prevalence of current tobacco use, while high alcohol consumption clusters were observed in the northeastern and Telangana districts. Southern districts showed clusters of both obesity (as measured by BMI) and highest rates of oral, breast, and cervical cancer screening, moreover districts in Tamil Nadu exhibited notable clusters of raised blood glucose prevalence. ConclusionOur analysis revealed variations in the prevalence of NCD risk factors at both the state and district levels. Accordingly, this study ranks districts based on the NCD burden, offering valuable insights to state and district teams to devise targeted measures for the prevention and control of NCDs, particularly in the most heavily affected districts.

Unequal geographies of gender-affirming care: A comparative typology of trans-specific healthcare systems across Europe

RationaleGender-affirming healthcare can carry significant benefits for trans people. However, there are substantial geographical inequalities in the provision of and access to trans-specific healthcare across Europe. Comparative healthcare systems research has typically focused on universal services, neglecting provision which serves specific groups within populations (e.g., trans people). ObjectiveThis study aimed to develop a comparative typology of trans-specific healthcare systems across 28 European countries (the EU 27 plus the UK), and to examine country-level correlates which may influence or be influenced by these systems. MethodsUsing hierarchical and k-means cluster analysis, countries were classified into four types based on measures of trans-specific healthcare provision, regulation and access. Possible country-level correlates (including socio-political climate, medical outcomes and the general healthcare system) were investigated. Results and discussionThe cluster analysis identified four clusters of trans-specific healthcare systems in Europe, characterized as: 1) Centralized conservative (highly centralized, extensive range of treatments, few trans-specific government policies); 2) Centralized reformist (highly centralized, extensive range of treatments, multiple trans-specific government policies); 3) Decentralized marketized (highly decentralized, moderate range of treatments, few trans-specific government policies); 4) Underdeveloped (highly decentralized, limited range of treatments, few or no trans-specific government policies). We found statistically significant differences between the clusters in rates of: public support for trans people; gender identity concealment; treatment access; overall health expenditure; gender inequality. ConclusionsThe study develops a novel typology of trans-specific healthcare systems in Europe. It also identifies a range of potential drivers and outcomes of geographical divergences and inequalities in trans-specific healthcare provision. Building on this typology, future comparative research should aim to link the structure of healthcare systems to outcomes for trans people. Comparative healthcare systems research must account for the distinctive forms taken by services and systems that provide healthcare to specific groups within populations.

Prevalence, intensity, and attachment sites of larval mites (Acari: Erythraeidae) infesting Erginulus clavotibialis, a Neotropical harvestman (Opiliones: Cosmetidae) from Belize

Larval erythraeid mites of the genus Leptus Latreille, 1796 are common ectoparasites of terrestrial arthropods, including harvestmen (Order Opiliones). In this study, we investigated sexual, ontogenetic, and geographic variation in infestations of the Neotropical cosmetid harvestmen Erginulus clavotibialis (Cambridge, 1904) by larval mites across multiple sampling locations in Belize. We did not observe any significant differences in the prevalence or intensity of mite infestation with respect to sex of the host or between juveniles and adults. However, there was significant variation in the prevalence of infestation between field sites, varying from 18-71%. The overall mean intensity of infestation was 3.2 mites/host. Larval mites exhibited a non-random distribution with respect to attachment sites, with significantly more mites occurring on femur IV. Larval mites were absent from the tarsi of the walking legs and were rarely observed attached to the pedipalps or chelicerae of the harvestmen. Of the ten mites attached to hosts that were examined with SEM, six larvae were found in close association to abandoned attachment cones.