National-level Data Research Articles

Association of COVID-19 Vaccine Intake with Diagnosis, Hospitalization, and Oxygenation/Ventilation: A Longitudinal Analysis, 2021–2022, Japan

Background/Objectives: Japan’s COVID-19 vaccination campaign achieved high coverage by 2022, yet limited national-level data has hindered evaluations of vaccine effectiveness. This study analyzed the impact of vaccines on infection outcomes while considering socioeconomic and behavioral factors in the Japanese population. Methods: A total of 19,482 individuals aged 16–81 years, who participated in both the 2021 (baseline) and 2022 (follow-up) waves of an Internet-based survey, were analyzed. Vaccine intake during the follow-up period (0/1/2+ doses) served as the exposure, while outcomes included COVID-19 diagnosis, hospitalization, and receipt of oxygenation/ventilation. Adjusted prevalence ratios (APRs) were calculated using Poisson regression models, controlling for baseline characteristics such as vaccination status, infection history, underlying medical conditions, socioeconomic factors, and preventive behaviors. Results: Overall, 81.6% of respondents received at least 1 dose of COVID-19 vaccine during the follow-up period. Among those without COVID-19 history at baseline (N = 19,182), 10.9% were diagnosed with COVID-19 in the past year, and 6.6% in the past 2 months. Respondents who received 1 or 2+ doses had lower diagnosis rates (APR = 0.76 and 0.43, respectively). For the past 2 months, only those with 2+ doses showed a significant reduction (APR = 0.51). Among 1999 diagnosed cases, those with 1 or 2+ doses showed lower hospitalization and oxygenation/ventilation likelihoods, though these differences were not statistically significant. Conclusions: The results supported the protective effect of COVID-19 vaccines against infection. Continued research is essential to further clarify the complex influence of vaccination, individual characteristics, and preventive behaviors on COVID-19 morbidity at the population level.

Designing and Validating a Survey for National-Level Data During the COVID-19 Pandemic in Sri Lanka: Cross-Sectional Mobile Phone Surveys

Background The COVID-19 pandemic has generated a demand for timely data, resulting in a surge of mobile phone surveys for tracking the impacts of and responses to the pandemic. Mobile phone surveys have become a preferred mode of data collection across low- and middle-income countries. Objective This study piloted 2 population-based, cross-sectional mobile phone surveys among Sri Lankan residents in 2020 and 2021 during the COVID-19 pandemic. The surveys aimed to gather data on knowledge, attitudes, and practices, vaccine acceptability, availability, and barriers to COVID-19 testing, and use of a medicine distribution service. Methods The study used Surveda, an open-source survey tool developed by the NCD (noncommunicable disease) Mobile Phone Survey Data 4 Health Initiative, for data collection and management. The surveys were conducted through interactive voice response using automated, prerecorded messages in Sinhala, Tamil, and English. The sample design involved random sampling of mobile phone numbers, stratified by sex, proportional to the general population. Eligibility criteria varied between surveys, targeting adults aged 35 years and older with any noncommunicable disease for the first survey and all adults for the second survey. The data were adjusted to population estimates, and statistical analysis was conducted using SAS (SAS Institute) and R software (R Core Team). Descriptive statistics, Rao-Scott chi-square tests, and z tests were used to analyze the data. Response rates, cooperation rates, and productivity of the sampling approach were calculated. Results In the first survey, n=5001, the overall response rate was 7.5%, with a completion rate of 85.6%. In the second survey, n=1250, the overall response rate was 10.9%, with a completion rate of 61.9%. Approximately 3 out of 4 adults reported that they avoided public places (888/1175, 75.6%), more than two-thirds avoided public transportation (808/1173, 68.9%), and 9 out of 10 practiced physical distancing (1046/1167, 89.7%). Approximately 1 out of 10 Sri Lankan persons reported being tested for COVID-19, and the majority of those received a polymerase chain reaction test (112/161, 70%). Significantly more males than females reported being tested for COVID-19 (98/554, 17.8% vs 61/578, 10.6%, respectively; P<.001). Finally, the majority of adult Sri Lankan people reported that they definitely or probably would get the COVID-19 vaccination (781/1190, 65.7%). Conclusions The surveys revealed that, overall, the adult Sri Lankan population adhered to COVID-19 mitigation strategies. These findings underscore the use of mobile phone surveys in swiftly and easily providing essential data to inform a country’s response during the COVID-19 pandemic, obviating the need for face-to-face data collection.

The Impact of National Big Data Pilot Zones on the Persistence of Green Innovation: A Moderating Perspective Based on Green Finance

Enhancing the persistence of corporate green innovation is crucial for promoting sustainable societal development. As big data technologies and related policies advance, digitalization emerges as an effective enabler of green innovation in enterprises. This study, grounded in resource-based theory and corporate ecology theory, examines the impact of national-level big data pilot zone reforms on the persistence of corporate green innovation, utilizing data from China’s A-share-listed companies from 2011 to 2021. It also explores the moderating effect of green finance development. Empirical results indicate that (1) the implementation of national-level big data pilot zones positively influences the persistence of green innovation, with robustness and endogeneity tests confirming these findings. (2) The development of regional green finance positively moderates this relationship. (3) A mediation analysis reveals that national-level big data policies enhance innovation persistence by alleviating financing constraints, promoting talent aggregation, and facilitating industrial upgrading. (4) The heterogeneity analysis shows that the positive impact of these reforms is more pronounced in non-state-owned, non-heavy polluting firms, those receiving high subsidies, and in regions with stringent environmental regulations. This study offers a novel theoretical perspective on and empirical evidence for digital transformation from the angle of national policy, supporting societal green development and contributing to policy enhancement aimed at achieving sustainable growth.

Epidemiological characterization of rare diseases in Brazil: A retrospective study of the Brazilian Rare Diseases Network

BackgroundThe Brazilian Policy for Comprehensive Care for People with Rare Diseases was implemented in 2014; however, national epidemiological data on rare diseases (RDs) are scarce and mainly focused on specific disorders. To address this gap, University Hospitals, Reference Services for Neonatal Screening, and Reference Services for Rare Diseases, all of which are public health institutions, established the Brazilian Rare Diseases Network (RARAS) in 2020. The objective of this study was to perform a comprehensive nationwide epidemiological investigation of individuals with RDs in Brazil. This retrospective survey collected data from patients receiving care in 34 healthcare facilities affiliated with RARAS in 2018 and 2019.ResultsThe survey included 12,530 participants with a median age of 15.0 years, with women representing 50.5% of the cohort. Classification according to skin color demonstrated that 5044 (47.4%) participants were admixed. Most had a confirmed diagnosis (63.2%), with a predominance of phenylketonuria (PKU), cystic fibrosis (CF), and acromegaly. Common clinical manifestations included global developmental delay and seizures. The average duration of the diagnostic odyssey was 5.4 years (± 7.9 years). Among the confirmed diagnoses, 52.2% were etiological (biochemical: 42.5%; molecular: 30.9%), while 47.8% were clinical. Prenatal diagnoses accounted for 1.2%. Familial recurrence and consanguinity rates were 21.6% and 6.4%, respectively. Mainstay treatments included drug therapy (55.0%) and rehabilitation (15.6%). The Public Health System funded most diagnoses (84.2%) and treatments (86.7%). Hospitalizations were reported in 44.5% of cases, and the mortality rate was 1.5%, primarily due to motor neuron disease and CF.ConclusionThis study marks a pioneering national-level data collection effort for rare diseases in Brazil, offering novel insights to advance the understanding, management, and resource allocation for RDs. It unveils an average diagnostic odyssey of 5.4 years and a higher prevalence of PKU and CF, possibly associated with the specialized services network, which included newborn screening services.

Digital health divide in Indonesia: evidence from national-level data

Abstract Indonesia is a country in south-east Asia with a diverse population and context underlined by its geographical condition as an archipelagic country. Due to closer proximity to the capital, the Western regions (e.g., provinces in Sumatra and Java islands) are relatively more developed than the central and eastern parts of Indonesia (e.g., Nusa Tenggara, Sulawesi, and Papua). In the last few years, the country started to embrace digital transformation for public services including the health sector. Accelerated by the COVID-19 pandemic, a proliferation of digital health services through for example the use of telehealth and health apps is now considered important to improve access and availability of health services, especially among marginalized and hard-to-reach populations. Nonetheless, the difference in access to information and technology infrastructure and services as well as in the level of digital literacy across different regions in Indonesia may perpetuate the existing inequity in access to health services. In 2022, data from the Indonesian Central Bureau of Statistics showed that the level of internet access in Indonesia’s capital Jakarta has reached 85%, while the level in the eastern part of Indonesia (i.e., Papua) is only 26%. Similarly, the level of internet access in the Western provinces tend to be higher than their Eastern counterparts. Additionally, a survey performed by the Ministry of Communication and Informatics to assess the level of digital literacy in Indonesia shows that 85% out of 10,000 respondents accessed the internet through smartphones. However, almost all respondents encounter problems when accessing the internet, especially regarding network quality which causes unstable and frequent connections disconnected. In addition, the level of digital literacy varies across different regions, with the Western region performing better than other regions (e.g., digital literacy index of 3.64 in Yogyakarta vs 3.55 in Papua in 2022).

Illustrating the Anticipate, Recruit, Retain, Adapt, Sustain (ARRAS) Framework for Surge Capacity. How Bangladesh, Sri Lanka, and Nepal Maintained Their Health Workforce During COVID-19.

Surge capacity-the ability to acquire additional workers and resources during unexpected increases in service demand-is often perceived as a luxury. However, the COVID-19 pandemic necessitated an urgent expansion of surge capacity within health systems globally. Health systems in Bangladesh, Nepal, and Sri Lanka managed to scale up their capacities despite severely limited budgets. This study employs a mixed-methods approach, integrating qualitative interviews with quantitative data analysis, to propose a comprehensive framework for understanding Human Resources for Health (HRH) surge capacity from 2018 to 2021, termed ARRAS: Anticipate, Recruit, Retain, Adapt, Sustain. We present national-level data to demonstrate how each country was able to maintain their per capita health care workforce during the crisis. Interviews with key informants from each country reinforce the ARRAS framework. Quantitative data revealed ongoing increases in doctors and nurses pre- and post-pandemic, but no country could rapidly expand its health workforce during the crisis. Qualitative findings highlighted critical strategies such as pre-crisis planning, financial incentives, telemedicine, and re-skilling the workforce. Despite adaptive measures, challenges included inadequate funding, poor data systems, and coordination issues. This study underscores the necessity for robust, long-term strategies to enhance surge capacity and better prepare health systems for future crises.

Bilateral value chain reshaping through regional trade agreements deepening: Evidence from belt and road countries

This paper investigates the impact of Regional Trade Agreements (RTAs) on the reshaping of value chains from both domestic and regional perspectives by using national-level data from the Belt and Road countries. The findings indicate that the depth of RTAs among Belt and Road countries can not only enhance regional integration characterized by regional value chain inter-connections and promote the value chain upgrading of trading partners in the regional production system, but also facilitates the construction of domestic value chains, thus forming a new pattern of bilateral value chain reshaping. The conclusions still hold after addressing the potential endogeneity and robustness concerns. Mechanism test results show that the effects of productivity enhancement and institutional quality improvement are important channels for RTAs-deepening to promote value chain reshaping. Heterogeneity test results indicate that ‘WTO-X’ provisions of RTAs are more conducive to promoting value chain reshaping, and the promoting effect of RTAs-deepening on value chain reshaping is more significant for the manufacturing industry. These findings have important policy implications to further expand high-level opening-up, deepen RTAs provisions and actively participate in global governance.

The Size of Transactions, Types of Products, and the Choice Between Electronic Payments and Cash Usage

Fueled by recent policy advancements and technological progress, India’s digital payment system is on the verge of becoming a noteworthy success story. Concurrently, data also highlights the continued reliance on cash. While broad national-level data can provide insights into overall citizen preferences, we utilize a survey-based data-set to gain insight into how factors such as ’transaction size,’ ’nature of the product,’ ’consumer perception,’ ’trust’ in digital payments, and the costs associated with digital transactions influence consumer payment behavior. While demographic factors like age and income play a role in these choices, we discover compelling evidence that an individual’s choice of digital payment methods is strongly shaped by their perception of these options, transaction size, trust, associated costs, and the product category. Notably, we observe that as transaction size increases, the use of digital payment methods tends to decrease.

The impact of environmental shocks due to climate change on intimate partner violence: A structural equation model of data from 156 countries

The impact of climate change on human societies is now well recognised. However, little is known about how climate change alters health conditions over time. National level data around climate shocks and subsequent rates of intimate partner violence (IPV) could have relevance for resilience policy and programming. We hypothesise that climate shocks are associated with a higher national prevalence of IPV two years following a shock, and that this relationship persists for countries with different levels of economic development. We compiled national data for the prevalence of IPV from 363 nationally representative surveys from 1993 to 2019. These representative data from ever-partnered women defined IPV incidence as any past-year act of physical and/or sexual violence. We also compiled data from the Emergency Events Database (EM DAT) on the national frequency of eight climate shocks from 1920 to 2022 within 190 countries. Using exploratory factor analysis, we fit a three-factor latent variable composed of climate shock variables. We then fit a structural equation model from climate shocks (lagged by two years) and IPV incidence, controlling for (log) national gross domestic product (GDP). National data representing 156 countries suggest a significant relationship between IPV and a climate factor (Hydro-meteorological) composed of storms, landslides and floods (standardised estimate = 0·32; SE = 0·128; p = 0·012). GDP has a moderately large cross-sectional association with IPV (estimate = -0·529; SE = 0·047; p = 0·0001). Other climate shocks (Geological: earthquakes/volcanos; Atmospheric: wildfire/droughts/extreme temperature) had no measurable association with IPV. Model fit overall was satisfactory (RMSEA = 0·064 (95%CI: 0·044–0·084); CFI = 0·91; SRMR = 0·063). Climate shocks have a longitudinal association with IPV incidence in global population-based data. This suggests an urgent need to address the higher prevalence of IPV likely to come about through climate shocks due to climate change. Our analysis offers one way policy makers could track national progress using existing data.

Gender Harassment and Women Entrepreneur: Special Reference to Agartala Municipal Area

Gender Harassment it’s not a simple matter for our society. It may simple for those people who do not face this kind of problem in their life. But according to national Level data out of five women one woman facing this kind of situation in their life. Now questions arise in our mind what is called Gender Harassment? Gender Harassment means any kind of bad behaviors towers women which are related to social, economic, political, sexual issues etc are called Gender Harassment. As a result of Gender Harassment Feelings of low self-esteem, self-blame and guilt can bear for months. Another thing is that Entrepreneur; Entrepreneur means the people who are basically motivated to do something which may fulfill his or her financial needs. The growing of number of subsistence of women as entrepreneurs has led to significant business and financial growth in the country. Women-owned productions enterprises are playing a important role in society by generate employment opportunities in the country. By means of a vision to promote the sustainable development of women entrepreneurs for impartial growth in the country, Startup India is devoted towards raise women entrepreneurship in India. Today we are talking about the women entrepreneurship but there have so many obstruggle for the upliftment of them. One of it is Gender Harassment towards women or girls. The present study are basically trying to focusing how the impact of Gender Harassment on women entrepreneur in Tripura at Agartala.

Abstract C139: Cancer related excess death and potential life years lost among Black Americans

Abstract Introduction: Cancer represents the second leading cause of death in the United States and disproportionately affects Black Americans. In recent years, cancer-related mortality rates have declined for both Black and White Americans. However, mortality rates and rate ratios alone are insufficient for characterizing the burden of cancer disparities between racial groups. Among the most prevalent cancers in the US, we evaluated trends in excess mortality and years of potential life lost between Black and White Americans. Methods: This was a serial cross-sectional study using US national level data from CDC Wonder between the years 1999-2020. We included White and non-Hispanic Black Americans with a cause of death from breast, prostate, lung, colon, bladder, or uterine cancer. We measured age-adjusted excess death as well as excess years of potential life lost for each cancer site among Black and White Americans, stratified by sex when applicable. Annual mortality rates for each cancer site were sourced from the CDC Cancer Statistic Data Visualization tool. Results: The age adjusted mortality rate for all cancers declined between 1999-2020 for Black (257.2 to 166.8 per 100,000) and White Americans (200.9 to 149.3 per 100,000). Site specific cancer mortality rates declined in Black and White Americans for breast, prostate, lung, colon, and bladder cancer, but increased for uterine cancer. Among the most prevalent cancer sites, there were a total of 115,43 excess deaths with 2,093,327 excess years potential life lost for Black men and 59,134 excess deaths with 1,508,052 excess years potential life lost for Black women over a 22-year period. The trend of annual excess death and years potential life lost has slowly increased for Black men with colon cancer as well as Black women with breast and uterine cancer. Annual excess death and years potential life lost in Black men with prostate cancer decreased until 2013 after which it has slowly increased. Conclusion: Despite declining mortality rates in most cancers in the United States, Black Americans still experience a staggering number of excess deaths and years potential life lost due to cancer. Furthermore, the discordance between declining mortality rates and increasing excess death or years potential life lost in breast, prostate, colon, and uterine cancer highlight that racial disparities in cancer care and outcomes are likely worsening among Black Americans. Action is needed to support interventions and organizations committed to addressing cancer health inequities among Black Americans. Citation Format: Daniel S. Carson, Navya Gunaje, Sarah K. Holt, Nana Frimpong, Jenney R. Lee, Liz Sage, Erika M Wolff, Yaw A. Nyame. Cancer related excess death and potential life years lost among Black Americans [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C139.

Post-pandemic increase in invasive group A strep infections in New Zealand

BackgroundSince October 2022, multiple high-income countries have reported an increase in invasive group A streptococcal (iGAS) infections. This study describes trends in iGAS infections in Aotearoa New Zealand (NZ) between 2017 and 2023, and examines associations of iGAS incidence, COVID-19 eras, and acute respiratory infections (ARI). MethodsAnalyses include national-level surveillance data on iGAS and ARI. Multivariable Poisson regression was used to examine relationships between COVID-19 era and iGAS incidence, and Pearson pairwise correlations were calculated to examine trends between ARI and iGAS. FindingsA sharp increase in iGAS was observed in 2023, with notable increases among children aged under ten years. Indigenous Māori and Pacific peoples were disproportionately affected. emm1 and emm12 were commonly reported in 2022–2023. Compared to pre-pandemic, iGAS decreased significantly during the COVID-19 restrictions era and increased once COVID-19 restrictions were relaxed, after adjusting for ethnicity, sex, and age. ARI was moderately correlated with iGAS (r = 0∙55) in 2022–2023. InterpretationThough delayed, NZ’s recent iGAS trends mirror those seen in the 2022/2023 multi-country iGAS surge. These findings expand existing research, suggesting a link between the easing of COVID-19 measures, increased ARI circulation, and the rise in iGAS. Continued and improved iGAS surveillance, is needed to better understand iGAS epidemiology and support public health response. iGAS in NZ will become notifiable in late 2024, which should help improve iGAS monitoring and support public health response. FundingThis research received no specific funding, though iGAS surveillance and typing in NZ is funded by the Ministry of Health, which was not involved in the analysis, interpretation, design, or any aspect of this study. No authors were paid to write this manuscript.

Racial, Ethnic, and Socioeconomic Disparities in Meeting Physical Activity Guidelines among Female Breast Cancer Survivors in the United States.

Cancer survivors show low physical activity participation rates in the U.S. However, there are limited national-level data on disparities in the prevalence of meeting physical activity guidelines among women with and without breast cancer. We aimed to evaluate national-level trends in meeting physical activity guidelines across demographic and socioeconomic characteristics of breast cancer survivors and women without cancer. Data for women aged ≥35-years with and without breast cancer were obtained from the 2004-2018 National Health Interview Survey (NHIS). We used NHIS survey weights to generate national-level prevalence estimates and calculate absolute and relative indices of disparity for breast cancer survivors and women without cancer meeting aerobic (150-mins/week) and muscle strengthening guidelines (2-sessions/week) stratified by demographic (e.g., race/ethnicity) and socioeconomic (e.g., homeownership) characteristics. We included 5,845 breast cancer survivors and 160,162 women without cancer. The weighted percentage of breast cancer survivors meeting aerobic guidelines was 37.7% compared to 40.9% of women without cancer. Fewer women met muscle strengthening guidelines. There were lower proportions of women who were younger (<50-years), were non-Hispanic Black, were Hispanic, worked 35+ hours/week, or rented their home among breast cancer survivors meeting aerobic guidelines compared to women without cancer meeting aerobic guidelines. Breast cancer survivors were less likely to meet physical activity guidelines compared to women without cancer. Demographic and socioeconomic disparities may exist among breast cancer survivors and women without cancer meeting physical activity guidelines. Targeted interventions may be necessary to address low physical activity participation among breast cancer survivors.

Israeli neonatal herpes simplex infection: Unique epidemiology and clinical profile

AbstractTo gather national level data on Israeli neonatal HSV (NHSV) infection and to evaluate the distinct clinical characteristics of NHSV and neonatal enteroviral meningitis (NEM). Israeli NHSV patients, hospitalized between January 2015 and April 2022 in 22 medical centers were assessed, together with NEM patients, hospitalized at Sheba Medical Center during the same period. NHSV demographic and clinical characteristics were documented and compared to those of NEM. Eighty‐five NHSV (73% males) and 130 NEM (62% males) patients were included. The incidence of NHSV was 5.9/100 000 live births, the common phenotype and HSV type were SEM (53%) and HSV1 (91%), respectively. Horizontal transmission was suspected in 50% cases (of which 67% underwent a Jewish ritual circumcision with direct wound sucking, 33% had relatives with highly suspicious herpetic lesions). Compared with NEM, NHSV tends to present with rash (14% vs. 60%, p‐value &lt; 0.01) and seizures (0% vs. 6%, p‐value 0.02), while fever, irritability and poor feeding appear more frequently in NEM (94% vs. 18%, p‐value &lt; 0.01; 37% vs. 1%, p‐value &lt; 0.01; 25% vs. 1%, p‐value &lt; 0.01 respectively). Of NEM patients, 28% were treated with acyclovir. Our results mark a decrease in the incidence rate of NHSV in Israel and a prominent mode of horizontal infection acquisition. We underscore the unique localized phenotype of NHSV, in contrast to enterovirus, which tends to cause a systemic disease with constitutional symptoms. These findings should be considered when evaluating the need for comprehensive empirical treatment for HSV in the context of neonatal fever, or according to a certain clinical presentation.

Post-vaccination, post-infection and hybrid immunity against severe cases of COVID-19 and long COVID after infection with SARS-CoV-2 Omicron subvariants, Czechia, December 2021 to August 2023.

BackgroundCOVID-19 remains a major infectious disease with substantial implications for individual and public health including the risk of a post-infection syndrome, long COVID. The continuous changes in dominant variants of SARS-CoV-2 necessitate a careful study of the effect of preventative strategies.AimWe aimed to estimate the effectiveness of post-vaccination, post-infection and hybrid immunity against severe cases requiring oxygen support caused by infections with SARS-CoV-2 variants BA1/2 and BA4/5+, and against long COVID in the infected population and their changes over time.MethodsWe used a Cox regression analysis with time-varying covariates and calendar time and logistic regression applied to national-level data from Czechia from December 2021 until August 2023.ResultsRecently boosted vaccination, post-infection and hybrid immunity provide significant protection against a severe course of COVID-19, while unboosted vaccination more than 10 months ago has a negligible protective effect. The post-vaccination immunity against the BA1/2 or BA4/5+ variants, especially based on the original vaccine types, appears to wane rapidly compared with post-infection and hybrid immunity. Once infected, however, previous immunity plays only a small protective role against long COVID.ConclusionVaccination remains an effective preventative measure against a severe course of COVID-19 but its effectiveness wanes over time thus highlighting the importance of booster doses. Once infected, vaccines may have a small protective effect against the development of long COVID.

Obstructive Sleep Apnea Is Associated with Worsened Hospital Outcomes in Children Hospitalized with Asthma.

Studies have shown a bidirectional relationship between asthma and obstructive sleep apnea (OSA). However, there is a paucity of national-level data evaluating the impact of OSA on hospital outcomes in pediatric hospitalizations for asthma. We analyzed the National Inpatient Sample and Kids Inpatient Database to include all pediatric hospitalizations with a primary diagnosis of asthma between 2003-2016. Using ICD codes, the pediatric asthma cohort was divided into two groups: those with and those without a concomitant diagnosis of OSA. The primary outcomes were in-hospital mortality and the need for mechanical ventilation. The secondary outcomes were the lengths of each hospital stay and total hospitalization charges. We analyzed 1,606,248 hospitalizations during the 14-year study period. The overall prevalence rate of OSA was 0.7%. Patients with asthma and OSA were significantly older (8.2 versus 5.9 years) and were more often male, p < 0.001. The OSA group had several increased comorbidities. The overall mortality rate was 0.03%, and multivariate regression analysis showed that OSA was associated with 4.3 times higher odds of in-hospital mortality (95% CI: 2.4 to 7.6, p < 0.001). Furthermore, OSA was associated with a 5.2 times greater need for mechanical ventilation (95% CI: 4.8 to 5.5, p < 0.001). Linear regression analyses demonstrated that OSA independently contributed an additional 0.82 days to the hospital stay length (95% CI: 0.79 to 0.86, p < 0.001) and an extra 10,479 USD (95% CI: 10,110 to 10,848, p < 0.001) in hospitalization charges. OSA in children admitted with asthma is associated with poor hospital outcomes such as increased mortality risk, the need for mechanical ventilation, and increased healthcare utilization.

A Life-Stage Approach to Precision Nutrition: A Narrative Review.

The concept of precision nutrition highlights the customization of nutrition to specific needs, emphasizing that a one-size-fits-all approach is not sufficient for either optimal nutrition or optimal health. Precision nutrition encompasses a range of factors, from broad strata of age and sex categories to personal characteristics such as lifestyle to an individual's unique genotype. This breadth of scope requires us to consider how precision nutrition can be implemented in an inclusive and appropriate way for individuals and groups within real-life populations. In this narrative review, we explore the potential of precision nutrition through a life-stage approach that emphasizes age- and gender-specific nutritional needs as these change across the lifespan. Focusing on adult life stages, we delineated trends in age-related conditions and health needs among Korean adults based on national-level survey data (KNHANES 2019-2021). We also reviewed the intake of nutrients associated with these health needs to better understand how life-stage guided approaches to nutrition and supplementation could support optimal health. Looking beyond preventing deficiency or disease, we discuss how tailored supplementation of essential vitamins, minerals, and certain bioactive substances could promote healthy functioning. Finally, we discuss the complexities and challenges of developing multivitamin/multimineral supplements (MVMS) to support life-stage appropriate nutrition while maximizing adherence. Future prospects include leveraging advancements in intelligent technologies and dietary assessments for tracking nutrient intake and health indicators and using these to optimize MVMS formulations in ways that are sensitive to a person's needs and priorities/preferences at different life stages. By adopting a life-stage guided approach to nutrition, we can better support health and well-being across the lifespan.

Exploring the interplay between social distancing, innovation adoption, and privacy concerns amid the COVID-19 crisis

Abstract Using the case of coronavirus disease-2019 (COVID-19) as a natural experiment, this study discusses how innovation policy should be designed in times of crisis when public interest and privacy concerns collide. For this purpose, the causal relationship between social distancing enforcement and innovation adoption in consideration of privacy concerns is explored by using national-level survey data. Our key findings from econometric analysis are as follows: first, the implementation of social distancing policies leads to an increase in the adoption of wearable devices. Second, the strengthening of social distancing has caused a decrease in individual privacy concerns. Finally, a decrease in individual privacy concerns leads to an increase in wearable device adoption. Social distancing during the COVID-19 not only accelerated innovation adoption but also led a decrease in privacy concerns. Our results suggest that government should play a role in safe guarding public privacy when individuals may let their guard down during times of crises.

Trends in traffic accident mortality and social inequalities in Ecuador from 2011 to 2022

BackgroundTraffic accidents (TA) remain a significant global public health concern, impacting low—and middle-income countries. This study aimed to describe the trend in TA mortality and inequalities in Ecuador for 2011–2022, distributed by year, gender, age group, geographical location, type of accident, and social inequalities.MethodsAn ecological study was conducted using INEC national-level data on TA fatalities in Ecuador. Mortality rates were calculated per 100,000 population and analyzed by year, gender, age group, geographic region, and accident type. Annual percentage variation (APV) was determined using linear regression models. Inequality analyses examined associations between TA mortality and socioeconomic factors like per capita income and literacy rates. Complex measures such as the Slope Inequality Index (SII) were calculated to assess the magnitude of inequalities.ResultsThere were 38,355 TA fatalities in Ecuador from 2011 to 2022, with an overall mortality rate of 19.4 per 100,000 inhabitants. The rate showed a non-significant decreasing trend (APV − 0.4%, p = 0.280). Males had significantly higher mortality rates than females (31.99 vs. 7.19 per 100,000), with the gender gap widening over time (APV 0.85%, p = 0.003). The Amazon region had the highest rate (24.4 per 100,000), followed by the Coast (20.4 per 100,000). Adults aged ≥ 60 years had the highest mortality (31.0 per 100,000), followed by those aged 25–40 years (28.6 per 100,000). The ≥ 60 age group showed the most significant rate decrease over time (APV − 2.25%, p < 0.001). Pedestrians were the most affected group after excluding unspecified accidents, with a notable decreasing trend (APV − 5.68%, p < 0.001). Motorcyclist fatalities showed an increasing trend, ranking third in TA-related deaths. Lower literacy rates and per capita income were associated with higher TA mortality risks. Inequality in TA mortality between provinces with the highest and lowest per capita income increased by 247.7% from 2011 to 2019, as measured by the SII.ConclusionWhile overall TA mortality slightly decreased in Ecuador, significant disparities persist across demographic groups and geographic regions. Older adults, males, pedestrians, and economically disadvantaged populations face disproportionately higher risks. The increasing trend in motorcycle-related fatalities and widening socioeconomic inequalities are particularly concerning.

Estimating the magnitude and healthcare costs of melanoma in situ and thin invasive melanoma overdiagnosis in Australia.

Research suggests a high proportion of melanoma in situ (MIS) may be overdiagnosed, potentially contributing to overtreatment, patient harm and inflated costs for individuals and healthcare systems. However, Australia-wide estimates of the magnitude of melanoma overdiagnosis are potentially outdated and there has been no estimation of the cost to the healthcare system. To estimate the magnitude and cost of overdiagnosed MIS and thin invasive melanomas in Australia. Using two different methods for calculating lifetime risk, we used routinely collected, national-level data to estimate overdiagnosed MIS and thin invasive melanomas (stage IA) in Australia in 2017 and 2021, separately for men and women. We multiplied the number of overdiagnosed melanomas by the estimated annual cost of a MIS or thin invasive melanoma to quantify the financial burden of melanoma overdiagnosis to the Australian healthcare system in the year following diagnosis. We estimated that between 67-70% of MIS were overdiagnosed in 2017, rising to 71-76% in 2021, contributing to between 19,829 (95%CI: 19,553-20,105) and 20,811 (95%CI: 20,528-21,094) overdiagnosed MIS. In 2021, the estimated costs in Australia ranged between $17.7 million (95%CI: $17.4-17.9 million) and $18.6 million (95%CI: $18.3-18.8 million). We estimated that 22-29% of thin invasive melanomas were overdiagnosed in 2017, rising to 28-34% in 2021, contributing to between 2,831 (95%CI: 2,726-2,935) and 3,168 (95%CI: 3,058-3,279) overdiagnosed thin invasive melanomas. In 2021, the estimated costs from thin invasive melanoma overdiagnoses ranged between $2.5 million (95%CI: $2.4-2.6 million) and $2.8 million (95%CI: $2.7-2.9 million). Melanoma overdiagnosis is a growing clinical and public health problem in Australia, producing significant economic costs in the year following overdiagnosis. Limiting melanoma overdiagnosis may prevent unnecessary healthcare resource use and improve financial sustainability within the Australian healthcare system.