Regional Variations Research Articles

Temporal and regional variation in the use of biologic and targeted synthetic DMARDs for rheumatoid arthritis: a nationwide cohort study.

To evaluate temporal and regional variation in biologic and targeted synthetic DMARD (b/tsDMARD) initiation for rheumatoid arthritis (RA) in England and Wales. An observational cohort study was conducted for people with RA enrolled in the National Early Inflammatory Arthritis Audit (NEIAA) between May 2018 and April 2022 who had 12-month follow-up data. Temporal trends in escalation to b/tsDMARDs within 12 months of initial rheumatology assessment were explored, including comparisons before and after publication (July 2021) of national guidelines that lowered the threshold for b/tsDMARD initiation to include moderate-severity RA. Case-mix-adjusted, mixed-effects regression was used to evaluate regional and hospital-level variation in b/tsDMARD initiation. Of 6,098 RA patients with available follow-up, 508 (8.3%) initiated b/tsDMARDs within 12 months of initial assessment. b/tsDMARD escalation increased marginally towards the end of the study period (9.2% in May 2021/22); however, no significant differences were evident after guidelines were published permitting b/tsDMARDs for moderate-severity RA. The proportion of individuals escalated to b/tsDMARDs varied considerably between regions, ranging from 5.1% in Wales to 10.7% in North-West England. Following case-mix adjustment, the intraclass correlation (ICC) for hospitals within regions was 0.17, compared with a between-region ICC of 0.0, suggesting that the observable regional variation reflected hospital-level differences rather than systematic differences between regions themselves. There is marked variation in escalation to b/tsDMARDs for people newly-diagnosed with RA throughout England and Wales, despite a universal healthcare system. These disparities must be addressed if we are to deliver equitable access to b/tsDMARDs, regardless of geography.

Sexually transmitted infections in the middle east and North Africa: comprehensive systematic review and meta-analysis

BackgroundGlobally, sexually transmitted infections (STIs) collectively cause 2.3 million deaths and 1.2 million cases of cancer annually. However, the epidemiology of STIs in the Middle East and North Africa (MENA) is not well assessed because of various social and cultural factors.MethodsA systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and covering 23 MENA countries, 19 STIs, and data from 20,435,971 participants. PubMed, Embase, regional and international databases, and country-level reports were searched up to May 2024.ResultsThe analysis revealed significant regional variations in the prevalence of STIs within the MENA region. In North Africa, the most common STIs were bacterial vaginosis (31%), human papillomavirus (HPV, 23%), and Candida spp. (15%). In the Gulf Cooperation Council region and Yemen, Ureaplasma (25%), nongonococcal urethritis (NGU, 16%), and Mycoplasma spp. (12%) were the predominant infections. In the Levant region, the top STIs were HPV (20%), hepatitis B virus (HBV, 9%), and Candida spp. (9%). In Iran, Ureaplasma spp. (18%), HPV (17%), and cytomegalovirus (8%) were the most prevalent infections, whereas Ureaplasma spp. (20%), Candida spp. (18%), and HPV (16%) were most frequently detected in Türkiye. Gender-based disparities were observed, with a higher prevalence of Ureaplasma spp., Neisseria gonorrhoeae, and herpes in men and higher rates of Mycoplasma spp., HPV, HBV, and Candida spp. in women. Overall, high rates of nongonococcal urethritis (16.3%), Ureaplasma spp. (13.7%), HPV (12.7%), and Candida spp. (9.4%) were recorded in the MENA region.ConclusionsMost MENA countries lack national STI screening programs, and the reported data are primarily from symptomatic individuals. Establishing robust surveillance systems, addressing stigma and barriers to healthcare access, and expanding STIs screening and vaccination programs are crucial for accurately capturing the true burden of STIs in MENA countries.

A systematic review on exploring the influence of Industry 4.0 technologies to enhance supply chain visibility and operational efficiency

This systematic review investigates the implications of Industry 4.0 technologies on supply chain visibility and operational efficiency. The primary aim is to discern the impact of technological integration on contemporary supply chain dynamics. Methods: A comprehensive search strategy identified 65 pertinent studies published between 2015 and 2023. The review adheres to systematic methodologies, employing the Critical Appraisal Skills Programme framework for quality assessment. Data synthesis incorporates qualitative and quantitative analyses to distill key themes and patterns. Results: The review unveils the pivotal role of information visibility in fortifying supply chain outcomes, emphasizing the need for a dual investment strategy encompassing technological solutions and a collaborative organizational culture. Regional variations in supply chain practices, insights from humanitarian supply chains, and the influence of environmental factors on agility broaden the understanding of Industry 4.0 implications. Organizations are urged to adopt a context-specific, adaptive approach, recognizing the significance of intangible assets and tailoring strategies to local contexts for optimal supply chain performance. This systematic review contributes a nuanced understanding of Industry 4.0’s transformative potential in supply chain management, emphasizing the interplay between technology, organizational culture, and regional contexts.

Two birds, one stone: minimum wage and child labor

PurposeThis paper investigates the impact of quasi-exogenous and substantial increases in the minimum wage on child labor outcomes in Türkiye. The study aims to provide empirical evidence on how minimum wage policies affect child labor outcomes in a developing country context, with a focus on gender and age differences. It seeks to understand whether minimum wage increases lead to a reduction in child labor and whether the impact is different for various demographic groups.Design/methodology/approachThe research employs a difference-in-differences methodology using data from the 2012 and 2019 Child Labor Force Survey in Türkiye. The treatment group consists of children from households with minimum wage earners, while the control group comprises children from other households. Various labor market outcomes are analyzed, and robustness checks are performed.FindingsOur findings indicate that while the overall effect of minimum wage increases on child labor is statistically insignificant, there are notable heterogeneous impacts across different demographic groups and employment sectors. Specifically, we observe a significant reduction in the employment probability of girls under the age of 15 and unpaid family workers. Additionally, the likelihood of younger children being wage earners decreases, and the minimum wage increase reduces employment in the agriculture and services sectors for certain subgroups. The impact is also more limited for children in single-adult-worker households.Social implicationsThese results underscore the varying effects of minimum wage policies on child labor and highlight the importance of considering demographic and sectoral differences in policy formulation. Policymakers should complement such policies with income-generating programs and targeted education initiatives to address child labor issues more comprehensively and sustainably.Originality/valueThis study fills a critical gap in the limited international literature on the causal effects of minimum wage policies on child labor incidence. One notable exception, Menon and van der Meulen Rodgers (2018) have explored the impact of minimum wage on child labor in India using regional variation, our study uniquely analyzes the effects at the household level in Türkiye. This approach provides valuable insights into how minimum wage changes affect child labor outcomes in a developing economy context with a high prevalence of minimum wage earners. It also contributes to the broader economic understanding of child labor and household income dynamics.

Comparative analysis of chloroplast genomes in ten holly (Ilex) species: insights into phylogenetics and genome evolution

In order to clarify the chloroplast genomes and structural features of ten Ilex species and provide insights into the phylogeny and genome evolution of the genus Ilex, we conducted a comparative analysis of chloroplast genomes using bioinformatics methods. The chloroplast genomes of ten Ilex species were obtained, and their structural features and variations were compared. The results indicated that all chloroplast genomes in the genus Ilex exhibit a double-stranded circular structure, with sizes ranging from 157,356 to 158,018 bp, showing minimal differences in size. The chloroplast genomes of the ten Ilex species have a relatively conservative gene count, with a total of 134 to 135 genes, including 88 or 89 protein-coding genes, and a conserved number of 8 rRNA genes. Each chloroplast genome contains 3 to 123 SSR (Simple Sequence Repeat) sites, predominantly composed of mononucleotide and trinucleotide repeats, with no detection of pentanucleotide or hexanucleotide repeats. The variation in dispersed repeat sequences among Ilex species is minimal, with a total repeat sequence number ranging from 1 to 14, concentrated in the length range of 30 to 42 base pairs. The expansion and contraction of chloroplast genome boundaries among Ilex species are relatively stable, with only minor variations observed in individual species. Variations in non-coding regions are more pronounced than those in coding regions, with the variability in the Large Single Copy region (LSC) being the highest, while the variability in the Inverted Repeat region A (IRa) is the lowest. The divergence time among Ilex species was estimated using the MCMC-tree module, revealing the evolutionary relationships among these species, their common ancestors, and their differentiation throughout the evolutionary process. The research findings provide a valuable reference for the systematic study and molecular marker development of Ilex plants.

In-depth analysis and trends of cancer mortality in Kazakhstan: a joinpoint analysis of nationwide healthcare data 2014–2022

BackgroundCancer remains a leading cause of death both globally and in Kazakhstan, making it crucial to track its mortality trends. This study aimed to investigate cancer mortality trends from 2014 to 2022 in Kazakhstan.MethodsThis study utilized data from Kazakhstan’s Unified National Electronic Health System to perform descriptive data analysis and employed Joinpoint regression models to analyze average annual percent change (AAPC) in cancer-related mortality estimates. The authors also examined the mortality-to-incidence ratio (MIR) and proportionate mortality (PM).ResultsThe study analyzed 123,622 cancer-related death reports from 2014 to 2022. Major causes included trachea, bronchus, and lung cancer (16.01%), stomach cancer (11.43%), and colon and rectum cancer (10.05%), accounting for 37.48% of all cancer-related deaths. AAPCs showed a significant increase in mortality for individuals aged 18–44 (1.36%; 95% CI: 0.05%; 2.71%), while those aged 45–59 and 60–74 experienced decreases of -2.02% (95% CI: -3.05%; -0.96%) and − 2.10% (95% CI:-3.22%; -0.96%), respectively. PM was stable until 2019 but decreased from 2020 to 2021, while MIR increased during the same period. A significant decrease in oesophageal cancer mortality was observed in both females (-4.03%; 95% CI: -6.11%; -1.83%) and males (-2.44%; 95% CI: -4.89%; -0.02%), whereas ovarian cancer mortality increased by 0.95% (95% CI: 0.03%; 1.91%). In males, mortality from trachea, bronchus, and lung cancers decreased by -2.14% (95% CI: -3.00%; -1.25%), while “other neoplasms” rose by 6.21% (95% CI: 1.40%; 11.27%). Regional analysis highlighted variability, with the Kyzylorda region showing a pronounced increase in mortality (27.18%; 95% CI: 14.11%; 42.35%).ConclusionsDespite slight increases in MIR during the COVID-19 pandemic, overall cancer mortality trends remained stable. The findings highlight the need for targeted interventions, especially for individuals aged 18–44, ovarian cancer, and “other neoplasms”. Further research is needed to explore regional mortality variations.

Environmental and Behavioral Determinants of Septicemia Mortality in Türkiye: A Ten-Year Analysis

This study examines the environmental and behavioral factors associated with variations in septicemia mortality rates across Turkish provinces. Province-level data spanning ten years were analyzed using ordinal logistic regression modeling to determine the predictors of septicemia mortality. Environmental factors such as humidity, temperature, and air pollutants, along with behavioral aspects including alcohol consumption, were evaluated. Analysis of the provided data revealed significant regional variations in septicemia mortality rates across areas with diverse environmental and social characteristics. Higher median humidity and stable environmental conditions (low variability in humidity and temperature) correlated with reduced mortality rates. Alcohol consumption was identified as a risk factor, moderately increasing the risk of septicemia mortality. The findings highlight the intricate relationship between environmental stability, personal behaviors, and septicemia outcomes. The study accentuates the need for targeted public health strategies and suggests that mitigating environmental risks and fostering healthy behaviors could effectively reduce septicemia mortality. Further studies should focus on individual-level data and explore the relationship between these factors in different climatic conditions.

Modern management model for KAREB Bojonegoro cooperative: Integration of ABM, lean six sigma, and RBV and TPB approaches

In global business competition, ABM helps cooperatives such as KAREB Bojonegoro Cooperative achieve cost efficiency without sacrificing quality. KAREB Cooperative's expenditure is very high, reaching IDR158.82 billion in five years, with the main costs on fuel, labor, and maintenance. Optimizing expenditure and cost management is important to reduce waste, increase efficiency, and profitability. Various studies have shown that Lean Six Sigma and ABM methods increase efficiency, reduce waste, and improve financial performance in various industries with proper implementation and intensive training. However, external factors, recent data, and regional variations, with deficiencies in data and methodology, and challenges in lean sigma implementation have not contributed simultaneously. This study offers the Integration of ABM, RBV, and TPB in Lean Sigma at KAREB Bojonegoro Cooperative because it is suspected that the condition of tobacco processing is not optimal and this approach needs to improve sustainable production efficiency. This study will analyze the implementation of ABM and Lean Sigma for cost control and waste reduction in tobacco drying at Kareb Cooperative with the contribution of Resource-Based View (RBV) and Theory of Planned Behavior (TPB) to improve process quality and optimal resource monitoring. This study uses a qualitative model with a case study method to assess the implementation of Activity-Based Management (ABM) in production cost efficiency, linking it with Lean Six Sigma, Resource-Based View (RBV), and Theory of Planned Behavior (TPB). Key informants from Kareb Cooperative Bojonegoro, including the Head of Production, Accounting, and HR, provided insights into the impact of ABM and internal factors on efficiency. The research instruments included in-depth interviews, observation, and documentation, while the research procedure followed a systematic flow to ensure the validity and relevance of the data. This study states that the implementation of ABM at Kareb Cooperative Bojonegoro allocates costs based on actual activities, improving efficiency and cost control. Costs include procurement of materials (Rp24,375,300,000), production (Rp9,216,862,000), and distribution (Rp6,000,000,000). Lean Sigma focuses on reducing waste such as overproduction, defects, and waiting by improving processes and training. The ability is quite large in identifying production inputs and related costs such as fuel (Rp14,375,300,000), raw materials (Rp10,000,000,000), and production and distribution processes. Waste management such as overproduction and waiting, as well as the implementation of ABM and Lean Sigma, aims to increase efficiency and reduce costs. Evaluation and training are carried out to optimize processes and reduce waste. Setting costs based on activities, while Lean Sigma uses the Just-In-Time (JIT) system. Variable costs are optimized, production is controlled to reduce defects,and distribution and storage are improved for cost efficiency. The keys to success are open communication, management support, and intensive training. The implementation of ABM and Lean Sigma in Kareb Bojonegoro Cooperative effectively reduces costs and waste through training, JIT, and process control. These findings are expected to increase productivity, reduce costs, and improve the competitiveness of cooperatives and provide a model for implementing modern management.

Unveiling power dynamics in Latin American economic education: A Foucauldian analysis of development economics discourses

This study explores Latin American perspectives on heterodox economic development by analyzing 23 development economics syllabi and conducting 37 semi-structured interviews with educators and students. Using a Foucauldian framework and an Archaeology of Knowledge approach, this research uncovers regional viewpoints and variations in course content. Results highlight the dominance of the neoclassical paradigm in syllabi and diverse opinions on development. This study provides nuanced insights into the coexistence of orthodox and heterodox paradigms in Latin America, revealing complex dynamics and power relations within economic education and the broader discourse on development in the region.

Optimizing solar panel tilt angles across diverse Algerian terrain

Purpose. To optimize the efficiency and performance of a solar system by maximizing the capture of solar radiation through determining the most optimal solar panel tilt angle. Methodology. Stochastic techniques are presently utilized for estimating, optimizing, and predicting various solar energy systems. The authors have developed an algorithm that simulates the echolocation behavior of bats. Findings. To attain this objective, we evaluated different angles of inclination for the incident energy surface that will maximize the sunlight. Next, we compared the intensity of incident solar energy from a horizontal surface and the same surface tilted at the optimum angle. As a result, we determined the optimal tilt angles for other Algerian cities not covered by this study, based on two factors: geometry and climate, using multiple linear regression analysis. The results obtained reflect average monthly and annual values for solar panel tilt angles. These results depend on the latitude and sunshine levels of the locations studied. Originality. The present study introduces a computational algorithm that utilizes the echolocation behavior of bats to determine the most advantageous tilt angle for a photovoltaic (PV) panel. Practical value. Optimizing solar panel angles across various terrains in Algeria is crucial for maximizing the energy efficiency of photovoltaic installations. The optimization algorithm based on the echolocation behavior of bats allows for the determination of optimal angles by taking into account regional, climatic, and seasonal variations, thereby increasing energy production. This innovative approach offers an effective solution for improving the profitability of solar systems while contributing to sustainable development.

The Prevalence of Intraoperative Neuromonitoring in Anterior Cervical Discectomy and Fusion: Trends, Variances, and Value Appraisal.

Retrospective cohort study. The purpose of this study was to (1) evaluate recent trends in the use of intraoperative neuromonitoring (IONM) for anterior cervical discectomy and fusion (ACDF) in the United States, (2) assess regional variations in the use of IONM, and (3) assess the association between IONM and clinical outcomes. IONM is frequently used during anterior cervical procedures to mitigate the risk of neurological injury. Prior studies have demonstrated decreasing utilization of IONM in ACDFs. However, no recent studies have re-assessed these trends. Cases of cervical myelopathy and radiculopathy that underwent ACDF from 2011 to 2021 were identified through the PearlDiver Patient Record Database. Rates of IONM were compared based on patient age, gender, income, and region. Complications, 30-day readmissions, and reimbursement rates were also assessed. We identified 285,939 patients undergoing isolated ACDF, with 45,943 (16.1%) of these cases using IONM. There was a significant increase in the use of IONM for ACDFs over the study period (R2=0.87, P<0.001). Significant regional variability was observed in the utility of IONM (Northeast; 21.2%, Midwest; 16.3%, South; 14.7%, West; 14.2%; P<0.001). Younger age and higher patient income were associated with increased utility of IONM (P<0.001). IONM was associated with significantly higher costs but no reduction in rates of postoperative neurological complications (P<0.001 and 0.29, respectively). This study demonstrates a significant increase in IONM utilization during ACDFs over the past decade. Considerable differences exist in IONM use concerning patient demographics, income, and geographic region, with the highest utilization in the Northeast. Notably, despite the association of IONM with over a 20% increase in reimbursement rates, its implementation was not associated with a reduction in rates of neurological complications.

Unveiling Regional Dynamics and Factors Influencing Fish Purchase and Consumption in Odisha, India

Despite India being a major global fish producer, per capita fish consumption remains notably low in several regions, raising concerns regarding the nutritional adequacy of diets. This study explores the factors influencing fish purchase and consumption patterns in the Cuttack and Khordha districts of Odisha, India. A comprehensive survey (n=400)was conducted, and a trans-regression analysis was applied to identify key factors. The results reveal that fish quality, with an emphasis on freshness, taste, and texture, is the most crucial factor influencing consumer preferences in both districts. Affordability, represented by fish prices, ranked second, while dressing facilities unexpectedly held significant importance, reflecting consumer preference for convenience in fish preparation. Sociocultural factors, including local traditions and dietary customs, also played a role but were less significant compared to other factors. The study highlights apromising trend of fish consumption exceeding recommended levels, contributing positively to nutritional goals. A comparative analysis betweenregions showed variability in meat consumption, with fish standing out as a primary dietary staple. These findings underscore the need for region-specific strategies to promote sustainable fish consumption, considering both economic and socio-cultural influences. The study contributes to the understanding of regional variations in fish consumption patterns and provides a foundation for targeted interventions to address nutritional challenges and promote sustainable dietary practices.

Determinants of coping strategies among agropastoralists in Kitui and Isiolo counties, Kenya

Agropastoralists in Kenya’s Arid and Semi-arid Lands (ASALs) face various shocks that threaten their livelihoods and expose them to significant health and economic risks. While existing studies often focus on climate-related shocks, they frequently overlook other challenges faced by these communities. A comprehensive understanding of how agropastoralists manage diverse shocks is essential to developing effective vulnerability reduction strategies. This study examined the major shocks experienced by agropastoral households in Kenya’s ASALs, their primary coping strategies, and the determinants informing the choice of the strategies adopted. Using cross-sectional data from 371 households in Isiolo (203) and Kitui (168) counties, this study applied descriptive analysis and multivariate probit (MVP) models to assess coping strategies and influencing factors. From 2016 to 2021, households faced shocks, such as droughts, livestock pests and diseases, crop pests, theft, and intercommunal conflicts. Regional variations were observed: crop pests were common in Kitui, whereas Isiolo experienced higher theft and conflict rates. Coping strategies include income diversification, asset sales, increased farm labor, and reduced food expenditure. Severe droughts and conflicts led to migration, while floods caused extreme measures such as withdrawing children from school. Key factors influencing coping strategies include household demographics, farm characteristics, and market proximity. Households with more adults, higher literacy, or greater income from crops and livestock are less likely to adopt costly strategies. This study recommends integrated interventions to enhance resilience to both climate and non-climate shocks.

Regional distribution and factors associated with early marriage in Ghana: a cross-sectional study

BackgroundEarly marriage, the formal or informal union before age 18, remains a critical challenge in several low-and middle-income countries. It has adverse health and education-related implications on child brides. This study examined the regional distribution of early marriage and its associated factors in Ghana.MethodsWe performed a cross-sectional analysis of data extracted from the 2022 Ghana Demographic and Health Survey. Our study comprised 10,098 ever married/cohabiting aged 15 to 49. Regional variations in the prevalence of child marriage were visualised using a spatial map. A mixed-effect multilevel binary logistic regression analysis was performed to assess the factors associated with early marriage. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI).ResultsThe prevalence of early marriage was 29.2% [27.9, 30.6] in Ghana. Women in the North East 38.2% [33.4, 43.2], Western North 36.7% [32.1, 41.5] and Ahafo regions 35.8% [32.0, 39.8] had the highest prevalence of early marriage, whilst women in the Western 22.2% [18.4, 26.5] and Greater Accra 19.7% [15.8, 24.3 regions] had the lowest prevalence of early marriage in Ghana. The odds of early marriage was lower among women aged 20-49 compared to those aged 15-19. Women with secondary [aOR = 0.40; 95% CI 0.33, 0.48] and higher education [aOR = 0.07; 95% CI 0.04, 0.12], those who belonged to the Gurma ethnic group [aOR = 0.59; 95% CI 0.41, 0.84], and women from richer [aOR = 0.64; 95% CI: 0.47, 0.87] and richest [aOR = 0.42; 95% CI 0.28, 0.64] households were less likely to be married early compared to those with no education, those belonging to the Akan ethnic group, and those from the poorest wealth quintile households, respectively. The odds of early marriage was higher among women whose family size was five or more [aOR = 1.50; 95% CI 1.31, 1.72] and women living in the Central [aOR = 1.72; 95% CI 1.16, 2.54], Volta [aOR = 1.97; 95% CI 1.17, 3.30], Eastern [aOR = 1.53; 95% CI 1.01, 2.29], Ashanti [aOR = 1.98; 95% CI 1.33, 2.97], Western North [aOR = 1.77; 95% CI 1.18, 2.65], and Ahafo regions [aOR = 1.74; 95% CI 1.18, 2.56].ConclusionAbout one in three marriages were early in Ghana, with variations across the regions. Age, wealth index, ethnicity, level of education, family size, and region were identified as factors associated with early marriages. The government and policymakers in Ghana should increase access to and completion of secondary education for girls, as it is crucial in reducing early marriage. Providing programmes that economically empower women and girls can decrease their vulnerability to early marriage. More vigorous enforcement of laws against early marriage is necessary. Engaging with communities, including tribal leaders, is essential to shift cultural attitudes toward early marriage.

Overcoming Product Catalog Challenges in Telecom : A Technical Perspective

This comprehensive article explores the intricate challenges telecom providers face in managing complex product catalogs across multiple customer touchpoints. With the global telecom market projected to reach $2.47 trillion by 2028, efficient catalog management is crucial for maintaining competitiveness and customer satisfaction. The article delves into the multifaceted complexities of telecom product catalogs, including regional pricing variations, dynamic promotional offers, and the need for real-time synchronization across platforms. It outlines key challenges such as catalog complexity, slow data retrieval, frequent updates, third-party integration latencies, high traffic spikes, and campaign management inconsistencies. The article then presents innovative technical solutions and best practices, including the adoption of industry-leading catalog solutions, leveraging ElasticSearch for faster data retrieval, implementing differential processing for updates, preprocessing third-party integrations, utilizing dynamic UI templates, employing advanced campaign management tools, and implementing inventory prefetching. These solutions aim to enhance operational efficiency, improve customer experiences, and accelerate time-to-market in the rapidly evolving telecom industry.

Research on the influencing factors of the difference in warming rates between the east, west and central regions of North America during the 21st century

Temperature in North America (NA) is a significant focus of current climate change research. This study focuses on various climate variables and employs linear regression and correlation coefficient analysis to examine the factors influencing the differences in warming rates across the eastern, western, and central regions of NA in the 21st century, as well as the correlations between these factors and temperature. Results indicate that NA temperatures are rising with notable regional variations in warming rates. Under the influence of cloud cover, the impact of precipitation on warming rates is relatively minor, whereas radiation significantly affects warming rates. Additionally, sea level pressure influences wind patterns, thereby significantly impacting warming rates. This study highlights the complexity of regional climate dynamics in NA and provides deep insights into regional climate differences.

Setting Up Methane Mitigation Measures for Indian Rice Fields: Representative Emissions and New Interpretations

AbstractRice cultivation produces methane (CH4) due to anaerobic conditions induced by flood irrigation, significantly contributing to global warming. While most studies use national emission factors (EFs), our study synthesized 726 published measurements across India (the second largest methane emitter after China) to develop district‐level water regime‐specific EFs for estimating district‐scale emissions and warming potential. CH4 emissions from Indian rice fields increased from 3.7 (3.4–4.1) Tg to 4.8 (4.4–5.3) Tg during 1966–2017, driven by rice area and water‐regime variations. Meanwhile, district‐level emissions increased by ∼930%, influenced by management practices such as animal manure, fertilizer application, and water input, accurately reflecting regional variations compared to previous estimates. Employing a novel muti‐output random forest mitigation model (R2 ∼ 0.9), we found that a 25% warming reduction at the district‐level requires curtailing animal manure, nitrogen fertilizer, and water input by 8.5%, 12.9%, and 10.9%, respectively. These curtailments nearly double for a 50% mitigation scenario. Comparing our emissions with previous bottom‐up studies (used as inputs in global climate models) revealed discrepancies in prior national figures. With top‐down estimates, our emissions correlated positively, suggesting higher reliability. Including our new regionally validated data in global climate models may provide more accurate climate projections at the Indian and global scales.

Regional variation in incidence and mortality due to hypertension in Sao Tome and Principe

Abstract Background The analysis of incidence and mortality due to hypertension (HT) provides statistical data for addressing public health programs, particularly in low-income countries where poor health systems impose constraints to address non-communicable diseases (NCDs). This study aims to assess the geographic pattern of incidence and mortality due to HT in Sao Tome and Principe (STP). Methods This is a descriptive ecological study. Aggregated data on new cases of and deaths due to HT by gender, age-group and district (2022-2023) were extracted from the Health National Database (STP Ministry of Health). Age-standardized incidence and mortality rates (ASIR and ASMR) and respective 95% confidence interval (95%CI) were obtained. Mortality-to-incidence ratio (MIR) was computed by district (lower values indicate better quality of care). Comparison between districts was done through standardized incidence ratios (SIR) and respective p-value. Analyses were stratified by gender. Results ASIR and ASMR per 100,000 were, respectively, 1168.9 (95%CI:1103.3-1237.6) and 76.8 (95%CI:62.0-96.2) among men and 2460.6 (95%CI:2365.0-2559.0) and 99.7 (95%CI:81.4-121.6) among women. Incidence of HT was significantly higher than expected (p &amp;lt; 0.001) in Agua Grande, Caue and Lemba with SIR varying from 122.8% (Agua Grande) to 201.1% (Caue) in men and from 125.1% (Lemba) to 224.1% (Caue) in women. Instead, Mé-Zochi presented much lower incidence than expected for both, men (SIR=43.1%;p&amp;lt;0.001) and women (SIR=38.4%;p&amp;lt;0.001). Large differences between districts were observed in MIR, varying from 0% (Caue and Lobata) to 84% (Mé-Zochi) in men and from 0% (Lobata) to 57% (Mé-Zochi) in women. Conclusions According to our findings there is, not only, a high incidence rate of HT, but also regional variation in this rate, deserving particular attention from policy-makers. Regional variation in hypertension incidence could be partially explained by differences in the quality of healthcare services. Key messages • Awareness should be given to the high incidence of hypertension demanding preventive strategies in the field of public health. • Public health strategies should address the quality of care in regards to the prevention, diagnosis and monitoring of hypertension.

Regional variations in breast cancer screening uptake and its associated factors in Ghana

Abstract Introduction Timely identification of breast cancer is critical for successful treatment and prevention, reducing its burden. Despite its significance, breast cancer screening services in Ghana are underutilized, with considerable regional variations in uptake rates. We examined the regional differences in breast cancer screening uptake and its associated factors in Ghana. Methods We analyzed data from 15,014 women of reproductive age from the 2022 Ghana Demographic and Health Survey. Spatial mapping illustrated regional variations in screening uptake. Multilevel logistic regression was employed to examine the factors associated with breast cancer screening uptake. Results National breast cancer screening prevalence was 18.4%, with regional variations observed across the 16 regions. Eastern, Western, Brong Ahafo, and Greater Accra had the highest screening uptake. The likelihood of breast cancer screening was higher among women aged 45-49 (aOR = 3.59; 95% CI = 12.52, 5.12), Married women (aOR = 1.44; 95% CI = 1.17-1.77), Higher education, employment, health insurance, recent health facility visits, media access, and wealth index (middle: aOR = 1.45, 95% CI = 1.08, 1.94; richest: aOR = 1.91, 95% CI = 1.36, 2.70). Islamic and African Traditional affiliations decrease screening likelihood (aOR = 0.77; 95% CI = 0.63, 0.95; aOR = 0.46; 95% CI = 0.22, 0.97). Rural residence and specific regions (Ashanti, Oti, Savannah, Upper West) reduce odds, while living in North East increases odds (aOR: 1.86; 95% CI = 1.14-3.03). Conclusions Cost-effective breast cancer screening services are crucial, particularly in rural areas with geographical disparities. Culturally and religiously sensitive protocols are needed to address regional and religious differences. Expanding Ghana’s national health insurance to cover preventive measures like breast cancer screening is essential. Promoting awareness through conventional and digital platforms is crucial for advocating screening. Key messages • Addressing geographical and cultural differences crucial for equitable breast cancer screening in Ghana. • Expanding health insurance and raising awareness vital to promote screening access and reduce disparities.

Trends in Regional Disparities of Cardiovascular Surgery and Mortality in South Korea

Abstract Objectives Regional disparities in cardiovascular care in South Korea have led to uneven patient outcomes. Although procedure access and needs are increasing, few studies have linked regional service availability to mortality rates. This study analyzed variation in utilization of major cardiovascular procedures by region and association with short-term mortality to provide better evidence on links between healthcare resources distribution and patient survival. Methods A cross-sectional study was conducted using nationwide claims data on patients who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), stent insertion, or aortic aneurysm resection in 2022. Regional variation was assessed by a Relevance Index (RI). The associations between regional RI and 30-day mortality were analyzed. Results The RI was lowest for aortic aneurysm resection (mean, 26.2; standard deviation, 26.1), indicating the most uneven regional distribution among the surgical procedures. Patients undergoing this procedure in regions with higher RIs showed significantly lower 30-day mortality (adjusted odds ratio [aOR], 0.73; 95% confidence interval, 0.55 to 0.96; p = 0.026) versus those with lower RIs. This suggests that cardiovascular surgery regional availability, as measured by RI, has an impact on mortality rates for certain complex surgical procedures. The RI was not associated with significant mortality differences for more widely available procedures like CABG (aOR, 0.96), PCI (aOR, 1.00), or stent insertion (aOR, 0.91). Conclusions Significant regional variation and underutilization of cardiovascular surgery were found, with reduced access linked to worse mortality for complex surgeries. Addressing disparities through cooperation among hospitals and policy efforts is warranted to improve outcomes. Key messages • This study analyzed regional variations in major cardiovascular procedures using the Relevance Index and investigated their impact on mortality rates within 30 days of admission. • Addressing regional disparities requires improved healthcare infrastructure and comprehensive networks of specialists to ensure timely and high-quality cardiovascular care across South Korea.