Regional Disparities Research Articles

Impact of Regional Disparities in Social Capital and Its Components on Quality of Life

According to the prevailing opinion, social capital is one of the most robust indicators of quality of life (QoL). We ask whether this insight applies to Slovakia, as well, on the basis of understanding social capital not as one holistic concept but as a set of interrelated components, which are trust, networks, and norms. The paper has two goals, the first of which is to determine the amount of social capital, its components, and QoL, as well as its spatial disparities, at a district level. In this case, the goal is to determine the quantity of the investigated variables. The data source is the World Value Survey, Round 7, in which Slovakia also participated. The second goal is to find out how social capital and its components affect the QoL in individual districts. In other words, we would like to determine the quality of the impact of social capital and its components on the QoL. The result is the knowledge that social capital as a whole reaches significantly lower values than the QoL and is not a predictor of the QoL in Slovakia. At the same time, however, disparities in the impact of social capital and its components on the QoL have high values. This knowledge challenges the understanding of holistic social capital as a robust indicator of QoL.

ANÁLISE DO PERFIL EPIDEMIOLÓGICO DAS INTERNAÇÕES E ÓBITOS POR LEUCEMIA NO BRASIL NA FAIXA ETÁRIA PEDIÁTRICA: UMA ANÁLISE DO ANO DE 2017 ATÉ A ATUALIDADE.

The present study is based on the epidemiological analysis of leukemia, the most common childhood cancer, which has a high prevalence and incidence rate in the pediatric population, as well as a significant impact on mortality in this age group. The objective of this research is to analyze the national profile of hospital admissions and deaths due to leukemia from 2017 to the present. For this purpose, secondary data from the Hospital Information System (SIH) and the Mortality Information System (SIM), collected from the DATASUS digital platform, were used. The selected variables included age groups under 1 to 19 years, male and female gender, and racial/ethnic categories of white, mixed-race, black, Asian, and indigenous populations. The results revealed a higher prevalence and incidence of hospitalizations for leukemia over the years, particularly in the Southeast, Northeast, and South regions, with a significant concentration in the 1 to 9-year age group, among males, and in the mixed-race and white populations. Regarding the number of deaths, substantial data were observed in the Southeast, Northeast, and North regions, predominantly in individuals aged 10 to 19 years, among males, and in the white and mixed-race populations. Given the above, the urgency of addressing leukemia in the pediatric population in Brazil is evident, as it impacts patients’ quality of life, the vital statistics of this population, and the healthcare system. The data highlight the need for public health actions to reduce regional disparities in specialized cancer care, late diagnoses, and ineffective and limited treatments.

Citrus Industry Agglomeration and Citrus Green Total Factor Productivity in China: An Empirical Analysis Utilizing a Dynamic Spatial Durbin Model

In the context of increasingly severe resource and environmental constraints, examining the impact of citrus industry agglomeration on the green total factor productivity (GTFP) of citrus is of great importance for the sustainable development of the citrus industry and is crucial for promoting the green, high-quality growth of China’s agricultural sector. In this study, the global Malmquist–Luenberger productivity index (GMLPI) model was used to measure the GTFP of mandarins and tangerines based on inter-provincial panel data from China’s major citrus-producing regions between 2007 and 2022. The dynamic spatial Durbin model was employed to empirically analyze the effects of citrus industry agglomeration on the GTFP of mandarins and tangerines, including the disaggregation of its spatial spillover effects. The results indicate that, in terms of temporal dynamics, the GTFP, technical progress index (GTC), and technical efficiency index (GEC) of mandarins and tangerines significantly fluctuated, especially during the period from 2007 to 2015. Regional disparities in GTFP and the GTC are more pronounced for mandarins than for tangerines, while the GEC shows greater regional disparities for tangerines than for mandarins. The intensification of citrus industry agglomeration has had a significant positive impact on the GTFP of mandarins and tangerines, both locally and in neighboring regions. The spatial correlation of the green total factor productivity of mandarins and tangerines fluctuated; mandarins showed significant spatial aggregation in some years, while tangerines showed significant spatial dispersion in several years. The local Moran scatterplot further reveals the significant negative spatial autocorrelation of mandarin and tangerine green total factor productivity from 2007 to 2022. The direct, indirect, and total effects of citrus industry agglomeration on the GTFP of mandarins and tangerines are significant and positive in both the short- and long-term, with short-term benefits exceeding long-term effects. Consequently, enhancing regional cooperation and exchange while advancing citrus industry agglomeration is essential for sustained productivity growth.

Tracking a Decade of Development of Early Childhood Care and Education in Kazakhstan, 2006–2015

The study employed data from the 2006, 2010–2011 and 2015 Multiple Indicator Cluster Surveys to assess the decade of early childhood care and education (ECCE) development in Kazakhstan. Enrollment grew from 15% to 60% but remained lower than the targeted rate of 75%. The effects of the wealth gradient and language disparities on enrollment were reduced significantly. Concurrently, regional disparities in enrollment increased during the reform period and the child’s age became a significant precursor of enrollment over time. Parents opted to enroll relatively older children to ECCE and this trend has been shown to become more prominent over time.

Global burden of low back pain and its attributable risk factors from 1990 to 2021: a comprehensive analysis from the global burden of disease study 2021

BackgroundThis study aimed to examine the evolving trends in the global burden of low back pain (LBP) from 1990 to 2021 and predicted disease burden until 2035.Materials and methodsLBP-related data were obtained from the Global Health Data Exchange (GHDx) query tool. All estimates and their 95% uncertainty intervals (UIs) were generated using DisMod-MR 2.1, a Bayesian meta-regression tool in Global Burden of Disease, Injury, and Risk Factor Study (GBD) 2021. Data processing and visualization were conducted using The R Programming Language software version 4.3.2 and Joinpoint 4.7.ResultsIn 2021, approximately 628.8 million people worldwide were affected by LBP, with approximately 266.9 million new incident cases and age-standardized incidence rate (ASIR) of 3176.6 per 100,000. Compared with 1990, although the ASIR and age-standardized disability-adjusted life years rate (ASDALYsR) decreased, absolute numbers increased significantly. Projections for 2035 reveal a continued decline in ASIR and ASDALYsR for LBP. The LBP burden varied by the sociodemographic index quintile and GBD region, with the highest ASIR and ASDALYsR observed in Central Europe and the greatest decrease in East Asia. Globally, women bear a higher burden of LBP than men, with middle-aged populations experiencing the heaviest burden. Occupational ergonomic factors, high body mass index, and smoking remain the primary risk factors for LBP, with occupational ergonomic factors contributing the most to the overall burden.ConclusionDespite a projected decline in incidence, the global burden of LBP persists, exhibiting significant regional and gender disparities. To mitigate its future burden, precise and effective prevention and control strategies targeting high-risk factors are imperative.

Multi-Dimensional Assessment, Regional Differences, and Influencing Factors of Agricultural Water Pollution from the Perspective of Grey Water Footprint in Zhejiang Province, China

The implementation of differentiated governance for agricultural water pollution (AWP) plays a significant role in alleviating the pressure on agricultural water resources. However, research that comprehensively assesses AWP and its influencing factors from a multidimensional perspective remains relatively limited. This study utilized the grey water footprint (GWF) model to quantify the agricultural grey water footprint (AGWF), agricultural grey water footprint efficiency (AGWFE), agricultural grey water footprint intensity (AGWFI), and agricultural water pollution level (AWPL) in Zhejiang from 2010 to 2020. Subsequently, we applied the standard deviational ellipse (SDE), the kernel density estimation (KDE), and the Dagum Gini coefficient to delve into the dynamic evolution and regional disparities of these indicators. Ultimately, we leveraged both the random forest model and the panel regression model to identify and examine the key factors shaping AGWF-related indicators. The results show that: (1) From 2010 to 2020, in Zhejiang, both AGWF and AGWFI exhibit a trend of first increasing and then decreasing, peaking in 2012. In contrast, AGWFE has consistently increased over the years, reaching an increase of 54.56 CNY/m3 by 2020. Meanwhile, despite fluctuations, AWPL in Zhejiang shows an overall gradual decline. (2) The centroids of relevant indicators for AWP in Zhejiang are primarily located in Jinhua (for AGWF and AGWFI), Shaoxing (for AWPL), and in the area where AGWFE converge. (3) Compared to 2010, the regional disparities in AGWF and AWPL have shrunk significantly in 2020, whereas the regional differences in AGWFE and AGWFI have increased to some extent. In most years, the regional disparities in AGWF, AGWFI, and AWPL are more pronounced in Northeastern Zhejiang compared to the southwestern part. (4) The influencing factors of AGWF, AGWFE, and AGWFI exhibit significant regional heterogeneity. In Northeastern Zhejiang, the primary factors influencing them are technological innovation, resource endowment, and crop-cultivation methods. Conversely, in the southwestern region, the primary factors exerting the same influence are the application intensities of fertilizers, pesticides, and agricultural film application. The primary drivers of AWPL in Zhejiang are grain yield, water resource availability, and crop-planting structure. Notably, these factors do not exhibit regional heterogeneity. The paper proposes AWP control policies from both a comprehensive and multi-dimensional perspective.

Abstract 4134851: Demographic and regional disparities in cerebrovascular disease mortality among adult patients with pre-existing atherosclerosis in the United States from 1999-2020

Introduction: Atherosclerosis (ATH) is a major risk factor for cerebrovascular disease (CEVD), with persistent mortality disparities. Our study aims to identify vulnerable regions and demographics in the US adult population with pre-existing ATH at risk of CEVD. Methods: CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) was used to access National Vital Statistics System data from 1999 to 2020. ATH-related CEVD was identified using CEVD as the underlying cause of death and ATH as a contributing cause of death. Results were presented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to examine changes in trend and annual percentage change (APC). Results: A total of 325,408 CEVD occurred in patients with ATH from 1999 to 2020 (AAMR = 6.9, 95% CI: 6.8-7). Increased mortality rates were observed in males (AAMR = 6.3) as compared to females (AAMR = 5.1) (Figure, Panel A). AAMRs were highest in Non-Hispanic Whites [NHW] (5.7, 95% CI: 5.7 - 5.8), followed by non-Hispanic blacks [NHB] (5.5, 95% CI: 5.4 - 5.5), Hispanics (4.1, 95% CI: 4.0 - 4.1) and non-Hispanic American Indian/Alaska Native [NH-AIAN] (3.6, 95% CI: 3.4 - 3.8). Non-Hispanic Asian/Pacific Islander [NH-API] had the lowest mortality rates (3.4, 95% CI: 3.4 - 3.5). Region-wise analysis revealed that mortality rates were highest in the West (6.4, 95% CI: 6.3-6.4) and Midwest (6.2, 95% CI: 6.1-6.2). The South reported the rate of 5.5 (95% CI: 5.5-5.6), while the Northeast had the lowest rate (4.4, 95% CI: 4.3-4.4). Mortality rates were consistently higher in rural areas (6.1, 95% CI: 6.0-6.1) compared to urban areas (5.3, 95% CI: 5.3-5.4) throughout the study period. Overall AAMR rose from 9.0 in 1999 to 10.4 in 2001, then steadily declined before increasing to 3.6 from 2016 to 2020 (APC: 0.41). After an initial decline, AAMR increased in men (APC: 1.09) from 2016 and in women (APC: 5.09) from 2018. AAMR also increased among NH-API (APC: 8.9) and NHB (APC: 8.3) from 2018 onwards, and NHW (APC: 0.1) from 2016 (Figure, Panel B). Conclusions: Our study reveals significant mortality disparities from CEVD in patients with ATH, identifying males, NHW, and residents in the West and Midwest as particularly at increased risk. Rural areas consistently show higher mortality rates than urban areas. These findings highlight the need for targeted interventions and strategic provision of healthcare resources to improve outcomes for vulnerable populations.

Trends of antiseizure medication utilization among pregnant people in four Canadian provinces from 1998 to 2023; a study from the Canadian mother-child cohort active surveillance initiative (CAMCCO)

BackgroundEpilepsy management during pregnancy is crucial for both the mother and fetus. The use of antiseizure medications (ASMs) during pregnancy requires careful consideration due to their potential effects on maternal and fetal health.MethodsThis study analyzed trends in ASMs use among pregnant people in four Canadian provinces over 20 years (Manitoba, Saskatchewan, Alberta, and Quebec). Descriptive statistics were utilized to examine the characteristics of the population, with the frequency and patterns of ASM use estimated throughout each trimester. Linear regression models were developed to analyze yearly patterns of ASM utilization for the overall study population, as well as for people with and without epilepsy.ResultsAmong 1,317,141 pregnant individuals across four provinces, 0.7% had epilepsy. Of the total pregnancies, 1.7% (n = 22,783) were exposed to ASMs, comprising 4,392 from pregnant people with epilepsy (PPWE) and 18,391 from those without epilepsy (PPWOE). Results demonstrated varying trends in ASM usage between provinces, with an overall increase in usage among people without epilepsy in Manitoba, Saskatchewan, and Alberta. ASM use among PPWOE surged significantly in Manitoba (24.2–149.1 per 10,000 pregnant people), Saskatchewan (29.4–107.0 per 10,000), and Alberta (65.7–241.7 per 10,000) (p < 0.05). In Alberta, PPWE’s ASM exposure also rose, from 23.6 in 2008 to 43.0 per 10,000 pregnant people in 2021, while Quebec witnessed a decrease from 59.2 in 1998 to 45.5 per 10,000 pregnancies in 2015. Analysis of ASM use by trimester illustrated a substantial decline among PPWOE from 365 days pre-pregnancy to the third trimester in all provinces. ASM utilization by drug class showcased significant shifts, with second-generation ASMs experiencing a notable rise. Carbamazepine, once prominent, declined, making way for lamotrigine. Regional variations underscore diverse preferences, such as clonazepam’s sustained popularity in Manitoba and Quebec.ConclusionThe study identified increasing trends in ASM use, particularly the increased use of second-generation ASMs, and differences in prescription patterns for pregnant individuals with and without epilepsy. These findings reveal changing ASM use patterns, including increased second-generation ASM use and regional disparities, providing valuable insights into real-world prescription practices.

Effects of entrepreneurship and governance quality on global and regional economic performance: A pathway to sustainable development

AbstractThis study investigated the effects of entrepreneurship and governance quality on global and regional economic performance, and the moderating influence of governance quality on the entrepreneurship‐economic performance nexus. The study used a panel of 109 countries from 2010 to 2022. Prais‐Winsten regression, standard Fixed Effects regression with robust standard errors, Fixed Effects regression with Driscoll and Kraay standard errors, and the dynamic system GMM regression were used. We find that the unconditional effect of entrepreneurship on global economic performance is mainly negative, while governance quality predominantly exerts positive effect on global economic performance, but generally failed to moderate the adverse effect of entrepreneurship. Interestingly, we find regional disparities indicating that the patterns in Europe and Asia align with the global results, while the dynamics in the Americas show that the unconditional effect of entrepreneurship on economic performance is mainly positive and significant, with governance quality also exerting significant positive influence and reinforcing the positive effect of entrepreneurship. For Africa, we find that entrepreneurship is a potent driver of economic performance when it is measured using Total Early‐stage Entrepreneurial Activity and Entrepreneurial Employee Activity. We discussed the policy implications of these findings in relation to the sustainable development goals.

Abstract 4130622: Neonatal Outcomes of Hypertensive Women Across US Races: 2016-2022

Background: Maternal hypertension, a major pregnancy complication, can adversely affect newborn health. We aim to evaluate the racial and ethnic disparities in neonatal outcomes among hypertensive pregnant women in the United States. Methods: Using data from the CDC WONDER Natality database, we conducted a retrospective cohort study focusing on live births to hypertensive mothers from 2016 to 2022. Neonatal outcomes, including NICU admissions, low birth weight, infant mortality, and assisted ventilation, were analyzed by calculating rates [95% CIs] per 1000 live births across maternal racial/ethnic groups and the US Census Bureau's regional classification: Northeast, Midwest, South, and West. Results: We analyzed 2,336,679 live births to hypertensive women (23% pre-pregnancy; 77% gestational). This cohort comprised: 0.2% infants born to Native Hawaiian/other Pacific Islander women (NH/PI), 0.9% to American Indian/Alaska Native women (AI/AN), 3.8% to Asian American women (AA), 19.6% to Hispanic/Latino women (H/L), 20.0% to Black/African American women (BA), and 55.4% to White American women (WA). Infant mortality rates were highest in BA (3.6 [3.5, 3.8]), followed by AA (2.1 [1.8, 2.4]), AI/AN (2.1 [1.6, 2.7]), H/L (1.9 [1.8, 2.0]), NH/PI (1.9 [1.0, 3.3]), and lowest in WA (1.5 [1.4, 1.6]). Similarly, NICU admission rates were highest in BA (217.2 [216.1, 218.4]) and lowest in WA (156 [155.4, 156.6]). Assisted ventilation rates were highest in NH/PI (131.8 [123.4, 140.7]) and lowest in AA (87.8 [86.0, 89.7]). Low birth weight rates were highest in BA (235.1 [233.9, 236.3]) and lowest in WA (121.8 [121.2, 122.4]). The Midwest had the highest rates for NICU admissions in NH/PI (254.2 [217.2, 295.2]), assisted ventilation in AI/AN (143.8 [133.2, 155.1]), and mortality in BA (4.1 [3.7, 4.5]). The South had the highest rate of low birth weight for BA (244.4 [242.9, 246.0]). Conclusion: Significant racial and regional disparities exist in neonatal outcomes among hypertensive women in the US. BA mothers consistently experienced the poorest outcomes, while WA mothers had the best. Further research is crucial to understand the reasons behind these disparities and develop targeted interventions for high-risk populations.

Inequalities and Differences in Health Status of Pre- and Perinatal Periods in Hungarian Long-Term Series Analysis (1997–2019)

Objectives: The main goal of this study is to publish findings on the lifestyle factors of pregnant women in Hungary and their impact on early childhood health status by examining changes over time and regional/geographical disparities. Methods: The source of the data is the raw indicators reported by health visitors as per mandatory annual report data for the period of 1997–2019. To examine the association, we used indicators of pregnant women’s states as explanatory variables (for example, pregnant women in very late care, prenatal smoking habits, and pregnant women without care), and the outcome indicators were prematurity, intrauterine malnutrition, and newborn babies with developmental disorders. A univariate Poisson regression was used to examine the correlations. Results: Our results show a decreasing trend in the proportion of pregnant women who smoke and of pregnant women who apply late for care (after 28 weeks of pregnancy), with an increasing indicator of regional differences. The research results of the prenatal and perinatal indicators show that the counties Borsod-Abaúj-Zemplén and Szabolcs-Szatmár-Bereg are the most critical areas in terms of health status in Hungary. The number of pregnancies attended very late (after 28 weeks) and the number of women who gave birth without health visitor care are associated with the number of preterm births (R2 = 0.7313; p < 0.001; R2 = 0.5519; p < 0.001) and intrauterine growth restrictions (R2 = 0.3306; p < 0.001; R2 = 0.2632; p < 0.001). Conclusion: Interventions to improve early childhood health in some counties of Hungary are urgently needed to reduce regional disparities. Such counties include Borsod-Abaúj-Zemplén, Szabolcs-Szatmár-Bereg, Heves, Somogy, Bács-Kiskun, and Nógrád. Health education for pregnant women and activities to strengthen the compliance of pregnant women are key to improving early childhood health outcomes.

Model and Ensemble Indicator-Guided Assessment of Robust, Exploitable Groundwater Resources for Denmark

Groundwater constitutes 99% of the Earth’s liquid freshwater and is crucial for human health, economic development, and ecosystem sustainability. This study assesses groundwater sustainability in Denmark by employing a comprehensive hydrological model and a set of ensemble indicators. The paper describes the methodology and the results based on nine selected indicators. Three indicators focus on recharge capture and aquifer sustainability, one focuses on groundwater level and wetland capture, two focus on baseflow and drainage flow capture, and three focus on eco flow capture. Our findings highlight that while overall exploitable groundwater resources are estimated at 1.1 billion m3/year, significant regional disparities exist, with certain areas, notably Zealand, facing over-exploitation rates exceeding 250% of sustainable limits. The indicators developed not only provide a framework for assessing current groundwater resource limits, but also serve as a basis for future monitoring and adaptive management strategies. This research underscores the need for stakeholder engagement and integrated approaches to ensure the sustainability of groundwater resources in the face of growing anthropogenic pressures and climate change. Our work contributes to the ongoing discourse on sustainable water management and offers a robust methodology for assessing groundwater sustainability.

The Impact of Seasonal Climate on Dryland Vegetation NPP: The Mediating Role of Phenology

Dryland ecosystems are highly sensitive to climate change, making vegetation monitoring crucial for understanding ecological dynamics in these regions. In recent years, climate change, combined with large-scale ecological restoration efforts, has led significant greening in China’s arid areas. However, the mechanisms through which seasonal climate variations regulate vegetation growth are not yet fully understood. This study hypothesizes that seasonal climate change affects net primary productivity (NPP) of vegetation by influencing phenology. We focused on China’s Windbreak and Sand-Fixation Ecological Function Conservation Areas (WSEFCAs) as representative regions of dryland vegetation. The Carnegie–Ames–Stanford Approach (CASA) model was used to estimate vegetation NPP from 2000 to 2020. To extract phenological information, NDVI data were processed using Savitzky–Golay (S–G) filtering and threshold methods to determine the start of season (SOS) and end of season (EOS). The structural equation model (SEM) was constructed to quantitatively assess the contributions of climate change (temperature and precipitation) and phenology to variations in vegetation NPP, identifying the pathways of influence. The results indicate that the average annual NPP in WSEFCAs increased from 55.55 gC/(m2·a) to 75.01 gC/(m2·a), exhibiting uneven spatial distribution. The pathways through which seasonal climate affects vegetation NPP are more complex and uneven. Summer precipitation directly promoted NPP growth (direct effect = 0.243, p < 0.001) while also indirectly enhancing NPP by significantly advancing SOS (0.433, p < 0.001) and delaying EOS (−0.271, p < 0.001), with an indirect effect of 0.133. This finding highlights the critical role of phenology in vegetation growth, particularly in regions with substantial seasonal climate fluctuations. Although the overall ecological environment of WSEFCAs has improved, significant regional disparities remain, especially in northwestern China. This study introduces causal mediation analysis to systematically explore the mechanisms through which seasonal climate change impacts vegetation NPP in WSEFCAs, providing new insights into the broader implications of climate change and offering scientific support for ecological restoration and management strategies in arid regions.

Disparities in end-of-life care and place of death in people with malignant brain tumors – a Swedish registry study

Abstract Background Malignant brain tumors often lead to death. While improving future treatments is essential, end-of-life care must also be addressed. To ensure equitable palliative care, understanding place of death is crucial, as disparities may lead to inequity of care. This study aims to identify place of death in adults with malignant brain tumors in Sweden, and the potential associations with official palliative care status by the ICD-10 code Z-51.5, sociodemographic factors, health service characteristics, and healthcare service utilization. Methods A population-level registry study examined the place of death among adults who died of malignant brain tumors in Sweden from 2013-2019. Descriptive statistics, univariable and multivariable binary logistic regression analyses were performed. Results We identified 3 888 adults who died from malignant brain tumors. Of these, 64.4% did not receive an official palliative care status. Specialized palliative care was not utilized in 57.2% at the place of death, and in 80.0% of nursing home deaths. In the last month of life, 53.5% of hospital deaths involved one transfer, while 41.8% had two or more transfers. The odds ratio of dying in hospital versus at home was higher, with two or more transfers (OR 0.63(0.40,0.99)). The odds ratio of dying in hospital versus at home showed significant regional differences. Conclusions Despite the severity of their diagnosis, only a minority of patients utilized specialized palliative services at death, and this varied by the place of death. Significant regional disparities were found between hospital and home deaths, indicating unequal end-of-life palliative care in this patient group.

Regional disparities in home health care utilization for older adults and their associated factors at the secondary medical area level: A Nationwide study in Japan.

As aging populations shift health care from hospitals to communities, Japan has implemented policies to promote home health care. This study explored regional differences in home health care recipients among older adults and related factors. We used nationwide data from 2020 to describe the proportion of older adults receiving regular home visits and the medical institutions utilized across secondary medical areas: urban, middle and depopulated areas. We examined factors associated with the proportion of patients receiving regular home visits. Exposures included each secondary medical area's medical and long-term-care (LTC) resources, adjusted for the older adult population; proportion of single-person households; and regional factors. We performed a multivariate negative binomial distribution analysis. A total of 333 secondary medical areas were included. Urban areas had more patients receiving regular home visits, primarily from enhanced home care support clinics/hospitals (HCSCs). Fewer patients received regular home visits in depopulated areas, and conventional HCSCs were more common. Multivariate analysis revealed that the number of conventional HCSCs (coefficient, 0.17 [95% confidence intervals (CI), 0.08 to 0.26]), enhanced HCSCs (coefficient, 0.21 [95% CI, 0.14 to 0.29]) and population density (coefficient, 0.10 [95% CI, 0.02 to 0.19]) were positively associated with higher home-visit rates. Beds in LTC welfare facilities (coefficient, -0.10 [95% CI, -0.19 to -0.01]) and beds in LTC health facilities (coefficient, -0.09 [95% CI, -0.17 to 0.00]) were negatively associated. Policies to promote home health care have led to high home-visit rates in urban areas. Medical and LTC resources and regional factors influence disparities. As Japan's population ages, it is crucial to recognize these disparities and develop medical and LTC systems tailored to each region's characteristics. Geriatr Gerontol Int 2024; ••: ••-••.

Enhancing adversarial transferability with local transformation

Robust deep learning models have demonstrated significant applicability in real-world scenarios. The utilization of adversarial attacks plays a crucial role in assessing the robustness of these models. Among such attacks, transfer-based attacks, which leverage white-box models to generate adversarial examples, have garnered considerable attention. These transfer-based attacks have demonstrated remarkable efficiency, particularly under the black-box setting. Notably, existing transfer attacks often exploit input transformations to amplify their effectiveness. However, prevailing input transformation-based methods typically modify input images indiscriminately, overlooking regional disparities. To bolster the transferability of adversarial examples, we propose the Local Transformation Attack (LTA) based on forward class activation maps. Specifically, we first obtain future examples through accumulated momentum and compute forward class activation maps. Subsequently, we utilize these maps to identify crucial areas and apply pixel scaling for transformation. Finally, we update the adversarial examples by using the average gradient of the transformed image. Extensive experiments convincingly demonstrate the effectiveness of our proposed LTA. Compared to the current state-of-the-art attack approaches, LTA achieves an increase of 7.9% in black-box attack performance. Particularly, in the case of ensemble attacks, our method achieved an average attack success rate of 98.3%.

Emerging trends in cognitive impairment and dementia among older populations in Asia: A systematic review.

Dementia and cognitive impairment rates in Asia have significant policy implications. Contrary to the existing literature, which primarily focused on the Western region, in this study, we provide novel insights into previously unexplored geographical contexts. We aimed to evaluate the prevalence of cognitive impairment and dementia in Asia. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we searched six bibliographic databases: Web of Science, Medline, Science Direct, Ovid, Google Scholar, and PubMed. We targeted cross-sectional studies on dementia and cognitive impairment in Asia, published between 2019-23. Our extensive search yielded 2593 original articles, of which 39 met eligibility criteria. This selection unveiled a significant rise in dementia and cognitive impairment prevalence in Asia, aligning now with trends observed in Western countries - a novel finding that challenges previous assumptions about regional prevalence disparities. The studies predominantly conducted in East Asia (n = 29), along with limited research from Southeast (n = 2), South (n = 7), and Central Asia (n = 1), underscore the geographical gaps in current research. This shift in prevalence patterns is potentially linked to demographic changes, urbanisation, environmental factors, ethnic diversity, and neuroimaging advancements. Identifying modifiable risk factors associated with dementia in these regions presents new avenues for prevention and intervention strategies. Current dementia research in Asia is concentrated in East Asia, with limited data from Southeast, South, and Central Asia. Comprehensive studies across all parts of Asia are crucial to establishing robust data collection methods and identifying modifiable risk factors. This can help manage and mitigate the growing burden of dementia in these societies.

Regional Disparities, Economic Development, and Neonatal Mortality and Hospital Delivery in China

A negative association between neonatal mortality and hospital delivery has been found in some low- and lower-middle-income countries but not in rural settings characterized by poor quality of maternal and child health care. To examine the association between neonatal mortality and hospital delivery in China across urban and rural regions, regional disparities, and varying levels of economic development. This retrospective cohort study used county-level data from 2008 to 2020 from the National Maternal & Child Health Statistics across mainland China. Statistical analysis was conducted from March to December 2023. Since 2008, China has strategically leveraged hospital deliveries with national subsidies to diminish neonatal mortality, particularly in rural areas. Neonatal mortality and hospital delivery rates were calculated, and their association was estimated using multivariable fixed-effects linear models of county-level cohort data to adjust for time-invariant differences across counties and controls for gross domestic product (GDP) per capita, women's years of education, hospital beds, and health workers. The analysis included data from 2930 counties, with 198.7 million live births across 36 255 county-year records between 2008 and 2020. The mean (SD) neonatal mortality rate per 1000 live births decreased in rural areas from 12.3 (7.5) in 2008 to 3.9 (2.7) in 2020 and decreased in urban areas from 5.0 (3.1) in 2008 to 2.0 (1.3) in 2020. Hospital delivery rates increased in rural areas from a mean (SD) of 93.4% (11.8%) in 2008 to 99.9% (0.6%) in 2020 and increased in urban areas from 97.7% (6.1%) in 2008 to 100.0% (0.1%) in 2020. In rural areas, an increase of 10 percentage points in hospital deliveries was associated with a neonatal mortality rate of -1.4 (95% CI, -1.9 to -1.0; P < .001) per 1000 live births, whereas this negative association was not observed in urban areas. When the analysis was stratified by regions and incomes, the negative association became considerably stronger in the western and central regions of China, as well as in counties with lower GDP per capita. This cohort study of more than 2900 counties in China suggests that an increase in hospital deliveries was associated with reduced neonatal mortality in rural and economically underdeveloped areas in China. To further reduce neonatal mortality and improve newborn health, it is imperative to increase the accessibility of hospital delivery services.

Are Climate Change Strategies Effective in Managing Urban Water Resources? The Case of Portugal

This study examines the relationship between climate mitigation, adaptation strategies, and water management practices in Portugal from 2015 to 2021. Utilizing climate and water resource data from 2015 to 2021, including meteorological data (emperature, rainfall), wastewater treatment volumes, and energy efficiency metrics, the data are sourced from national agencies such as IPMA, ERSAR, APA, and Eurostat. The methodology employs correlation analysis to assess the relationships between climate variables (e.g., temperature, rainfall) and water resource indicators (e.g., reclaimed wastewater, energy efficiency). Despite notable reductions in greenhouse gas emissions and improvements in wastewater treatment efficiency, water resource stability remains a complex issue, particularly with regional disparities such as severe droughts in the Algarve. Additionally, the study evaluates the effectiveness of rainwater harvesting systems, reclaimed wastewater, and infiltration facilities, revealing a decline in reclaimed wastewater efficiency despite increased wastewater treatment. Rainwater harvesting systems (RWHSs) offer resilience, but their broader adoption is hindered by high costs and public perception challenges. Key recommendations include the development of resilient infrastructure, enhanced support for reclaimed water use, and increased investment in research to address water management challenges amid climate variability.

Construction of Long-Term Grid-Scale Decoupling Model: A Case Study of Beijing-Tianjin-Hebei Region

Against the backdrop of rapid global economic development, the Beijing-Tianjin-Hebei (BTH) region, a pivotal economic hub and environmentally sensitive area in China, faces significant challenges in sustaining its landscape ecosystem. Given the region’s strategic importance and vulnerability to environmental pressures, this study investigated the intricate relationships between landscape ecological risk, urban expansion, and economic growth (EG) in the BTH region. Utilizing the landscape as the focal point, we constructed a decoupling model at the grid scale to explore the decoupling relationship between the landscape ecological risk index (ERI), construction area growth (CAG), and EG. The results showed that (1) distinct stages and regional disparities were observed in the trends of ERI, CAG, and EG within the BTH region. The hot and cold spot patterns for these factors did not align consistently. (2) From 1995 to 2019, the coupling relationship between ERI, CAG, and EG in the BTH region underwent a fluctuating transition, initially moving from an undesirable state to an ideal state, and subsequently reverting to an undesirable state. Although the overall trends in these relationships showed some convergence, there were notable spatial distribution differences. (3) The spatial heterogeneity of the two decoupling relationships in the BTH region was relatively poor. Further analysis revealed that the evolution of these decoupling relationships was closely intertwined with regional policy shifts and adjustments.