Significant Temporal Trends Research Articles

Team and Electronic Health Record Features and Burnout Among Family Physicians

In the context of a growing volume of electronic health record (EHR)-based work and post-COVID-19 pandemic staffing pressures, health system leaders need an up-to-date understanding of changes in family physicians' experiences of burnout, determinants of burnout, and how to enhance the family physicians' experience. To evaluate the association of family physicians' perceptions of team structure and EHR experiences with burnout and identify modifiable practice structure factors associated with team and EHR experiences. A serial cross-sectional survey study was conducted from December 1, 2016, to October 24, 2023. Participants included family physicians seeking continuous certification through the American Board of Family Medicine. Yearly prevalence of burnout, perceived team efficiency, perceived EHR proficiency, and perceived EHR time were the outcomes. Multivariable logistic regression models subsequently assessed associations of team- and EHR-related experiences with burnout and the association between practice structure and staffing features in team efficiency and EHR time. The study included 10 315 physicians who answered the subset of questions related to burnout on the American Board of Family Medicine's Continuous Certification Questionnaire between 2017 and 2023. Among the sample, 5584 respondents (54.1%) were male, and the median age was 50 (IQR, 43-58) years. The proportion of physicians reporting burnout ranged from 37.9% in 2017 to a peak of 42.8% in 2022, which did not represent a significant temporal trend (P = .91). Appropriate home EHR use was associated with 0.58 (95% CI, 0.53-0.64; P < .001) times the odds of burnout, while high team efficiency was associated with 0.61 (95% CI, 0.56-0.67; P < .001) times the odds of burnout. Physician collaboration with a registered nurse was associated with greater odds of high team efficiency (odds ratio [OR], 1.35; 95% CI, 1.22-1.50). Collaboration with a physician assistant was associated with greater odds of appropriate home EHR time (OR, 1.13; 95% CI, 1.03-1.24). In this national cross-sectional study of US family physicians, appropriate time spent on the EHR at home and primary care team efficiency were associated with lower odds of burnout. These findings suggest that clinical leaders and policymakers should focus on optimizing primary care team support and family physicians' EHR experiences to enhance the sustainability of primary care practice.

Integrating endovascular techniques into established open neurosurgery practice: a temporal analysis of treatment evolution in a dual-trained neurosurgical unit

ObjetiveIn Europe, units with Dual-trained Neurovascular Surgeons (DTNS) skilled in both open neurosurgery (ON) and endovascular neurosurgery (EN) are scarce. For instance, in Spain, our unit is unique within the public health system, where all neurovascular procedures are carried out by DTNS. Our study aims to evaluate the evolution in treating ruptured intracranial aneurysms (rICAs) and assess the impact of this evolution on clinical outcomes. MethodsA retrospective cohort study was performed on rICAs treated in our unit from October 2012 to June 2023. We reviewed clinical and radiological data to analyze the evolution of ON and EN over time, as well as their impact on patient outcomes. Univariate, multivariate, and mixed-effects models were utilized to discern temporal changes. ResultsThe modified Fisher Scale (mFS) and the modified World Federation of Neurological Surgeons scale (mWFNS) showed strong correlation with the outcome at 6 months outcomes, both with p < 0.00001. However, the surgical intervention method, ON versus EN, did not significantly affect outcomes (p > 0.85). In adjusted multivariate logistic regression, mFS (−1.579, p: 0.011) and mWFNS (−0.872, p < 0.001) maintained their significance. rICAs location was significant when comparing ON to EN p = 0.0001. A significant temporal trend favored the selection of EN p = 0.0058). Mixed-effects time series modeling indicated that while patient characteristics and rICA specifics did not predict treatment choice, the year of treatment was significantly correlated (0.161, p = 0.002). Logistic regression with interaction terms for time and treatment type did not produce significant results. ConclusionOur findings suggest that despite an increased adoption of EN techniques, there has been no change in patient outcomes. Even with the rise of EN, our unit continues to perform ON for a higher proportion of rICAs than most national hospitals. We propose that a “dual approach” offers advantages in a patient individualized treatment decision protocol in the European context.

Social inequalities in the mental well-being of adolescents in Barcelona (2016-2021)

Abstract Crises have the potential to affect mental well-being (MWB), especially at vital stages of personal development such as adolescence. The objective of this study was to investigate the 2016-21 trends of social inequalities in the MWB of adolescents in Barcelona, stratifying by sex. Sequential, cross-sectional study based on the FRESC survey, held by the ASPB, representative of 8th and 10th grade adolescents (13-16 years old) schooled in Barcelona, in 2016 (N = 2,154) and 2021 (N = 2,299). MWB was examined using the validated WEMWBS, scoring from 14 (lowest) to 70 (highest) MWB. A temporal trend analysis of inequalities in MWB was carried out using the student socioeconomic status (SES) (low/average/high), measured with the validated FAS. For each group, the effect size of the WEMWBS means was measured with Cohen’s D. Linear regressions were performed, adjusting for academic grade, student country of origin, type of school and school index of vulnerable students. Adjusted β coefficients (aβ) and their statistical significance (p&amp;lt;.05) were estimated. In 2016, boys had higher MWB mean scores than girls (54.0 vs 50.8) (p&amp;lt;.01). In 2021, sex differences persisted, but with lower scores (51.7 vs 47.0) (p&amp;lt;.01) and still with a moderate effect size (0.52 in 2021 vs 0.40 in 2016). In multivariate regression models, boys in low SES showed the greatest MWB decrease in 2016 (low vs high SES: aβ= -3.44; p&amp;lt;.01). A significant temporal trend 2016-2021 of MWB worsening was observed in all groups, except for boys in low SES. The greatest deterioration in MWB was observed in girls, similarly in different SES (low SES: aβ= -3.52; p&amp;lt;.01). Boys in low SES showed the worst MWB in 2016 whereas all SES categories of girls had a significant trend of deterioration in MWB (2016-21). The latter could be attributed, among other factors, to a differential effect of the COVID-19 pandemic. These results underline the importance of addressing inequalities in the MWB, particularly among adolescent girls. Key messages • This study reveals a deterioration in mental well-being temporal trends (2016-2021) among adolescents in Barcelona, especially in girls. • Findings emphasize the need to address social inequalities for improving mental well-being outcomes in adolescent populations.

Trends of Diphtheria–Tetanus–Pertussis and Measles Vaccine Coverage Preceding and during the COVID-19 Pandemic: An Analysis of the WHO European Region from 2000 to 2022

Available data highlights the significant impact of the COVID-19 pandemic on global vaccination trends. Despite this, comprehensive evaluations of these changes at the European level are still scarce. This study examines coverage for diphtheria, tetanus, and pertussis (DTP) and measles-containing vaccines (MCV) in the WHO European Region from 2000 to 2022. Vaccination coverage data, defined as the percentage of surviving infants who received the first and third doses of DTP (DTP1 and DTP3) and the first and second doses of MCV (MCV1 and MCV2), were extracted from UNICEF databases. Joinpoint regression analysis was employed to identify joinpoints in the time series and to estimate Annual Percent Changes (APCs) and Average Annual Percent Changes (AAPCs) over predefined timeframes. The coverages for DTP1 and MCV1 exhibit a similar trend, overall characterized by four joinpoints, one of which is in 2019. In contrast, the coverage for DTP3 does not show a significant temporal trend and lacks joinpoints, while the vaccination coverage for MCV2 shows a steadily increasing trend, with three identified joinpoints. A comparative analysis with the pre-pandemic period reveals a significant increase in the number of countries characterized by a decreasing trend during the pandemic period for all considered vaccination coverages, as indicated by the negative AAPC values. These results highlight the effect of the pandemic on childhood vaccination coverage. Compared to a mere descriptive analysis, the temporal analysis of trends using joinpoint regression provides significant opportunities to identify variations in vaccination coverages and pinpoint areas for intervention in future vaccination strategies.

Provenance of mineral dust deposited on Antarctica over the last sixty years by strontium isotopic analysis of snow from Dome C

The strontium (Sr) concentration and 87Sr/86Sr isotope ratio have been determined in 132 snow pit samples collected at Dome C, on the East Antarctic Plateau, corresponding to the period 1958–2019, and in 12 surface snow samples collected at the same site in 2016–2017. The average Sr concentration was 8.1 ± 5.7 pg g−1 (mean ± SD) in snow pit samples and 10.1 ± 8.0 pg g−1 (mean ± SD) in surface snow, without any significant temporal trend. The 87Sr/86Sr isotope ratio showed small variations (<0.15%), with an average 87Sr/86Sr value of 0.7094 ± 0.0010 (mean ± SD) in snow pit and 0.7103 ± 0.0004 (mean ± SD) in surface snow samples. These results seem to suggest that no change in the source(s) of mineral dust has occurred throughout the period investigated.Comparison of the 87Sr/86Sr isotope ratio of the snow samples with those of potential source areas suggests that the mineral dust reaching the East Antarctic plateau over the last decades is of a mixed origin, with a contribution from Patagonia and one or more other source(s) having a more radiogenic Sr isotopic signature, with a major fraction coming from South Australia.

Museum-archived myctophids reveal decadal trends in microplastic and microfiber ingestion

Global plastic production has surged since the 1960s, resulting in the pervasive presence of microplastics in the environment, yet there is a substantial gap in understanding historical trends of plastic pollution in wildlife. Recent discoveries of significant microplastic contamination in fishes have sparked considerable contemporary advancements in analytical methods and hold the potential to fill gaps in historical trends. We measured the presence of microplastics in museum-archived myctophids (Stenobrachius leucopsarus, Diaphus theta, and Tarletonbeania crenularis) collected from 1962 to 2016, to determine if trends in contamination levels over time correspond with the rise in plastics production. Seventy particles were extracted from 57 of the 240 individuals (23.8 % average occurrence across the time series) consisting of primarily blue and black microfibers. Anthropogenically modified cellulose was the dominant material (87 %) identified through μFTIR analysis, with polypropylene and polyethylene particles occurring secondarily. Although the complete time series across a broad geographical range of the North Pacific did not reveal a significant temporal trend, myctophids collected in proximity to the U.S. west coast showed a trend towards increasing incidence of microplastic and microfiber ingestion over time (p ≤ 0.05). Using historical samples of species with higher ingestion levels and consistent collection locations would improve the reliability of future investigations.

Long‐term trends in mountain groundwater levels across Canada and the United States

AbstractMountains have a critical role in freshwater supply for downstream populations. As the climate changes, groundwater stored in mountains may help buffer the impacts to declining water resources caused by decreased snowpack and glacier recession. However, given the scarcity of groundwater observation wells in mountain regions, it remains unclear how mountain groundwater is being impacted by climate change across ecoregions. This study quantifies temporal trends in mountain groundwater levels and explores how various climatic, physiographic and anthropogenic factors affect these trends. We compiled data from 171 public groundwater observation wells within mountain regions across Canada and the United States, for which at least 20 years of monthly data is available. The Mann‐Kendall test for monotonic trend revealed that 54% of these wells have statistically significant temporal trends (p &lt; 0.05) over the period of record, of which 69% were negative and therefore indicating overall declining groundwater storage. Wells in the western mountain ranges showed stronger trends (both positive and negative) than the eastern mountain ranges, and higher elevation wells showed fewer negative trends than the low elevation (&lt;400 m asl) wells (p &lt; 0.05). Correlation, Kruskal‐Wallis tests, stepwise multiple linear regression and random forest regression were used to identify factors controlling groundwater trends. Statistical analysis revealed that lower‐elevation mountain regions with higher average annual temperatures and lower average annual precipitation have the greatest declines in groundwater storage under climate change. Trends in temperature and precipitation, and ecoregion were also important predictors on groundwater level trends, highlighting geographic differences in how mountain wells are responding to climate change. Furthermore, sedimentary bedrock aquifers showed markedly more negative trends than crystalline bedrock aquifers. The findings demonstrate that the impact of climate change on mountain water resources extends to the subsurface, with important implications for global water resources.

Long-term patterns of stream macroinvertebrates in an alpine cirque landscape

Alpine landscapes are notable regarding their sensitivity to environmental change. Surface waters are especially sensitive as many are influenced by glacial meltwaters that are diminishing with the retreat of glaciers worldwide. The Macun Lakes region, Swiss National Park, is an alpine cirque landscape housing a number of lakes interconnected by streams. The area has been non-glaciated for decades, although rock glaciers are still present in the south basin. Surface waters, 10 stream sites in the present study, have been monitored in mid-summer since the year 2001 for physico-chemistry, periphyton and macroinvertebrates (including 74 species of chironomids). Water physico-chemistry revealed that the two main basins in the catchment differed, reflecting the inputs of rock glacier waters in the south basin. However, trends suggest that waters are becoming more similar as rock glacier inputs diminish over time along with a general decrease in nitrogen levels in all waters. Periphyton biomass showed some spatial differences among sites and a general decrease after 2010. Macroinvertebrate assemblages, including chironomids, clearly differed among basins and spatially along the stream network in each basin. Notably, no significant temporal trend was observed in the long-term data for macroinvertebrates, including chironomids, at the monitored sites. The results suggest that lotic macroinvertebrates may be buffered by the interconnectedness of streams and lakes in the landscape, which mitigates major response patterns of running waters to environmental change.

Seasonal and Interannual Variability of the Trophic State in the Marano and Grado Lagoon (Adriatic Sea, Italy) during the 2011–2021 Period

The Marano and Grado Lagoon (Adriatic Sea, Italy) is an important transitional environment that furnishes numerous ecosystem services and is under protection as Site of Community Importance. It suffers from an excess of nutrients, especially nitrate (NO3−), and has been designated as a nitrate vulnerable zone. In this work, sixteen water bodies were seasonally monitored for physicochemical parameters and nutrients, to elucidate the trophic state of the lagoon and to check the occurrence of significant temporal trends in a time series from 2011 to 2021. Steep gradients of spatial and seasonal distribution were observed for all parameters with elevated concentration of N-NO3− (up to 360 µM) in the western sector. The whole lagoon was in phosphorous limitation (P-PO43− mean ± s.d. = 0.15 ± 0.22 µM) with a mean Redfield ratio of 1130. The concentration of nutrients was significantly correlated with the degree of both freshwater inputs and precipitation. The calculation of trophic indices shows that the lagoon is in an oligotrophic to hypertrophic condition (i.e., TRIX 1.9–6.8). The analysis of the temporal series showed that despite some significant trends, the time span considered is too short to detect significant changes in the trophic state of this dynamic environment.

Two decades of increasing functional and phylogenetic richness in a mountaintop flora in central Norway

AbstractQuestionsAnalysing how multiple facets of biodiversity vary across space and time can help to predict the vulnerability of mountaintop floras to future environmental changes. Here we addressed the following questions: (a) Are elevational patterns of mountaintop plant diversity consistent across taxonomy, function and phylogeny? (b) How have the taxonomic, functional and phylogenetic dimensions of mountaintop plant communities changed over the past two decades? (c) Is the magnitude of these temporal trends dependent on elevation?LocationDovrefjell, central Norway.MethodsThe floristic composition of four mountaintops, spread across an elevational gradient from the tree line to the uppermost margins of vascular plant life, was surveyed every 7 years between 2001 and 2022. Six metrics of taxonomic, functional and phylogenetic richness and differentiation were calculated for each mountaintop and survey. Using these data, we assessed how richness and differentiation metrics varied over space (across the elevational gradient) and over time (between surveys).ResultsAll diversity metrics decreased towards higher elevations, except phylogenetic differentiation which increased significantly by 7% per 100 m elevational gain. Taxonomic richness remained virtually stable between 2001 and 2022, whereas phylogenetic richness increased by 7.5% per decade. Functional richness also increased, but mainly on the lowest mountaintop, by 17% per decade. No significant temporal trends in taxonomic, functional and phylogenetic differentiation were detected.ConclusionsOur findings underpin rearrangements in the functional and phylogenetic structure of mountain plant communities over the past two decades that cannot be predicted from trends in taxonomic richness alone. This highlights the necessity to look beyond species richness and consider multiple facets of biodiversity when studying environmental change impacts on mountain biodiversity and ecosystem functioning.

Reconstruction of the marine carbonate system at the Western Tropical Atlantic: trends and variabilities from 20 years of the PIRATA program

The Western Tropical Atlantic Ocean (WTAO) is crucial for understanding CO2 dynamics due to inputs from major rivers (Amazon and Orinoco), substantial rainfall from the Intertropical Convergence Zone (ITCZ), and CO2-rich waters from equatorial upwelling. This study, spanning 1998 to 2018, utilized sea surface temperature (SST) and sea surface salinity (SSS) data from the PIRATA buoy at 8°N 38°W to reconstruct the surface marine carbonate system. Empirical models derived total alkalinity (TA) and dissolved inorganic carbon (DIC) from SSS, with subsequent estimation of pH and fCO2 from TA, DIC, SSS, and SST data. Linear trend analysis showed statistically significant temporal trends: DIC and fCO2 increased at a rate of 0.7 µmol kg-1 year-1 and 1.539 µatm year-1, respectively, and pH decreased at a rate of -0.001 pH units year-1, although DIC did not show any trend after data was de-seasoned. Rainfall analysis revealed distinct dry (July to December) and wet (January to June) seasons, aligning with lower and higher freshwater influence on the ocean surface, respectively. TA, DIC, and pH correlated positively with SSS, exhibiting higher values during the dry season and lower values during the wet season. Conversely, fCO2 correlated positively with SST, showcasing higher values during the wet season and lower values during the dry season. This emphasizes the influential roles of SSS and SST variability in CO2 solubility within the region. Finally, we have analysed the difference between TA and DIC (TA-DIC) as an indicator for ocean acidification and found a decreasing trend of -0.93 ± 0.02 μmol kg-1 year-1, reinforcing the reduction in the surface ocean buffering capacity in this area. All trends found for the region agree with data from other stations in the tropical and subtropical Atlantic Ocean. In conclusion, the use of empirical models proposed in this study has proven to help filling the gaps in marine carbonate system data in the Western Tropical Atlantic.

Myopia Prevalence in Latin American Children and Adolescents: A Systematic Review and Meta-Analysis.

Although myopia is a growing global concern, comprehensive studies on its prevalence among Latin American (LATAM) children and adolescents are still lacking. Thus, we conducted a systematic review and meta-analysis to determine the prevalence of myopia in LATAM children and adolescents aged three to 20. The study conducted a thorough literature search from January 1, 1975, to February 28, 2023, identifying 24 studies on the prevalence of myopia in LATAM that met the inclusion criteria. Quality assessment and standardized data collection were performed. The meta-analysis used a random-effects model due to heterogeneity and calculated prevalence rates. Finally, the analysis of data from 24 eligible studies revealed a myopia prevalence of 8.61% (range 0.80-47.36%, 95% confidence interval (CI): 5.22-13.87%, p < 0.05) among 165,721 LATAM children and adolescents. No significant age-based associations or temporal trends were observed in this study. Studies with non-cycloplegic or objective assessment exhibited a numerically higher, although statistically non-significant, myopia prevalence (10.62%, 95% CI: 4.9-21.6%) compared to studies using cycloplegia (7.17%, 95% CI: 3.40-14.50%). In conclusion, myopia affects approximately one in 11 LATAM children and adolescents. Given the increasing exposure of LATAM youth to known myopia risk factors, such as extensive near-work, online learning, and limited outdoor activities, it is crucial to monitor myopia trends in this region. Further research is imperative to address and prevent myopia in LATAM.

Understory plants evade shading in a temperate deciduous forest amid climate variability by shifting phenology in synchrony with canopy trees.

Global warming is leading understory and canopy plant communities of temperate deciduous forests to grow leaves earlier in spring and drop them later in autumn. If understory species extend their leafy seasons less than canopy trees, they will intercept less light. We look for mismatched phenological shifts between canopy and understory in 28 years (1995-2022) of weekly data from Trelease Woods, Urbana, IL, USA. The observations cover 31 herb species of contrasting seasonality (for 1995-2017), three sapling species, and the 15 most dominant canopy tree species for all years, combined with solar radiation, temperature and canopy light transmittance data. We estimate how understory phenology, cold temperatures, canopy phenology, and solar radiation have individually limited understory plants' potential light interception over >2 decades. Understory and canopy phenology were the two factors most limiting to understory light availability, but which was more limiting varied greatly among species and among/within seasonality groups; solar radiation ranked third and cold fourth. Understory and canopy phenology shifts usually occurred in the same direction; either both strata were early or both were late, offsetting each other's effects. The four light-limiting factors combined showed significant temporal trends for six understory species, five toward less light interception. Warmer springs were significantly associated with shifts toward more light interception in three sapling species and 19 herb species. Canopy phenology became more limiting in warmer years for all three saplings species and 31 herb species. However, in aggregate, these variables mostly offset one another; only one sapling and seven herb species showed overall significant (and negative) relationships between light interception and spring temperature. The few understory species mismatched with canopy phenology due to changing climate are likely to intercept less light in future warmer years. The few species with data for carbon assimilation show broadly similar patterns to light interception.

Disparities in neoadjuvant chemotherapy for pancreatic adenocarcinoma with vascular involvement

BackgroundMultiagent neoadjuvant chemotherapy (NAT) has been linked with improved survival for locally advanced (LA) or borderline resectable (BR) pancreatic ductal adenocarcinoma (PDAC). However, the existence of disparities in its utilization remains to be elucidated. MethodsAll adults with PDAC were tabulated from the 2011–2017 Nationwide Cancer Database. Tumor vascular involvement was determined using the clinical T stage and CS_EXTENSION variables. The significance of temporal trends was calculated using Cuzick's non-parametric test. A Cox proportional hazard model was used to assess the impact of NAT utilization on hazard of two-year mortality. A logistic regression model was developed to determine factors associated with receipt of NAT. ResultsOf 3811 patients meeting inclusion criteria, 50.8 % received NAT. NAT utilization significantly increased over the study period, from 31.7 % in 2011 to 81.1 % in 2017 (p < 0.001). NAT was associated with significantly reduced two-year mortality (Hazards Ratio 0.34, 95 % Confidence Interval [CI] 0.18–0.67).After adjustment, younger (Adjusted Odds Ratio [AOR] 0.97/year, CI 0.96–0.98) and Black (AOR 0.65, CI 0.48–0.89; ref: White) patients demonstrated reduced odds of NAT. Furthermore, patients with Medicare (AOR 0.73, CI 0.59–0.90; ref: Private) or Medicaid insurance (AOR 0.67, CI 0.46–0.97; ref: Private) had lower odds of NAT, as did those treated at non-academic institutions (Community: AOR 0.42, CI 0.35–0.52, Integrated: 0.68, CI 0.54–0.85) or in the lowest education quartile (AOR 0.52, CI 0.29–0.95; ref: Highest). ConclusionsWe identified increasing utilization of NAT for BR/LA pancreatic adenocarcinoma. Despite being linked with significantly reduced two-year mortality, socioeconomic disparities affect odds of NAT.

Increasing cancer-related mortality and demographic disparities in young adults in the United States between 1999 and 2020.

10569 Background: The global rise in cancer incidence in the young adult population (≤ 45 years), particularly in obesity-related cancers, is of growing concern. As the demographic afflicted by cancer expands beyond traditional boundaries, a nuanced understanding of the unique characteristics and challenges specific to young adults is imperative for developing interventions that address their distinct needs. In this study, we characterize cancer mortality rates in the young adult population to assess for emerging trends and cancer burden in the United States. Methods: The Centers for Disease Control database was queried for all underlying causes of death due to cancer (ICD 10 codes C00-C97) between 1999 and 2020. Malignancies that primarily affect the elderly, such as prostate and multiple myeloma, were excluded. Age-adjusted mortality (AAMR) rates per 100,000 people were extracted for adult patients between 25 and 44 years of age. AAMR was assessed by demographic and clinical variables, including race, geographic density, sex, and primary site. Joinpoint trend analysis was used to identify the presence of statistically significant temporal trends. Average annual percent change (AAPC) was considered statistically significant if p &lt; 0.05. Results: Between 1999 and 2020, 366,478 cancer-related deaths occurred in young adults in the United States. The overall AAMR was 20.7, decreasing from 24.8 in 1999 to 17.5 in 2020 at a rate of -1.6% annually (p&lt;0.05). However, increasing mortality was seen in a number of primary sites, including uterine cancer with an increase of 2.6% annually (p&lt;0.05) and colorectal cancer with an increase of 0.8% annually (p&lt;0.05). Overall AAMR was highest for non-Hispanic Black individuals at 28.3, 29% higher than the next highest group (non-Hispanic White) at 21.2 and almost double that of non-Hispanic Asians at 14.7. Individuals residing in rural populations experienced the highest AAMRs at 24.3 and the slowest rates of decrease at -1.6% annually (p&lt;0.05), compared with urban individuals whose AAMR was 19.8 with a decrease of -1.9% annually (p&lt;0.05). Primary sites with the highest AAMRs included breast (3.1), lung (2.1), and colorectal (1.8) cancers. Conclusions: The current study sheds light on the evolving landscape of cancer mortality among young adults in the United States. The overall decrease in age-adjusted mortality rates is promising, reflecting advancements in cancer care and prevention strategies. However, the alarming increase in mortality rates for specific cancer types, such as uterine and colorectal cancers, underscores the need for targeted interventions and heightened awareness, especially in at-risk populations. The identified racial and geographic disparities further emphasize the importance of implementing tailored approaches to address the unique challenges faced by diverse populations.

Integrating endovascular techniques into established open neurosurgery practice: a temporal analysis of treatment evolution in a dual-trained neurosurgical unit

ObjetiveIn Europe, units with Dual-trained Neurovascular Surgeons (DTNS) skilled in both open neurosurgery (ON) and endovascular neurosurgery (EN) are scarce. For instance, in Spain, our unit is unique within the public health system, where all neurovascular procedures are carried out by DTNS. Our study aims to evaluate the evolution in treating ruptured intracranial aneurysms (rICAs) and assess the impact of this evolution on clinical outcomes. MethodsA retrospective cohort study was performed on rICAs treated in our unit from October 2012 to June 2023. We reviewed clinical and radiological data to analyze the evolution of ON and EN over time, as well as their impact on patient outcomes. Univariate, multivariate, and mixed-effects models were utilized to discern temporal changes. ResultsThe modified Fisher Scale (mFS) and the modified World Federation of Neurological Surgeons scale (mWFNS) showed strong correlation with the outcome at 6 months outcomes, both with p < 0.00001. However, the surgical intervention method, ON versus EN, did not significantly affect outcomes (p > 0.85). In adjusted multivariate logistic regression, mFS (−1.579, p: 0.011) and mWFNS (−0.872, p < 0.001) maintained their significance. rICAs location was significant when comparing ON to EN p = 0.0001. A significant temporal trend favored the selection of EN p = 0.0058). Mixed-effects time series modeling indicated that while patient characteristics and rICA specifics did not predict treatment choice, the year of treatment was significantly correlated (0.161, p = 0.002). Logistic regression with interaction terms for time and treatment type did not produce significant results. ConclusionOur findings suggest that despite an increased adoption of EN techniques, there has been no change in patient outcomes. Even with the rise of EN, our unit continues to perform ON for a higher proportion of rICAs than most national hospitals. We propose that a “dual approach” offers advantages in a patient individualized treatment decision protocol in the European context.

Sex-Specific Differences in the Progression of Huntington’s Disease Symptoms – A National Study in China

Introduction: Huntington’s disease (HD) is a rare, inherited neurodegenerative disorder. Despite extensive research on symptom progression and sex differences in Western populations, little is known about these aspects within the Chinese context. The objective of this study was to investigate the temporal trends of symptoms in individuals with HD in China. Methods: A nationwide cross-sectional study was conducted in Chinese individuals diagnosed with HD. Symptom progression over time, encompassing physical, psychiatric, and cognitive symptoms, was self-reported. We calculated the proportions of individuals who currently had each symptom by disease duration, and tested corresponding temporal trends by linear regression analyses. Results: A total of 269 individuals diagnosed with HD were included. Specific symptoms were found to progress more significantly in males compared to females over time, including psychotic symptoms (p = 0.007), urinary incontinence (p = 0.013), reduced concentration (p = 0.005), font alteration (p = 0.029), atypical facial expression (p = 0.037), and suicidal ideation (p = 0.047). In terms of cognitive and psychiatric symptoms, no significant temporal trends were identified in females, while males demonstrated significant increasing trends, with reduced concentration (p = 0.005) and psychotic symptoms (p = 0.007) standing out. Conclusions: This study emphasizes the existence of sex-specific symptom progression in HD within the Chinese population, underscoring the importance of considering sex in clinical practice. Further research should investigate the mechanisms behind these differences and explore tailored treatment options.

Robotic versus laparoscopic surgery for colorectal disease: a systematic review, meta-analysis and meta-regression of randomised controlled trials.

Robotic surgery (RS) is gaining prominence in colorectal procedures owing to advantages like three-dimensional vision and enhanced dexterity, particularly in rectal surgery. Although recent reviews report similar outcomes between laparoscopic surgery (LS) and RS, this study investigates the evolving trends in outcomes over time, paralleling the increasing experience in RS. A systematic review, meta-analysis and meta-regression were conducted of randomised controlled trials exploring postoperative outcomes in patients undergoing RS or LS for colorectal pathology. The primary outcome measure was postoperative complications. Risk of bias was evaluated using the Cochrane Collaboration's assessment tool. Randomised controlled trials were identified from the PubMed®, Embase® and CINAHL® (Cumulative Index to Nursing and Allied Health Literature) databases via the Cochrane Central Register of Controlled Trials. Of 491 articles screened, 13 fulfilled the inclusion criteria. Meta-analysis of postoperative complications revealed no significant difference between RS and LS (relative risk [RR]: 0.96, 95% confidence interval [CI]: 0.79 to 1.18, p=0.72). Meta-regression analysis of postoperative complications demonstrated a significant trend favouring RS over time (yearly change in Ln(RR): -0.0620, 95% CI: -0.1057 to -0.0183, p=0.005). Secondary outcome measures included operative time, length of stay, blood loss, conversion to open surgery, positive circumferential resection margins and lymph nodes retrieved. The only significant findings were shorter operative time favouring LS (mean difference: 41.48 minutes, 95% CI: 22.15 to 60.81 minutes, p<0.001) and fewer conversions favouring RS (RR: 0.57, 95% CI: 0.37 to 0.85, p=0.007). As experience in RS grows, evidence suggests an increasing safety profile for patients. Meta-regression revealed a significant temporal trend with complication rates favouring RS over LS. Heterogeneous reporting of complications hindered subgroup analysis of minor and major complications. LS remains quicker. Rising adoption of RS coupled with emerging evidence is expected to further elucidate its clinical efficacy.

Door to needle time trends after transition to tenecteplase: A Multicenter Texas stroke registry

BackgroundTenecteplase (TNK) is considered a promising option for the treatment of acute ischemic stroke (AIS) with the potential to decrease door-to-needle times (DTN). This study investigates DTN metrics and trends after transition to tenecteplase. MethodsThe Lone Star Stroke (LSS) Research Consortium TNK registry incorporated data from three Texas hospitals that transitioned to TNK. Subject data mapped to Get-With-the-Guidelines stroke variables from October 1, 2019 to March 31, 2023 were limited to patients who received either alteplase (ALT) or TNK within the 90 min DTN times. The dataset was stratified into ALT and TNK cohorts with univariate tables for each measured variable and further analyzed using descriptive statistics. Logistic regression models were constructed for both ALT and TNK to investigate trends in DTN times. ResultsIn the overall cohort, the TNK cohort (n = 151) and ALT cohort (n = 161) exhibited comparable population demographics, differing only in a higher prevalence of White individuals in the TNK cohort. Both cohorts demonstrated similar clinical parameters, including mean NIHSS, blood glucose levels, and systolic blood pressure at admission. In the univariate analysis, no difference was observed in median DTN time within the 90 min time window compared to the ALT cohort [40 min (30–53) vs 45 min (35-55); P = .057]. In multivariable models, DTN times by thrombolytic did not significantly differ when adjusting for NIHSS, age (P = .133), or race and ethnicity (P = .092). Regression models for the overall cohort indicate no significant DTN temporal trends for TNK (P = .84) after transition; nonetheless, when stratified by hospital, a single subgroup demonstrated a significant DTN upward trend (P = 0.002). ConclusionIn the overall cohort, TNK and ALT exhibited comparable temporal trends and at least stable DTN times. This indicates that the shift to TNK did not have an adverse impact on the DTN stroke metrics. This seamless transition is likely attributed to the similarity of inclusion and exclusion criteria, as well as the administration processes for both medications. When stratified by hospital, the three subgroups demonstrated variable DTN time trends which highlight the potential for either fatigue or unpreparedness when switching to TNK. Because our study included a multi-ethnic cohort from multiple large Texas cities, the stable DTN times after transition to TNK is likely applicable to other healthcare systems.

Analyzing Trends in Mental and Behavioral Health Support for Children: A Comprehensive Study Using National Survey of Children's Health Database.

Objective This study aimed to explore mental and behavioral health support trends for children aged 3-17, analyzing treatment and counseling using United States data from the 2016-2020 National Survey of Children's Health (NSCH) database. Methods Employing a retrospective observational design,we systematically retrieved and analyzed NSCH Database data from 2016 to 2020.The focus was on understanding mental and behavioral health treatment percentages over time, specifically targeting demographic variations such as age groups, gender, race/ethnicity, and the federal poverty level percentage. Graphical representation utilized Excel, summarizing results based on aggregated data for distinct time intervals, highlighting the importance of mental and behavioral health support for children aged 3-17. Results The study identified significant temporal trends in mental and behavioral health treatment, revealing notable fluctuations across demographic and socio-economic variables. Of the 22,812 participants, 51.7% (CI: 50.2-53.1%, n=12,686) received treatment, exposing disparities. Gender differences were evident, with higher treatment rates in females (53.7%, CI: 51.6-55.9%, n=6,166) thanmales(50.1%, CI: 48.2-52.0%, n=6,520). Age-specific patterns indicated lower intervention rates in younger children (33.5%, CI: 28.6-38.8%, n=447, ages 3-5) compared to adolescents (58.1%, CI: 56.2-59.9%, n=8, 222 ages 12-17). Conclusion The conclusion highlights significant temporal fluctuations and pronounced demographic disparities. Findings underscore varying prevalence rates among age groups, genders, racial/ethnic backgrounds, and socio-economic status categories. This study provides valuable insights for policymakers, healthcare professionals, and researchers, informing targeted interventions to enhance mental and behavioral health support for United States children.