Time-series Study Research Articles

Association Between Extreme Heat and Outpatient Visits for Mental Disorders: A Time-Series Analysis in Guangzhou, China.

Previous evidence on heatwaves' impact on mental health outpatient visits is limited, especially uncertainty on how different heatwave definitions affect this relationship. In this time-series study, we assessed the association between heatwaves and outpatient visits for mental disorders in Guangzhou, China. Daily outpatient visits for mental disorders and its specific categories (schizophrenia, mood, and neurotic disorders) were sourced from the Urban Resident-based Basic Medical Insurance (URBMI) and the Urban Employee-based Basic Medical Insurance (UEBMI) claims databases in Guangzhou from 2010 to 2014. The study employed nine heatwave definitions, based on combinations of three daily mean temperature thresholds (90th, 92.5th, and 95th percentiles) and durations (2, 3, and 4days). Using quasi-Poisson generalized linear models (GLMs), we estimated the risks (at lag 0day) and cumulative effects (lag 0-10days) of heatwaves on mental disorder outpatient visits. Age, gender, types of medical insurance were considered as potential effect modifiers. We observed a positive association between heatwaves and increased total outpatient visits for mental disorders, both at lag 0day and during lag 0-10days. The impact of heatwave was significant at lag 0day for schizophrenia, mood and neurotic disorders visits, it remained significant for neurotic and mood disorders visits during lag 0-10days. Heatwave durations lasting more than 4days were associated with higher relative risks of mental disorders at lag 0day. Older adults had relatively higher effect estimations than younger individuals. This research highlights the effects of extreme heat on mental health.

Relationship between temperature and acute myocardial infarction: a time series study in Xuzhou, China, from 2018 to 2020

BackgroundIt is widely known that the incidence rate and short-term mortality of acute myocardial infarctions (AMIs) are generally higher during the winter months. The goal of this study was to determine how the temperature of the environment influences fatal acute myocardial infarctions in Xuzhou.MethodsThis observational study used the daily meteorological data and the data on the cause of death from acute myocardial infarction in Xuzhou from January 1, 2018, to December 31, 2020. After controlling meteorological variables and pollutants, the distributed nonlinear lag model (DLNM) was used to estimate the correlation between temperature and lethal AMI.ResultsA total of 27,712 patients with fatal AMI were enrolled. 82.4% were over the age of 65, and 50.9% were men. Relative to the reference temperature (15 ℃), the 30-day cumulative RRs of the extremely cold temperature (− 2 ℃) for the general population, women, and people aged 65 years and above were 4.66 (95% CI: 1.76, 12.30), 15.29 (95% CI: 3.94, 59.36), and 7.13 (95% CI: 2.50, 20.35), respectively. The 30-day cumulative RRs of the cold temperature (2 ℃) for the general population, women, and people aged 65 years and above were 2.55 (1.37, 4.75), 12.78 (2.24, 5.36), and 3.15 (1.61, 6.16), respectively. No statistically significant association was observed between high temperatures and the risk of fatal AMI. The influence of the cold effect (1st and 10th) was at its peak on that day, and the entire cold effect persisted for 30 days. Temperature extremes had an effect on the lag patterns of distinct age and gender stratifications.ConclusionAccording to this study, the risk of fatal AMI increases significantly in cold weather but not in hot weather. Women above the age of 65 are particularly sensitive to severe weather events. The influence of frigid weather on public health should also be considered.

Strategies to improve the implementation of preventive care in primary care: a systematic review and meta-analysis

BackgroundAction on smoking, obesity, excess alcohol, and physical inactivity in primary care is effective and cost-effective, but implementation is low. The aim was to examine the effectiveness of strategies to increase the implementation of preventive healthcare in primary care.MethodsCINAHL, CENTRAL, The Cochrane Database of Systematic Reviews, Dissertations & Theses – Global, Embase, Europe PMC, MEDLINE and PsycINFO were searched from inception through 5 October 2023 with no date of publication or language limits. Randomised trials, non-randomised trials, controlled before-after studies and interrupted time series studies comparing implementation strategies (team changes; changes to the electronic patient registry; facilitated relay of information; continuous quality improvement; clinician education; clinical reminders; financial incentives or multicomponent interventions) to usual care were included. Two reviewers screened studies, extracted data, and assessed bias with an adapted Cochrane risk of bias tool for Effective Practice and Organisation of Care reviews. Meta-analysis was conducted with random-effects models. Narrative synthesis was conducted where meta-analysis was not possible. Outcome measures included process and behavioural outcomes at the closest point to 12 months for each implementation strategy.ResultsEighty-five studies were included comprising of 4,210,946 participants from 3713 clusters in 71 cluster trials, 6748 participants in 5 randomised trials, 5,966,552 participants in 8 interrupted time series, and 176,061 participants in 1 controlled before after study. There was evidence that clinical reminders (OR 3.46; 95% CI 1.72–6.96; I2 = 89.4%), clinician education (OR 1.89; 95% CI 1.46–2.46; I2 = 80.6%), facilitated relay of information (OR 1.95, 95% CI 1.10–3.46, I2 = 88.2%), and multicomponent interventions (OR 3.10; 95% CI 1.60–5.99, I2 = 96.1%) increased processes of care. Multicomponent intervention results were robust to sensitivity analysis. There was no evidence that other implementation strategies affected processes of care or that any of the implementation strategies improved behavioural outcomes. No studies reported on interventions specifically designed for remote consultations. Limitations included high statistical heterogeneity and many studies did not account for clustering.ConclusionsMulticomponent interventions may be the most effective implementation strategy. There was no evidence that implementation interventions improved behavioural outcomes.Trial registrationPROSPERO CRD42022350912.

Acute effects of ambient nitrogen dioxide pollution on outpatient visits for neurological diseases in Xinxiang, China

BackgroundAccumulating evidence suggests that exposure to air pollution acts as a potential trigger for neurological diseases (NDs), yet the current knowledge regarding the impact of ambient nitrogen dioxide (NO2) on the patients with NDs remains limited. In this study, we conducted a time-series study to evaluate the association between short-term exposure to NO2 and hospital visits for NDs in Xinxiang, China.MethodsAn over-dispersed Poisson generalized additive model was used to analyze the association between ambient NO2 concentrations and daily outpatient visits for NDs from January 1, 2015 to December 31, 2017. The model adjusted for meteorological factors, temporal trends, day of the week, and public holidays. The concentrations of air pollutants were collected from four air quality stations in Xinxiang.ResultsA total of 38, 865 outpatient visits for NDs were retrieved during the study period. 86.5% of the patients were below the age of 65 years. It was revealed that a 10 µg/m3 increase in NO2 at lag 0 was associated with a significant rise of 1.50% (95% CI: 0.45–2.56%) in outpatient visits for NDs, which was stronger during the cold season. However, the overall results from stratified analyses did not reach statistical significance.ConclusionsShort-term exposure to NO2 is associated with increased outpatient visits for NDs. These findings underscore the need for implementing mitigating measures to reduce the neurological health effects of air pollutants.

Controls on the stable Mo isotopic composition of inner-continental precipitation

The molybdenum (Mo) isotope budget of the surface environment has been well characterized in recent decades, facilitating accurate mass balance modeling of the ancient redox-driven Mo cycle. One yet unresolved component is the range of possible processes and sources that result in isotopically heavy river waters relative to continental sources. Following a recent hypothesis that isotopically heavy δ98Mo of precipitation may control the final δ98Mo of river water relative to its continental source bedrock, we investigated the δ98Mo composition of 19 snow samples from three locations in Central Europe: the Swiss Alps (“Alpine” samples) from the Hochalpine Forschungsstation Jungfraujoch (HFSJ) in both summer and winter, the Swiss Jura Mountains in winter and the French Vosges Mountains in winter. Stream waters from two snowmelt-fed streams were additionally collected from the Alpine site. Snow sample δ98Mo compositions were highly variable, ranging from −0.03 to +1.93 ‰, with no clear mixing trends indicating complex sources, source pathways, or post-depositional processing. Only the winter snow samples from the high-altitude HFSJ site had δ98Mo values consistently heavier than typical continental crust. The δ98Mo results were coupled with radiogenic Sr isotopic, major ion, and trace element compositions as tracers for three major sources of airborne ion inputs: sea salt, mineral dust, and anthropogenic aerosols. We found that the most likely source of Mo to precipitation in the lower elevation Vosges and Jura Mountains samples was isotopically light soil mineral dust, which reflected the underlying bedrock sources, with a likely additional anthropogenic component. The isotopically heavy winter snow samples at the elevated HFSJ site were attributed to a higher input of carbonate mineral dust from long-distance transport of carbonate-rich Saharan dust, which was overwritten in the summer by an influx of low elevation sources transported upwards during higher vertical thermal mixing. Finally, we concluded that precipitation has a negligible direct effect on the overall Mo content and isotopic composition of inner continental European streams and rivers relative to other sources, such as bedrock weathering. Future time-series studies may augment these conclusions to show possible heterogeneity of precipitation as well as the addition of sample sites closer to marine sources, where a larger flux of isotopically heavy marine aerosols to streams might be expected.

Impact of the COVID-19 pandemic on telogen effluvium: a nationwide multicentre interrupted time series study.

There is ongoing debate regarding the association between telogen effluvium (TE) and COVID-19, as well as COVID-19 vaccines. To investigate the impact of the COVID-19 pandemic and vaccination on the development of TE among patients visiting dermatology clinics in South Korea. Between 2017 and 2022, data regarding patients with TE and other types of hair loss were collected from 22 hospitals in South Korea. An interrupted time series analysis was conducted, dividing the time into periods before and after the COVID-19 pandemic, as well as before and after the COVID-19 vaccination. There was a significant slope change in the percentage of cases of TE during the postpandemic period (slope change 0.011, 95% confidence interval 0.005-0.017, P < 0.001), but no significant changes were observed after vaccination. The percentage of patients with other types of hair loss was not associated with COVID-19 or vaccination. The retrospective nature of the study may have limited the ability to establish causation. This multicentre study provides insights into the epidemiology of TE, showing a significant increase in cases of TE following the COVID-19 pandemic. However, there was no association between the occurrence of TE and COVID-19 vaccines.

Air pollution exposure and inflammatory bowel disease: a systematic literature review of epidemiological and mechanistic studies

This systematic literature review investigates the relationship between air pollution exposure and inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC). Despite the growing concern over air pollution's impact on various health outcomes, studies specifically addressing effects on the digestive system, particularly IBD, are relatively rare. This review aims to synthesize the current knowledge on this topic, focusing on the mechanisms underlying these associations and the role of different air pollutants. Following PRISMA guidelines, a systematic literature search of PubMed and Web of Science databases was conducted, yielding 13 epidemiological studies and six mechanistic (toxicological) studies meeting the inclusion criteria. The epidemiological studies examined associations between IBD and various air pollutants, including PM2.5 (particles with an aerodynamic diameter smaller than, or equal to, 2.5 µm), PM10 (particles with an aerodynamic diameter smaller than, or equal to, 10 µm), PM2.5–10 (coarse particles with an aerodynamic diameter in the range of 2.5–10 µm), BC (black carbon), NO2 (nitrogen dioxide), NO (nitrogen monoxide), NOx (nitrogen oxides), N2O (nitrous oxide), CO (carbon monoxide), SO2 (sulfur dioxide), VOC (volatile organic compounds), O3 (ozone), Ox (oxidant capacity), and traffic load. Study methodologies varied among these 13 epidemiological studies, including four cohort studies, two ecological studies, three case-control studies, two studies using two-sample Mendelian randomization, and two longitudinal time-series studies. Eight studies investigated associations with Crohn's disease and ulcerative colitis separately, while five studies analyzed IBD as a whole without distinguishing between CD and UC. Eleven studies found statistically significant associations between air pollution exposure and IBD, although inconsistent results were found in several of these studies. A total number of six mechanistic (toxicological) studies were retrieved. Among these six studies, five were using particulate matter as exposure metric, and one was based on NO2 and O3 as exposure metrics. With a combination of animal, human, and in vitro studies, the results in terms of biological mechanisms indicate that air pollution exposure influences the composition of the gut microbiome, altering metabolic functions within the gut, and creates immunological reactions with inflammation contributing to the development of IBD. Consequently, the results suggest a link between air pollution exposure and both the onset and exacerbation of IBD. However, differences in study design, exposure assessment, and pollutant types make it challenging to draw any firm conclusions. Moreover, the lack of multi-pollutant models in most epidemiological studies makes it difficult to estimate the individual effect of specific air pollutants. This review highlights the need for further research utilizing robust study designs and standardized exposure assessment methods to better understand the impact of air pollution on IBD. By elucidating these associations, policymakers and healthcare professionals can develop effective strategies to mitigate the adverse effects of air pollution on digestive health.

The effect of air pollutants on COPD-hospitalized patients in Lanzhou, China (2015-2019).

Lanzhou is the largest heavy industrial city in northwest China and it is a typical geographical valley-like city. However, there are few studies on the relationship between air pollutants and COPD, and their respective sample sizes are small, resulting in inconsistent results. The aim of this study is to analyze the effects of air pollutants on COPD hospitalizations in Lanzhou, China. An ecological time series study with distributed lag non-linear model (DLNM) was used for analysis. Daily COPD hospitalization data in Lanzhou from 1 January 2015 to 31 December 2019 were collected from 25 hospitals, as well as air pollutant data and meteorological data. A total of 18,275 COPD hospitalizations were enrolled. For 10 μg/m3 increase in PM2.5, PM10, SO2, NO2, and 1 mg/m3 increase in CO at lag 07 day, the RR95%CI of COPD hospitalizations were 1.048 (1.030, 1.067), 1.008 (1.004, 1.013), 1.091 (1.048, 1.135), 1.043 (1.018, 1.068), and 1.160 (1.084, 1.242), respectively. The exposure-response curves between air pollutants (except O3-8h) and COPD hospitalizations were approximately linear with no thresholds. Female, and the harmful effect of PM on aged <65 years, the effect of gaseous pollutant on those aged ≥65 years, were stronger, particularly in the cold season. Exposure to air pollutants (except O3-8h) might increase the risk of COPD hospitalizations. O3-8h has a weak and unstable effect on COPD. Exposure to air pollutants (except O3-8h) increases the risk of COPD hospitalizations. O3-8h has a weak and unstable effect on COPD hospital admissions. The harmful effect of gaseous pollutants (except O3-8h) on COPD-hospitalized patients was stronger than that of PM.

Strengthening China’s National Essential Public Health Services Package for hypertension and diabetes care: protocol for an interrupted time series study with mixed-methods process evaluation and health economic evaluation

BackgroundDespite major primary health care (PHC) reforms in China with the 2009 launch of the National Essential Public Health Service Package, the country experiences many challenges in improving the management of non-communicable diseases in PHC facilities. “EMERALD” is a multifaceted implementation strategy to strengthen the management of hypertension and type-2 diabetes mellitus (T2DM) in PHC facilities. The study aims to: (1) examine the effectiveness of EMERALD in improving hypertension and T2DM management; (2) evaluate the implementation of the interventions; and (3) use the study findings to model the long-term health economic impact of the interventions.MethodsThe EMERALD intervention components include: (1) empowerment for PHC providers through training and capacity building; (2) empowerment for patient communities through multi-media health education; and (3) empowerment for local health administrators through health data monitoring and strengthening governance of local PHC programs. An interrupted time series design will be used to determine the effectiveness of the interventions based on routinely collected health data extracted from local health information systems. The primary effectiveness outcome is the guideline-recommended treatment rates for people with hypertension and T2DM. Secondary effectiveness outcomes include hypertension and T2DM diagnosis and control rates, and enrolment and adherence rates to the recommended care processes in the National Essential Public Health Service Package. A mixed-methods process evaluation will be conducted to evaluate the implementation of the interventions, including the reach of the target population, adequacy of adoption, level of implementation fidelity, and maintenance. Qualitative interviews with policy makers, health administrators, PHC providers, and patients with hypertension and/or T2DM will be conducted to further identify factors influencing the implementation. In addition, health economic modelling will be performed to explore the long-term incremental costs and benefits of the interventions.DiscussionThis study is expected to generate important evidence on the effectiveness, implementation, and health economic impact of complex PHC interventions to strengthen the primary care sector’s contribution to addressing the growing burden of non-communicable diseases in China.Trial registrationThe study has been registered on Chinese Clinical Trial Registry at https://www.chictr.org.cn/ (Registration number ChiCTR2400082036, on March 19th 2024).

SINGULAR SPECTRAL ANALYSIS OF TEMPERATURE MULTIDIMENSIONAL TIME SERIES

In the paper the algorithm of singular structural analysis and forecasting of a multidimensional series by the MSSA method is used. The program was developed, in which the steps of the method for the selection of singular decomposition components were implemented, the analysis and forecast of real time series was carried out. Singular spectrum analysis (SSA) is increasingly used in the study of time series. Unlike other methods of statistical research of time series, this method is used to study the structure, selection of individual components and forecast of both stationary and non-stationary time series. It does not require an analytical model of the series. In fact, this approach is based on the method of principal components. It is based on the transformation of a series into a matrix and its singular decomposition. After identifying the components of the singular decomposition, their grouping takes place, which leads to the decomposition of the original series into additive components, such as trend, oscillations (periodics), and noise. The SSA method allows you to continue the structure of the time series, thus building a forecast (continuation). An important direction of the development of the SSA method as a method of time series analysis is its generalization for the analysis of multidimensional time series. The method is known as MSSA (Multi-Channel SSA) or E-EOFs (Extended Empirical Orthogonal Functions). In this case, the expected result is the simultaneous decomposition of several series into interpreted components. However, a sufficiently complete theory for MSSA does not exist.

Ultrasonographic Measurement of Optic Nerve Sheath Diameter in Patients with Traumatic Head Injury: A Prospective Observational Study

Introduction: The early detection of elevated intracranial pressure is crucial for guiding interventions and improving patient outcomes in head injury patients. The intracranial pressure assessment with invasive intracranial devices is the gold standard. These devices however has a risk of infection, bleeding and dislodgement. Optic nerve sheath diameter measurement using ultrasonography has emerged as a promising method for indirect intracranial pressure estimation. Aims: To observe the changes in optic nerve sheath diameter over period of time, and to correlate the optic nerve sheath diameter with computed tomography findings of raised intracranial pressure in traumatic head injury. Methods: A prospective cross-sectional time series study was conducted at Nepalgunj Medical College to assess the utility of ultrasonography measurement of optic nerve sheath diameter in patients with head injuries from August 2023 to January 2024. Forty-nine patients with head injuries were included in the study. The ultrasonographic optic nerve sheath diameter measurements were obtained at admission, 48 hours post-admission, and 1 month post-head injury. The clinical parameters including Glasgow Coma Scale and radiological findings from Computed Tomography head were recorded. Results: Forty nine patients were enrolled in the study. Among them, 44.90% (27) were male and 55.10% (22) were female. Age ranged from 5 to 66 years, with a mean of 33.94 ± 15.27 years. The mean optic nerve sheath diameter was 5.24±0.86 mm at admission which decreased to 4.31±0.62 mm at 48 hours and 4.02±0.47 mm at 1 month. Our study showed significant reduction in optic nerve sheath diameter after conservative or surgical treatment in patients with head injury (F = 27.017; P =0.002) Conclusion: The ultrasonographic measurement of optic nerve sheath diameter proved to be a valuable tool in monitoring intracranial pressure in patients with head injuries.

Fiscal austerity and municipal health spending: an interrupted time series study.

To analyze the impact of the fiscal austerity policy (PAF) on health spending in Brazilian municipalities, considering population size and source of funds. The interrupted time series method was used to analyze the effect of the PAF on total expenditure, resources transferred by the Federal Government, and own/state per capita resources allocated to health in the municipalities. The time series analyzed covered the period from 2010 to 2019, every six months. The first semester of 2015 was adopted as the start date of the intervention. The municipalities were grouped into small (up to 100,000 inhabitants), medium (101,000 to 400,000 inhabitants), and large (over 400,000 inhabitants). The data was obtained from the Sistema de Informações sobre Orçamentos Públicos em Saúde (Information System on Public Health Budget). The results for the national average of municipalities show that the PAF had a negative impact on the level of total expenditure and own/state resources allocated to health in the first half of 2015, without causing statically significant changes in the trends of any of the indicators analyzed in the period after 2015. Small municipalities saw a drop in total expenditure, while large municipalities saw a drop in own/state resources, and medium-sized municipalities saw a drop in both variables. There was no statistically significant drop in the volume of funds transferred by the Federal Government in the immediate aftermath of the implementation of the PAF in any of the municipal groups analyzed. In the medium-term, the PAF only had a negative impact on the large municipalities, which saw significant reductions in the trends of own/state resources and those transferred by the Union for health. In general, the impact of the PAF on health financing in municipalities was immediate and based on the decrease in own/state resources allocated to health. In large municipalities, however, the impact lasted from 2015 to 2019, mainly affecting health expenditure from federal funds.

Effect modification of air pollution on the association between heat and mortality in five European countries

BackgroundEvidence suggests that air pollution modifies the association between heat and mortality. However, most studies have been conducted in cities without rural data. This time-series study examined potential effect modification of particulate matter (PM) and ozone (O3) on heat-related mortality using small-area data from five European countries, and explored the influence of area characteristics. MethodsWe obtained daily non-accidental death counts from both urban and rural areas in Norway, England and Wales, Germany, Italy, and the Attica region of Greece during the warm season (2000–2018). Daily mean temperatures and air pollutant concentrations were estimated by spatial-temporal models. Heat effect modification by air pollution was assessed in each small area by over-dispersed Poisson regression models with a tensor smoother between temperature and air pollution. We extracted temperature-mortality relationships at the 5th (low), 50th (medium), and 95th (high) percentiles of pollutant distributions. At each air pollution level, we estimated heat-related mortality for a temperature increase from the 75th to the 99th percentile. We applied random-effects meta-analysis to derive the country-specific and overall associations, and mixed-effects meta-regression to examine the influence of urban-rural and coastal typologies and greenness on the heat effect modification by air pollution. ResultsHeat-related mortality risks increased with higher PM levels, rising by 6.4% (95% CI: −2.0%–15.7%), 10.7% (2.6%–19.5%), and 14.1% (4.4%–24.6%) at low, medium, and high PM levels, respectively. This effect modification was consistent in urban and rural regions but more pronounced in non-coastal regions. In addition, heat-mortality associations were slightly stronger at high O3 levels, particularly in regions with low greenness. ConclusionOur analyses of both urban and rural data indicate that air pollution may intensify heat-related mortality, particularly in non-coastal and less green regions. The synergistic effect of heat and air pollution implies a potential pathway of reducing heat-related health impacts by improving air quality.

A Time Series Study of Financial Sector Development and Original Sin in Nigeria

This study examined financial sector development and original sin in Nigeria financial market. Time series data was sourced from Central Bank of Nigeria Statistical Bulletin from 1990-2023. Original sin measured by Nigeria external debt per exchange rate, Capital market development as market capitalization to gross domestic product, Foreign exchange market as variation in naira exchange rate per US Dollar, banking sector development as percentage total bank assets to gross domestic product, money market development as insurance total assets to gross domestic product, Money market development as value of money market instrument to gross domestic product. The study employed descriptive statistics and multiple regression models to estimate the relationship that exists between the dependent and independent variables. The null Hypotheses (H0) were tested at 0.05 level of significance, Ordinary Least Square (OLS), Augmented Dickey Fuller Test, Johansen Co-integration test, normalized co-integrating equations and parsimonious vector error correction model were used to conduct the investigations and analysis. The study found that 57.0% variation on original sin can be traced and explained by variation on the independent variables as formulated in the regression model. However, the F-Statistics and the F-probability justifies that the model is significant and adequate in explaining variation on the dependent variable. The β coefficient shows that capital market development have negative effect on original sin, foreign exchange market have positive effect on original sin, banking sector development have negative effect on original sin, insurance sector development and money market development have positive effect on original sin. From the findings, the study concludes that the independent variables determine positively and negatively original sin in Nigeria. We recommend that the need for policies to deepen the capital market as this can cushion the effect of the negative effect of external borrowing and domiciled in Nigeria currency rather than international currency. There should be institutionalized policies to enhance the value of the naira against other international currencies as this can reduce the pressure of exchange rate variation in international debt and international monetary environment. Public expenditure should be directed to the productive sector of the economy as this can enhance the productive capacity of the economy and reduce the negative effect on balance of payment and other macroeconomic variables. Policies should be advanced to reduce external borrowings; this can reduce the debt burden and reduce the incidence of original sin in the financial market.

Hospitalizations and deaths from diabetes mellitus in northeastern Brazil between 2010 and 2019

Objective: To identify the epidemiological profile of hospitalizations and deaths due to Diabetes Mellitus, based on secondary data, in the Northeastern Brazilian States, between 2010 and 2019. Methods: Ecological, time series study that used secondary data extracted from the website of the Department of Informatics of the Unified Health System (DATASUS). The population of this study consisted of all hospitalizations and deaths due to Diabetes Mellitus of people living in the Northeastern Brazilian States during the period investigated. The following variables were investigated: age group; sex; color/race; character of care due to hospitalization and deaths due to Diabetes Mellitus. Results: During the period there were fluctuations in the mortality rate, with a decreasing trend, but without statistical significance (p=0.0523). It was observed that older adults, women and browns are more frequent among hospitalizations. In addition, it was found that the older adults suffered more emergency hospitalizations compared to elective ones. There was a statistically significant association in the variables, age group, sex and race and type of care (p&lt;0.001). Older adults, women and browns are the most prevalent among deaths, regardless of the nature of care. Conclusion: Deaths and hospitalizations due to Diabetes Mellitus were...

Ambient air pollution contributed to pulmonary tuberculosis in China

ABSTRACT Published studies on outdoor air pollution and tuberculosis risk have shown heterogeneous results. Discrepancies in prior studies may be partially explained by the limited geographic scope, diverse exposure times, and heterogeneous statistical methods. Thus, we conducted a multi-province, multi-city time-series study to comprehensively investigate this issue. We selected 67 districts or counties from all geographic regions of China as study sites. We extracted data on newly diagnosed pulmonary tuberculosis (PTB) cases, outdoor air pollutant concentrations, and meteorological factors in 67 sites from January 1, 2014 to December 31, 2019. We utilized a generalized additive model to evaluate the relationship between ambient air pollutants and PTB risk. Between 2014 and 2019, there were 172,160 newly diagnosed PTB cases reported in 67 sites. With every 10-μg/m3 increase in SO2, NO2, PM10, PM2.5, and 1-mg/m3 in CO, the PTB risk increased by 1.97% [lag 0 week, 95% confidence interval (CI): 1.26, 2.68], 1.30% (lag 0 week, 95% CI: 0.43, 2.19), 0.55% (lag 8 weeks, 95% CI: 0.24, 0.85), 0.59% (lag 10 weeks, 95% CI: 0.16, 1.03), and 5.80% (lag 15 weeks, 95% CI: 2.96, 8.72), respectively. Our results indicated that ambient air pollutants were positively correlated with PTB risk, suggesting that decreasing outdoor air pollutant concentrations may help to reduce the burden of tuberculosis in countries with a high burden of tuberculosis and air pollution.

The short-term association between environmental variables and daily pediatric asthma patient visits in Hangzhou, China: A time-series study

BackgroundTo date, a large number of studies have shown correlations between environmental variables and pediatric asthma in short-term lag time. However, their results are inconsistent. Therefore, we aimed to evaluate the short-term impact of environmental variables on daily pediatric asthma patients’ visits (DPAPV) in Hangzhou, China, and find the most important risk factor. MethodsGeneralized additive distribution lag non-linear model (GAM-DLNM) was applied to explore the effect of environmental variables on DPAPV in single- and multi-variable models in Hangzhou, China from 2014 to 2021. Then, risk factors of pediatric asthma were selected (p < 0.05 both in single- and multi-variable models) and used weighted quantile sum (WQS) regression model to evaluate their relative importance. ResultsThere were 313,296 pediatric asthma patient records between 2014 and 2021. Both in single- and multi-variable models, PM2.5, PM10, and NO2 exhibited significant positive correlations in short-term lag time and these correlations reached their maximum in lag day 2 (RR = 1.00, 95%CI:1.00 to 1.01), lag day 2 (RR = 1.00, 95%CI:1.00 to 1.01), and lag day 3 (RR = 1.04, 95%CI:1.02 to1.05), respectively. The WQS index showed that NO2 had the greatest relative importance (weight over 70 %). The relative importance of NO2 increased with time passing. Males were more susceptible to the adverse effects of NO2. ConclusionPM2.5, PM10, and NO2 had significant adverse effects on pediatric asthma. Among them, NO2 presented the greatest and most important adverse effect on the disease. Therefore, parents could give priority to paying attention to NO2 to control children's asthma.

New Evidence of the Impact of the National Drug Price Negotiation Policy on the Availability, Utilization, and Cost of Anticancer Medicines in China: An Interrupted Time Series Study.

The increasing global burden of cancer has become a significant challenge for public health. The Chinese government introduced the National Drug Price Negotiation (NDPN) policy with the goal of lowering the prices of innovative drugs and enhancing their accessibility. This study aims to evaluate the impact of the 2021 NDPN policy on the availability, utilization, and cost of anticancer medicines in China. Data was gathered from 1519hospitals between April 2021 and December 2022, with a focus on eight anticancer drugs affected by the 2021 NDPN policy. The availability, Defined Daily Doses (DDDs), and cost per Defined Daily Dose (DDDc) before and after the intervention were evaluated through interrupted time series analysis. The NDPN policy resulted in a substantial 5.10% increase in the availability of anticancer drugs (p < 0.001). Utilization also experienced a significant surge, with an immediate increase of 11,254.36 DDDs (p < 0.001) and a monthly increase of 1208.28 DDDs (p < 0.001) following policy implementation. The DDDc decreased by US$ 111.00 (p < 0.001) immediately after the policy. Disparities in regional drug utilization were evident, with higher usage in the eastern region. The 2021 NDPN policy has notably enhanced the availability and utilization of anticancer medications in China while reducing their cost, in line with the policy's objectives. However, continuous monitoring is essential to ensure sustained access and to tackle regional disparities in drug utilization.

Does environmental regulation matter for healthcare utilisation in China? An interrupted time series study.

In recent years, China has implemented a series of environmental regulation policies to improve air quality, but the health effects of these policy changes need to be accurately clarified and quantified. The objective of this study was to empirically examine the effects of levying construction dust pollution fees on healthcare utilisation in a southern city of China. The study used a unique administrative insurance claim dataset from the city's Urban Employee Basic Medical Insurance scheme between 2013 and 2015. The sample included 69,961 enrolees. An interrupted time series design was employed to investigate whether and how the healthcare utilisation of enrolees changed after the policy change. The results showed that this environmental regulation policy did not affect the inpatient utilisation of enrolees but did negatively impact outpatient utilisation. In addition, outpatient utilisation of chronic disease coverage decreased for patients with chronic diseases, including diabetes and hypertension. This study provides evidence that enhancing environmental regulations helps reduce medical costs, which can benefit China and other developing countries to improve environmental quality and promote public health.

Decreases in purchases of energy, sodium, sugar, and saturated fat 3 years after implementation of the Chilean food labeling and marketing law: An interrupted time series analysis.

In 2016, Chile implemented a multiphase set of policies that mandated warning labels, restricted food marketing to children, and banned school sales of foods and beverages high in nutrients of concern ("high-in" foods). Chile's law, particularly the warning label component, set the precedent for a rapid global proliferation of similar policies. While our initial evaluation showed policy-linked decreases in purchases of high-in, a longer-term evaluation is needed, particularly as later phases of Chile's law included stricter nutrient thresholds and introduced a daytime ban on advertising of high-in foods for all audiences. The objective is to evaluate changes in purchases of energy, sugar, sodium, and saturated fat purchased after Phase 2 implementation of the Chilean policies. This interrupted time series study used longitudinal data on monthly food and beverage purchases from 2,844 Chilean households (138,391 household-months) from July 1, 2013 until June 25, 2019. Nutrition facts panel data from food and beverage packages were linked at the product level and reviewed by nutritionists. Products were considered "high-in" if they contained added sugar, sodium, or saturated fat and exceeded nutrient or calorie thresholds. Using correlated random-effects models and an interrupted time series design, we estimated the nutrient content of food and beverage purchases associated with Phase 1 and Phase 2 compared to a counterfactual scenario based on trends during a 36-month pre-policy timeframe. Compared to the counterfactual, we observed significant decreases in high-in purchases of foods and beverages during Phase 2, including a relative 36.8% reduction in sugar (-30.4 calories/capita/day, 95% CI -34.5, -26.3), a 23.0% relative reduction in energy (-51.6 calories/capita/day, 95% CI -60.7, -42.6), a 21.9% relative reduction in sodium (-85.8 mg/capita/day, 95% CI -105.0, -66.7), and a 15.7% relative reduction in saturated fat (-6.4 calories/capita/day, 95% CI -8.4, -4.3), while purchases of not-high-in foods and drinks increased. Reductions in sugar and energy purchases were driven by beverage purchases, whereas reductions in sodium and saturated fat were driven by foods. Compared to the counterfactual, changes in both high-in purchases and not high-in purchases observed in Phase 2 tended to be larger than changes observed in Phase 1. The pattern of changes in purchases was similar for households of lower versus higher socioeconomic status. A limitation of this study is that some results were sensitive to the use of shorter pre-policy time frames. Compared to a counterfactual based on a 36-month pre-policy timeframe, Chilean policies on food labeling, marketing, and school food sales led to declines in nutrients of concern during Phase 2 of implementation, particularly from foods and drinks high in nutrients of concern. These declines were sustained or even increased over phases of policy implementation.