Changes In Time Trends Research Articles

Spatiotemporal Variability and Trend of Ozone Pollution from Satellite Data (2003- 2021) in Iraq

Ozone (O3) occurs naturally in the Earth's upper atmosphere, and at ground level is a dangerous pollutant hurts plants and lung tissue and it’s a major component of smog. The purpose of this study to analyze the time series, trend, and spatial-temporal changes of monthly Relative Humidity (RH), Outgoing Longwave Radiation (OLR), and O3 in Iraq using the Atmospheric Infrared Sounder (AIRS) ascending AIRS3STM data during 2003 - 2021. The time series over six stations (Mosul, Sulaymaniyah, Khanaqin, Rutba, Baghdad, and Basra) have been analyzed and showed similar changes and fluctuation in O3 and OLR. The results of the study obtained were: minimum (decreasing, January–December) and maximum (increasing, May–August), and the mean and standard deviation were (0.044±0.003 ppmv) for O3 and (298± 22 Wm-2) for OLR during the study period. During December to February, the highest RH values were recorded, while the lowest RH values occurred from June to August. The monthly mean and standard deviation of RH was (28.66±29.54 g/kg). Further O3 trends revealed negative results in their annual series over all stations, except for Khanaqin and Basra, which had a positive trend. The O3 concentrations were consistently connected with other meteorological variables (the O3 has a negative correlation with RH and a beneficial correlation with temperature). The O3 spatiotemporal maps showed recorded the highest values recorded in April and May over Mosul and Sulaymaniyah (0.055–0.057), and in December, at middle and southern regions (Baghdad and Basra), there were the lowest O3 value (0.033). These results were due to meteorological and geographical factors. The results showed the efficient use of AIRS data to analyze the variations and distributions of atmospheric factors over different regions. In addition, AIRS observations can be used to obtain atmospheric, climatic, and environmental scientific reports and analyses for large, regional, and global regions and for long, continuous periods.

Disability-adjusted Life Years of Hepatitis B in Iran during 2009–2019: An Analysis Based on the Global Burden of Disease Study 2019

Background and Purpose Hepatitis B virus infection is currently among the ten leading causes of death from infectious diseases in the world. The aim of the current study is spatial analysis related to life years adjusted by hepatitis B disability in Iran from 2009 to 2019. Materials and Methods The study is ecological. Using data from the Global Burden of Diseases (GBD), cause-specific mortality served as the basis for estimating disability-adjusted life years (DALYs). Time trend analysis of DALYs attributed to hepatitis B from 2009 to 2019 and spatial pattern analysis and identification of high-risk and low-risk clusters of DALYs attributed to hepatitis B in Iranian provinces were performed. Time trend changes were evaluated using joinpoint regression analysis. Results The most likely high-risk cluster with LLR=238.59 in the West of Iran includes the western provinces of the country (Lorestan, Kermanshah, Hamedan, Markazi, Khuzestan, and Ilam) (relative risk of occurrence 2.31). The three provinces of Lorestan (RR=2.22), Sistan and Baluchistan (RR=1.73), Golestan (RR=1.46) have the highest relative Khazar, and the three provinces of Gilan (RR=0.41), Mazandaran (CIR=0.48) and Kurdistan (CIR=0.51) had the lowest relative risk. During the years 2009 to 2019, the total DALYs decreased by 1.5% annually (p<0.05). Conclusion According to the results of the disease control and prevention programs, it can be effective in reducing the disease burden in the country by giving priority to the provinces that are among the high-risk disease clusters.

Body dissatisfaction and dieting among Finnish adolescents: a 20-year population-based time-trend study

Body image has an important role in the health and development of adolescents. Body dissatisfaction and dieting can become chronic and continue into adulthood. There is a lack of recent, comprehensive studies on ongoing trends on body dissatisfaction. This study assessed time-trend changes in self-reported body dissatisfaction and dieting among Finnish adolescents at four assessment points. Representative samples of adolescents (N = 6660) aged 13–16 years participated in school-based, cross-sectional studies in 1998 (N = 1458), 2008 (N = 2044), 2014 (N = 1809), and 2018 (N = 1349), respectively. The studies were similar in design, methodology, and geographical recruitment areas. Body dissatisfaction and dieting were assessed with a questionnaire including items derived from the DSM-IV criteria for anorexia and bulimia nervosa. From 1998 to 2018, dieting and fears related to gaining weight decreased among females. Body dissatisfaction reduced among females, and their wishes to become thinner became less prevalent. Consuming large amounts of food at one time consistently decreased among females and males and there were no changes in the rates of willful vomiting. The number of females in the 90th percentile with the most severe symptoms decreased. The results indicate that body dissatisfaction and disturbed dieting improved among females during the 20-year study. Despite these positive developments, the overall level of symptoms among females remained substantial, indicating that females have much higher levels of body dissatisfaction and dieting than males.

Prevalence of hospital-associated infections and its association with discharge destinations and hospital readmissions in Brussels, Belgium, from 2008 to 2020: A hospital-based, cross-sectional study.

To examine time trends of hospital-associated infections (HAIs) in people living in the Brussels-Capital Region, and to evaluate the consequences for hospitals and long-term care facilities (LTCFs). Cross-sectional analyses of yearly hospital administrative data. All Belgian hospitals and discharge destinations, focusing on LTCFs. All individuals from the Brussels-Capital Region hospitalized for >1 day throughout Belgium between 2008 and 2020 (N = 1,915,572). We calculated HAI prevalences and then, adjusting for confounders, the odds of being discharged to a LTCF or being readmitted within 30 days postdischarge after an HAI. HAIs included hospital-associated bloodstream infections, hospital-associated urinary tract infections, hospital-associated pneumonia, ventilator-associated pneumonia, and surgical-site infections. Between 2008 and 2020, we identified 77,004 HAIs. Changes in time trends occurred. We observed a decrease of all HAIs from 2012 to 2014 from 5.17% to 2.19% (P < .001) and an increase from 2019 to 2020 from 3.38% to 4.06% (P < .001). Among patients with HAIs, 24.36% were discharged to LTCFs and 13.51% underwent early readmission. For stays ≥4 days, HAIs were associated with higher odds of LTCF discharge (adjusted odds ratio [aOR], 1.25; 95% confidence interval [CI], 1.22-1.28), but with lesser odds of early readmission (aOR, 0.88; 95% CI, 0.85-0.90). Administrative data can be useful to detect HAIs trends, but they seem to underestimate the burden compared to surveillance systems. Risk factors of readmission should be identified during hospital stays to ensure continuity of care. Considering the results from 2020 coinciding with the COVID-19 pandemic, monitoring the impact of HAIs should continue.

Temporal Changes in Suicide Mortality Rates Before and During the COVID-19 Pandemic in Colombia. A Joint Point Regression Model

IntroductionThe coronavirus disease (COVID-19) pandemic was declared in March 2020. This disease affects the respiratory system, and shown high rates of morbidity and mortality during 2020 and 2021. Neurological compromise and increased rates of depression, anxiety, insomnia, and substance abuse have also been described. Public health policies to prevent COVID-19 infection, decrease in control and monitoring of mental illness, and social and economic impact may have contributed to the increase in suicidal ideation and suicides. It is not yet clear if there have been changes in suicide mortality rates in Colombia before and during the pandemic. ObjectiveTo describe and analyze the changes in the temporal trends of suicide mortality rates in Colombia between 2008 and 2020. MethodsBased on national records, suicide mortality rates observed in Colombia during the COVID-19 pandemic were calculated and compared with those reported in previous years (2008–2019). Mortality rates were analyzed by age, sex, educational level, type of affiliation to health system, region, and etiology of death by suicide. Using the joint point regression software 3.4.4, changes in time trends in suicide mortality rates were estimated for each mentioned variable. Annual percentage changes (APC) were estimated, and their statistical significance was calculated. ResultsThe crude suicide mortality rate in Colombia in 2020 (5.4 per 100000 inhabitants) decreased compared to those reported in the previous 3 years. Estimates of changes in time trends in suicide mortality rates between 2008 and 2020 showed a decrease in men of −5.28 (APC) (p<0.05) between 2018 and 2020, and an increase in women of 3.75 (APC) (p<0.05) between 2011 and 2020. Regarding age (by five-year periods), an increase of 3.87 (APC) (p<0.05) was determined in people between 15 and 19 years old between 2012 and 2020. According to health system affiliation regimen, decreases were estimated between 2016 and 2020 (−58.45 CPA; p<0.05) for people affiliated to especial and exceptional health regimes; and between 2015 and 2020 (−53.49 CPA; p<0.05) for the uninsured. ConclusionsThe crude suicide mortality rate during the COVID-19 pandemic in Colombia decreased compared to what was reported in the previous years. Although significant changes were found in the temporal trends of suicide mortality rates in different periods for all variables, no significant increases were identified between 2019 and 2020.

Trends in Management of Fetuses with Suspected Lower Urinary Tract Obstruction (LUTO): A High-Risk Fetal and Pediatric Center Experience in a Universal-Access-to-Care System.

Neonates with lower urinary tract obstruction (LUTO) experience high morbidity and mortality associated with the development of chronic kidney disease. The prenatal detection rate for LUTO is less than 50%, with late or missed diagnosis leading to delayed management and long-term sequelae in the remainder. We aimed to explore the trends in prenatal detection and management at a high-risk fetal center and determine if similar trends of postnatal presentations were noted for the same period. Prenatal and postnatal LUTO databases from a tertiary fetal center and its associated pediatric center between 2009 and 2021 were reviewed, capturing maternal age, gestational age (GA) at diagnosis, and rates of termination of pregnancy (TOP). Time series analysis using autocorrelation was performed to investigate time trend changes for prenatally suspected and postnatally confirmed LUTO cases. A total of 161 fetuses with prenatally suspected LUTO were identified, including 78 terminations. No significant time trend was found when evaluating the correlation between time periods, prenatal suspicion, and postnatal confirmation of LUTO cases (Durbin-Watson [DW] = 1.99, p = 0.3641 and DW = 2.86, p = 0.9113, respectively). GA at referral was 20.0 weeks (interquartile range [IQR] 12, 35) and 22.0 weeks (IQR 13, 37) for TOP and continued pregnancies (p < 0.0001). GA at initial ultrasound was earlier in terminated fetuses compared to continued (20.0 [IQR 12, 35] weeks vs. 22.5 [IQR 13, 39] weeks, p < 0.0001). While prenatal LUTO suspicion remained consistently higher than postnatal presentations, the rates of postnatal presentations and terminations remained stable during the study years (p = 0.7913 and 0.2338), as were GA at TOP and maternal age at diagnosis (p = 0.1710 and 0.1921). This study demonstrated that more severe cases of LUTO are referred earlier and are more likely to undergo TOP. No significant trend was detected between time and prenatally suspected or postnatally confirmed LUTO, highlighting the need for further studies to better delineate factors that can increase prenatal detection.

The impact of the COVID-19 pandemic on the quality of centre-based cardiac rehabilitation

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Slovenian Research Agency Ministry of Health, Slovenia. Background The coronavirus-19 (COVID-19) pandemic has severely disrupted the provision of cardiac rehabilitation (CR), with responses ranging from outright closure of CR centres to adapting CR provision to the diversion of resources and changing public health guidance. Using interrupted time-series analysis, we sough to estimate the impact of the COVID-19 pandemic the quality centre-based CR. Methods Quality indicators for 1,268 patients undergoing centre-based CR after a myocardial infarction were extracted from the national CR registry, and summarized with a composite quality score (i.e., adjudicating one point for each: antithormbotic therapy, high-potency statin therapy, low-density lipoprotein cholesterol [LDL-C] &amp;lt;1.4 mmol/L, systolic blood pressure &amp;lt;130 mmHg, body mass index &amp;lt;25 kg/m2, non-smoking status, &amp;gt;20% improvement in exercise capacity from baseline). Composite quality scores were aggregated on monthly time units; an interrupted time series of 52 time points was constructed, with breakpoint defined on 1 March 2020. Using Prais-Winsten (autoregressiove order 1) segmented regression, change in level and time trend of the composite quality score were estimated, with 95% confidence intervals [95%CI]. Results After the pandemic outbreak, waiting times for CR increased (from 56 [IQR 36-82] to 75 [IQR 58-102] days, p&amp;lt;0.001), while duration of CR (from 100 [SD 58] to 90 [SD 67] days) and number of sessions (from 33 [SD 7] to 28 [SD 9]) decreased (p&amp;lt;0.001 for both). The outbreak of COVID-19 was associated with a non-significant change in level (+0.370 [95%CI -0.207; 0.946] points, p=0.204) and a significant change in trend (-0.0438 [95%CI -0.0841; -0.0437] points/per month, p=0.034) of the composite quality score. Patterns for estimates did not change significantly after adjustment for number of sessions and/or duration of CR. See Figure 1. Conclusons The COVID-19 pandemic has affected the quality of centre-based CR, with a trainsient (non-significant) increase followed by a persistent (significant) trend of decreasing quality of CR provision. Our findings suggest the need for intensifying the quality of secondary prevetive care during CR in the forthcoming post-pandemic recovery.

Quantifying topical antimicrobial use before and during participation in an antimicrobial stewardship programme in Dutch companion animal clinics.

The emergence of bacterial strains resistant to topical antimicrobials in both human and veterinary medicine has raised concerns over retaining the efficacy of these preparations. Yet, little information is available regarding the use of topical antimicrobials in either sector for planning targeted interventions. This study aims to quantify the use of topical antimicrobials in 44 Dutch companion animal clinics before and during their participation in an antimicrobial stewardship programme (ASP), to explore the effect of the intervention on topical antimicrobial use (AMU). Hence, prescription and clinic animal population data, collected from July 2012 until June 2018 were used. Specifically, the period from July 2012 until June 2015 was defined as pre-intervention period, whereas clinics started to participate in the ASP from March 2016 onwards. As quantification metric, the Defined Daily Dose for Animals (DDDA) was used and a mixed effect times series model with auto-regression was applied to monthly topical AMU data. The intervention effect was modelled using a step function with a change in (linear) time trend and clinic characteristics, as potential determinants of topical AMU, were assessed using a multivariable regression model. A seasonal pattern was identified, in the pre-intervention period, where topical AMU was highest in July-August and lowest in February-March. In addition, total topical AMU appeared to significantly decrease over time in the pre-intervention period and the proportion of dogs in the clinic was positively associated with topical AMU. The intervention effect was significant only for second line and for skin product AMU. This study demonstrates that during participation in an ASP, second line and skin product AMU decreased in Dutch companion animal clinics. Additionally, this study demonstrates the existence of a seasonal effect and a decrease in topical AMU over time already before introduction of a targeted intervention.

THE BURDEN OF END-STAGE OSTEOARTHRITIS IN AUSTRALIA: A POPULATION-BASED STUDY ON THE INCIDENCE OF TOTAL KNEE ARTHROPLASTY ATTRIBUTABLE TO OVERWEIGHT/OBESITY

To determine the risk of total knee replacement (TKR) for primary osteoarthritis (OA) associated with overweight/obesity in the Australian population.This population-based study analyzed 191,723 cases of TKR collected by the Australian Orthopaedic Association National Joint Registry and population data from the Australian Bureau of Statistics. The time-trend change in incidence of TKR relating to BMI was assessed between 2015-2018. The influence of obesity on the incidence of TKR in different age and gender groups was determined. The population attributable fraction (PAF) was then calculated to estimate the effect of obesity reduction on TKR incidence.The greatest increase in incidence of TKR was seen in patients from obese class III. The incidence rate ratio for having a TKR for obesity class III was 28.683 at those aged 18-54 years but was 2.029 at those aged &gt;75 years. Females in obesity class III were 1.7 times more likely to undergo TKR compared to similarly classified males. The PAFs of TKR associated with overweight or obesity was 35%, estimating 12,156 cases of TKR attributable to obesity in 2018. The proportion of TKRs could be reduced by 20% if overweight and obese population move down one category.Obesity has resulted in a significant increase in the incidence of TKR in the youngest population in Australia. The impact of obesity is greatest in the young and the female population. Effective strategies to reduce the national obese population could potentially reduce 35% of the TKR, with over 10,000 cases being avoided.

MP67-05 IMPACTS ON FUNCTIONAL AND ONCOLOGICAL OUTCOMES OF ROBOTIC-ASSISTED RADICAL PROSTATECTOMY 10 YEARS AFTER THE TASKFORCE RECOMMENDATIONS AGAINST PSA SCREENING

You have accessJournal of UrologyCME1 Apr 2023MP67-05 IMPACTS ON FUNCTIONAL AND ONCOLOGICAL OUTCOMES OF ROBOTIC-ASSISTED RADICAL PROSTATECTOMY 10 YEARS AFTER THE TASKFORCE RECOMMENDATIONS AGAINST PSA SCREENING Marcio Covas Moschovas, Jaber Abdel, Shady Saikali, Seetharam Bhat, Marco Sandri, Travis Rogers, David Loy, and Vipul Patel Marcio Covas MoschovasMarcio Covas Moschovas More articles by this author , Jaber AbdelJaber Abdel More articles by this author , Shady SaikaliShady Saikali More articles by this author , Seetharam BhatSeetharam Bhat More articles by this author , Marco SandriMarco Sandri More articles by this author , Travis RogersTravis Rogers More articles by this author , David LoyDavid Loy More articles by this author , and Vipul PatelVipul Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003330.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For experienced surgeons, prostate cancer outcomes are ultimately affected by the pathology of the disease they treat. Over the last decade, we have experienced a dramatic alteration in the pathology we are addressing. During this time, the most significant shift in prostate cancer management was the 2012 USPSTF (United States Preventive Service Task Force) decision to recommend against PSA screening. This has affected the types of prostate cancers we are treating and potentially influenced treatment outcomes. We aimed to analyze the functional and oncologic trends in prostate cancer outcomes in the largest single surgeon series. METHODS: We retrospectively reviewed our prospective IRB-approved prostate cancer registry for 11396 patients that underwent RALP between 2008 and 2021. Each patient had at least a 12-month follow-up. The cohort was divided into two groups before and 6 months after the USPSTF recommendation. Group 1: 1/2008- 12/2012, Group 2: 1/ 2013-12-2021. Group 1 had 4760 patients, and Group 2 had 6636 patients, with a median follow-up of 109 and 38 months, respectively. We assessed the functional and oncologic outcomes of the two groups. RESULTS: We detected time-trend changes after 2012. There was a migration to younger ages, less than 60, and an increase in the median preoperative PSA (5 to 6 ng/ml). There was 18% increase in the higher grade and stage of the disease, Gleason ≥3+4 (19% increase), and ≥ pT3 (18% increase). This translated into a 6% increase in positive surgical margins with an initial rapid increase that was tempered with a surgical adjustment in the amount of (NS) nerve sparing. There was a 24% reduction in full nerve sparing in response to the worsening pathology. Outcomes were also affected by the modification in NS. Comparing groups 1 and 2, there was a significant decline in post-operative outcomes: 12-month continence reduction by 9%, reduction in potency by 27%, and trifecta by 22%. CONCLUSIONS: We have witnessed a significant change in the types of patients we are seeing and the outcomes we are able to deliver. We are seeing younger patients with higher-grade diseases, and the increasing number of high-risk patients has led to worse functional and oncologic outcomes. The initial rapid rise in PSM was leveled by the move towards more partial nerve sparing. The USPSTF recommendation has affected the oncology and outcomes of prostate cancer in an increasingly younger patient population. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e944 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marcio Covas Moschovas More articles by this author Jaber Abdel More articles by this author Shady Saikali More articles by this author Seetharam Bhat More articles by this author Marco Sandri More articles by this author Travis Rogers More articles by this author David Loy More articles by this author Vipul Patel More articles by this author Expand All Advertisement PDF downloadLoading ...

Trends in assault-related hospitalizations during the SARS-CoV-2 pandemic

IntroductionViolence remains a priority issue in the United States (US) requiring public health input to discern the magnitude and impact of violence on the health system. Concerns over violence and the injuries resulting from violence have increased following the SARS-CoV-2 pandemic which exacerbated an array of individual and economic stressors related to violence including increased unemployment, alcohol intake, social isolation, anxiety and panic and decreased access to health services. The aim of this study was to analyze the trends in violence-related injuries in the state of Illinois during the SARS-CoV-2 lockdown periods and post-lockdown in order to inform future public health policy. Material and methodsOutpatient and inpatient assault related injuries treated in Illinois hospitals from 2016 through March 2022 were analyzed. Segmented regression models evaluating change in time trends were adjusted for seasonality, serial correlation, overall trend and economic variables. ResultsThe annual rate of assault related hospitalizations per one million Illinois residents decreased from 3857.8 pre-pandemic to 3458.7 pandemic period. However, during the pandemic there was an increase in deaths and in the proportion of injuries involving open wounds, internal injuries, and fractures, while there was a reduction in less serious injuries. Segmented regression time series models demonstrated significant increase in firearm violence in all four pandemic periods examined. Firearm violence increased particularly in subgroups including African-American victims, 15–34-year-olds, and Chicago residents. ConclusionDuring SARS-CoV-2, we saw an overall reduction in assault related hospitalization, however, findings demonstrated an increase in serious injuries which may be associated with social and economic stressors of the pandemic, increased gun-violence while decrease in less serious injuries may be linked to hospital avoidance for non-lethal injuries during the peak waves of the pandemic. Our findings have implications for ongoing surveillance, service planning and management of the increased gunshot and penetrating assault cases and further demonstrate the need for public health input into the violence epidemic in the US.

How did the Brazilian military use to get sick before Covid-19? An analysis of the hospitalization profile of the active-duty personnel in the Brazilian Army Central Hospital from 1998 to 2018

Background: The covid-19 pandemic showed how understanding the epidemiology of specific populations is extremely necessary for adequate health care. For this, it is necessary to know the health-disease profile of the military population (which differs from civilians), but free from the biases that the exceptional events of this catastrophe could generate. Aims: The study aims to characterize the temporal trend and the profile of hospitalizations of active-duty military admitted to the Brazilian Army Central Hospital from 1998 January 1st to 2018 December 31st (before Covid-19 pandemic). Methodology: Analytical cross-sectional study with non-nominal secondary data from the records of the Hospital Information System of the Brazilian Army Central Hospital. Simple linear regression (p&lt;0.005) and descriptive statistics were performed. Results: 20,292 hospitalizations were recorded in the period, of which 93.2% were for males (no change in time trend) and 6.2% were for female (with a significant increase in the historical series). Among males, the predominant age bracket was “21 to 30 years old” (44.5%), “brown” race (47.3%), “Corporals and Soldiers” ranks (61.8%) and hospitalized by the group of specialties of “Orthopedics, Traumatology, and Rheumatology” (33.9%). For females, the predominant age bracket was “31 to 40 years old” (51.4%), “white” race (55%), “Non-commissioned officers” ranks (58.9%) and hospitalized by the group of specialties “Gynecology and Obstetrics” (43, 1%). Conclusions: During the studied period, among the active-duty military personnel hospitalized, there was a predominance of males, young, Corporals and Soldiers with musculoskeletal impairment.

Time trend changes in the amount and type of physical activities over a 20-year period in urban elementary school sixth-graders

Time trend changes in the amount and type of physical activities over a 20-year period in urban elementary school sixth-graders

Impact of COVID-19 on Liver Transplant Activity in the USA: Variation by Etiology and Cirrhosis Complications.

The COVID-19 pandemic has impacted the care of patients with liver disease. We examined impact of COVID-19 on liver transplant (LT) activity in the USA. LT listings in the United Network for Organ Sharing (UNOS) database (April 2018-May 2021) were analyzed to examine the impact of COVID-19 pandemic on the LT activity based on etiology: hepatitis C virus (HCV), alcohol-associated liver disease (ALD), alcoholic hepatitis (AH), and nonalcoholic steatohepatitis (NASH) complications: hepatocellular carcinoma (HCC) and acute-on-chronic liver failure (ACLF) grade 2 or 3) and Model for End-Stage Liver Disease (MELD) score. Joinpoint regression models assessed time trend changes on a log scale. Of 23,871 recipients (8,995 in the COVID era, April 2018-February 2020), mean age 52 years, 62% men, 61% Caucasian, 32% ALD, 15% HCC, 30% ACLF grades 2-3, and mean MELD score 20.5), monthly LT changes were a decrease of 3.4% for overall LTs and 22% for HCC after September 2020, and increase of 4.5% for ALD since 11/2020 and 17% since 03/2021 for ACLF grade 2-3. Monthly MELD scores increased by 0.7 and 0.36 after June 2020 for HCV and HCC respectively. The COVID-19 pandemic has impacted LT activity, with a decrease of LTs especially for HCC, and an increase of LTs for ALD and severe ACLF. Strategies are needed to reorganize cirrhosis patients to overcome the aftereffects of COVID-19 pandemic.

Experimental Implementation of NSER Mobile App for Efficient Real-Time Sharing of Prehospital Patient Information With Emergency Departments: Interrupted Time-Series Analysis.

BackgroundWith the aging society, the number of emergency transportations has been growing. Although it is important that a patient be immediately transported to an appropriate hospital for proper management, accurate diagnosis in the prehospital setting is challenging. However, at present, patient information is mainly communicated by telephone, which has a potential risk of communication errors such as mishearing. Sharing correct and detailed prehospital information with emergency departments (EDs) should facilitate optimal patient care and resource use. Therefore, the implementation of an app that provides on-site, real-time information to emergency physicians could be useful for early preparation, intervention, and effective use of medical and human resources.ObjectiveIn this paper, we aimed to examine whether the implementation of a mobile app for emergency medical service (EMS) would improve patient outcomes and reduce transportation time as well as communication time by phone (ie, phone-communication time).MethodsWe performed an interrupted time-series analysis (ITSA) on the data from a tertiary care hospital in Japan from July 2021 to October 2021 (8 weeks before and 8 weeks after the implementation period). We included all patients transported by EMS. Using the mobile app, EMS can send information on patient demographics, vital signs, medications, and photos of the scene to the ED. The outcome measure was inpatient mortality and transportation time, as well as phone-communication time, which was the time for EMS to negotiate with ED staffs for transport requests.ResultsDuring the study period, 1966 emergency transportations were made (n=1033, 53% patients during the preimplementation period and n=933, 47% patients after the implementation period). The ITSA did not reveal a significant decrease in patient mortality and transportation time before and after the implementation. However, the ITSA revealed a significant decrease in mean phone-communication time between pre- and postimplementation periods (from 216 to 171 seconds; −45 seconds; 95% CI −71 to −18 seconds). From the pre- to postimplementation period, the mean transportation time from EMS request to ED arrival decreased by 0.29 minutes (from 36.1 minutes to 35.9 minutes; 95% CI −2.20 to 1.60 minutes), without change in time trends. We also introduced cases where the app allowed EMS to share accurate and detailed prehospital information with the emergency department, resulting in timely intervention and reducing the burden on the ED.ConclusionsThe implementation of a mobile app for EMS was associated with reduced phone-communication time by 45 seconds (22%) without increasing mortality or overall transportation time despite the implementation of new methods in the real clinical setting. In addition, real-time patient information sharing, such as the transfer of monitor images and photos of the accident site, could facilitate optimal patient care and resource use.

Time trends in treated incidence, sociodemographic risk factors and comorbidities: a Finnish nationwide study on anxiety disorders

IntroductionAnxiety disorders (ADs) are common in childhood and adolescence and global estimates suggest they affect 6.5% of individuals under 19 years of age.Yet, there has been a lack of research on time trends and socio-demographic risks for children and adolescents who receive treatment for ADs.ObjectivesWe aim to fill gaps in our knowledge by examining a nationwide sample of Finnish children and adolescents diagnosed in specialized healthcare settings.MethodsWe used register data of all singleton children born in Finland from 1992-2006 and diagnosed with ADs from 1998-2012. Changes in time trends in incidence were studied by dividing the study sample into three cohorts by birth years: 1992-1996, 1997-2001 and 2002-2006. The 22,388 individuals with ADs were matched with 76,139 controls. Nested case-control design was used to study the socio-demographic risk factors.ResultsComparing the 1992-1996 and 2002-2006 cohorts showed the cumulative incidence of treated ADs at the age of 10 increased from 0.3% to 1.2% (females) and 0.46% to 1.9% (males). Subjects had higher odds of being diagnosed with an AD if mothers had low SES (OR 1.49, 95% CI 1.42-1.58) and were single parents (OR 1.99, 95% CI 1.84-2.15) at birth. Unipolar depression was the most common psychiatric comorbidity (31.2%).Conclusions ADs diagnosed by specialized services increased from 1998-2012 in both genders. This could indicate real increase in overall ADs, an increase in seeking treatment or both phenomena. The findings on maternal socioeconomic status and single parenting help improve understanding of environmental risk for anxiety disorders among children and adolescents.DisclosureNo significant relationships.

How did the adoption of wP-pentavalent affect the global paediatric vaccine coverage rate? A multicountry panel data analysis

ObjectivesSeveral studies have highlighted the effects of combination vaccines on immunisation coverage at the national or subnational level. This study examined the effects globally. Worldwide introduction of whole-cell pertussis pentavalent...

Time trends in treated incidence, sociodemographic risk factors and comorbidities: a Finnish nationwide study on anxiety disorders

BackgroundThere has been a lack of research about the time trends and socio-demographic risk factors for children and adolescents who receive treatment for anxiety disorders. This study aimed to fill these gaps in our knowledge by examining a nationwide sample of Finnish children and adolescents diagnosed in specialized healthcare settings.MethodsThis study comprised national register data of all singleton children born in Finland from 1992–2006 who were diagnosed with anxiety disorders from 1998–2012. The changes in time trends in incidence were studied by dividing the study sample into three cohorts by birth years: 1992–1996, 1997–2001 and 2002–2006, who were followed up until the age of 20, 15 and 10 years, respectively. The 22,388 individuals with anxiety disorders were age and gender matched with 76,139 controls from the general population. Logistic regression was used to examine the socio-demographic risk factors and anxiety disorders in the entire sample. Comorbid disorders were examined in the oldest birth cohort (1992–1996 born).ResultsComparing the 1992–1996 and 2002–2006 cohorts showed that the cumulative incidence of treated anxiety disorders at the age of 10 increased from 0.3 to 1.2% among females and 0.46 to 1.9% among males. Subjects had higher likelihood for being diagnosed with an anxiety disorder if their mothers had low maternal socio-economic status class at birth (OR 1.53, 95% CI 1.45–1.61) compared to higher SES class, and marital status was single at the time of birth (OR 2.02, 95% CI 1.87–2.17) compared to married or in a relationship. They had lower risk of anxiety disorders diagnosis if born in rural (OR 0.82, 95% CI 0.79–0.86) or semi-urban areas (OR 0.79, 95% CI 0.76–0.82) when compared to urban residence. There was a wide range of psychiatric comorbidities, and unipolar depression was the most common (31.2%).ConclusionAnxiety disorders diagnosed by specialized Finnish services increased from 1998–2012 in both genders. This could indicate a real increase in overall anxiety disorders or an increase in treatment seeking. The findings on maternal socioeconomic status and single parenting improve the recognition of the environmental risk factors for anxiety disorders among children and adolescents.

Association of Media Coverage on Transgender Health With Referrals to Child and Adolescent Gender Identity Clinics in Sweden

Increasing numbers of transgender and gender diverse children and adolescents have been referred to gender identity clinics in Sweden in the past decade, and previous studies have found an association between media attention and referral counts. Whether the tone of media stories is associated with referrals is not yet known. To investigate whether positive or negative media coverage on transgender and gender diverse issues is associated with referral counts to child and adolescent gender identity clinics. In this cross-sectional study, referrals counts were collected from all 6 specialized gender identity clinics in Sweden, along with information on referral date, sex assigned at birth, and birth year. Participants were all individuals younger than 19 years, referred to a gender identity clinic between January 1, 2017, and December 31, 2019. Data were analyzed from May 2020 to September 2021. Exposures included 3 major media events related to transgender health care in 2019; 1 event was categorized as positive and 2 events were categorized as negative press coverage. Referral counts before and after each of the 3 major media events were assessed, and the moderating association of sex assigned at birth and age was examined with stratified analyses. Weekly referral counts and trends were assessed with interrupted time series analysis. Among 1784 referrals (359 referrals [21.4%] among individuals aged <13 years; 1034 referrals [72.1%] among individuals assigned female at birth and 401 referrals [27.9%] among individuals assigned male at birth), a negative association between media coverage and referral counts was found for the first of the negative media events. In the 3 months following the event, referrals decreased by 25.4% (95% CI, -31.9% to -18.9%) overall, by 32.2% (95 CI, -41.8% to -22.8%) for individuals assigned female at birth, and by 25.3% (95 CI, -32.4% to -18.3%) for individuals aged 13 to 18 years. In the interrupted time series analysis, a mean weekly decrease of 3% in the referrals was observed in the extended time interval of 39 weeks (incidence rate ratio, 0.97; 95 CI, 0.95 to 0.99). For the other 2 media events, no changes in referral counts or time trends were observed. These findings suggest that an event of negative media coverage on transgender-specific health care was negatively associated with access to health care for transgender children and adolescents; therefore, nuanced and accurate media coverage, as well as increased awareness of these mechanisms among key stakeholders, is essential.

Diagnostic Accuracy of H. pylori Status by Conventional Endoscopy: Time-Trend Change After Eradication and Impact of Endoscopic Image Quality.

AimTo assess the time trend of diagnostic accuracy of pre- and post-eradication H. pylori status and interobserver agreement of gastric atrophy grading.MethodsA series 100 of conventional endoscopic image sets taken from subjects undergoing gastric cancer screening at a polyclinic were evaluated by 5 experienced assessors. Each assessor independently examined endoscopic findings according to the Kyoto classification and then determined the H. pylori status (never, current, or past infected). Gastric atrophy was assessed according to the Kimura-Takemoto classification and classified into 3 grades (none/mild, moderate, or severe). The image series that ≥3 assessors considered to have good quality were arbitrarily defined as high-quality image (HQI) series, and the rest were defined as low-quality image (LQI) series.ResultsThe overall diagnostic accuracy of H. pylori status was 83.0%. It was lowest in subjects with current infection (54%), gradually increased at 1 year (79%, P < 0.001) and 3 years (94.0%, P = 0.002), but then did not significantly change at 5 years (91.0%, P = 0.420) after eradication. The rate of LQI series was 28%. The overall diagnostic accuracy of H. pylori status dropped from 88.9% to 67.9% (P < 0.001), and the mean kappa value on gastric atrophy grading dropped from 0.730 to 0.580 (P = 0.002) in the HQI and LQI series, respectively.ConclusionsDiagnostic accuracy of H. pylori status increased over time after eradication. LQI series badly affected the diagnostic accuracy of H. pylori status and the level of agreement when grading gastric atrophy.