Time Trends Research Articles

Cotinine-measured secondhand smoke exposure among federal housing assistance recipients without active tobacco or nicotine in the United States: NHANES, 2007-2018.

The prevalence of cigarette smoking is high among U.S. Department of Housing and Urban Development (HUD) assistance recipients, putting others at risk for secondhand smoke (SHS) exposure. We evaluated the burden of SHS exposure among HUD-assisted children, adolescents, and adults. Using 2007-2018 National Health and Nutrition Examination Survey (NHANES) data linked with HUD administrative data, we assessed SHS exposure prevalence, defined using serum cotinine, among non-tobacco, non-nicotine-using, HUD-assisted children and adolescents (ages 3-17 years, n=955) and adults (ages ≥18 years, n=878) and among low-income, HUD-unassisted children and adolescents (n=5,788) and adults (n=8,027). Time trends were evaluated. Unadjusted and adjusted multivariable logistic regression models were created to assess SHS exposure by HUD assistance status. The prevalence of SHS exposure during 2015-2018 was 73.2% [95% CI: 63.2%-81.7%] among HUD-assisted children and adolescents and 50.1% [40.1%-60.1%] among HUD-assisted adults. Decreases in SHS exposure among HUD-assisted individuals from 2007-2010 through 2015-2018 were significant only for ages 12-17 years (78.6% [68.0%-87.0%] to 64.3% [52.5%-74.9%]; P=0.04). Among low-income individuals, SHS exposure was higher during 2007-2018 among HUD-assisted than HUD-unassisted children and adolescents (Odds Ratio: 3.39 [2.58-4.47]) and adults (2.11 [1.66-2.68]). Results remained significant after adjusting for social, demographic, and housing characteristics. HUD-assisted children, adolescents, and adults had higher exposure to SHS than those not receiving HUD assistance. SHS exposure among HUD-assisted individuals was high for all years studied, compared to published estimates for the general U.S. population, but did decrease among children and adolescents ages 12-17 years. This study is the first to provide biomarker-derived prevalence estimates of SHS exposure among recipients of HUD assistance within a nationally representative sample of the United States. The findings suggest that HUD-assisted children, adolescents, and adults are an at-risk population for SHS exposure, independent of known confounding social and demographic factors.

Using causal diagrams and superpopulation models to correct geographic biases in biodiversity monitoring data

Abstract Biodiversity monitoring schemes periodically measure species' abundances and distributions at a sample of sites to understand how they have changed over time. Often, the aim is to infer change in an average sense across some wider landscape. Inference to the wider landscape is simple if the species' abundances and distributions are similar at sampled to non‐sampled locations. Otherwise, the data are geographically biased, and some form of correction is desirable. We combine causal diagrams with ‘superpopulation models’ to correct time‐varying geographic biases in biodiversity monitoring data. For a given time‐period, expert‐derived causal diagrams are used to deduce the set of variables that explain the geographic bias, and superpopulation models adjust for these variables to produce a corrected estimate of a landscape‐wide mean of for example abundance or occupancy. Estimating a time trend in the variable of interest is achieved by fitting models for multiple time‐periods and, if the drivers of bias are suspected to change over time, by constructing per period causal diagrams. We test the approach using simulated data then apply it to real data from the UK Butterfly Monitoring Scheme (UKBMS). If the variables that explain the geographic bias are known and measured without error, our method is unbiased. Introducing measurement error reduces the method's efficacy, but it is still an improvement on using the sample mean. When applied to data from the UKBMS, the approach gives different results to the scheme's current method, which assumes no geographic bias. Where the goal is to estimate change in some variable of interest at the landscape level (e.g. biodiversity indicators), models that do not adjust for geographic bias implicitly assume it does not exist. Our approach makes the weaker assumption that there is no geographic bias conditional on the adjustment variables, so it should yield more accurate estimates of time trends in many circumstances. The method does require assumptions about the drivers of bias, but these are codified explicitly in the causal diagrams. Operationalising our approach should be less costly than full probability sampling, which would be needed to satisfy the assumptions of conventional approaches.

Segregation in hospital care for Medicare beneficiaries by race and ethnicity and dual-eligible status from 2013 to 2021.

To examine the extent of segregation between hospitals for Medicare beneficiaries by race, ethnicity, and dual-eligible status over time. We used Medicare inpatient hospital provider data for fee-for-service (FFS) beneficiaries, and the Dartmouth Atlas of Health Care from 2013 to 2021 nationwide, for hospital referral regions (HRRs), and for and hospital service areas (HSAs). We conducted time trend analysis with dissimilarity indices (DIs) for Black (DI-Black), Hispanic (DI-Hispanic), non-White (including Black, Hispanic, and other non-White) (DI-non-White), and dual-eligible (DI-Dual) beneficiaries. DIs between hospitals were contextualized and correlated with population compositions and residential DIs. We included 3177 hospitals with more than 250 Medicare FFS beneficiaries discharged per year. We cross-linked data on hospital-level patient race, ethnicity, and dual-eligible status with geographic data and examined time trends using linear mixed models. Nationwide DIs ranged from 0.23 to 0.53. HRRs and HSAs generally had low segregation (DI medians: 0.08-0.19, highest among Black, then non-White, Hispanic, and dual-eligible beneficiaries). However, some HRRs and HSAs had moderate or high segregation (DI-Black >0.30 in 19.1% of HRRs and 5.8% of HSAs; DI-non-White >0.30 for two HRRs with high American Indian/Alaska Native populations). Time trends indicated small declines in segregation from 2013 to 2021 (0.15%-0.30% per year; all p < 0.001). DI-Dual correlated moderately with non-White populations. For Medicare FFS, we observe generally low and slightly declining levels of segregation across HRRs and HSAs, with notable exceptions. Improving race reporting and contextualizing select areas of higher segregation with their hospital and residential population compositions can help frame and understand health inequities. Interpretation of HRR-level DI may require additional historical, demographic, and spatial context due to its potential to oversimplify, overstate, or obscure segregation. Future work should identify drivers and mitigators of segregation, including sorting patterns among health systems.

Detrending for Intensive Longitudinal Dyadic Data Analysis Using DSEM

Possible time trends are a common violation of the stationarity assumption, which is crucial in intensive longitudinal data analysis. Here we focus on the detrending issue in intensive longitudinal dyadic data analysis using Dynamic Structural Equation Modeling (DSEM). We first adjusted Savord et al. (2023) DSEM extension of the Actor-Partner Interdependence Model to better capture the interdependence between dyad members. Based on the adjusted model, using a simulation study, we investigated the influence of ignoring trends and compared two detrending practices—using residual DSEM (RDSEM) to separate time effects from the within-level autoregression or adding time covariate in autoregressive equations. Recommendations about whether and how to detrend are discussed.

The incidence trends of papillary thyroid carcinoma in Belarus during the post-Chernobyl epoch.

The increase of papillary thyroid cancer (PTC) rate among children who were exposed to post-Chernobyl 131-I release was reported only four years after the accident, first in Belarus where the heaviest fallout happened. The evolution of the occurrence of thyroid carcinoma based on the age-period-cohort analysis and the effects of age, period, and birth cohort on time trends aimed to reveal if post-Chernobyl follicular cells irradiation still has been impacting on incidence rate of papillary thyroid carcinoma nowadays. The Belarusian Cancer Registry was used to identify patients with PTC diagnosed during the years 1980-2019. The incidence trends were analysed using Join-point regression software. The highest peak of age-specific incidence curve was shown during the years 1980-2001 in the age group of 15-19 years old that was associated also with short-latency cases of post-Chernobyl PTC. This is the same age group that demonstrated significant growth of the incidence rate during the years 2006-2019, largely because of the increasing number of non-exposed patients with PTC (p < 0.001). Influence of post-Chernobyl exposure also can be seen in the young adults age-groups of patients (for 20-24 years old during the years 1980-2003 and 2013-2019, p < 0.001; for 25-29 years old during the years 1980-1999 and 1999-2011, p < 0.001). After the Chernobyl accident, epidemiological waves that reflect the age shift of the group of children exposed to 131-I have consistently emerged. Currently, the incidence rate continues to increase only in the cohort of patients aged 20-44 years.

Association Between Short-Term Exposure to Ambient PM2.5 and Its Components with Hospital Admissions for Patients with Coronary Heart Disease and Comorbid Diabetes Mellitus in Beijing, China.

Existing researches had primarily investigated the associations between various air pollutants and the risk of coronary heart disease (CHD) or diabetes mellitus (DM) separately. However, the significance and effects of PM2.5 and its components in patients with CHD and comorbid DM (CHD-DM) remain unclear. Patient data was sourced from the Beijing Municipal Health Commission Information Centre between January 1, 2014, and December 31, 2018. We utilized Generalized Additive Models (GAM) to analyze the relationship between daily hospital admissions for CHD-DM patients and PM2.5 exposure. The hospital admissions were treated as count data, offset by the total CHD-DM population, with a logarithmic link function. Smooth functions were included to account for the non-linear effects of time trends and meteorological factors used in both Chinese and WHO air quality guidelines. In Beijing, records show 215,267 hospital admissions for patients with CHD-DM. Every 10 μg/m3 increase of particles with an aerodynamic diameter ≤ 2.5 μm (PM2.5) corresponded to a 0.62% (95%CI: 0.49 to 0.76) increment for CHD-DM patients' admissions. As for the PM2.5 components: Per 10 μg/m3 increase of SO42- was 2.31% (95%CI: 1.51 to 3.11), NO3- was 3.35% (95%CI: 2.47 to 4.23), for NH4+ the percentage change value was 4.37% (95%CI: 2.99 to 5.77), for OM was 5.36% (95%CI: 4.19 to 6.55), for BC was 36.51% (95%CI: 28.09 to 45.47) increment for CHD-DM patients' admissions. Based on the WHO 2021 air quality guideline, our estimation suggests that a reduction in PM2.5 concentrations could prevent approximately 2.62% (95%CI: 2.04% to 3.2%) hospital admissions, corresponding to 5632 (95%CI: 4397 to 6879) CHD-DM patients, could be avoidable. Patients with CHD-DM who were exposed to PM2.5 and its components had an increased risk of hospital admissions. Furthermore, among all PM2.5 components, BC may be the most significant contributor to the association between PM2.5 and hospital admissions among CHD-DM patients.

Learning curve analysis of extraperitoneal single-site robotic-assisted radical prostatectomy: a CUSUM-based approach

This study applied cumulative sum (CUSUM) analysis to evaluate trends in operative time and blood loss, It aims to identify key milestones in mastering extraperitoneal single-site robotic-assisted radical prostatectomy (ss-RARP). A cohort of 100 patients who underwent ss-RARP, performed by a single surgeon at the First Affiliated Hospital of Guangzhou Medical University between March 2021 and June 2023, was retrospectively analyzed. To evaluate the learning curve, the CUSUM (Cumulative Sum Control Chart) technique was applied, revealing the progression and variability over time. A cubic polynomial model was utilised to fit the non-linear data trends accurately. Key perioperative outcomes, such as operative duration and estimated blood loss, were assessed and compared between distinct learning stages to identify improvements and transitions during the surgeon’s proficiency development. A total of 100 patients were included, with a mean age of 71.44 ± 5.46 years. The median operative time was 119.53 min (94, 144), and the best-fit equation for the CUSUM learning curve of operative time was y = 387.0373 – 3.4334x – 0.2982x2 + 0.003x3 (R2 = 0.898), reaching its peak at the 11th case. The median blood loss was 49.9 ml (20, 50), and the best-fit equation for the CUSUM learning curve of blood loss was y = 444.9362 + 23.6787x – 0.7719x2 + 0.0049x3 (R2 = 0.957), reaching its peak at the 27th case. The learning curve was divided into a learning phase (1–27 cases) and a proficient phase (28 cases onward). Intraoperative blood loss significantly decreased from 75.93 ± 79.19 mL to 40.27 ± 35.27 mL in the proficient phase (P < 0.05), while operative time remained similar between phases (P > 0.05).There were no statistically significant differences in pelvic drainage tube placement time, drainage volume, positive surgical margin rate, hospital stay duration, or postoperative pain scores (P > 0.05). The findings suggest that proficiency in ss-RARP is typically achieved after approximately 27 cases, indicating a manageable and safe learning curve. These insights can inform the design of surgical training programmes, optimising early learning and improving clinical outcomes for novice surgeons.

Data-Driven Machine Learning Strategy for Designing Metal-Ion-Doped γ-Bi2MoO6 Photocatalysts to Enhance Degradation Performance.

Doped semiconductors are often used to improve photocatalytic efficiency and address the challenges of easy recombination of electron-hole pairs and poor photoluminescence. However, the reproducibility and complexity of experimental studies result in time-consuming and less cost-effective studies, and it is difficult to gain insights into the intrinsic properties of doped photocatalysts to control their performance. Introducing a machine learning approach, we constructed a photocatalytic model of transition-metal- and rare earth metal-ion-doped γ-Bi2MoO6. We selected 18 factors of preparation conditions and dopant ion properties, and constructed 806 data sets through literature collection for correlation analysis, paving the way for a more efficient and cost-effective research process. The results of our study are promising. The trained and improved XGboost model demonstrated high resistance to the variability caused by data segmentation, with a cross-validated model showing a coefficient of determination of 0.942. Through the combination of characteristic importance and Shapley additive explanation analysis, the importance and correlation trends of preparation conditions and dopant ion properties are obtained, especially the positive correlation trend of excitation time and preparation time and the negative correlation trend of atomic mass and bandwidth. Model prediction and experimental validation are used to demonstrate the effectiveness and behavioral prediction ability, and the Zn and Cd elements are successfully predicted for doping modification means. This study contributes to the modification and preparation of γ-Bi2MoO6 materials and provides a solid foundation for the efficient design of photocatalysts.

The impact of published guidance on trends in the pharmacological management of depression in children and adolescents- a whole population e-cohort data linkage study in Wales, UK.

This study evaluated the impact of 2015/2016 prescribing guidance on antidepressant prescribing choices in children. A retrospective e-cohort study of whole population routine electronic healthcare records was conducted. Poisson regression was undertaken to explore trends over time for depression, antidepressant prescribing, indications and secondary care contacts. Time trend analysis was conducted to assess the impact of guidance. A total of 643 322 primary care patients in Wales UK, aged 6-17 years from 2010-2019 contributed 3 215 584 person-years of follow-up. Adjusted incidence of depression more than doubled (IRR for 2019 = 2.8 [2.5-3.2]) with similar trends seen for antidepressants. Fluoxetine was the most frequently prescribed first-line antidepressant. Citalopram comprised less than 5% of first prescriptions in younger children but 22.9% (95% CI 22.0-23.8; 95% CI 2533) in 16-17-year-olds. Approximately half of new antidepressant prescribing was associated with depression. Segmented regression analysis showed that prescriptions of 'all' antidepressants, Fluoxetine and Sertraline were increasing before the guidance. This upward trend flattened for both 'all' antidepressants and Fluoxetine and steepened for Sertraline. Citalopram prescribing was decreasing significantly pre guidance being issued with no significant change afterward. Targeted intervention is needed to address rising rates of depression in children. Practitioners are partially adhering to local and national guidance. The decision-making process behind prescribing choices is likely to be multi-factorial. Activities to support implementation of guidance should be adopted in relation to safety in prescribing of antidepressants in children including timely availability of talking therapies and specialist mental health services.

Mental Health Care Utilization and Prescription Rates Among Children, Adolescents, and Young Adults in France

Amid escalating mental health challenges among young individuals, intensified by the COVID-19 pandemic, analyzing postpandemic trends is critical. To examine mental health care utilization and prescription rates for children, adolescents, and young adults before and after the COVID-19 pandemic. This population-based time trend study used an interrupted time series analysis to examine mental health care and prescription patterns among the French population 25 years and younger. Aggregated data from the French national health insurance database from January 2016 to June 2023. Data were analyzed from September 2023 to February 2024. The number of individuals with at least 1 outpatient psychiatric consultation, those admitted for full-time psychiatric hospitalization, those with a suicide attempt, and those receiving psychotropic medication was computed. Data were stratified by age groups and sex. Quasi-Poisson regression modeled deseasonalized data, estimating the relative risk (RR) and 95% CI for differences in slopes before and after the pandemic. This study included approximately 20 million individuals 25 years and younger (20 829 566 individuals in 2016 and 20 697 169 individuals in 2022). In 2016, the population consisted of 10 208 277 of 20 829 566 female participants (49.0%) and 6 091 959 (29.2%) aged 18 to 25 years. Proportions were similar in 2022. Significant increases in mental health care utilization were observed postpandemic compared with the prepandemic period, especially among females and young people aged 13 years and older. Outpatient psychiatric consultations increased among women (RR, 1.13; 95% CI, 1.07-1.20), individuals aged 13 to 17 years (RR, 1.15; 95% CI, 1.06-1.23), and individuals aged 18 to 25 years (RR, 1.08; 95% CI, 1.03-1.14). Hospitalizations for suicide attempt increased among women (RR, 1.14; 95% CI, 1.02-1.27) and individuals aged 18 to 25 years (RR, 1.07; 95% CI, 1.03-1.12). Regarding psychotropic medications, almost all classes, except hypnotics, increased in prescriptions between 2016 and 2022 for females, with a particularly marked rise in the postpandemic period. For men, only increases in the prescriptions of antidepressants (RR, 1.03; 95% CI, 1.01-1.06), methylphenidate (RR, 1.09; 95% CI, 1.06-1.12), and medications prescribed for alcohol use disorders (RR, 1.08; 95% CI, 1.04-1.13) were observed, and these increases were less pronounced than for women (antidepressant: RR, 1.13, 95% CI, 1.09-1.16; methylphenidate: RR, 1.15; 95% CI, 1.13-1.18; alcohol use dependence: RR, 1.12; 95% CI, 1.08-1.16). Medications reserved for severe mental health situations, such as lithium or clozapine, were prescribed more frequently starting at the age of 6 years. In this study, an interrupted time-series analysis found a marked deterioration in the mental health of young women in France in the after the COVID-19 pandemic, accentuating a trend of deterioration that was already observed in the prepandemic period.

Postneonatal Cerebral Palsy in Europe: Prevalence and Clinical Characteristics According to Contributory Events: An SCPE Study.

Postneonatal cerebral palsy (PNCP) is rare and requires large databases to be studied over time. To study the time trend of prevalence of PNCP overall and by cause, and to describe the clinical characteristics of children with PNCP according to cause and compared with children with pre/peri/neonatal CP (PPNCP). The Surveillance of Cerebral Palsy in Europe (SCPE) database was used. Primary events (the first known chronological event in the causal chain) were classified according to the SCPE classification (six main and 19 sub-categories). Prevalence trends for children born during 1976-2012 were modelled using multilevel generalised linear models. The clinical characteristics of PNCP and PPNCP cases born after 1998 were reported as proportions. The prevalence rates of PNCP were 1.76 (95% confidence interval (CI) 1.37, 2.23) and 0.82 per 10,000 live births (95% CI 0.73, 0.92) in children born during 1976-1980 and 2006-2012, respectively. The models showed a 2% annual decline in overall prevalence (prevalence rate multiplied by 0.98 each year) and a 10% decline for infectious causes for every 5-year change. The prevalence rate in children born during 2006-2012 was 0.26 per 10,000 (95% CI 0.21, 0.32) for infectious causes, which remained the most frequent. No trend emerged for other causes. Unilateral spastic CP, associated impairments and severe gross motor dysfunction were more frequent in PNCP than in PPNCP, and PNCP showed predominantly grey matter injury (55.6%). Seventeen percent were born preterm. PNCP differed by cause, with cerebrovascular accidents presenting the least severe and hypoxic causes the most severe forms. Our study confirms the decrease in the prevalence of PNCP in children born up to 2012, particularly for CP, due to infectious causes, which remain the most frequent. Children with PNCP had more severe presentation overall than those with PPNCP, with severity depending on the cause.

Monitoring and assessment of population, reproductive, and health effects in colonial waterbirds breeding at contaminated Great Lakes sites in Michigan

Abstract Immunological, reproductive, and population endpoints were assessed in fish-eating birds during 2010–2019 in the Saginaw River and Bay and River Raisin Areas of Concern (AOCs) and Grand Traverse Bay, which are ecosystems historically contaminated with polychlorinated biphenyls, dibenzo-p-dioxins, and dibenzofurans. Reference sites were in the lower St. Marys River (herring gulls and Caspian terns), eastern Lake Superior (terns), and eastern Lake Huron (black-crowned night herons). Relative risk ratios for embryonic nonviability (from both infertility and mortality) in gull embryos were 2–3-fold higher than the reference site in both AOCs and Grand Traverse Bay. Twelve of 13 deformed embryos and chicks (e.g., crossed bills and gastroschisis) were observed at the contaminated sites. Productivity of 4-week-old tern chicks in Saginaw Bay was 35% lower than that at reference sites. In the River Raisin AOC, productivity of 4-week gull chicks was poor in 7 of 10 years. Numbers of breeding herring gulls decreased significantly in the River Raisin AOC, and breeding Caspian terns, a state-threatened species, declined in the Saginaw River and Bay AOC. The mean T cell-dependent phytohemagglutinin skin response was suppressed 50%–56% in gull chicks in both AOCs and Grand Traverse Bay, and 49% in terns and 33% in herons in Saginaw Bay. Antibody responses in gull chicks in the River Raisin AOC and Grand Traverse Bay were 1.6–2-fold lower than reference. Time trend analyses showed no significant improvements in reproductive and immune endpoints in either AOC or Grand Traverse Bay over the study period. Embryonic death increased with time in gulls in the lower Saginaw Bay, and antibody responses decreased in terns in the outer Saginaw Bay.

Architectural concretes for 3D construction printing

Introduction. One of the rising architectural trends of the present time is to increase the comfort and aesthetics of the territories of populated areas through artistic improvement, a significant role in which is given to various types of small architectural forms. The most budgetary and, at the same time, reliable and durable material for them is architectural concrete. The bottleneck in the use of concrete for the manufacture of small architectural forms is the relative difficulty of giving it complex spatial configurations. At the current level of development of concrete work technology, this drawback can be easily overcome through the use of construction 3D printing technology. The aim of the work was to develop effective architectural concrete for the manufacture of small architectural forms using the 3D construction printing method, based on composite binders containing weathered quartzite sandstones as a mineral additive, as one of the types of local energy-efficient raw materials. Materials and methods: The section presents comparative characteristics of weathered and unweathered quartzite sandstones.Results. The data on the dynamics of component grinding; compositions and characteristics of composite binders and fine-grained concretes based on them; results of manufacturing a pilot batch of small architectural forms using the construction printing method are presented.Discussion and conclusions. The description and analysis of the obtained experimental data are presented. The conclusions are formulated in which it is noted that for the organization of the production of modern small architectural forms, the technology of 3D construction printing is used, which allows the implementation of complex various spatial forms of products with any level of individualization without increasing costs. The developed molding mixtures confirmed the high efficiency of using weathered quartzite sandstone as part of a composite binder and technogenic sand. The introduction of the developed materials meets the requirements of energy and resource conservation, since the consumption of Portland cement and non-renewable natural resources is reduced.

The direct and urinary electrolyte-mediated effects of ambient temperature on population blood pressure: A causal mediation analysis.

High ambient heat can directly influence blood pressure (BP) through the vasodilation of the skin vasculature and indirectly by affecting urinary volume and electrolyte levels. We evaluated the direct and urine electrolyte-mediated effects of ambient temperature on BP. We pooled 5,624 person-visit data from a community-based stepped-wedge randomized control trial in southwest coastal Bangladesh from December 2016 to May 2017. Same-day ambient temperature data from local weather stations were linked to participant BP and urine electrolytes using geo-locations of their residential addresses. We implemented causal mediation analyses using the product methods of coefficients with linear mixed models under the sequential ignorability assumption. Separate models were run for each urinary electrolyte mediator (sodium, potassium, calcium, and magnesium), followed by combined models to evaluate the natural direct and electrolyte-mediated indirect effects of temperature on BP. Models had participant-level random intercepts and were adjusted for age, sex, body mass index (BMI), religion, exercise, smoking status, sleep hours, alcohol consumption, urine creatinine, time trend, household assets, drinking water salinity, and seasonality. For the combined mediators (sodium, potassium, calcium, and magnesium), for every 5°C increase in average daily temperature: the direct effect on systolic BP was -1.42 (95% CI: -1.94, -0.92) mmHg and urine sodium mediated effect was -0.12 (95% CI: -0.20, -0.05) mmHg; while urine potassium mediated effect was 0.15 (95% CI: 0.08, 0.25) mmHg; urine calcium-mediated effect 0.06 (95% CI: 0.01, 0.12) mmHg; and urine magnesium mediated effect -0.00 (95% CI: -0.03, 0.02) mmHg. We detected similar associations for diastolic BP, pulse pressure, and mean arterial pressure. We found a significant inverse direct effect of ambient temperature on BP compared to minimally mediated urine electrolyte effects. Further studies are needed to uncover the underlying mechanisms of ambient heat and BP associations and to describe the clinical consequences of these associations.

More Drugs and Fewer Strokes? Time Trends in CVD Medication and Incidence of Stroke With German Health Insurance Data.

Successful prevention of cardiovascular diseases (CVD) may reduce the burden of diseases. Preventive medication is an important measure to decrease the risks of cardiovascular events, in particular myocardial infarction and stroke. The aim of this study is to analyze the prevalence of CVD preventive medication in Germany over time with respect to sex and age and to compare it with the temporal development of strokes. The study is based on statutory health insurance claims data from the AOK Niedersachsen (AOKN) covering the years 2005-2018. The study population comprises all AOKN insured persons aged 18 years and older (N = 2 088 495). Age-standardized time trends of the prevalence of CVD preventive medication and incidence of stroke were calculated for men and women in different age groups. After that, the relationship of both measures was examined in an ecological correlation. We found a clear increase in medication prevalence over time. In 2018, about 35% of the total population and about 85% of those over 85 years of age received CVD preventive medication. At the same time, age-standardized incidence rates of ischemic stroke were decreasing slightly. The ecological correlation showed a negative association between medication prevalence and stroke incidence especially in the higher age groups. High correlation coefficients indicate that higher medication prevalence could be linked to better population health. Further research is needed to draw conclusions about the effects of increasing medicalization, including adverse risks and side effects at the population level.

Mesoscale modelling of fibrin clots: the interplay between rheology and microstructure at the gel point.

This study presents a numerical model for incipient fibrin-clot formation that captures characteristic rheological and microstructural features of the clot at the gel point. Using a mesoscale-clustering framework, we evaluate the effect of gel concentration or gel volume fraction and branching on the fractal dimension, the gel time, and the viscoelastic properties of the clots. We show that variations in the gel concentration of our model can reproduce the effect of thrombin in the formation of fibrin clots. In particular, the model reproduces the fractal dimension's dependency on gel concentration and the trends in elasticity and gelation time with varying thrombin concentrations. This approach allows us to accurately recreate the gelation point of fibrin-thrombin gels, highlighting the intricate process of fibrin polymerization and gel network formation. This is critical for applications in the clinical and bioengineering fields where precise control over the gelation process is required.

Contact force calculation and evolution analysis of granular systems based on micro-CT experiment

The calculation of inter-granule contact force in three-dimensional (3D) granular systems is a key and challenging aspect of granular mechanics research. Two elastic rubber balls are used as research objects for in-situ flat pressing Micro-CT experiments. Based on the Hertzian contact theory and Tatara large deformation contact theory, the contact model of elastic balls is verified, and the theoretical formula of the contact force of elastic balls based on the experiment is obtained. Taking the 3D granular systems as research object, in-situ probe loading experiment of micro-CT is carried out to obtain the 2D image sequence of the granules, after a series of digital transformations, the digital body images emerge, the contact force networks of the 3D granular systems under different loading conditions are obtained by constructing pore network models. The contact force distribution and evolution law of the granular systems are analyzed. The relation among the number of strong contacts, the distribution evolution, and the stability of the granular system is explored. The results show that the two elastic ball contact model conforms to the Hertzian contact theory and Tatara large deformation contact theory, and the contact force fitting formula based on experiment can characterize the contact force between two granules reasonably and effectively. The contact force of granules under probe loading is distributed in a net-like pattern starting from the contact point of the indenter and gradually transmitted to the lower and the surrounding area. The trend of average contact force is consistent with the trend of the contact times, showing a significant phase transition. With the increase of contact times, the frequency of particle compression increases, resulting in a greater contact force between granules, ultimately stabilizing at about 10.5 N. The number of strong contacts accounts for 45% to 50% of the total number of contacts, distributed throughout the whole granular system and supporting the network structure of the granular system. The larger values are concentrated below the indenter and exhibit a branching distribution. In the loading process, an equilibrium point is established at &lt;i&gt;z&lt;/i&gt; = 14 mm, where the number of strong contacts reaches the peak. The network structure of strong contact force is spread throughout the entire 3D granular system, establishing the main skeleton that can withstand external loads. As the loading continues, the total value of strong contact forces increases, and their distribution within the granular system becomes more uniform.

Time trends of catheter-directed treatment in acute pulmonary embolism in Germany

Time trends of catheter-directed treatment in acute pulmonary embolism in Germany

Ten Year Time Trends of Amputation Surgery in Peripheral Arterial Disease in Germany: Before and During the COVID-19 Pandemic

Ten Year Time Trends of Amputation Surgery in Peripheral Arterial Disease in Germany: Before and During the COVID-19 Pandemic

Energy poverty and health inequalities in Barcelona: A cross-sectional trends study in the context of COVID-19, energy crisis and climate change, 2016-2021.

The aim of this study was to analyse the time trends in Barcelona before and during the adverse context of COVID-19, energy crisis, and climate change in 1) the energy poverty (EP) prevalence; 2) the association between EP and health and 3) the impact of EP on health, according to the axes of inequality (sex, age, social class, and country of birth). We conducted a cross-sectional trends study using data from the 2016 and 2021 Barcelona Health Survey. This study clearly recognizes that EP continues to be an important public health problem in the context of Barcelona. The results show that EP did increase somewhat, though not as sharply as hypothesized in the current adverse context. Neither did it have as large consequences on the effects of EP on health as we expected to see. However, it demonstrates that there is still a strong association between EP and poor health, particularly in vulnerable groups such as people born in LMI countries and manual workers, who experienced an increase in the impact of EP on poor health outcomes, which suggests increasing health inequalities.