U-shaped Pattern Research Articles

Exploring the effects of multi-dimensional geographic environment on daily sleep and physical activity based on the Actigraph data

Understanding the interplay between people’s daily sleep and physical activity and how geographic environment influences them are important for developing healthy cities. However, such research has been limited. This study aims to explore the bidirectional and nonlinear relationship between daily sleep and physical activity, and further investigate the comprehensive influences of multi-dimensional geographic environment on these health behaviors. Based on the objective data on sleep and physical activity over seven consecutive days using wrist-based accelerometers in Beijing, China, we developed a series of models to analyze the mutual influences between people’s daily sleep and physical activity, and employed the generalized additive model (GAM) to examine their potential nonlinear relationships and how geographic environment – including meteorological conditions, built environment, and social environment – influences them. The results show that sleep and physical activity exhibit notable bidirectional relationship. Moderate-to-vigorous physical activity (MVPA) is observed to improve sleep quality, but it decreases sleep duration. In contrast, total sleep time (TST) exhibits an inverted U-shaped pattern with both MVPA and total step counts, with the optimal sleep duration at 5 hours. Furthermore, meteorological factors, built environment characteristics, and social environment have significant linear or nonlinear effects on people’s daily sleep and physical activity. The outcomes of this study offer valuable insights for enhancing residents’ health and developing healthy cities.

Primary care utilization in Bulgaria: some effects of the COVID-19 pandemic

Abstract Background Disruptions to primary care provision during the pandemic set back prior advancements in screening and chronic disease management. Delays in routine vaccination added to preexisting hesitancy and sustained the downward trend in vaccination rates. The study examines the magnitude and duration of primary care disruptions in Bulgaria between 2020 and 2022. Methods The impact of the pandemic on primary care is assessed using administrative data from the National Health Insurance Fund covering the annual number of primary care services. To evaluate the effect on healthcare utilization, the average number of check-ups per person during the pandemic is compared to a pre-pandemic period (2017-2019). Results After the onset of the pandemic, all visits declined significantly on an annual basis. In 2020, overall prophylactic check-ups dropped by 6-13% and remained lower than the baseline until 2022. Initial figures for 2023 suggest some recovery, while specific services are likely to experience an ongoing decrease. During the pandemic, the average number of prophylactic examinations for children fell between 6.9 and 9.3%. In 2022, there was a modest resumption, although these services did not reach the preceding levels. Adult prophylactic visits declined by approximately 10-12% between 2020 and 2021, but following a U-shaped pattern, they rebounded in 2022. Visits associated with chronic diseases experienced a drop of 7.8% in 2020 and continued to decrease in the next two years. Child vaccination was affected for a shorter period. In 2022, the coverage for most vaccine-preventable diseases was close to the pre-pandemic levels. However, the uptake of MMR and pneumococcal vaccines failed to demonstrate a clear path to recovery. Conclusions During the pandemic, a considerable drop in primary care utilization has been recorded. Effective recovery requires sustained service delivery and a rapid post-lockdown rebound to mitigate the negative impact on health outcomes. Key messages • Primary care needs additional recovery measures to prevent long-term harmful impacts on health outcomes. • Investing in service delivery innovations can boost resilience during disruptive events.

Using Machine Learning to identify the social determinants of the mid-life decline in mental health

Abstract Background The mid-life decline in mental well-being, depicted as a U-shaped pattern, is debated across disciplines. This study seeks to identify the social determinants of this decline and the overall contribution of social determinants to changes in mid-life mental health. Methods We use data from the 1970 British Cohort Study, from the ages 26, 34, and 42 (N = 6992, 51.5% female). Mental distress was measured using the 9-score Malaise Inventory. Mental distress increased from age 34 (M = 1.67) to 42 (M = 1.86; p < 0.001), with 17.8% declining by at least 1 SD on the inventory. We contrasted this group of decliners with those exhibiting stable mental health. We included socioeconomic and family factors, as well as physical health and health behaviours as potential determinants of mental health decline (at ages 26, 34, or at birth). We combine Random Forest and logistic regressions. Results The Random Forest’s Variable Importance (VI; root Mean Squared Error (MSE)), revealed social class at birth (VI = 0.023), physical multimorbidity at age 26 (VI = 0.22), and income quintile at age 34 (VI = 0.022) as most important predictors. Regressions confirmed that low birth social class (OR = 1.51 [1.25-1.83]), high-income at age 34 (OR = 0.68 [0.53-0.88]), and physical multimorbidity at age 26 (OR = 1.25 [1.06-1.48]) predict mental health decline. For those with high income and social class, the predicted probability of mid-life mental health decline is 0.109 (CI = [0.08-0.139]), rising to 0.277 (CI = [0.227-0.324]) for high risk individuals. Social class does not predict changes in mental health between ages 26 - 34. Interpretation We show that various social determinants of health contribute to the observed decline in mental health during mid-life. Social class at birth, income, and physical health are the most relevant predictors; they reduce the risk of decline from up to 27% to 11%. The contribution of social class appears specific to mid-life, and it could help explain the U-shaped pattern. Key messages • Social Factors Matter: Social class, income, and health predict mid-life mental decline. • Mid-life Class Impact: Social class uniquely affects mental health decline in mid-life.

A longitudinal study of the impacts of area-level social cohesion on multimorbidity in Scotland

Abstract Background Multimorbidity is a growing global public health challenge, commonly referring to the co-occurrence of 2+ conditions but with varying measurements. Prior evidence has linked social cohesion with single health conditions; however, its impact on multimorbidity remains unclear. This study aims to examine the association between area-level social cohesion and multimorbidity and to explore whether this association will vary across multimorbidity measurements and levels of urban-rural classification. Methods Using a dataset that links the Scottish Longitudinal Study (5.3% of the Scottish population) with hospitalisation records (2001-2019) and an index that reflects area-level social cohesion (2012), focused on the cohorts of adults aged 40+, we used 3-level logistic regression to account for the clustered data structure of diagnosed chronic conditions over time within individuals within neighbourhoods. Results Areas with the highest social cohesion were observed to have the lowest risks of multimorbidity (p < 0.001), even after adjusting for area-level income deprivation. Varying by multimorbidity measurements, an inverted U-shaped pattern was observed between reduced area-level social cohesion and increased risks of having 2+ co-occurring chronic conditions; while a linear pattern was found for mental-physical multimorbidity. Moderated by levels of urban-rural classification, as compared to rural residents, urban residents were more sensitive to the impact of social cohesion on the co-occurrence of 2+ conditions; however, for mental-physical multimorbidity, no interaction effects between area-level social cohesion and urban-rural classification were found. Conclusions Although varying patterns were seen for different multimorbidity measurements, people living in areas with the highest area-level social cohesion were less likely to be multimorbid. This study offers new insights for developing effective place-based public health interventions. Key messages • This is the first longitudinal study that analysed the association between area-level social cohesion and multimorbidity using a nationally representative dataset based on secondary care data. • Area-level social cohesion affects multimorbidity, but its impact may vary by multimorbidity measurements and by urban-rural classification.

Extent and impact of obesity in patients with diabetes and acute myocardial infarction - experience from a national cohort

Abstract Background Elevated body mass index (BMI) has an adverse effect on cardiovascular riskfactors where diabetes and coronary artery disease increases with obesity. However, less in known about the prevalence and the grades of obesity in a diabetes population with acute myocardial infarction (AMI) and the impact on prognosis. Further, for the moment there is a shortage of access to cardioprotective weight loss medications as Glucagon Like Peptide Receptor Agonists (GLP-1 RA). Purpose To explore features and grades of obesity in patients with diabetes and AMI and impact on outcome in a national perspective. Methods All patients with diabetes and AMI admitted for coronary angiography in Sweden the years 2010-2021 were included. Information on BMI was collected at the time of angiography and grouped into obesity categories: low BMI (<18.5 kg/m2), normal BMI (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), obesity grade 1 (30.0-34.9 kg/m2), obesity grade 2 (35.0-39.9 kg/m2) and obesity grade 3 (≥40.0 kg/m2). Information on baseline characteristics and outcome was collected from national registries. Mortality was followed until March 2022. Restricted cubic spline analysis of association between continuous BMI and age-adjusted mortality was performed where normal BMI served as a reference with Hazard Ratio (HR) 1.0. Results Of 19 378 patients with diabetes, 67% were men and 46% suffered a STEMI. Normal BMI was present in 21%, overweight in 41%, obesity grade 1 in 25%, obesity grade 2 in 9% and obesity grade 3 in 3% (Figure 1). Age was decreasing with grade of obesity (72 years in normal BMI vs. 62 years in obesity grade 3, p<0.001). Hypertension and hyperlipidaemia were more common in patients with more severe obesity than in those with normal BMI (67% vs. 80%, p<0.001, and 44% vs. 50%, p<0.001, in normal BMI and obesity grade 3 respectively) while a higher proportion of those with normal BMI had suffered a previous MI (10% vs. 6% in obesity grade 3, p<0.001) and a previous stroke (10% vs. 5% in obesity grade 3, p<0.001). In patients with normal BMI STEMI was more common (51% vs. 39%, p<0.001) than in those with obesity grade 3. In patients with obesity grade 3 GLP-1 RA was used in 14% compared to 4% in those with normal BMI. Figure 2 depicts age-adjusted HR and 95% Confidence Interval for mortality for different BMI levels with a U-shaped pattern illustrating that associated mortality risk is higher when obesity is present especially grade 2 and 3. Conclusion Obesity is common affecting around one third of patients with diabetes and AMI and impacts survival. This strengthens that after AMI use of effective weight loss cardioprotective treatment should be prioritised in patients with diabetes and obesity especially if severe.

Trends in overall and abdominal obesity among Korean adults, 2007-2022: an Age-period-cohort analysis

Abstract Overall and abdominal obesity, often defined as having high body mass index (BMI) and waist circumference (WC), are associated with an increased risk of chronic disease. A comprehensive understanding of trends and contributing factors is necessary to reduce the disease burdens. This study investigated the nationwide trends and independent effects of age, period, and birth cohort on BMI and WC in Korean adults. We conducted hierarchical age-period-cohort (cross-classified random-effects models) analyses using measured BMI and WC data from 85,292 Korean adults (aged ≥19) in the Korea National Health and Nutrition Examination Survey 2007-2022. We also examined whether the age, period, and cohort effects varied by socioeconomic subgroups. In 2007-2022, the age-standardized mean BMI (23.6 to 24.2 kg/m2) and WC (81.7 to 83.5 cm) increased in the overall population. An upward trend was evident among men, while only a slight change was observed in women. The mean BMI was highest at age 47 (25.1 kg/m2) in men and age 60 (24.2 kg/m2) in women and it decreased at older ages. Controlling for age and period effects, mean BMI was lowest among the birth cohorts of 1960-1964 (24.15 kg/m2), with the highest mean BMI observed among the birth cohorts of 1919-1939 (24.97 kg/m2) and 1990-2003 (24.99 kg/m2). The mean WC was highest at age 55 (88.0 cm) in men and age 79 (83.4 cm) in women. Similar U-shaped birth cohort effect was observed with WC, with the lowest mean observed among the birth cohorts of 1960-1964 [82.92 (0.30)]. At most age, period, and birth cohorts, mean BMI and WC were consistently higher among adults at lower income and education. The overall period effect was consistently found in all socioeconomic subgroups, but the gap in BMI between income and education subgroups widened over time. Our findings suggest that BMI and WC slightly increased in overall Korean adults in 2007-2022, with some inequalities among age, sex, birth cohort, and socioeconomic subgroups. Key messages • The obesity indices increased from 2007 to 2022, but the cohort effect on BMI and WC showed a U-shaped pattern with the lowest mean among birth cohorts of 1960-1964. • The obesity prevalence is varied by socioeconomic status, suggesting that more intense interventions may be needed to target the susceptible groups.

Association of HbA1C with mortality and cardiovascular outcome in patients with type 2 diabetes using drugs with different hypoglycemic risk

Abstract Background Previous clinical trials showed that intensive glucose control did not reduce macrovascular events and mortality. It was speculated that severe hypoglycaemia contributed to these adverse outcomes. More contemporary clinical trials using newer anti-diabetic agents with less hypoglycaemic potential showed a linear relationship between major adverse cardiovascular events (MACE) and HbA1c reduction according to a meta-regression analysis. Purpose The aim of this study was to examine the association between clinical outcomes and HbA1c under different treatment backgrounds in the real-world setting. We hypothesised that when using drugs with minimal hypoglycaemic risk, lower HbA1c would be associated with better outcomes. Methods This was a retrospective population-based cohort study using a multi-centre electronic medical record database. Eligible patients were those diagnosed with type 2 diabetes between 2009 and 2020 who received non-insulin antidiabetic drugs. Patients were stratified into two groups based on the drugs received: drugs with high hypoglycaemic risk (sulphonylurea, meglitinide) and drugs with low hypoglycaemic risk (thiazolidinediones, acarbose, DPP4 inhibitors, GLP1 agonists, SGLT-2 inhibitors). Patients were excluded if they had received these drugs for less than 180 days or had received both high and low hypoglycaemic risk oral drugs simultaneously. HbA1c levels were assessed from the index date to the date of the interested outcome or the end of the study period (31 December 2021), whichever came first. The relationship between HbA1c and clinical outcomes was examined using a Cox proportional hazards model. The outcomes of interest included all-cause mortality and MACE. Results The study population consisted of 6,923 patients, including 3,639 high hypoglycaemic risk drug users and 3,284 low hypoglycaemic risk drug users. Patients with lower HbA1c levels during the follow-up period were older and frailer. After adjusting for baseline covariates, the association between the risk of death and HbA1c presented a U-shaped pattern, and this U-shaped association was similar in the two treatment cohorts (Table 1). On the other hand, the association between the risk of MACE and HbA1c presented a J-shaped pattern. In the high hypoglycaemic risk drug cohort, patients with the highest HbA1c levels (mean HbA1c 9.6%) were associated with a higher risk of MACE compared to the group with a mean HbA1c of 7.2% (hazard ratio [HR] 4.16, 95% confidence interval [CI] 2.07-8.37); lower HbA1c levels were not associated with a lower risk of MACE (Table 2). In contrast, in the low hypoglycaemic risk drug cohort, lower HbA1c levels were associated with a higher risk of MACE (HR 3.82, 95% CI 1.29-11.28). Conclusion Lower HbA1c levels were not associated with a lower risk of all-cause mortality and MACE. Furthermore, this phenomenon was independent of the hypoglycaemic risk of anti-diabetic drugs.

LVEF trajectory in HFimpEF and its association with prognosis

Abstract Background The 2021 revised Universal Definition of Heart Failure (HF) introduced the subgroup known as HF with improved ejection fraction (HFimpEF), aiming to establish a standardized definition for left ventricular ejection fraction (LVEF) improvement and emphasize the importance of longitudinally assessment of LVEF. However, there remains an insufficient characterization of the association between serial LVEF trajectory before and after impEF, and outcomes in HFimpEF. Purpose We aim to delineate the LVEF trajectory in patients with impEF and to discern specific LVEF trajectory pattern that portends an unfavorable prognosis. Methods We conducted a retrospective analysis by including hospitalized HF patients with baseline LVEF ≤ 40% and satisfactory serial echocardiographic follow-ups. ImpEF was defined as a follow-up LVEF measurement of > 40% with a ≥10-point increase from baseline. Longitudinal LVEF trajectories for patients with impEF (before and after LVEF improvement) were plotted according to the clinical outcome of all-cause death using Loess curves. LVEF changes over time were analyzed by unconditional non-linear mixed-effects modeling, and compared between the groups of patients who died and those who survived using conditional non-linear mixed-effects modeling. Results Among the initial 923 patients with reduced LVEF, 517 had impEF. According to Loess curves and non-linear mixed-effects analysis, LVEF trajectory of impEF differed according to the clinical outcome of death. For patients who suffered all-cause death, there was a comparatively limited improvement in LVEF followed by a more rapid plateauing and decline, exhibiting an inverted U-shaped pattern with lower LVEF values towards both ends of the distribution. Conclusions In HFimpEF, an inverted U-shaped trajectory of LVEF, characterized by limited initial improvement followed by subsequent decline, is associated with poorer prognosis. Serial LVEF monitoring in patients with HFimpEF could help with early identification of at-risk patients.Graphical Abstract

Differential amino acid usage leads to ubiquitous edge effect in proteomes across domains of life that can be explained by amino acid secondary structure propensities

Amino acids are the building blocks of proteins and enzymes which are essential for life. Understanding amino acid usage offers insights into protein function and molecular mechanisms underlying life histories. However, genome-wide patterns of amino acid usage across domains of life remain poorly understood. Here, we analysed the proteomes of 5590 species across four domains and found that only a few amino acids are consistently the most and least used. This differential usage results in lower amino acid usage diversity at the most and least frequent ranks, creating a ubiquitous inverted U-shape pattern of amino acid diversity and rank which we call an ‘edge effect’ across proteomes and domains of life. This effect likely stems from protein secondary structural constraints, not the evolutionary chronology of amino acid incorporation into the genetic code, highlighting the functional rather than evolutionary influences on amino acid usage. We also tested other contemporary hypotheses regarding amino acid usage in proteomes and found that amino acid usage varies across life’s domains and is only weakly influenced by growth temperature. Our findings reveal a novel and pervasive amino acid usage pattern across genomes with the potential to help us probe deep evolutionary relationships and advance synthetic biology.

What is the optimal range of fasting stress hyperglycemia ratio for all-cause mortality in American adults: An observational study.

To date, no studies have been conducted to assess the impact of fasting stress hyperglycemia ratio (SHR) on all-cause mortality. Therefore, the objective of our study is to investigate the association between SHR and all-cause mortality in a population of American adults. The study population was derived from NHANES data spanning from 2005 to 2018. The exposure variable SHR was derived from fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c%), and the specific calculation formula was as follows: (FBG (mmol/L))/(1.59 × HbA1c (%) - 2.59). The outcome variable was all-cause mortality. A total of 18,457 participants were enrolled in this prospective cohort study. Following a median follow-up period of 90 months, all-cause mortality was observed in 10.32% of the subjects. Cox proportional hazards regression model indicates that there is no significant difference between SHR and all-cause mortality in the fully adjusted model, whether analyzed as a continuous or categorical variable (P for trend > 0.05). Through the 2-piecewise Cox proportional hazards regression model, we have determined that the inflection point of SHR in relation to all-cause mortality is 0.88. It has also been observed that when the value of SHR is on the left side of the inflection point (SHR ≤ 0.88), there is a significant 77% (HR: 0.23; 95% CI: 0.10-0.50) reduction in all-cause mortality for each additional unit increase in SHR. Conversely, when the value of SHR exceeds 0.88, there is a substantial 2.40-fold (HR: 2.40; 95% CI: 1.61-3.58) increase in the risk of all-cause mortality (P for log likelihood ratio test < .001). The subgroup analysis results demonstrate that sex has the potential to modify the association between SHR and all-cause mortality within the population exhibiting SHR ≤ 0.88. The relationship between SHR and all-cause mortality follows a U-shaped pattern, where in the lowest risk of death for the average American adult is observed at an SHR value of 0.88. Furthermore, in men with SHR ≤ 0.88, there is a significant inverse relationship between the increase in SHR and the risk of all-cause mortality.

Effects of Working Capital Management on Small-Sized Businesses in Competitive Environments with Economic Policy Uncertainty—A Case Study Applied to Chilean Companies

Working capital is a strategic resource that not only enhances financial performance but also ensures the long-term sustainability of organizations, especially SMEs. In the context of evolving economic policies and the challenges of gender equity affecting Chilean companies, this study explores how economic policy risk (EPU) and CEO characteristics influence working capital, which are essential investments for sustainable growth. The analysis covers 12,839 SMEs from 2014 to 2019. Using a fixed-effects panel data model, the findings reveal that firms tend to increase their investment in working capital in response to rising economic policy uncertainty. However, the relationship follows a non-linear inverted U-shaped pattern, which suggests the existence of an investment optimum between working capital and the EPU. Considering the level of competition, companies increase their investment in working capital when the level of competition is higher. Regarding the gender and age of CEOs, it is observed that women invest less in working capital, as do young CEOs. These results underscore the importance of EPU, along with the gender and age of CEOs, as key factors in promoting sustainable working capital management.

Physical activity levels and musculoskeletal disease risk in adults aged 45 and above: a cross-sectional study

BackgroundMusculoskeletal disease (MSD) is a major cause of disability among older adults, and understanding the role of physical activity (PA) in preventing these conditions is crucial. This study aimed to explore the association between PA levels and MSD risk among adults aged 45 and above, clarify the dose‒response relationship, and provide tailored guidelines.MethodsUsing data from the China Health and Retirement Longitudinal Study (CHARLS), a cross-sectional analysis was conducted on 15,909 adults aged 45 and over. The study population was divided into MSD (n = 7014) and nMSD (n = 8895) groups based on musculoskeletal health status. PA levels were assessed using the International Physical Activity Questionnaire and categorized into low intensity physical activity (LIPA), moderate vigorous physical activity (MVPA), and vigorous physical activity (VPA). Multivariable logistic regression models and restricted cubic spline regression were used to examine the relationship between PA levels and MSD risk in middle-aged and older adults. Sensitivity analyses and stratified analyses were also performed.ResultsThe main outcome measures were musculoskeletal diseases prevalence and PA levels. MVPA and VPA reduced MSD risk by 19% [OR = 0.81, 95% CI (0.72, 0.90), P < 0.001] and 12% [OR = 0.88, 95% CI (0.79, 0.98), P < 0.05], respectively. What’s more, after adjusting for confounding factors, VPA increased risk by 32% [OR = 1.32, 95% CI (1.04, 1.66), P < 0.05]. The relationship was nonlinear, showing a U-shaped pattern with age and hypertension status as significant moderators. The optimal PA energy expenditure was identified as approximately 1500 metabolic equivalents of tasks (METs) per week for adults aged 45–74, 1400 METs per week for those aged 75 and above, and 1600 METs per week for hypertensive adults aged 45 and older.ConclusionsFor adults aged 45 years and older, VPA significantly increases the risk of MSD. Adults aged 45 years and older should adjust their weekly METs based on their age. Additionally, those with hypertension should moderately increase their weekly METs to promote optimal musculoskeletal health.

Gender inequality in time allocation across life stages: a comparative study in a Latin American country

ABSTRACT The study analyzes gender differences in time use in the Latin American context, from a comparative perspective (2010–2019) and across life stages. Particularly, the study presents evidence on the likelihood of women and men spending time on three types of activities: Household work, paid work activities, and personal activities. Logistic regression was applied using data from time use surveys conducted in Peru in 2010 and 2019. The results suggests that women were much more likely to spend additional time on household work, while men were more likely to spend additional time on paid work and personal activities. However, these differences became less pronounced in 2019. In terms of age groups, a U-shaped and an inverted U-shaped pattern were found for paid work activities and household chores respectively. In both cases, the largest gender gap was found in the 30–39 age group, possibly related to motherhood. The originality of the research lies in providing a comprehensive analysis of gender inequality in time use in a developing country that has one of the highest rates of female labor force participation in the region, and is also characterized by a patriarchal structure in which machismo and marianismo influence time distribution.

Correlation between body mass index and gender-specific 28-day mortality in patients with sepsis: a retrospective cohort study.

To investigate the potential correlation between body mass index (BMI) and the 28-day mortality rate among sepsis patients and the gender difference in this association. The current research was a retrospective cohort study. A total of 14,883 male and female cohorts of sepsis patients were included in the Medical Information Mart for Intensive Care IV (MIMIC-IV V2.2) database. Patients in each gender cohort were further classified as underweight, normal weight, overweight, or obese according to BMI and the World Health Organization (WHO) BMI categories. The 28-day mortality from the date of ICU hospitalization was the primary outcome measure. The BMI and 28-day mortality exhibited an L-shaped relationship (p for nonlinearity <0.001) with significant gender-specific differences. Subgroup analysis revealed different association patterns between the male and female cohorts. Specifically, BMI and mortality exhibited a U-shaped curve relationship among the males (p for nonlinearity <0.001) and an L-shaped relationship among the females (p for nonlinearity = 0.045). This study proposes a link between extreme BMI and 28-day mortality in patients with sepsis. Underweight patients have an increased risk of mortality; however, this risk decreases in overweight and obese patients. Upon stratifying by sex, a U-shaped pattern was observed, indicating an association between BMI and 28-day mortality in males, while an L-shaped pattern emerged in females.

Daily NO2 Simulation Research Based on Automatic Machine Learning Ensemble Models

To understand the spatial distribution of NO2 near the surface, we utilized measured data from NO2 monitoring stations and combined it with column concentration data from the Tropospheric Monitoring Instrument （TROPOMI）, taking the Yangtze River Delta region as the study area. We considered the impact of factors such as population, elevation, and meteorological conditions on NO2 levels. We used automated machine learning to select five machine-learning algorithms with high simulation accuracy, namely ET, RF, XGBoost, LightGBM, and Catboost, and then integrated these five algorithms using the Stacking model to simulate the daily NO2 concentration in the Yangtze River Delta region from March 2020 to February 2021. The results indicated that the RMAE and MAE values of the Stacking ensemble model were 7.078 and 5.270, respectively, which outperformed the single algorithms of ET, RF, XGBoost, LightGBM, and Catboost. The spatial distribution of high NO2 concentrations in the Yangtze River Delta region, consisting of three provinces and one municipality, exhibited a U-shaped pattern with the convergence point located at the intersection of the three provinces, extending towards the southwest. Notably, urban pollution was particularly significant in the urban agglomerations centered around Shanghai, Hangzhou, Nanjing, and Hefei. There were 27 cities that exceeded the national standard daily limit. Changzhou was the city with the most serious NO2 pollution, with the NO2 concentration exceeding the standard for 14 d, followed by Shanghai, with 13 d. In terms of seasonal variation, the order of severity was as follows： winter, autumn, spring, and summer, with the least NO2 pollution occurring on July 9th during the summer, and the most severe NO2 pollution was observed on December 23rd during the winter.

Clinical characterization and detection of subclinical atherosclerosis in subjects with extreme hyperalphalipoproteinemia

Introduction and objectivesThe association between HDL cholesterol (HDL-C) levels and death from cardiovascular disease follows a U-shaped pattern, increasing at the extremes. The objective of the study was to characterise a sample of subjects with extreme hyperalphalipoproteinemia (HAE). Material and methods53 cases with HAE were recruited, 24 women (HDL-C > 135 mg/dl) and 29 men (HDL-C > 116 mg/dl). A detailed medical history was taken and questionnaires on adherence to the Mediterranean diet and physical activity were collected. Carotid ultrasounds were performed to detect the presence of suclinical atherosclerosis. ResultsThe most prevalent cardiovascular risk factor (CVRF) was dyslipidemia (64%) with no significant differences between men and women, unlike hypertension (21% in women, versus 55% in men, p = 0.01) and others CVRF, for example, diabetes. 7% of the series had previous cardiovascular disease, women had higher LDL cholesterol (p = 0.002) and HDL-C than men (without significant differences). Plaque was detected in 53% of cases, being more prevalent in men. Patients with plaque were older, drank more alcohol and smoked more (p < 0.05). ConclusionsMen had a higher prevalence of CVRF than women, except for dyslipidemia. Subclinical atherosclerosis occurred in more than half of the series. Age, alcohol consumption and smoking were independently associated with the presence of plaque, however, our data do not show a significant influence of HDL-C levels.

How does digital technology innovation drive synergies for reducing pollution and carbon emissions?

Digital technological innovation is a key force in reshaping production and achieving green, low-carbon development, provides new impetus to reducing pollution emissions (PE) and carbon emissions (CE). This study employed the coupled coordination model, panel regression model and spatial Durbin model to examine how the digital technology innovation level (DTIL) and digital technology transfer scale (DTTS) affected synergies for reducing pollution and carbon emissions (PCRS) in the Yangtze River Delta region from 2015 to 2021. The results showed that: The evolution of PCRS is characterized by high synergy cities are increasing, low synergy cities are decreasing, and excellent coordination cities are becoming more concentrated. In the synergistic type migration evolution, the core area primarily ascends; the central and peripheral areas remain mostly stable. The effects of DTIL and DTTS on PCRS follow a non-linear inverted U-shaped pattern. DTIL has a stronger effect on reducing PE, while DTTS tends to increase CE. In terms of spatial spillover effects, DTIL has an inverted U-shaped relationship with PCRS in local regions and a positive spillover effect on neighboring regions; DTTS has a negative impact on PCRS in local regions, but shows an inverted U-shaped relationship in neighboring regions. Both of them also affect PCRS through industrial structure and energy efficiency.

Green finance and land ecological security: A potential mechanism for sustainable development

With growing global concern for environmental issues, green finance (GF) has emerged as a key tool for promoting sustainable development. However, research on its impact on land ecological security (LES) is limited. This study explores the spatial and non-linear effects of GF on LES, focusing on the roles of agricultural e-commerce (AEC) and agricultural industry agglomeration (AIA). Our findings reveal significant first, spatial auto-correlation in LES and an inverted U-shaped pattern in the spatial impact of GF. Second, AEC enhances this inverted U-shaped relationship, shifting the knee point leftward and resulting in a higher marginal effect of GF on LES. Conversely, AIA weakens the relationship, shifting the knee point rightward and potentially flipping the pattern. Additionally, heterogeneity researches results indicate that this spatial effect exists only in primary grain distribution areas, and not in primary grain producing areas or grain production and distribution balanced areas. Robustness tests, including instrumental variables and alternative core explanatory variables, confirm the credibility of these results. This research offers targeted policy recommendations for the GF-LES relationship.

Smartphone addiction in Iranian schoolchildren: a population-based study

Smartphone addiction is a public health problem and is increasing globally. It is important to know the latest status of this phenomenon in different region of the world. This study aimed to investigate smartphone addiction in an Iranian student population. The participants were a random sample of Shahroud Schoolchildren Eye Cohort study in 2018. Smartphone addiction was measured by the Smartphone Addiction Scale Short Version (SAS-sv) questionnaire. The prevalence and mean estimates were reported with 95% confidence intervals. The analysis of variance, t-test and multiple logistic regression were used for analysis of data. The mean age of 2682 participating students was 13.5 year with an age range of 10 to 15 year, and 1197 (44.6%) of them were girls. The mean SAS-sv score was 27.96 (95% CI: 27.36–28.58) for boys and 26.10 (95% CI: 25.34–26.80) for girls. This score follows a U-shaped pattern with a lower mean score observed at age 8. The Prevalence of smartphone addiction was 29.8% (95% CI: 28.1–31.5) in studied population. Compared to 10 year old students, smartphone addiction was higher in 14 (Odds Ratio (OR) = 1.7, 95% CI: 1.1–2.7) and 15 (OR = 2.4, 95% CI: 1.5–3.8) years old students. Smartphone addiction was higher in boys (OR = 1.9; 95% CI, 1.5–3.0; P value < 0.001). Smartphone addiction was not different in urban and rural students after adjusting for age and gender (P = 0.089). Compared to European countries the prevalence of smartphone addiction in Iranian students is relatively high and need prompt intervention especially in boys and older adolescents.

Longitudinal associations between prenatal internalizing symptoms and mindfulness traits with postnatal bonding difficulties.

Mothers' reported connection, or bond, with their infants develops across the early postnatal period and is relevant to mother and offspring functioning. Little is known, however, about early predictors of bonding difficulties over time. The present study examined prenatal anxiety, depressive symptoms, and trait mindfulness and variation in bonding difficulties in mothers across the first two months postnatal. Participants were 120 pregnant women (Mage=31.09 years, SD = 4.81; 80% White). Measures of anxiety, depression, and five facets of mindfulness were administered mid-pregnancy (approximately 20 weeks gestation) and bonding difficulties were assessed every two weeks from approximately 1 to 7 weeks postnatal. Using multilevel modeling to account for within-person repeated assessments, we found an inverted U-shaped pattern across time such that bonding difficulties initially worsened before improving around five weeks postnatal. Prenatal anxiety and depressive symptoms were longitudinally associated with greater bonding difficulties overall and were unrelated to the trajectory of change. The mindfulness facets of acting with awareness and being nonjudging of one's own experience were longitudinally associated with less bonding difficulties overall, weaker initial increases in bonding difficulties, and earlier improvements. Prenatal anxiety and depression may be risk factors for bonding difficulties that are persistent across the early postnatal period. In contrast, mindfulness tendencies before childbirth, specifically acting with awareness and being nonjudging towards oneself, may support early feelings of bonding over time.