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Objectives: The influence of comorbidity on long-term hospitalization and mortality after COVID-19 in adults (40–59 years) and older adults (≥60 years) is yet to be explored. Methods: This is a Danish population-based cohort study of patients with a first-time positive PCR test for COVID-19 from 1 March 2020, to 28 February 2022 (N = 1,034,103). Exposed cohorts were patients with 1) a Charlson Comorbidity Index (CCI) score of 1–2 and 2) a CCI score ≥3, who were compared to patients without comorbidity (CCI of zero) within the groups of adults (67.9%) and older adults (32.1%) for the risk of hospitalization and mortality. Next, within the age groups, each disease category of the CCI was considered as an exposed cohort and compared to patients who did not have the specific disease of interest. Adjusted hazard ratios (HR) for hospitalization and mortality were estimated by Cox regression models adjusted for confounders. Results: The highest HRs were in adult patients with a CCI score of ≥3. The adjusted HR was 4.54 (95%CI: 4.38–4.70) for hospitalization, and among older adults it was 3.05 (95%CI: 2.99–3.11). The adjusted HR for mortality among adults with a CCI score ≥3 was 21.04 (95%CI: 18.86–23.47), and the adjusted HR for mortality among older adults was 4.61 (95%CI: 4.44–4.78). The underlying disease influenced the risk estimates among adults and older adults, and "dementia" had the highest impact on mortality. Conclusion: A CCI score of 1 or above increases the risk of hospitalization and mortality up to 2 years after a positive PCR test of COVID-19 for adults and older adults. Further, the type of underlying disease in older adults highly influences the risk of hospitalization and mortality. [ABSTRACT FROM AUTHOR]

Determination of microsatellite instability (MSI)/mismatch repair (MMR) status in cancer has several clinical implications. Our aim was to integrate MSI/MMR status from patients tested in Greece to assess the prevalence of MSI-high (MSI-H)/deficient MMR (dMMR) per tumor type, testing patterns over time and concordance between MSI and MMR status. We retrospectively recorded MSI/MMR testing data of patients with diverse tumor types performed in pathology and molecular diagnostics laboratories across Greece. Overall, 18 of 22 pathology and/or molecular diagnostics laboratories accepted our invitation to participate. In the 18 laboratories located across the country, 7916 tumor samples were evaluated for MSI/MMR status. MSI/MMR testing significantly increased in patients with colorectal cancer (CRC) and other tumor types overtime (p < 0.05). The highest prevalence was reported in endometrial cancer (47 of 225 patients, 20.9%). MSI-H/dMMR was observed in most tumor types, even in low proportions. Among 904 tumors assessed both for MSI and MMR status, 21 had discordant results (overall discordance rate, 2.3%). We reported MSI-H/dMMR prevalence rates in patients with diverse cancers, while demonstrating increasing referral patterns from medical oncologists in the country overtime. The anticipated high rate of concordance between MSI and MMR status in paired analysis was confirmed. [ABSTRACT FROM AUTHOR]

Background: Our knowledge about the attitudes of healthcare staff to palliative care in pediatric oncology is scarce. We aimed to assess their perceptions of palliative care in Hungary and find answers to the question of how to provide good palliative care for children. Method: Physicians (n = 30) and nurses (n = 43) working in the field of pediatric oncology (12 of them specialized in hospice care) were interviewed. Palliative care practice (communication, integration of palliative care, professionals' feelings and attitudes, and opportunities for improvement) was assessed by semi-structured interviews evaluated in a mixed quantitative and qualitative way by narrative categorical content analysis and thematic analysis. Results: All providers displayed high negative emotions, positive evaluations, and used many active verbs. Nurses showed higher levels of denial, more self-references, and were more likely to highlight loss. Physicians emphasized the importance of communication regarding adequate or inadequate palliative care. Hospice specialists showed a higher passive verb rate, a lower self-reference, a lower need for psychological support, and a greater emphasis on teamwork and professional aspects. Conclusion: Our results show that nurses are more emotionally stressed than doctors in palliative care in pediatric oncology. To our knowledge, a study comparing doctors and nurses in this field has yet to be carried out. Our results suggest that pediatric oncological staff can positively evaluate a child's palliative care despite the emotional strain. Regarding hospices, professional practice in palliative care may be a protective factor in reducing emotional distress and achieving professional well-being. [ABSTRACT FROM AUTHOR]

More than 400 confirmed mpox cases have been reported in China. The mpox vaccination is crucial to mitigate mpox transmission, especially for at-risk populations. This study aimed to determine mpox vaccination hesitancy and its associated factors in Chinese men who have sex with men (MSM). This nationwide cross-sectional study was conducted among 7538 Chinese MSM in 27 MSM social organizations from 21 provinces, municipalities, and autonomous regions of China from 31 July to 4 August 2023. Of them, the rate of mpox vaccination hesitancy was 5.59% (421/7538). The most common reason for mpox vaccination hesitation was concerns of safety and side effects (62.71%, 264/421), followed by concerns of privacy (38.24%, 161/421), thoughts of impossible infection (37.53%, 158/421), no effectiveness in preventing reinfection (30.88%, 130/421), and no worry about infection (12.35%, 52/421). Regarding the concerning characteristics of the vaccines, concerns of vaccine safety ranked first (71.74%, 5408/7538), followed by vaccine effectiveness (14.05%, 1059/7538), vaccine costs (7.35%, 554/7538), and the continuity of vaccine effectiveness (3.91%, 295/7538). The highest odds ratio of mpox vaccination hesitation was seen in MSM who were infected with mpox virus (aOR = 2.38; 95%CI = 1.08, 5.23), followed by those aged ≥60 years (aOR = 2.25; 95%CI = 1.31, 3.88), those who were unemployed (aOR = 1.66; 95%CI = 1.25, 2.19), and those who had an education level of postgraduate and above (aOR = 1.55; 95%CI = 1.01, 2.37). However, MSM who had a higher level of mpox-related knowledge (moderate: aOR = 0.53; 95%CI = 0.36, 0.77; high: aOR = 0.30; 95%CI = 0.23, 0.40) had a lower odds ratio of mpox vaccination hesitation. MSM in China had low hesitancy toward mpox vaccination. The safety and effectiveness of the vaccine and privacy were important aspects of hesitancy. Health education on mpox-related knowledge should be encouraged to promote future vaccination plans. [ABSTRACT FROM AUTHOR]

Nationwide trends in glaucoma surgical procedures were assessed by using the NDB Open Data 2014 and 2020. In Japan, 33,340 non-laser, 54,569 laser, and 88,019 total glaucoma surgeries were performed in 2014. In 2020, 60,108 non-laser, 60,547 laser, and 120,655 total glaucoma surgeries were performed. The rates from 2014 to 2020 were 180%, 111%, and 137%, respectively. In each procedure, angle surgery (326%), tube shunt surgery (383%), ciliary coagulation (489%), and gonio-laser (225%) were remarkably increased, while iridectomy (75%) and iris laser (77%) decreased during the same period. An increase in laser surgery was seen in young age groups, namely, 55–59 years old and younger, while non-laser surgery was increased in old age groups, namely, 45–49 years old and older. In 2020, 47.6 non-laser, 48.0 laser, and 95.6 total glaucoma surgeries were performed per 100,000 persons. None of the vital statistics, including prefectural population, mean age, and rate of ≥65-year-old people, were significantly associated with the number of glaucoma surgeries. Glaucoma practice patterns changed each time a new device or procedure was introduced. The results of the current study reflected the use of new procedures, such as minimally invasive glaucoma surgery, tube shunt, selective laser trabeculoplasty, and micropulse cyclophotocoagulation. [ABSTRACT FROM AUTHOR]

Rosacea is a chronic inflammatory skin disorder associated with various ocular manifestations. However, little is known about the association between rosacea and glaucoma. This study aimed to determine the risk of glaucoma in patients with rosacea. This nationwide population-based retrospective cohort study enrolled 1056 individuals with rosacea and 10,440 age- and sex-matched controls without rosacea from the Korean National Health Insurance System (NHIS) database from 2002 to 2015. The incidence rate of glaucoma was 1215.4 per 100,000 person-years (PYs) in patients with rosacea and 741.3 per 100,000 PYs in patients without rosacea. A significantly higher cumulative incidence probability of glaucoma was observed in patients with rosacea than in non-rosacea controls (p = 0.0004). Rosacea was associated with an increased risk of developing glaucoma (adjusted hazard ratio [aHR], 1.659; 95% confidence interval [CI], 1.245–2.211) compared to those without rosacea. In subgroup analysis, increased risk of glaucoma was observed in patients with rosacea younger than 50 years (aHR, 1.943; 95% CI, 1.305–2.893), females (aHR, 1.871; 95% CI, 1.324–2.644), and patients with hypertension (aHR, 1.561; 95% CI, 1.037–2.351) compared to those without rosacea. Rosacea is associated with an increased risk of developing glaucoma. Proper screening for glaucoma should be conducted in rosacea patients younger than 50 years, females, and patients with hypertension to better control the disease and prevent vision loss from glaucoma. [ABSTRACT FROM AUTHOR]

Generating an unbiased inventory of mass movements is challenging, particularly in a large region such as China. However, due to the enormous threat to human life and property caused by the increasing number of mass movements, it is imperative to develop a reliable nationwide mass movement susceptibility model to identify mass movement-prone regions and formulate appropriate disaster prevention strategies. In recent years, the mixed-effects models have shown their unique advantages in dealing with the biased mass movement inventory, yet there are no relevant studies to compare different mixed-effects models. This research compared three mixed-effects models to explore the most plausible and robust susceptibility mapping model, considering the inherently heterogeneously complete mass movement information. Based on a preliminary data analysis, eight critical factors influencing mass movements were selected as basis predictors: the slope, aspect, profile curvature, plan curvature, road density, river density, soil moisture, and lithology. Two additional factors, namely, the land use and geological environment division, representing the inventory bias were selected as random intercepts. Subsequently, three mixed-effects models—Statistical-based generalized linear mixed-effects model (GLMM), generalized additive mixed-effects model (GAMM), and machine learning-based tree-boosted mixed-effects model (TBMM)—were adopted. These models were used to evaluate the susceptibility of three distinct types of mass movements (i.e., 28,814 debris flows, 54,586 rockfalls and 108,432 landslides), respectively. The results were compared both from quantitative and qualitative perspectives. The results showed that TBMM performed best in all three cases with AUROCs (Area Under the Receiver Operating Characteristic curve) of cross-validation, spatial cross-validation, and predictions on simulated highly biased inventory, all exceeding 0.8. In addition, the spatial prediction patterns of TBMM were more in line with the natural geomorphological underlying process, indicating that TBMM can better reduce the impact of inventory bias than GLMM and GAMM. Finally, factor contribution analysis showed the key role of topographic factors in predicting the occurrence of mass movements, followed by road density and soil moisture. This study contributes to assessing China's overall mass movement susceptibility situation and assisting policymakers in master planning for risk mitigation. Further, it demonstrates the tremendous potential of TBMM for mass movement susceptibility assessment, despite inherent biases in the inventory. [ABSTRACT FROM AUTHOR]

The emergence of bacterial infections in companion animals is a growing concern as humans can also be infected through the transmission of pathogenic bacteria. Because there have been few studies conducted on companion animals, the extent and significance of prevalence in veterinary practices remain unknown. This is the first nationwide surveillance report aimed at elucidating the prevalence pattern and associated infections of isolated bacteria from dogs in Korea. Bacterial isolates were collected from seven different laboratories participating in the Korean Veterinary Antimicrobial Resistance Monitoring System from 2018 to 2019. The samples were obtained from the diarrheal stool, skin/ear, urine, and respiratory samples of veterinary hospital-visited dogs. Isolation and identification of bacterial species was carried out using a bacterial culture approach and then confirmed with matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF) and polymerase chain reaction (PCR). Out of 3135 isolates in dogs, 1085, 1761, 171, and 118 were extracted from diarrheal stool, skin/ear, urine, and respiratory samples, respectively. The overall prevalence of bacteria was higher among two age groups (1–5 and 6–10 years) with a 66.5 percent prevalence. This study showed that Escherichia coli was the most prevalent species among isolated bacterial species of diarrheal and urine origin, whereas Staphylococcus pseudintermedius was the most prevalent among skin and respiratory sample isolates. The data on the prevalence of bacteria for each dog specimen could provide basic information to estimate the extent of bacterial infection and antimicrobial resistance development and to guide veterinarians in therapeutic decisions in clinical practices throughout Korea. [ABSTRACT FROM AUTHOR]

The intensive development of both interferometric technology and sensors in recent years allows Interferometric Synthetic Aperture Radar (InSAR)-based applications to be accessible to a growing number of users. InSAR-based services now cover entire countries and soon even the whole of Europe. These InSAR systems require massive amounts of computer processing power and significant time to generate a final product. Most, if not all, of these projects have a limited "monitoring component", aimed at historical analysis but are rarely, if ever, updated. Consequently, the results do not necessarily meet every purpose or specific user requirement. It is now clear that the increasing computing capacity and big data provided by the sensors have initiated the development of new InSAR services. However, these systems are only useful when linked to specific real-world operational problems. Continuous monitoring of a country's ageing water management infrastructure has become an increasingly critical issue in recent years, in addition to the threats posed by climate change. Our article provides a comprehensive overview of a nationwide, dedicated, operational InSAR application, which was developed to support the operational work of the Hungarian Disaster Management Service (HDMS). The objective was to provide monthly monitoring of 63 water facilities, including 83 individual objects, distributed throughout Hungary, in combination with the development of a near real-time warning system. Our work involved the compilation of a completely new InSAR System as a Service (SaaS) which incorporates user requirements, preparatory work, the compilation of the Sentinel-1 automatic processing pipeline, the installation of corner reflectors, a special early warning system, and a dedicated user interface. The developed system can automatically start to evaluate the S1 measurements within 24 h of downloading the data into the system storage forward the results toward the warning system before the next image arrives. Users are provided with detailed information on the stability of 70% of the 83 water facility objects monitored through the dedicated user interface. The additional early warning system currently operates as a preliminary "spatial decision support system", but the HDMS is willing to make it fully operational over the next few years. [ABSTRACT FROM AUTHOR]

Gene fusions involving NTRK1, NTRK2, and NTRK3 are rare drivers of cancer that can be targeted with histology-agnostic inhibitors. This study aimed to determine the nationwide landscape of NTRK/TRK testing in the Netherlands and the usage of pan-TRK immunohistochemistry (IHC) as a preselection tool to detect NTRK fusions. All pathology reports in 2017–2020 containing the search term 'TRK' were retrieved from the Dutch Pathology Registry (PALGA). Patient characteristics, tumor histology, NTRK/TRK testing methods, and reported results were extracted. NTRK/TRK testing was reported for 7457 tumors. Absolute testing rates increased from 815 (2017) to 3380 (2020). Tumors were tested with DNA/RNA-based molecular assay(s) (48%), IHC (47%), or in combination (5%). A total of 69 fusions involving NTRK1 (n = 22), NTRK2 (n = 6) and NTRK3 (n = 41) were identified in tumors from adult (n = 51) and pediatric (n = 18) patients. In patients tested with both IHC and a molecular assay (n = 327, of which 29 NTRK fusion-positive), pan-TRK IHC had a sensitivity of 77% (95% confidence interval (CI), 56–91) and a specificity of 84% (95% CI, 78–88%). These results showed that pan-TRK IHC has a low sensitivity in current routine practice and warrants the introduction of quality guidelines regarding the implementation and interpretation of pan-TRK IHC. [ABSTRACT FROM AUTHOR]

A nationwide model of groundwater recharge for New Zealand (NGRM), as described in this paper, demonstrated the benefits of satellite data and global models to improve the spatial definition of recharge and the estimation of recharge uncertainty. NGRM was inspired by the global-scale WaterGAP model but with the key development of rainfall recharge calculation on scales relevant to national- and catchment-scale studies (i.e., a 1 km × 1 km cell size and a monthly timestep in the period 2000-2014) provided by satellite data (i.e., MODIS-derived evapotranspiration, AET and vegetation) in combination with national datasets of rainfall, elevation, soil and geology. The resulting nationwide model calculates groundwater recharge estimates, including their uncertainty, consistent across the country, which makes the model unique compared to all other New Zealand estimates targeted towards groundwater recharge. At the national scale, NGRM estimated an average recharge of 2500 m3/s, or 298 mm/year, with a model uncertainty of 17%. Those results were similar to the WaterGAP model, but the improved input data resulted in better spatial characteristics of recharge estimates. Multiple uncertainty analyses led to these main conclusions: the NGRM model could give valuable initial estimates in data-sparse areas, since it compared well to most ground-observed lysimeter data and local recharge models; and the nationwide input data of rainfall and geology caused the largest uncertainty in the model equation, which revealed that the satellite data could improve spatial characteristics without significantly increasing the uncertainty. Clearly the increasing volume and availability of large-scale satellite data is creating more opportunities for the application of national-scale models at the catchment, and smaller, scales. This should result in improved utility of these models including provision of initial estimates in data-sparse areas. Topics for future collaborative research associated with the NGRM model include: improvement of rainfall-runoff models, establishment of snowmelt and river recharge modules, further improvement of estimates of rainfall and AET, and satellite-derived AET in irrigated areas. Importantly, the quantification of uncertainty, which should be associated with all future models, should give further impetus to field measurements of rainfall recharge for the purpose of model calibration. [ABSTRACT FROM AUTHOR]

The present study aimed to evaluate the yearly number of Colles' fractures in Italy from 2001 to 2016, based on official information found in hospitalization records. A secondary aim was to estimate the average length of hospitalization for patients with a Colles' fracture. A tertiary aim was to investigate the distribution of the procedures generally performed for Colles' fractures' treatment in Italy. An analysis of the National Hospital Discharge records (SDO) maintained at the Italian Ministry of Health, concerning the 15 years of our study (from 2001 to 2016) was performed. Data are anonymous and include the patient's age, sex, domicile, length of hospital stays (days), primary diagnoses and primary procedures. From 2001 to 2016, 120,932 procedures for Colles' fracture were performed in Italy, which represented an incidence of 14.8 procedures for every 100,000 adult Italian inhabitants. The main number of surgeries was found in the 65-69- and 70-74-year age groups. In the present study, we review the epidemiology of Colles' fractures in the Italian population, the burden of the disease on the national health care system (in terms of length of hospitalization) and the distribution of the main surgical procedures performed for the treatment of the disease.

A workflow for combining airborne lidar, optical satellite data and National Forest Inventory (NFI) plots for cost efficient operational mapping of a nationwide sample of 5 x 5 km squares in the National Inventory of Landscapes in Sweden (NILS) landscape inventory in Sweden is presented. Since the areas where both satellite data and lidar data have a common data quality are limited, and impose a constraint on the number of available NFI plots, it is not feasible to perform classifications in a single step. Instead a stratified approach where canopy cover and canopy height are first predicted from lidar data trained with NFI plots is proposed. From the lidar predictions a forest stratum is defined as grid cells with more than 3 m mean tree height and more than 10% vertical canopy cover, the remaining grid cells are defined as open land. Both forest and open land are then classified into broad vegetation classes using optical satellite data. The classification of open land is trained with aerial photo interpretation and the classification of the forest stratum is trained with a new set of NFI plots. The result is a rational procedure for nationwide sample based vegetation characterization. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has already resulted in more than 6 million deaths worldwide as of December 2022. The COVID-19 has also been greatly affecting the activity of the human population in China and the world. It remains unclear how the human activity-intensity changes have been affected by the COVID-19 spread in China at its different stages along with the lockdown and relaxation policies. We used four days of Location-based services data from Tencent across China to capture the real-time changes in human activity intensity in three stages of COVID-19-namely, during the lockdown, at the first stage of work resuming and at the stage of total work resuming-and observed the changes in different land use categories. We applied the mean decrease Gini (MDG) approach in random forest to examine how these changes are influenced by land attributes, relying on the CART algorithm in Python. This approach was also compared with Geographically Weighted Regression (GWR). Our analysis revealed that the human activity intensity decreased by 22-35%, 9-16% and 6-15%, respectively, in relation to the normal conditions before the spread of COVID-19 during the three periods. The human activity intensity associated with commercial sites, sports facilities/gyms and tourism experienced the relatively largest contraction during the lockdown. During the relaxations of restrictions, government institutions showed a 13.89% rise in intensity at the first stage of work resuming, which was the highest rate among all the working sectors. Furthermore, the GDP and road junction density were more influenced by the change in human activity intensity for all land use categories. The bus stop density was importantly associated with mixed-use land recovery during the relaxing stages, while the coefficient of density of population in entertainment land were relatively higher at these two stages. This study aims to provide additional support to investigate the human activity changes due to the spread of COVID-19 at different stages across different sectors.

Adiposity rebound (AR) is defined as the second rise in the body mass index (BMI) usually occurring in early childhood. This study aimed to investigate the timing of AR and the factors determining early AR (EAR) by tracking BMI patterns using large-scale longitudinal nationwide data (n = 142,668; 73,389 boys and 69,279 girls) over seven time periods (4–6, 9–12, 18–24, 30–36, 42–48, 54–60, and 66–71 months). The average BMI rebound indicating AR was found before the age of 5 years (6th time period, 54–60 months). Interestingly, children experiencing BMI rebound during the 4th to 6th time periods showed a small increase in the proportion of underweight in the 2nd time period, but a dramatically higher proportion of underweight during the corresponding time period, similar to M-shaped patterns. In contrast, overweight or obese children in the above group showed opposite W-shaped patterns. The parameters predicting the risk of EAR are diverse for each time period by sex. Adequate breastfeeding before the age of 1 year, adequate diet, and reduced sugar-sweetened beverage consumption after the age of 1 year were important for reducing EAR. This study presents for the first time, the timing of AR and the major determinants of EAR among Korean infants and children based on large-scale nationwide data. [ABSTRACT FROM AUTHOR]

This study aimed to inspect norovirus contamination of groundwater treatment systems used in food-catering facilities located in South Korea. A nationwide study was performed in 2010. Water samples were collected and, for the analysis of water quality, the temperature, pH, turbidity, and residual chlorine content were assessed. To detect norovirus genotypes GI and GII, RT-PCR and semi-nested PCR were performed with specific NV-GI and NV-GII primer sets, respectively. The PCR products amplified from the detected strains were then subjected to sequence analyses. Of 1,090 samples collected in 2010, seven (0.64%) were found to be norovirus-positive. Specifically, one norovirus strain was identified to have the GI-6 genotype, and six GII strains had the GII, GII-3, GII-4, and GII-17 genotypes. The very low detection rate of norovirus most likely reflects the preventative measures used. However, this virus can spread rapidly from person to person in crowded, enclosed places such as the schools investigated in this study. To promote better public health and sanitary conditions, it is necessary to periodically monitor noroviruses that frequently cause epidemic food poisoning in South Korea. [ABSTRACT FROM AUTHOR]

Simple Summary: Surgery, radiotherapy, and chemotherapy/immunotherapy as monotherapy or in combination are the pillars of the treatment of head and neck cancer (HNC). Nation-wide population-based data on treatment rates per population and year for HNC are sparse. The data of virtually all HNC cases (apart from thyroid cancer) treated as inpatients in Germany between 2005 and 2018 were analyzed. Treatment rates for nearly all treatment types increased for cancer of the oral cavity, oropharynx, and salivary glands. Treatment rates for nasopharyngeal cancer in both sexes and hypopharyngeal cancer in men mainly decreased. In women, surgery for hypopharyngeal cancer decreased, but radiotherapy, chemotherapy, or in combination, increased. Laryngeal cancer showed a mixed picture: Surgery and neck dissection decreased in men and remained unchanged in women, whereas radiotherapy, chemotherapy, or in combination, remained unchanged in men, but increased in women. Changes in treatment are dependent on the subsites and are different for men and women for several subsites. Advances in head and neck cancer (HNC) treatment might have changed treatment strategies. This study determined, with focus on gender disparity, whether treatment rates have changed for inpatients in Germany between 2005 and 2018. Nation-wide population-based diagnosis-related groups (DRG) data of virtually all HNC cases (1,226,856 procedures; 78% men) were evaluated. Poisson regression analyses were used to study changes of annual treatment rates per German population. For surgery, the highest increase was seen for women with cancer of the oral cavity (relative risk (RR) 1.14, 95% confidence interval (CI) 1.11–1.18, p < 0.0001) and the highest decrease for men with laryngeal cancer (RR 0.90, CI 0.87–0.93). In women with oropharyngeal cancer, the highest increase of radiotherapy rates was seen (RR 1.18, CI 1.10–1.27, p < 0.0001). A decrease was seen in men for hypopharyngeal cancer (RR 0.93, CI 0.87–0.98, p = 0.0093). The highest increase for chemotherapy/immunotherapy was seen for women with oropharyngeal cancer (RR 1.16, CI 1.08–1.24, p < 0.0001), and a decrease in men with hypopharyngeal cancer (RR 0.93, CI 0.88–0.97, p = 0.0014). Treatment patterns had changed for nearly all subsites and therapy types. There were relevant gender disparities, which cannot be explained by the DRG data. [ABSTRACT FROM AUTHOR]

Background: Nonalcoholic fatty liver disease is considered to be the hepatic component of metabolic syndrome (MetS). However, the association between changes in MetS status and the risk of liver cirrhosis (LC) has not been investigated to date. This study assessed the association between changes in MetS and subsequent nonviral LC development. Methods: Data were obtained from the Korean National Health Insurance Service. Individuals who participated in health screenings from both 2009 to 2010 and 2011 to 2012 were included. The primary outcome was LC development according to the static and dynamic MetS status. Subjects were stratified into four groups according to the change in MetS status observed from the two-year interval screening (2009–2011). Cox regression analysis was used to examine the hazard ratios of LC. Results: During a median of 7.3 years of follow-up, 24,923 incident LC cases developed among 5,975,308 individuals. After adjusting for age, sex, smoking, alcohol, regular exercise, and body mass index, the adjusted hazard ratios (95% confidence intervals) for LC development were 1.39 (1.33–1.44) for the MetS-Developed group, 1.32 (1.26–1.37) for the MetS-Recovered group, and 1.51 (1.45–1.56) for the MetS-Sustained group, relative to the MetS-Free group. Stratified analyses according to age, sex, smoking, alcohol intake, exercise, diabetes mellitus, hypertension, dyslipidemia, and chronic kidney disease showed similar results. Conclusions: Both static and dynamic MetS status are independent risk factors for LC development. The risk of LC was the highest in people with sustained MetS and was lower in the MetS-Recovered group than in the MetS-Sustained group. These results suggest that improving a person's MetS status may be helpful in preventing LC. [ABSTRACT FROM AUTHOR]

Simple Summary: This study reveals that pathogenic or likely pathogenic germline variants are detected in one fourth of all young patients with colorectal cancer in a nationwide cohort. Immunohistochemistry staining for mismatch repair deficiency is an easy way to detect Lynch syndrome in the young colorectal cancer patient. Introduction: The prevalence of pathogenic or likely pathogenic germline variants (PGV) in colorectal cancer (CRC) in young patients is seen in approximately one in five patients, with the majority of cases having gene variants associated with Lynch syndrome (LS). The primary aim was to describe the prevalence of 18 genes, all associated with hereditary polyposis and CRC, in a nationwide population of young CRC (yCRC) patients, and outline disease characteristics in patients with or without germline variants. Methods: We screened 98 patients aged 18–40 with CRC diagnosed in 2010–2013 for variants in MSH2, MSH6, MLH1, PMS2, EPCAM, APC, MUTYH, SMAD4, BMPR1A, STK11, PTEN, POLE, POLD1, NTHL1, AXIN2, MSH3, GREM1 and RNF43 using Next Generation Sequencing. Comparisons between patients' characteristics in patients with PGV, and patients without germline variants (NPGV) were analyzed. Results: PGV were detected in twenty-four patients (24.5%), and twenty-one patients (21.1%) had variants in the mismatch repair (MMR) genes associated with LS. Variants in the APC and MUTYH genes were detected in 1% and 4%, respectively. Patients with NPGV had more advanced disease with adverse histopathological features. Conclusion: PGV was detected in one in four yCRC patients, and one in five yCRC patients had disease causing variants in the mismatch repair genes associated with LS. [ABSTRACT FROM AUTHOR]

Background: Short-term exposure to particulate matter (PM) has been related to mortality worldwide. Most evidence comes from studies conducted in major cities, while little is known on the effects of low concentrations of PM and in less urbanized areas. We aim to investigate the relationship between PM and all-cause mortality at national level in Italy., Methods: Daily numbers of all-cause mortality were collected for all 8092 municipalities of Italy, from 2006 to 2015. A satellite-based spatiotemporal model was developed to estimate daily PM 10 (inhalable particles) and PM 2.5 (fine particles) concentrations at 1-km resolution. Multivariate Poisson regression models were fit to estimate the association between daily PM and mortality at province level, and then, results were pooled with a random-effects meta-analysis. Associations were estimated by combination of age and sex and degree of urbanization of the municipalities. Flexible functions were estimated to explore the shape of the associations at low PM concentrations., Results: We analyzed 5,884,900 deaths (40% among subjects older than 85 years, 60% occurring outside the main urban areas). National daily mean (interquartile range) PM 10 and PM 2.5 concentrations were 23 (14) μg/m 3 and 15 (11) μg/m 3 , respectively. Relative increases of mortality per 10 μg/m 3 variation in lag 0-5 (average of last six days since death) PM 10 and PM 2.5 were 1.47% (95% Confidence Intervals (CI): 1.15%, 1.79%) and 1.96% (1.33%, 2.59%), respectively. Associations were highest among elderly and women for PM 10 only, similar between rural and urbanized areas, and were present even at low concentrations, e.g., below WHO guidelines., Conclusions: Air pollution was robustly associated with peaks in daily all-cause mortality in Italy, both in large cities and in less urbanized areas of Italy. Current WHO Air Quality Guidelines (2021) for PM 10 and PM 2.5 are not sufficient to protect public health.

Simple Summary: The presence of an EGFR activating mutation in tumors of non-small-cell lung cancer patients enables effective targeted therapy towards EGFR. Studies that describe a nationwide uptake of EGFR testing, the impact of the switch from single-gene EGFR to multi-gene testing, and the clinical response towards EGFR inhibitors in first-line treatment are limited. From 2013 to 2017 the percentage of patients routinely tested for EGFR mutations increased from 73% to 81% in the Netherlands. A strong shift towards EGFR testing as part of a multi-gene next generation sequencing analysis was observed. However, this did not change the percentage of EGFR mutations that were reported for this patient population, which remained stable at 12%. When treated with EGFR inhibitors that were available in a routine clinical setting prior to 2018, clear differences were observed between the type of EGFR mutation and survival. EGFR mutation analysis in non-small-cell lung cancer (NSCLC) patients is currently standard-of-care. We determined the uptake of EGFR testing, test results and survival of EGFR-mutant NSCLC patients in the Netherlands, with the overall objective to characterize the landscape of clinically actionable EGFR mutations and determine the role and clinical relevance of uncommon and composite EGFR mutations. Non-squamous NSCLC patients diagnosed in 2013, 2015 and 2017 were identified in the Netherlands Cancer Registry (NCR) and matched to the Dutch Pathology Registry (PALGA). Overall, 10,254 patients were included. Between 2013–2017, the uptake of EGFR testing gradually increased from 72.7% to 80.9% (p < 0.001). Multi-gene testing via next-generation sequencing (increased from 7.8% to 78.7% (p < 0.001), but did not affect the number of detected EGFR mutations (n = 925; 11.7%; 95% confidence interval (CI), 11.0–12.4) nor the distribution of variants. For patients treated with first-line EGFR inhibitors (n = 651), exon 19 deletions were associated with longer OS than L858R (HR 1.58; 95% CI, 1.30–1.92; p < 0.001) or uncommon, actionable variants (HR 2.13; 95% CI, 1.60–2.84; p < 0.001). Interestingly, OS for patients with L858R was similar to those with uncommon, actionable variants (HR 1.31; 95% CI, 0.98–1.75; p = 0.069). Our analysis indicates that grouping exon 19 deletions and L858R into one class of 'common' EGFR mutations in a clinical trial may mask the true activity of an EGFR inhibitor towards specific mutations. [ABSTRACT FROM AUTHOR]

Objective: This nationwide study aimed to investigate the association between newly diagnosed systemic sclerosis (SSc) and previous appendicitis history. Methods: A total of 1595 patients who were newly diagnosed with SSc were recruited as the SSc cases from the 2003 to 2012 claims data of the entire population in Taiwan. The other 15,950 individuals who had never been diagnosed with SSc during 2003 and 2012 were selected as the non-SSc controls to match the SSc cases. We defined that the index date as the first date of SSc diagnosis of SSc cases and the first date of ambulatory visit for any reason of non-SSc controls. Conditional logistic regression analysis was applied for the association between appendicitis and the risk of the incident SSc, tested by estimating odds ratios (ORs) with 95% confidence intervals (CIs). Potential confounders, including the Charlson comorbidity index (CCI), a history of periodontal disease, salmonella infection, and intestinal infection, were controlled. We further designed sensitivity analyses by varying the definition of appendicitis according to the status of receiving primary appendectomy. Results: The mean age was 51 years in the case and control groups. Females accounted for 77.5%. A total of 17 (1.1%) out of 1595 SSc cases and 81 (0.5%) out of 15,950 non-SSc controls had a history of appendicitis before the index date had a history of appendicitis. A significant association between appendicitis and the risk of SSc was confirmed (OR, 2.03; 95% CI, 1.14–3.60) after adjusting potential confounders. CCI ≥ 1 (OR, 8.48; 95% CI, 7.50–9.58) and periodontal disease (OR, 1.55; 95% CI, 1.39–1.74) were also significantly associated with the risk of SSc. The association between appendicitis and SSc risk remained robust using various definitions of appendicitis. Conclusion: Our study demonstrated appendicitis was associated with the incident SSc. CCI ≥ 1 and periodontal disease also contributed to the risk of developing SSc. [ABSTRACT FROM AUTHOR]

Simple Summary: This is the first nationwide study on chemotherapy use and intensive care unit (ICU) admission in the last three months before death in patients with cancer of the stomach or esophagus. Chemotherapy use and ICU admission shortly before death were relatively infrequent in the Netherlands. Chemotherapy was used less often in hospitals that treat many patients compared to hospitals that treat fewer patients. In patients that received chemotherapy before their final three months before death, chemotherapy was prescribed four times more often in the last three months before death compared to patients without previous chemotherapy use. Since intensive care unit (ICU) admission and chemotherapy use near death impair the quality of life, we studied the prevalence of both and their correlation with hospital volume in incurable gastroesophageal cancer patients as both impair the quality of life. We analyzed all Dutch patients with incurable gastroesophageal cancer who died in 2017–2018. National insurance claims data were used to determine the prevalence of ICU admission and chemotherapy use (stratified on previous chemotherapy treatment) at three and one month(s) before death. We calculated correlations between hospital volume (i.e., the number of included patients per hospital) and both outcomes. We included 3748 patients (mean age: 71.4 years; 71.4% male). The prevalence of ICU admission and chemotherapy use were, respectively, 5.6% and 21.2% at three months and 4.2% and 8.0% at one month before death. Chemotherapy use at three and one months before death was, respectively, 4.3 times (48.0% vs. 11.2%) and 3.7 times higher (15.7% vs. 4.3%), comparing patients with previous chemotherapy treatment to those without. Hospital volume was negatively correlated with chemotherapy use in the final month (rweighted = −0.23, p = 0.04). ICU admission and chemotherapy use were relatively infrequent. Oncologists in high-volume hospitals may be better equipped in selecting patients most likely to benefit from chemotherapy. [ABSTRACT FROM AUTHOR]

Approximately 90% of the world's population is involved in some spiritual/religious practice, and this dimension has a relevant role in life. Many studies demonstrate the associations between spirituality/religiosity (S/R), and physical, mental, and social health. Systematic reviews have indicated positive associations; however, the mechanisms behind religious coping are not fully understood. The present study aimed to examine the role of religious affiliation in general (ordinary) and health-related decisions. A nationwide, population-based, cross-sectional study was conducted in Brazil using a self-administered online survey. How much religious affiliation influences decision making was investigated. A total of 1133 participants were included, who were classified as Catholics (43.9%), Evangelicals (18.7%), spiritualists (12.8%), non-religious (11.9%), and others (12.7%). Most participants (66.5%) believed that their religious affiliations had moderate to high influences on their decisions. Participants rated the influence as high in marriage (62.7%), in donations (60.1%), in volunteering (55%), in friendships (53.9%), and in work (50.5%). Concerning health-related decisions, the influence was rated as high in drug use (45.2%), in accepting medical recommendations (45%), and in smoking (43.2%). The influence of religious affiliation on general decision making was significantly correlated for dietary restrictions ( r = 0.462), alcohol consumption ( r = 0.458), drug use ( r = 0.441), tobacco consumption ( r = 0.456), and refusal of medical recommendations ( r = 0.314). Improving the understanding of how a patient's beliefs, practices, and experiences affect their health may help healthcare practitioners to take into account religious considerations, not only regarding influences on habits but also regarding adherence to medical treatment advice.

In this paper, we propose a technique to share the licensed spectrums of all mobile network operators (MNOs) of a country with in-building small cells per MNO by exploiting the external wall penetration loss of a building and introducing the time-domain eICIC technique. The proposed technique considers allocating the dedicated spectrum Bop per MNO only its to outdoor macro UEs, whereas the total spectrum of all MNOs of the country Bco to its small cells indoor per building such that technically any small indoor cell of an MNO can have access to Bco instead of merely Bop assigned only to the MNO itself. We develop an interference management strategy as well as an algorithm for the proposed technique. System-level capacity, spectral efficiency, and energy efficiency performance metrics are derived, and a generic model for energy efficiency is presented. An optimal amount of small indoor cell density in terms of the number of buildings L carrying these small cells per MNO to trade-off the spectral efficiency and the energy efficiency is derived. With the system-level numerical and simulation results, we define an optimal value of L for a dense deployment of small indoor cells of an MNO and show that the proposed spectrum sharing technique can achieve massive indoor capacity, spectral efficiency, and energy efficiency for the MNO. Finally, we demonstrate that the proposed spectrum sharing technique could meet both the spectral efficiency and the energy efficiency requirements for 5G mobile networks for numerous traffic arrival rates to small indoor cells per building of an MNO. [ABSTRACT FROM AUTHOR]

Both periodontal disease (PD) and inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are important diseases of the alimentary tract. Microbiome and immune-mediated inflammatory processes play important roles in these diseases. An association between PD and IBD may exist. This study investigated the risk of IBD in patients with PD. This study used data from the National Health Insurance Research Database of Taiwan from 1996 to 2013. A total of 27,041 patients with PD were enrolled as a study group, and 108,149 patients without PD were selected as the control group after matching by gender, age, insured region, urbanization, and income with a 1:4 ratio. Cox proportional hazards regression was used to calculate the risk of IBD. Of the 135,190 participants enrolled in this study, 5392 (4%) with newly diagnosed IBD were identified. The overall incidence of subsequent IBD was similar in both groups (3.8% vs. 4%, adjusted hazard ratio (aHR) = 1.01, 95% confidence interval (CI): 0.94⁻1.08). However, an increased risk of UC in the PD group was found after adjusting confounding factors (aHR: 1.56, 95% CI: 1.13⁻2.15; p < 0.05). This study demonstrated that patients with PD had approximately one-half higher risk of subsequent UC. Further studies are warranted to elucidate the relationship between PD and UC.

Background: Air pollution from road traffic has been associated to an increased risk of lung cancer. Herein, we investigated the association between lung cancer mortality and residence near Italian highways or national major roads., Methods: Information on deaths for lung cancer registered from 1990 to 2010 and stratified by age, gender, and urban or rural municipality of residence at death were obtained from the National Institute of Statistics. Distance between the centroid of the municipality of residence and closest major roadways was considered as a proxy of pollution exposure. Relative Risks (RR) and 95% confidence intervals (CI) were computed using Poisson log-linear models adjusted for age, calendar period, deprivation index, North/South gradient, and urban/rural status., Results: A gradient in risk for lung cancer mortality was seen for residents within 50 meters (m) of national major roads. In particular, in rural municipalities a statistically significant increased risk for lung cancer death was observed in both sexes (RR = 1.27 for distance <25 m vs. 500-1999 m, 95% CI 1.17-1.42, in men; RR = 1.97, 95% CI 1.64-2.39, in women). In urban municipalities, weak risks of borderline significance were documented in both sexes (RR = 1.06, 95% CI 0.99-1.15 in men; and RR = 1.09, 95% CI 0.97-1.22 in women). No statistically significant association emerged between residence within 100 to 500 m from highways and RRs of death for lung cancer., Conclusions: In Italy, residing near national major roads, in particular in rural municipalities, was related to elevated risks of death for lung cancer.