How Zambia reduced inequalities in under-five mortality rates over the last two decades: a mixed-methods study
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ABSTRACT: Background
SUBMITTER: Jacobs C
PROVIDER: S-EPMC9940360 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
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Project description:Climate change has already altered the environmental conditions of the world's oceans. Here we report declines in gastropod abundances and recruitment of mussels (Mytilus edulis) and barnacles (Semibalanus balanoides) over the last two decades that are correlated with changes in temperature and ocean conditions. Mussel recruitment is declining by 15.7% per year, barnacle recruitment by 5.0% per year, and abundances of three common gastropods are declining by an average of 3.1% per year (Testudinalia testudinalis, Littorina littorea, and Nucella lapillus). The declines in mussels and the common periwinkle (L. littorea) are correlated with warming sea temperatures and the declines in T. testudinalis and N. lapillus are correlated with aragonite saturation state, which affects rates of shell calcification. These species are common on shores throughout the North Atlantic and their loss is likely to lead to simplification of an important food web on rocky shores.
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Project description:The great challenge of reducing soil nutrient depletion and assuring agricultural system productivity in low-income countries caused by limited synthetic fertilizer use necessitates local and cost-effective nutrient sources. We estimated the changes of the nitrogen budget of agricultural systems in the East African Community from 1961 to 2018 to address the challenges of insufficient nitrogen inputs and serious soil nitrogen depletion in agricultural systems of the East African Community region. Results showed that total nitrogen input increased from 12.5 kg N ha-1yr-1 in the 1960s to 21.8 kg N ha-1yr-1 in the 2000s and 27 kg N ha-1yr-1 in the 2010s. Total nitrogen crop uptake increased from 12.8 kg N ha-1yr-1 in the 1960s to 18.2 kg N ha-1yr-1 in the 2000s and 21.8 kg N ha-1yr-1 in the 2010s. Soil nitrogen stock increased from -2.0 kg N ha-1yr-1 in the 1960s to -0.5 kg N ha-1yr-1 in the 2000s and 0.3 kg N ha-1yr-1 in the 2010s. Our results allow us to substantiate for the first time that soil nitrogen depletion decreases with increasing input of nitrogen in agricultural systems of the East African Community region. This suggests that increases in nitrogen inputs through biological nitrogen fixation and animal manure are the critical nitrogen management practices to curb soil nitrogen depletion and sustain agricultural production systems in the East African Community region in order to meet food demand for a growing population.Supplementary informationThe online version contains supplementary material available at 10.1007/s13593-023-00881-0.
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Project description:ObjectiveAs the number of female medical students and surgical residents increases, the increasing number of female academic surgeons has been disproportionate. The purpose of this brief report is to evaluate the AAMC data from 1969 to 2018 to compare the level of female academic faculty representation for surgical specialties over the past four decades.DesignThe number of women as a percentage of the total surgeons per year were recorded for each year from 1969-2018, the most recent year available. Descriptive statistics were performed. Poisson regression examined the percentage of women in each field as the outcome of interest with the year and specialty (using general surgery as a reference) as two predictor variables.SettingData from the American Association of Medical Colleges (AAMC).ParticipantsAll full-time academic faculty physicians in the specialties of obstetrics and gynecology (OB/GYN), general surgery, ophthalmology, otolaryngology (ENT), plastic surgery, plastic surgery, urology, neurosurgery, orthopaedic surgery and cardiothoracic surgery as per AAMC records.ResultsThe percentage of women in surgery for all specialties evaluated increased from 1969 to 2018 (OR 1.04, p<0.001). Compared with general surgery, the rate of yearly percentage change increased more slowly in neurosurgery (OR 0.84; P = .004), orthopaedic surgery (OR 0.82; P = .002), urology (OR 0.59; P < .001), and cardiothoracic surgery (OR 0.38; P < .001). There was no significant difference in the rate of yearly percentage change for plastic surgery (OR 1.01; P = .840). The rate of yearly percentage change increased more rapidly in OB/GYN (OR 2.86; P < .001), ophthalmology (OR 1.79; P < .001) and ENT (OR 1.70; P < .001).ConclusionsRepresentation of women in academic surgery is increasing overall but is increasing more slowly in orthopaedic surgery, neurosurgery, cardiothoracic surgery and urology compared with that in general surgery. These data may be used to inform and further the discussion of how mentorship and sponsorship of female students and trainees interested in surgical careers may improve gender equity in the future.
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Project description:AimsTo Assess changes in infective endocarditis (IE) epidemiology over the last 5 decades.Methods and resultsWe searched the published literature using PubMed, MEDLINE, and EMBASE from inception until December 2011.Data fromEinstein Medical Center, Philadelphia, PA were also included. Criteria for inclusion in this systematic review included studies with reported IE microbiology, IE definition, description of population studied, and time frame. Two authors independently extracted data and assessed manuscript quality. One hundred sixty studies (27,083 patients) met inclusion criteria. Among hospital-based studies (n=142; 23,606 patients) staphylococcal IE percentage increased over time, with coagulase-negative staphylococcus (CNS) increasing over each of the last 5 decades (p<0.001) and Staphylococcus aureus (SA) in the last decade (21% to 30%; p<0.05). Streptococcus viridans (SV) and culture negative (CN) IE frequency decreased over time (p<0.001), while enterococcal IE increased in the last decade (p<0.01). Patient age and male predominance increased over time as well. In subgroup analysis, SA frequency increased in North America, but not the rest of the world. This was due, in part, to an increase in intravenous drug abuse IE in North America (p<0.001). Among population-based studies (n=18; 3,477 patients) no significant changes were found.ConclusionImportant changes occurred in IE epidemiology over the last half-century, especially in the last decade. Staphylococcal and enterococcal IE percentage increased while SV and CN IE decreased. Moreover, mean age at diagnosis increased together with male:female ratio. These changes should be considered at the time of decision-making in treatment of and prophylaxis for IE.
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Project description:ObjectiveTo evaluate the change of the risk of bias (RoB) of acupuncture randomized controlled trials (RCTs) in the past five decades.MethodsMultiple databases were searched. We included RCTs identified from systematic reviews (SRs) on acupuncture. General characteristics and RoB judgment for each domain were extracted. The proportions of RCTs at high and unclear RoB were calculated and the changes were examined by the Mann-Kendall test.ResultsWe included 368 SRs including 4 715 RCTs. The rates of RCTs at unclear RoB were the highest in allocation concealment (63%), and at the lowest in incomplete outcome data (35%); in the last five decades, statistically significant reductions were found for random sequence generation (P < 0.001) and selective reporting (P = 0.01), and increases for blinding of participants and personnel (P < 0.001), blinding of outcome assessment (P < 0.001) and incomplete outcome data (P = 0.04). For the proportions of RCTs at high RoB, blinding of participants and personnel (47%) and blinding of outcome assessment (35%) were the poorest domains; there were no significant differences in changes for all domains.ConclusionsAlthough improvements concerning unclear risk were observed for random sequence generation and selective reporting, major issues remain for allocation concealment and blinding. It is imperative to use valid randomization, specify how it is conducted, and try to test for selection bias and the success of masking by using the Berger Exner test.
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Project description:Despite the growing interest in predicting global and regional trends in vegetation productivity in response to a changing climate, changes in water constraint on vegetation productivity (i.e., water limitations on vegetation growth) remain poorly understood. Here we conduct a comprehensive evaluation of changes in water constraint on vegetation growth in the extratropical Northern Hemisphere between 1982 and 2015. We document a significant increase in vegetation water constraint over this period. Remarkably divergent trends were found with vegetation water deficit areas significantly expanding, and water surplus areas significantly shrinking. The increase in water constraints associated with water deficit was also consistent with a decreasing response time to water scarcity, suggesting a stronger susceptibility of vegetation to drought. We also observed shortened water surplus period for water surplus areas, suggesting a shortened exposure to water surplus associated with humid conditions. These observed changes were found to be attributable to trends in temperature, solar radiation, precipitation, and atmospheric CO2. Our findings highlight the need for a more explicit consideration of the influence of water constraints on regional and global vegetation under a warming climate.
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Project description:BackgroundThe paper presents an overview of air quality in the 27 member countries of the European Union (EU) and the United Kingdom (previous EU-28), from 2000 to 2017. We reviewed the progress made towards meeting the air quality standards established by the EU Ambient Air Quality Directives (European Council Directive 2008/50/EC) and the World Health Organization (WHO) Air Quality Guidelines by estimating the trends (Mann-Kendal test) in national emissions of main air pollutants, urban population exposure to air pollution, and in mortality related to exposure to ambient fine particles (PM2.5) and tropospheric ozone (O3).ResultsDespite significant reductions of emissions (e.g., sulfur oxides: ~ 80%, nitrogen oxides: ~ 46%, non-methane volatile organic compounds: ~ 44%, particulate matters with a diameter lower than 2.5 µm and 10 µm: ~ 30%), the EU-28 urban population was exposed to PM2.5 and O3 levels widely exceeding the WHO limit values for the protection of human health. Between 2000 and 2017, the annual PM2.5-related number of deaths decreased (- 4.85 per 106 inhabitants) in line with a reduction of PM2.5 levels observed at urban air quality monitoring stations. The rising O3 levels became a major public health issue in the EU-28 cities where the annual O3-related number of premature deaths increased (+ 0.55 deaths per 106 inhabitants).ConclusionsTo achieve the objectives of the Ambient Air Quality Directives and mitigate air pollution impacts, actions need to be urgently taken at all governance levels. In this context, greening and re-naturing cities and the implementation of fresh air corridors can help meet air quality standards, but also answer to social needs, as recently highlighted by the COVID-19 lockdowns.
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Project description:ObjectiveTo conduct a comprehensive bibliometric analysis of the application of artificial intelligence (AI) in Rare diseases (RDs), with a focus on analyzing publication output, identifying leading contributors by country, assessing the extent of international collaboration, tracking the emergence of research hotspots, and detecting trends through keyword bursts.MethodsIn this bibliometric study, we identified and retrieved publications on AI applications in RDs spanning 2003 to 2023 from the Web of Science (WoS). We conducted a global research landscape analysis and utilized CiteSpace to perform keyword clustering and burst detection in this field.ResultsA total of 1501 publications were included in this study. The evolution of AI applications in RDs progressed through three stages: the start-up period (2003-2010), the steady development period (2011-2018), and the accelerated growth period (2019-2023), reflecting this field's increasing importance and impact at the time of the study. These studies originated from 85 countries, with the United States as the leading contributor. "Mutation", "Diagnosis", and "Management" were the top three keywords with high frequency. Keyword clustering analysis identified gene identification, effective management, and personalized treatment as three primary research areas of AI applications in RDs. Furthermore, the keyword burst detection indicated a growing interest in the areas of "biomarker", "predictive model", and "data mining", highlighting their potential to shape future research directions.ConclusionsOver two decades, research on the AI applications in RDs has made remarkable progress and shown promising results in the development. Advancing international transboundary cooperation is essential moving forward. Utilizing AI will play a more crucial role across the spectrum of RDs management, encompassing rapid diagnosis, personalized treatment, drug development, data integration and sharing, and continuous monitoring and care.
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Project description:Mortality is a key indicator of forest health, and increasing mortality can serve as bellwether for the impacts of global change on forest ecosystems. Here we analyze trends in forest canopy mortality between 1984 and 2016 over more than 30 Mill. ha of temperate forests in Europe, based on a unique dataset of 24,000 visually interpreted spectral trajectories from the Landsat archive. On average, 0.79% of the forest area was affected by natural or human-induced mortality annually. Canopy mortality increased by +2.40% year-1, doubling the forest area affected by mortality since 1984. Areas experiencing low-severity mortality increased more strongly than areas affected by stand-replacing mortality events. Changes in climate and land-use are likely causes of large-scale forest mortality increase. Our findings reveal profound changes in recent forest dynamics with important implications for carbon storage and biodiversity conservation, highlighting the importance of improved monitoring of forest mortality.
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Project description:ObjectiveTo determine whether government efforts in reducing inequalities in health in European countries have actually made a difference to mortality inequalities by socioeconomic group.DesignRegister based study.Data sourceMortality data by level of education and occupational class in the period 1990-2010, usually collected in a census linked longitudinal study design. We compared changes in mortality between the lowest and highest socioeconomic groups, and calculated their effect on absolute and relative inequalities in mortality (measured as rate differences and rate ratios, respectively).SettingAll European countries for which data on socioeconomic inequalities in mortality were available for the approximate period between years 1990 and 2010. These included Finland, Norway, Sweden, Scotland, England and Wales (data applied to both together), France, Switzerland, Spain (Barcelona), Italy (Turin), Slovenia, and Lithuania.ResultsSubstantial mortality declines occurred in lower socioeconomic groups in most European countries covered by this study. Relative inequalities in mortality widened almost universally, because percentage declines were usually smaller in lower socioeconomic groups. However, as absolute declines were often smaller in higher socioeconomic groups, absolute inequalities narrowed by up to 35%, particularly among men. Narrowing was partly driven by ischaemic heart disease, smoking related causes, and causes amenable to medical intervention. Progress in reducing absolute inequalities was greatest in Spain (Barcelona), Scotland, England and Wales, and Italy (Turin), and absent in Finland and Norway. More detailed studies preferably using individual level data are necessary to identify the causes of these variations.ConclusionsOver the past two decades, trends in inequalities in mortality have been more favourable in most European countries than is commonly assumed. Absolute inequalities have decreased in several countries, probably more as a side effect of population wide behavioural changes and improvements in prevention and treatment, than as an effect of policies explicitly aimed at reducing health inequalities.
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