Indigenous dog breeds of the Balearic Islands constitute an essential part of regional biodiversity and cultural heritage, yet many face endangerment due to shrinking population sizes and delayed institutional recognition. This study assessed the usefulness of multivariate statistics and data-mining tools to analyse temporal trends and census evolution in these breeds, with emphasis on the influence of breeder associations and conservation structures. Canonical discriminant analysis effectively distinguished demographic patterns among breeds while identifying and accounting for multicollinearity, enabling the exclusion of unreliable variables. A single discriminant function captured nearly all variability, highlighting its strong ability to separate breeds according to registry and census characteristics, with registry size emerging as the dominant discriminatory factor. Decision-tree modelling showed that rapid creation and official recognition of breeder associations accelerated conservation progress by promoting organisational stability and earlier institutional protection. Early foundational actions-such as systematic record keeping and development of breed standards-substantially reduced the time required for official recognition. Functional classification also shaped vulnerability: herding and guarding breeds exhibited greater susceptibility to census decline. Additionally, the number of breeding females recorded in foundational censuses emerged as a critical long-term sustainability indicator. The integrated application of multivariate and data-mining approaches provides a robust analytical framework for understanding demographic dynamics in endangered dog populations. Results emphasise that rapid organisational development, early pedigree and phenotypic documentation, and preservation of traditional functional roles, particularly hunting, are central to the effective conservation of Balearic indigenous dog breeds. These insights offer actionable guidance for breeders, associations, and policymakers aiming to safeguard genetic diversity and cultural heritage.
Following the Bicentennial of the republic, there are still no estimates of child mortality for the various Indigenous peoples of the Peruvian Amazon, who represent 1% of the national population and 4% of the total indigenous population. This basic health indicator has previously been calculated using the Demographic and Health Survey at the national level and across different socioeconomic groups. However, the sample size of this survey limits the reliability of estimates for the different Amazonian Indigenous peoples. Using individual-level data from mothers registered in the national censuses, we can provide the first estimate of child mortality among Indigenous peoples in the Peruvian Amazon. Our findings reveal significant inequity affecting Amazonian Indigenous peoples, with a child mortality rate of three times higher than in Lima and 70% higher than that of other residents of the Amazon. Rural Shipibo-Konibo children face a double mortality rate compared to Awajún children. Although higher maternal education and greater household wealth are associated with lower mortality rates among Amazonian Indigenous children, significant disparities persist when these children are compared with those from other ethnic groups with similar levels of mothers' education and wealth. Even after accounting for socioeconomic factors, mortality among Amazonian Indigenous children remains disproportionately high, a result that is robust to both linear and count-data regression models.
Patient portals are essential infrastructure, reinforced by the 21st Century Cures Act, yet adoption remains inequitable. The COVID-19 pandemic accelerated portal adoption as telehealth expansion and remote test-result delivery made electronic access integral to care, but racial and ethnic disparities persisted. Understanding activation determinants is critical for addressing digital health disparities, particularly among neurology patients, for whom cognitive, speech, and mobility impairments can complicate portal use. We examined the demographic, geographic, and neighborhood-level factors associated with patient portal activation among neurology patients in the Washington, DC metropolitan area. We conducted a cross-sectional study of 72,417 patients with at least one outpatient neurology encounter (including telehealth) at two academic medical centers sharing a common electronic health record in Washington, DC. The primary outcome was portal activation, defined as having logged into the portal at least once (a manual patient step). We examined associations using multivariable logistic regression (reporting adjusted odds ratios [aORs]) adjusting for age, sex, race/ethnicity, visit counts, and year of most recent encounter, and we assessed geographic patterning at multiple scales (the DC metropolitan catchment area, DC's eight wards, census tracts via geocoded addresses, and residential zip codes) using Pearson and Spearman correlations between ward- and tract-level American Community Survey indicators and activation. Portal activation was 64.7% overall (46,851/72,417); patients averaged 9.7 visits (SD 18.9). Activation varied by race/ethnicity: Non-Hispanic White 76.1% (21,420/28,154), Non-Hispanic Asian 57.6% (1,109/1,925), Non-Hispanic Black 57.0% (13,057/22,900), and Hispanic 55.0% (1,979/3,600). In adjusted models, odds of activation were lower for Non-Hispanic Black (aOR 0.46, 95% CI 0.44-0.48), Hispanic (aOR 0.34, 95% CI 0.31-0.37), and Non-Hispanic Asian (aOR 0.47, 95% CI 0.42-0.52) patients versus Non-Hispanic White patients, and each SD increase in age was associated with lower odds (aOR 0.60, 95% CI 0.59-0.61; all P<.001). Activation differed across DC wards, from 48.0% (Ward 7) to 82.0% (Ward 2). Ward-level activation correlated strongly with educational attainment (r=0.95, P<.001), broadband access (r=0.89, P=.003), and median income (r=0.81, P=.02); educational attainment was the strongest independent neighborhood predictor in joint models. Within individual wards, Non-Hispanic White patients activated at 85.7%-91.2% versus 50.5%-63.6% for Non-Hispanic Black patients, and disparities persisted in a sensitivity analysis restricted to 2024-2026 encounters (Non-Hispanic Black aOR 0.37, 95% CI 0.35-0.39). To our knowledge, this is the first multi-scale geographic analysis of patient portal activation. Activation was shaped by demographic, socioeconomic, and geographic factors, yet racial disparities persisted within individual wards regardless of socioeconomic advantage, indicating that neighborhood resources alone do not explain the digital divide. Health systems should pair targeted measures, such as ward-level enrollment support and digital literacy assistance, with culturally tailored, clinic-based activation support to achieve digital health equity.
Volunteer-based palliative care programs often lack the tools to ensure consistent service delivery across their full patient census. This study assessed the impact of a clinical decision support system (CDSS) on the daily percentage of eligible patients visited in a hospital-based adolescent and young adult (AYA) palliative care peer support program. We analyzed data from Streetlight at University of Florida (UF) Health from November 14, 2021 to November 14, 2025. On November 14, 2022, a CDSS feature was introduced to display each patient's cumulative percentage of days visited on the program census. Segmented generalized linear regression was used to estimate changes in the level and slope of daily visit coverage before and after implementation. Estimates were adjusted for census size, volunteer staffing, and temporal patterns. CDSS implementation was associated with an immediate 7.6 percentage-point increase in visit coverage (95% CI: 2.5 to 12.6), equivalent to approximately 1.7 additional patients visited per day at a median census of 22 patients. This corresponds to roughly 440 additional patient visits per year assuming weekday-only operation. The intervention also significantly improved the post-implementation trend, reversing a pre-existing decline in visit coverage. CDSSs can leverage real-time program data to improve service delivery in palliative care support programs by increasing coverage and complementing human decision-making.
Random variation in reproductive success-genetic drift-profoundly shapes genetic diversity and evolutionary trajectories. The strength of drift depends on the variance in descendant number, σ2d, which governs key evolutionary outcomes: for instance, the establishment probability of a beneficial mutation scales inversely with σ2d. However, whether σ2d itself evolves over long timescales has remained unclear, because allele-frequency fluctuations depend on drift only through the effective population size, Ne = N/σ2d, which blends census population size with descendant-number variance. Here, we disentangle these components by using model-based Bayesian inference combined with joint tracking of (i) frequency fluctuations of neutrally barcoded lineages and (ii) census population sizes across growth cycles in the E. coli Long-Term Evolution Experiment (LTEE). Analyzing 33 clones spanning the ancestor through 50,000 generations in two replicate populations (Ara-2 and Ara+2), we find that the strength of genetic drift evolved markedly-and divergently-between the two replicate populations. Both census size and σ2d changed substantially through time, with most variation in Ne driven by shifts in σ2d rather than census size. After approximately 2,000 generations, the σ2d of the two populations diverged sharply: Ara+2 generally remained close to a bottleneck-only null expectation, whereas Ara-2 exhibited 1.5-5× stronger drift, consistent with an evolved increase in stochasticity during growth. These results imply that mutations can alter both the mean and the variance of the descendant-number distribution, and we show that the joint distribution of mutational effects on fitness and on σ2d can substantially modulate the rate of adaptation. The key parameter governing genetic drift can therefore itself evolve in the LTEE, with direct consequences for adaptation.
Through interactional, multilevel models of social determinants of health (SDoH) incorporating comprehensive census-level and individual-level SDoH-factors, to assess whether pituitary adenoma disparities are more strongly associated with community-level factors compared to individual-level ones. This retrospective study analyzed pituitary adenoma patients nationally between 2010 and 2018 using multivariate, age-adjusted regressions and cox-proportional hazards models; covariates of sex, race-ethnicity, census-level rurality-urbanicity, census-level Yost-Index score (aggregating 7 SES-measures of education, income, housing) and clinical outcomes of mortality, surgical resection, & delays-in-treatment (3 months-or-over from diagnosis). Across 44,514 pituitary adenomas-patients, all-cause mortality featured markedly positive independent predictors of decreasing Yost-SES (OR, 1.43; 95% CI, 1.35-1.52; p < 0.001) and Male-Sex (OR, 1.24; 95% CI, 1.16-1.32; p < 0.001). Indicated surgery receipt showed markedly positive independent predictors of Male-Sex (OR, 1.64; 95% CI, 1.59-1.72; p < 0.001), Minority Race/Ethnicity (OR, 1.18; 95% CI, 1.14-1.23; p < 0.001), and Rurality (OR, 1.08; 95% CI, 1.01-1.16; p = 0.030). Having a delay-of-treatment showed markedly positive independent predictors of Female-Sex (OR, 1.24; 95% CI, 1.18-1.30; p < 0.001) and decreasing Yost-SES (OR, 1.14; 95% CI, 1.08-1.20; p < 0.001). Through assessing individual- and community-level social determinants in tandem, this study identified detrimental SDoH-associations with pituitary adenoma care and prognosis. Community-level Yost-Index SES and individual sex showed stronger associations with observed disparities, presenting multilevel considerations for prospective initiatives to consider.
Compare characteristics of community-associated (CA) versus healthcare-associated (HCA) extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) urinary tract infection (UTI) cases and assess associations between ESBL-E UTI prevalence and census-tract social vulnerability. Retrospective cohort study. Monroe County, NY, January 2020-December 2023. Population surveillance of first urinary ESBL-E isolate among county residents. ESBL-E, defined as resistance to ≥1 third-generation cephalosporin, was identified from inpatient and outpatient urinary specimens. Demographic, clinical, and healthcare exposure data were abstracted; cases were classified as CA or HCA using standardized definitions. Addresses were geocoded to census tracts and linked to CDC Social Vulnerability Index (SVI) scores. Characteristics were compared using χ2 and Wilcoxon tests. Generalized linear models assessed associations between SVI themes and ESBL-E prevalence by epidemiologic classification. Of 3,100 ESBL-E UTI cases, 1,621 (52.3%) were CA and 1,468 (47.4%) HCA. CA cases were younger (median 56 vs 71.5 years), more often female (89.5% vs 68.4%), and less medically complex than HCA cases. HCA prevalence increased with SVI score, while CA prevalence remained stable across SVI levels. The HCA association was mainly driven by SVI Theme 2 (household composition/disability; P = .0011). CA and HCA ESBL-E UTIs exhibit distinct epidemiology. No association was observed between SVI and CA ESBL-E UTI prevalence. HCA prevalence increased with social vulnerability, largely driven by SVI Theme 2, potentially reflecting healthcare exposure and medical complexity. Factors driving CA ESBL-E differ, and ESBL-E reduction efforts should consider broader structural and community factors beyond those captured by the SVI.
Using legal epidemiological and social determinants of health frameworks, this study examines how racial and spatial inequalities shape cardiometabolic health outcomes in Greenville County, South Carolina. We used Census tract-level data from the CDC PLACES project, and the U.S. Census Bureau to assess associations between racial/ethnic composition and cardiometabolic indicators, including coronary heart disease, hypertension, and obesity. Our regression-based mediation analysis examined whether socioeconomic factors (household income and education attainment) explained these associations. Tracts with greater Black and Hispanic/Latino populations had much higher cardiometabolic disease and risk factor rates. These inequities were partly mediated by lower educational attainment and income, emphasizing the role socioeconomic inequality plays in emergence of racial and spatial disparities of health outcomes in these communities. The results demonstrate the way structural inequities ingrained in land-use policy, education opportunities, and neighborhood characteristics contribute to racial inequities for the health of our communities. Policies that expand access to education and economic opportunities, ensure fair land use, and promote equitable urban and regional planning are critical for reducing health inequity in rapidly growing medium sized regions in the U.S.
Patients with infective endocarditis (IE) face an elevated risk of cerebrovascular disease; however, national trends in mortality related to both cerebrovascular disease and IE remain poorly characterized. This study examines contemporary mortality trends among US adults aged ≥25 years in the United States with coexisting cerebrovascular disease and IE from 1999 to 2024. We analyzed the mortality data using the CDC WONDER mortality database, extracting age-adjusted mortality rates (AAMR) per 100,000 population. We identified cerebrovascular disease and IE using the respective ICD-10 codes. We included those fatalities where cerebrovascular disease and IE were either the underlying or the contributing cause. We evaluated the mortality trends by year, sex, race and ethnicity, and census region. Joinpoint regression was used to calculate the annual percent change (APC) in AAMR with 95% confidence intervals. From 1999 to 2024, a total of 43,799 deaths occurred with an overall AAMR of 0.75/100,000. The AAMR increased from 0.83 in 1999 to 0.87 in 2024 (AAPC: 0.44; 95% CI: 0.04 to 0.88; p < 0.05). Joinpoint analysis demonstrated a decreasing trend from 1999 to 2015 (APC: -1.54; 95% CI: -2.53 to -0.76; p < 0.05) and an increasing trend from 2015 to 2024 (APC: 4.05; 95% CI: 2.54 to 7.39; p < 0.05). Men had a higher AAMR (0.86) than women (0.67). Black or African American had the highest AAMR (0.94) compared to other racial groups. The Midwest (0.83) region had the highest AAMR among census regions. The mortality related to concomitant cerebrovascular disease and infective endocarditis increased throughout the study period, with a more prominent rise in the last 10 years. These mortality trends warrant further investigation.
Early mobilization (EM) in Intensive Care Units (ICUs) is a well-established strategy to mitigate complications of immobility, including ICU-acquired weakness, delirium and prolonged hospitalization. Despite strong clinical evidence and guideline recommendations supporting its safety and efficacy-even for mechanically ventilated patients-EM remains underutilized globally. Nurses, as frontline caregivers, play a pivotal role in EM implementation; however, gaps in their knowledge, attitudes and practices, along with perceived barriers, hinder its routine application, particularly in resource-limited settings. This study aimed to assess ICU nurses' knowledge, attitudes, self-perceived practices and perceived barriers regarding EM in southeastern Iran. A descriptive-correlational study was conducted in southeastern Iran. Nurses from eight units across three university-affiliated hospitals participated, using a census sampling method. Data were collected via a validated Persian-translated questionnaire comprising five sections: demographics, EM knowledge (21 items), attitude (11 items), practice (12 items) and perceived barriers (12 items). Descriptive statistics, Pearson correlation and multiple linear regression analyses were performed using SPSS v22. In total, 128 nurses demonstrated moderate knowledge (mean = 10.89/21) and high positive attitudes (mean = 42.32/55) and moderate self-perceived EM practices (mean = 40.99/60). Key knowledge gaps involved mobilizing mechanically ventilated patients and recognizing contraindications. The strongest barriers were patient-related: medical instability and over-sedation. Higher knowledge correlated significantly with more positive attitudes and better practices (p < 0.05). Master's-level education predicted better attitudes, while nursing background and personal EM study predicted improved practice. Based on self-reported data, this study suggests a potential disconnect between favourable attitudes and self-perceived EM practices among Iranian ICU nurses, potentially due to knowledge gaps-especially in complex cases-and patient-centred barriers. It highlights the potential need for targeted educational interventions and standardized protocols. Findings support integrating structured EM training into nursing curricula and continuing education, developing interdisciplinary protocols and addressing sedation and stability concerns to enhance EM uptake and improve ICU patient outcomes.
Time-related sterility maintenance (TRSM) remains common in Japanese operating rooms, requiring re-sterilisation of unopened supplies at fixed intervals, although microbiological evidence indicates that sterility loss is event-driven, not time-driven. Its avoidable burden remains unquantified. To quantify the annual cost, carbon dioxide-equivalent (CO2e) emissions, water use, and labour from re-sterilising expired supplies under TRSM, and the upper-bound proportion avoidable by transition to event-related sterility maintenance (ERSM). Single-centre observational and modelling study integrating a gate-to-gate environmental assessment (a partial boundary rather than a full cradle-to-grave life-cycle assessment), cost-consequence analysis, and discrete-event simulation (DES). A one-month census of expired supplies (746 items) was annualised with the institutional modality mix (steam:VH2O2:EO = 8:1:1) and literature-derived emission factors. As re-sterilisation is predominantly co-loaded, costs were allocated as a marginal increment by load factor. A competing-risk DES, with an event-related contamination hazard from five-year data, yielded a modelled upper bound; conservative scenarios retaining re-sterilisation for legitimate non-time triggers (damage, recall, audit, inventory checks) were added. Uncertainty was assessed by probabilistic (Monte Carlo, 5,000 iterations) sensitivity analysis. An estimated 8,952 items were re-sterilised annually at one 643-bed centre. The avoidable fraction was a modelled upper bound of 99.9% (95% interval 99.6-100%); under conservative scenarios, 80-95% remained avoidable. At the upper bound, median avoidable burden was ¥1.24 million/year (≈US$8,300), 1,768 kg CO2e/year, 10,727 L water/year, and 147 hours/year. TRSM generated approximately 1.8 tonnes of avoidable CO2e, over ¥1 million, and up to 147 hours of avoidable labour annually, supporting evaluation of ERSM as a decarbonisation and efficiency measure.
Firearm violence arises from a complex interplay of local conditions and state regulations. Using coincidence analysis (CNA), we examined how combinations of city-level prevention efforts and state-level firearm policies correspond to fatal shooting rates across 100 US cities. Drawing on data from the Community Justice Violence Prevention Index, Everytown's gun-law rankings, the US Census Bureau, and the Gun Violence Archive, we identified configurations of state policies and local efforts associated with relatively low rates of firearm-related fatalities. Five distinct pathways characterized cities with lower shooting rates, involving combinations of regional location, restraining order prohibitors, authority to deny firearm purchases, police use-of-force data collection, microstamping for new handguns, city population, ban-the-box initiatives, city-wide reporting for hate crimes, school-based violence prevention programs, and local emergency response improvements. Findings underscore how multilevel policy environments jointly shape firearm violence outcomes and demonstrate the value of configurational methods for public health and policy research.
Coronary artery disease (CAD) is the leading cause of death worldwide. Among women, CAD is often underestimated, resulting in underdiagnosis and undertreatment. This study aimed to assess the prevalence of CAD and its risk factors in adult women, using data from the Tehran Cohort Study (TeCS). We analyzed data from 4478 women with complete CAD information collected during the TeCS recruitment phase. The age-weighted prevalence of CAD was estimated using the 2016 national census data and previous CAD diagnoses. Logistic regression models were applied to identify factors independently associated with CAD in women. The overall prevalence of CAD was 4.48% (mean age: 53.0 ± 12.37 years), with an age-weighted prevalence of 4.1% (95% CI: 3.1%-5.4%). Increasing age was strongly associated with CAD, with women aged ≥ 75 years showing markedly higher odds (OR: 11.94, 95% CI: 3.93-36.31, p < 0.001). Hypertension (OR: 2.58, 95% CI: 1.75-3.80, p < 0.001), hyperlipidemia (OR: 2.25, 95% CI: 1.55-3.24, p < 0.001), and diabetes mellitus (OR: 2.07, 95% CI: 1.49-2.88, p < 0.001) were also significant determinants of CAD. Older age groups exhibited a higher prevalence of CAD risk factors. Within the CAD group, a greater proportion of women had multiple comorbid risk factors compared with their non-CAD counterparts in the same age categories. The prevalence of CAD and its associated risk factors among women in Tehran is substantial. These findings highlight the need for targeted preventive strategies to reduce CAD incidence in vulnerable female populations.
Social invisibility represents a real challenge for people with albinism in obtaining appropriate health care. The aim of this research was to analytically encompass what the scientific literature reveals on the subject, by means of an integrative literature review in the SciELO database. Nineteen original articles were included, available in full and covering topics such as: culture; social, family and economic aspects; human rights and life experiences. The results were categorized into epidemiological characteristics, symbolic perspectives and social rights. It was found that epidemiological estimates are inconclusive and imprecise, without official census data. Cultural symbolism is deeply rooted in myths, legends and ancient beliefs, which contributes to stigmatization and discrimination, as well as being used to justify acts of violence. Violations of social rights are frequent and legislation is often not effectively enforced, becoming a mere dead letter. It is crucial to ensure the implementation of public policies and social practices based on equity, dignity and social justice. A invisibilidade social representa para as pessoas com albinismo um desafio concreto para os cuidados apropriados em saúde. Nesta pesquisa objetivou-se abarcar analiticamente o que a literatura científica desvela sobre o tema, por meio de uma revisão integrativa de literatura na base de dados SciELO. Foram incluídos 19 artigos originais, disponíveis na íntegra e que abordaram temas como: cultura; aspectos sociais, familiares e econômicos; direitos humanos; e experiências de vida. Os resultados foram categorizados em características epidemiológicas, perspectivas simbólicas e direitos sociais. Constatou-se que as estimativas epidemiológicas são inconclusivas e imprecisas, sem dispor de um dado censitário oficial. O simbolismo cultural é profundamente enraizado em mitos, lendas e crenças antigas, o que contribui para estigmatizações e discriminações, além de ser utilizado para justificar atos de violência. As violações dos direitos sociais são frequentes e as legislações muitas vezes não são efetivamente cumpridas, tornando-se mera letra morta. É crucial assegurar a efetivação de políticas públicas e práticas sociais com base na equidade, dignidade e justiça social. La invisibilidad social representa un verdadero desafío para las personas con albinismo a la hora de obtener una atención sanitaria adecuada. El objetivo de esta investigación fue abarcar analíticamente lo que la literatura científica revela sobre el tema, por medio de una revisión integrativa de la literatura en la base de datos SciELO. Se incluyeron 19 artículos originales, disponibles en su totalidad y que abarcan temas como: cultura; aspectos sociales, familiares y económicos; derechos humanos y experiencias de vida. Los resultados se clasificaron en características epidemiológicas, perspectivas simbólicas y derechos sociales. Se constató que las estimaciones epidemiológicas son poco concluyentes e imprecisas, sin datos censales oficiales. El simbolismo cultural está profundamente arraigado en mitos, leyendas y creencias ancestrales, lo que contribuye a la estigmatización y la discriminación, además de utilizarse para justificar actos de violencia. Las violaciones de los derechos sociales son frecuentes y la legislación a menudo no se aplica de forma efectiva, convirtiéndose en mera letra muerta. Es crucial garantizar la aplicación de políticas públicas y prácticas sociales basadas en la equidad, la dignidad y la justicia social.
To estimate attention-deficit/hyperactivity disorder (ADHD) prevalence across gender identity, transgender status, and sexual identity using whole-population linked data in Aotearoa New Zealand (NZ). A nationwide cohort study using the 2023 NZ Census linked to administrative health data within Stats NZ's Integrated Data Infrastructure. Individuals aged 5 to 24 years were included. ADHD was identified from lifetime diagnosis and treatment records. Modified Poisson regression models estimated adjusted incident rate ratios (IRRs) by gender, transgender status, and sexual identity. Among 1,266,456 individuals, 43,095 (3.4%) had ADHD. ADHD prevalence was higher among those identifying with another gender (10.3%) than males (4.6%) or females (2.0%), and among transgender (9.9%) than non-transgender individuals (3.4%). Among those aged 15 to 24 years, ADHD prevalence was higher in non-heterosexual (8.0%) than heterosexual individuals (3.6%). Adjusted analyses showed similarly elevated rates. ADHD prevalence was substantially higher among gender-diverse, transgender, and sexual diverse populations, highlighting the need for inclusive and equitable assessment and care pathways.
Kawasaki disease is the leading cause of acquired heart disease in children worldwide. Previous studies from Chandigarh, India, documented a rising incidence until 2019. The COVID-19 pandemic, with its infection-control measures and emergence of multisystem inflammatory syndrome in children, disrupted established epidemiological trends. We aimed to evaluate the impact of the pandemic on incidence, clinical features, and coronary outcomes in children with Kawasaki disease in the Union Territory of Chandigarh. This study was conducted at the tertiary care teaching institute in North-West India, from January 2020 to December 2024. Demographic, clinical, laboratory, and echocardiographic data were collected. Population estimates were derived from national census projections, and annual incidence rates were calculated for children <5 years and <15 years. Temporal and seasonal trends were analysed using regression models and Chow tests. A total of 442 children with Kawasaki disease were diagnosed during the study period-of these, 60 (median age 40.5 months, 62% male, 63% complete, and 37% incomplete Kawasaki disease) were residents of Chandigarh. Incidence declined markedly during the pandemic (1.7 and 3.4 per 100,000 children <5 years in 2020 and 2021, respectively), followed by a rebound in 2022 (8.4) and 2023 (5.8), and a sharp rise in 2024 (13.9), the highest incidence recorded to date in Chandigarh. Coronary artery abnormalities were detected in 13% of patients, with 3.3% showing persistent lesions at 6 weeks. No deaths occurred, and seasonal patterns remained unchanged compared with 2015-2019. Kawasaki disease incidence in Chandigarh declined transiently during the COVID-19 pandemic but rebounded sharply post-pandemic, exceeding the highest previously reported estimates. Despite fluctuations, clinical features and coronary outcomes remained stable. These findings reinforce Kawasaki disease as an endemic childhood vasculitis in Chandigarh, India, and highlight the need for ongoing surveillance and early recognition as an important contributor to acquired heart disease burden in children.
For families navigating juvenile idiopathic arthritis (JIA) or systemic lupus erythematosus (SLE), effective communication with healthcare teams is vital. We examined how language preference other than English (LPOE) associates with patient-provider interactions and standardized outcome assessment. In this retrospective cohort of patients with JIA or SLE at a tertiary care center (2016-2024), LPOE patients were matched 1:2 to English language preference (ELP) counterparts by age, diagnosis, polyarticular course and disease duration. We used multivariable negative binomial or logistic regression to compare rates of patient- and provider-initiated communications, adjusted for disease severity indicators and the COVID-19 pandemic period. Insurance and census tract-level Child Opportunity Index (COI) were evaluated in separate models. We secondarily compared rates of physician global visual assessment scale (PhVAS) completion. We matched 60 JIA/SLE patients in LPOE families to 107 ELP counterparts. LPOE families initiated fewer communications in both unadjusted (incidence rate ratio [IRR] 0.45 [95% CI: 0.29-0.72]) and adjusted analyses (adjusted IRR [aIRR] 0.51 [95% CI: 0.31-0.84]). Moreover, LPOE families initiated 0.18-fold fewer communications during the COVID-19 pandemic (p<0.001 for interaction). There was no significant difference in provider-initiated communication frequency by language preference. Physician VAS were less often completed for LPOE families (adjusted OR 0.58 [0.32-1.03]) , though this difference was not statistically significant. Reduced communication frequency between LPOE families with care teams may drive language-related disparities, particularly during periods of system stress. Enhanced outreach to families with barriers to health care engagement may facilitate more equitable care delivery.
Neuro-oncology is increasingly centralized in academic tertiary centers, potentially creating geographic and economic inequities. This study aims to quantify the national distribution of neuro-oncologists and evaluates the association between regional economic capacity, metropolitan urbanicity and population-level clinical outcomes. We conducted a nationwide cross-sectional ecological analysis using 2025 United Council for Neurologic Subspecialties (UCNS) data, US Bureau of Economic Analysis state-level GDP, and US Census Bureau demographics. Geographic proximity was modeled for US counties using geodesic distance from population centroids. Outcome measures included CNS tumor mortality and Disability-Adjusted Life Years (DALYs). We identified 323 UCNS-certified neuro-oncologists. Workforce distribution was strongly associated with state-level economic magnitude (r=0.930 [95% CI: 0.878-0.960], p<0.0001), with GDP explaining 86.4% of variance (R2=0.864). Specialists were located exclusively within metropolitan statistical areas (MSAs), however 81.1% of MSAs lacked local subspecialty presence. Spatial analysis revealed 45.4% of the US population resides <20 miles from the nearest neuro-oncologist, while 16.5% live in "Care Deserts" (>100 miles). Lower specialist density was ecologically correlated with higher mortality rates for pediatric (ρ = -0.34 [95% CI: -0.57 to -0.06], p = 0.015) and adult (ρ = -0.352 [95% CI: -0.57 to -0.07], p = 0.011) groups. Similar inverse associations were observed for DALYs in both pediatric (ρ=-0.339) and adult (ρ=-0.347) populations. Neuro-oncology workforce distribution is associated with state-level economic magnitude. However, sensitivity analyses suggest this association is partly attributable to population scale and infrastructure concentration rather than regional affluence per se. Lower specialist density was ecologically associated with higher CNS tumor mortality and DALYs in underserved regions. Addressing these structural inequities requires systemic interventions, including telemedicine and decentralized care models.
The growing demand for quick and convenient meals has altered eating behaviors and contributed to the rise in convenience stores in South Korea. Convenience stores often provide energy-dense, nutrient-poor foods, which may contribute to unhealthy eating behaviors and increase chronic disease risk. This study aims to examine the association of convenience store density with the prevalence of chronic diseases across 250 districts in South Korea. District-level data on the prevalence of obesity and hypertension, as well as covariates, were obtained from the 2022 Korea Community Health Survey. Data on convenience stores were sourced from the 2022 Census on Establishments. Moran's I and LISA analyses were conducted to assess and identify spatial autocorrelation and clustering patterns in obesity and hypertension prevalence across South Korea. Additionally, ordinary least squares (OLS) regression and spatial error model (SEM) were employed to examine the association between convenience store density and disease prevalence. The results of the OLS model indicated that convenience store density was associated with both obesity and hypertension in South Korea; however, only its association with hypertension was found to be significant, after adjusting for spatial autocorrelation using the SEM. The prevalence of hypertension increased by 0.968% for each additional convenience store per 1,000 people. Convenience store density was significantly associated with hypertension, even after accounting for spatial autocorrelation. These findings highlight the need for further research and policy interventions to mitigate the health risks associated with convenience store density in influencing hypertension and obesity.
Workforce planning is an urgent need for oral and maxillofacial surgery (OMS). Access to OMS is essential for managing a wide range of conditions, yet disparities in specialist distribution may limit access in rural regions. This study aims to evaluate the geographic distribution of the OMS workforce in Georgia and identify disparities in access between metropolitan and nonmetropolitan regions. A cross-sectional study was conducted using the 2024 Georgia Board of Dentistry database to identify licensed OMS in Georgia. County-level demographic and socioeconomic data were obtained from the U.S. Census. The primary predictor variable was county-level geographic classification, defined using 2023 Rural-Urban Continuum Codes (RUCC), which categorize counties as metropolitan (codes 1 to 3) or nonmetropolitan (codes 4 to 9). Additional variables included county-level socioeconomic indicators (median household income and percent rural population) and OMS demographics (sex and age). The primary outcome variable was OMS density by county, defined as the number of surgeons per 100,000 residents and per 100 square miles. None. The Kruskal-Wallis test was used to compare the data between the 9 RUCCs, and the Mann-Whitney U test was used to compare data between metropolitan and nonmetropolitan counties. Statistical significance was defined as P < .05. A total of 205 OMS were identified, of whom 182 (88.8%) were male. Of these, 193 (94.1%) practiced in metropolitan counties. Surgeon density was statistically significantly higher in metropolitan versus nonmetropolitan counties (1.12 ± 0.95 vs 0.34 ± 0.88 per 100,000, P < .001), and 89.4% of nonmetropolitan counties had no surgeon present. Surgeon density differed statistically significantly across RUCC categories (P < .001), with RUCC 1 counties having the highest density (1.33 ± 1.81 per 100,000) and RUCC 9 counties having none. Median household income was statistically significantly higher in metropolitan counties ($70,153.81 ± $18,908.06 vs $52,072.22 ± $10,011.87, P < .001). The OMS workforce in Georgia is highly concentrated in metropolitan areas, leaving most rural counties with limited access to specialty care. These findings highlight statistically significant geographic disparities and the need for targeted workforce strategies to improve access in underserved regions.