Temporal and Spatial Heterogeneity of PM2.5 Related to Meteorological and Socioeconomic Factors across China during 2000–2018

In recent years, air pollution caused by PM2.5 in China has become increasingly severe. This study applied a Bayesian space–time hierarchy model to reveal the spatiotemporal heterogeneity of the PM2.5 concentrations in China. In addition, the relationship between meteorological and socioeconomic factors and their interaction with PM2.5 during 2000–2018 was investigated based on the GeoDetector model. Results suggested that the concentration of PM2.5 across China first increased and then decreased between 2000 and 2018. Geographically, the North China Plain and the Yangtze River Delta were high PM2.5 pollution areas, while Northeast and Southwest China are regarded as low-risk areas for PM2.5 pollution. Meanwhile, in Northern and Southern China, the population density was the most important socioeconomic factor affecting PM2.5 with q values of 0.62 and 0.66, respectively; the main meteorological factors affecting PM2.5 were air temperature and vapor pressure, with q values of 0.64 and 0.68, respectively. These results are conducive to our in-depth understanding of the status of PM2.5 pollution in China and provide an important reference for the future direction of PM2.5 pollution control.

Digital Divide in Online Education During the COVID-19 Pandemic: A Cosmetic Course From the View of the Regional Socioeconomic Distribution

Objectives: During the pandemic, quarantine has led to the lockdown of many physical educational institutions. Thus, massive open online courses (MOOCs) have become a more common choice for participants. MOOCs are often flagged as supplemental methods to educational disparities caused by regional socioeconomic distribution. However, dissenters argue that MOOCs can exacerbate the digital divide. This study aimed to compare the participants' performance before and after the outbreak of COVID-19, analyze the impact of the epidemic on online education of cosmetic dermatology from the view of the regional socioeconomic distribution, and investigate whether MOOCs exacerbate the digital divide in the COVID-19 epidemic.Methods: The study was conducted in participants of the MOOC course Appreciation and Analysis of Cosmetics from January 2018 to December 2020. Based on the platform data and official socioeconomic statistics, correlation of multivariate analysis was used to determine the factors related to the number of total participants. A panel regression model and stepwise least squares regression analysis (STEPLS) were employed to further analyze the relationship between GDP, population, number of college students and number of total participants in different years in the eastern, central and western regions of China.Results: The number of total participants in 2020 surged 82.02% compared with that in 2019. Completion rates were generally stable in 2018 and 2019 before the COVID-19 pandemic and significantly decreased in 2020 after the outbreak of the pandemic. GDP was the most important socioeconomic factor that determined the total number of participants and it was positively related to the total number of participants before and after the outbreak of the pandemic. The number of college students was unrelated to the total number of participants before the epidemic, and after the outbreak of COVID-19 in 2020, the number became positively related in all regions of China.Conclusions: This study shows that the epidemic pushes more people to choose MOOCs to study cosmetic dermatology, and online education could exacerbate rather than reduce disparities that are related to regional and socioeconomic status in the cosmetic field in the COVID-19 pandemic.

Social determinants and spatio-temporal variation of Ischemic Heart Disease in Manitoba

Introduction The aim was to study any spatial and/or temporal patterns of ischemic heart disease (IHD) prevalence and measure the effects of selected social determinants on these spatial and space-time patterns. Methods Data were obtained from the Population Research Data Repository housed at the Manitoba Centre for Health Policy to identify persons who were diagnosed with IHD between 1995 and 2018. These persons were geocoded to 96 geographic regions of Manitoba. An area-level socioeconomic factor index (SEFI-2) and the proportion of the population who was Indigenous were calculated for each geographic region using the 2016 Canadian Census data. Associations between these factors and IHD prevalence were measured using Bayesian spatial Poisson regression models. Temporal trends and spatio-temporal trends were measured using Bayesian spatio-temporal Poisson regression models. Results Univariable models showed a significant association with increased regional Indigenous population proportion associated with a higher prevalence of IHD (RR: 0.07, 95% CredInt: (0.05, 0.10)) and for SEFI-2 (RR: 0.17, 95% CredInt: (0.11, 0.23)). Using a multivariable model, after accounting for the proportion of the population that was Indigenous, there was no evidence of an association between IHD prevalence and area-level socioeconomic factor. Spatio-temporal models showed no significant overall temporal trend in IHD prevalence, but there were significant spatially varying temporal trends within the 96 regions. Conclusions Association between Indigenous population proportion and IHD is consistent with previous research. No significant overall temporal trend was measured. However, regions with significantly increasing trends and significantly decreasing trends in IHD prevalence were identified.

Willingness to Pay for Assisted Reproductive Technologies by Pastoral Herd Owners in Southern Rangelands of Kenya

Uptake of Assisted Reproductive Technologies (ARTs) can widen and accelerate access to quality breeding stock under pastoral systems, but user participation without subsidy is uncertain when the herders have to meet the direct cost. Analysing willingness to pay (WTP) for ARTs may provide insights into potential uptake of ARTs when development agencies withdraw subsidies and private entrepreneurs take up the service delivery. This study estimated WTP for ARTs among 130 pastoral herd owners participating in Sahiwal cattle breed upgrading program implemented in Transmara Sub County in the southern rangelands of Kenya. The average WTP was KES 3,643 (USD 33.4), equivalent to 21.4% premium with reference to base price (KES 3,000) (USD 27.5). Sixty-seven percent of the pastoral herd owners expressed WTP above the hypothesized market price, twice more than those expressing WTP below the hypothesized market price (33%). The first choice attributes influencing the WTP for ARTs were high milk yield (62%), high value calves (37%), and high growth rates (1%). Gender was the only socioeconomic factor significantly (P<0.005) influencing WTP, with men expressing higher WTP than women (KES 3,870 (USD 35.5) versus KES 3,223 (USD 26.6). The results indicate a high likelihood of pastoral herd owners continuing to access and use ARTs at own cost, which provides opportunities for private sector participation in ARTs delivery and upscaling to increase access to superior Sahiwal genetic resources in pastoral herds. This will need putting in place policy interventions supportive of efficient ARTs delivery mechanisms.

44. Cost Effectiveness and Clinical Outcomes of Long Acting Lipoglycopeptides Used in Transitions of Care for Deep-Seated Infections

Background Dalbavancin and oritavancin are long-acting lipoglycopeptides (LaLGPs) FDA-approved for one-time only dosing for skin and skin structure infections. The use of these agents in serious, deep-seated infections requiring protracted antibiotic courses is of increasing interest. The purpose of this study is to evaluate the economic and clinical utility of LaLGPs in patients requiring protracted antibiotic courses who are not ideal candidates for oral transition or outpatient parenteral antibiotic therapy (OPAT). Methods This is a retrospective, observational, matched cohort study of adult patients who received a LaLGP. Patients who received a LaLGP were matched 1:1 to those who received standard of care (SOC) therapy by age (+/- 10 years), infection type, microorganism, and socioeconomic factor (e.g. persons who inject drugs, homelessness). Cost effectiveness was evaluated as total healthcare-related costs between groups. Clinical failure was a composite endpoint of mortality, recurrence, or need for extended antibiotics beyond planned course within 90 days of initial infection. Secondary outcomes included hospital length of stay and proportion of patients who left against medical advice (AMA). Results A total of 46 patients were included (23 per group). The most frequent indication was endovascular infection and the most common organism methicillin-resistant Staphylococcus aureus. The average length of stay was 22.9 days vs. 31.9 days in the LaLGP and SOC cohorts, respectively (p=0.153). The average total healthcare-related cost of care was USD &295,589 in the LaLGP cohort compared to &326,089 in the SOC cohort (p=0.282). LaLGPs were associated with a mean savings of &30,500 - &55,831 per patient (cumulative cost savings of &701,510). There was no difference in clinical failure between the two cohorts (22% vs. 30%; p=0.491). Nearly 26% of patients in the SOC cohort left AMA compared to 0% in the LaLGP cohort (p=0.022). Conclusion Receipt of LaLGPs may be a beneficial treatment option for patients with socioeconomic factors and deep-seated infections who are not candidates for oral transition or OPAT. Disclosures Julie Ann Justo, PharmD, MS, BCPS-AQ ID, bioMerieux (Speaker’s Bureau)Merck & Co. (Advisor or Review Panel member)Therapeutic Research Center (Speaker’s Bureau)Vaxart (Shareholder) P. Brandon Bookstaver, Pharm D, ALK Abello, Inc. (Grant/Research Support, Advisor or Review Panel member)Biomerieux (Speaker’s Bureau)Kedrion Biopharma (Grant/Research Support, Advisor or Review Panel member)

Upregulated PD-1 Signaling is an Important Antagonist to Glomerular Health in Aged Kidneys

Kidney aging and its contribution to disease and its underlying mechanisms are not well understood. With an aging population, kidney health becomes an important medical and socioeconomic factor. We previously showed that podocytes isolated from aged mice exhibit increased expression of Programed Cell Death Protein 1 (PD-1) surface receptor and its two ligands (PD-L1, PD-L2). PDCD1 transcript increases with age in micro-dissected human glomeruli, which correlates with lower eGFR, and higher segmental glomerulosclerosis and vascular arterial intima to lumen ratio. In vitro studies in podocytes demonstrate a critical role for PD-1 signaling in cell survival and induction of a Senescence-Associated Secretory Phenotype (SASP). To prove PD-1 signaling is critical to podocyte aging, aged mice were injected with anti-PD-1 antibody (aPD-1ab). Treatment significantly improved the aging phenotype in both kidney and liver. In the glomerulus, it increased the life-span of podocytes, but not parietal epithelial, mesangial or endothelial cells. Transcriptomic and immunohistochemistry studies demonstrate that anti-PD-1 treatment improved the health-span of podocytes. It restored the expression of canonical podocyte genes, transcription factors and gene regulatory networks, increased cellular metabolism signatures and lessened SASPs. These results suggest a critical contribution for increased PD-1 signaling towards both kidney and liver aging.

Clinical Presentation, Risk Factors and Outcomes of Demographic Analysis of Blepharitis in Adults Presenting at Multiple Healthcare Centres

Objective: To identify symptoms, risk factors and outcomes of demographic analysis in adult patients withblepharitis.Study Design: Cross-sectional study.Place and Duration: The study was conducted in the Department of Ophthalmology at THQ Hospital, Kabirwala from 8 January 2020 to 8 June 2020.Materials and Methods: 100 patients were included in the study. Aged above 21 with symptoms of Blepharitis.Fluorescein strips and Slit lamp 90 D techniques were used to evaluate the patients for the presence of visualindications of blepharitis.Results: Sixty-five females and thirty-five males were included in the study. The age group of 21-30 years hadthe highest number of patients. Dry eyes, poor hygiene, low-socioeconomic factor and seborrhoea dermatitiswere significant risk factors. Most common symptoms included irritation, foreign body sensation, swelling overeyelids, hyperaemia, Epiphora and photosensitivity.Conclusion: Proper guidelines for protection and good hygiene should be provided to people. Dry eyes, poorhygiene, low-socioeconomic factor, seborrhoea dermatitis, irritation, foreign body sensation, swelling overeyelids, hyperaemia, Epiphora and photosensitivity are the most common symptoms and risk factors to find thereason behind Blepharitis, in this study. Females, due to their hormonal changes, are more prone to having thisdisease.

The Evolution of the Interactive Relationship between Urbanization and Land-Use Transition: A Case Study of the Yangtze River Delta

In recent years, the impact of land-use systems on global climate change has become increasingly significant, and land-use change has become a hot issue of concern to academics, both within China and abroad. Urbanization, as an important socioeconomic factor, plays a vital role in promoting land-use transition, which also shows a significant spatial dependence on urbanization. This paper constructs a theoretical framework for the interaction relationship between urbanization and land-use transition, taking the Yangtze River Delta as an example, and measures the level of urbanization from the perspective of population urbanization, economic urbanization and social urbanization, while also evaluating the level of land-use morphologies from the perspective of dominant and recessive morphologies of land-use. We construct a PVAR model and coupled coordination model based on the calculated indexes for empirical analysis. The results show that the relationship between urbanization and land-use transition is not a simple linear relationship, but tends to be complex with the process of urbanization, and reasonable urbanization and land-use morphologies will promote further benign coupling in the system. By analyzing the interaction relationship between urbanization and land-use transition, this study enriches the study of land-use change and provides new pathways for thinking about how to promote high-quality urbanization.

The biomedical, socioeconomic and demographic predictors of heart failure readmissions

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Sydney Local Health District Introduction Heart failure hospitalisations and readmissions pose a significant clinical and economic burden internationally. Current studies support a range of biomedical and sociodemographic factors as predictors of HF readmissions; however, there are a paucity of studies synthesising the research on this topic. Purpose The purpose of this systematic review was to identify biomedical, socioeconomic and demographic predictors of heart failure-related readmissions in adults with heart failure. Methods Electronic databases (Medline, Embase and Scopus) were searched using a structured search strategy. The particular risk factors of interest were left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) function class, brain natriuretic peptide (BNP), heart rate, blood pressure, employment status, income, age, sex, ethnicity, indigenous status, marital status, and socioeconomic indexes for areas (SEIFA) scores. After the removal of duplicates, the article selection process was conducted by two independent authors according to an inclusion and exclusion criteria. The articles were first filtered by title and abstract against the inclusion and exclusion criteria. The remaining articles were then assessed by reviewing the studies in full text. The relevant Critical Appraisal Skills Programme (CASP) tools were then used to appraise the final articles included for review. Results In total 1,516 papers were retrieved from the search. Of the 1,516 papers, 666 were from Medline, 567 were from CINAHL, 282 were from Embase, and one paper was from an independent search. After the removal of duplicates, 1296 papers were filtered according to title and abstract and 1183 papers were excluded from this process. 95 papers were assessed by reading them in full and of the 95 papers, 77 were excluded. This resulted in eighteen studies being included for review. Unemployment was the only socioeconomic factor predictive of HF readmissions (HR = 1.09; 95%CI= 1.05-1.14; p = 0.03) and SEIFA scores did not predict HF readmissions in adults with HF (p &gt; 0.05). Indigenous status was a risk factor of HF readmissions according to one study (p &lt; 0.05). Age or sex did not affect the risk of HF readmissions in adults with HF (p &gt; 0.05). NYHA function class, BNP levels, and heart rate predicted HF readmissions in the population of interest. LVEF and blood pressure were non-significant predictors of HF readmissions (p &gt; 0.05). Conclusions Current HF guidelines have a strong biomedical focus in the management of HF patients. This review however, shows there are sociodemographic factors that are predictive of HF readmissions in addition to the biomedical predictors that have been more extensively studied. Future studies should examine their combined effect on readmission risk and the early interventions to prevent readmissions.

Patterns and predictors of sick leave after Covid-19 and long Covid in a national Swedish cohort

Background The impact of Covid-19 and its long-term consequences is not yet fully understood. Sick leave can be seen as an indicator of health in a working age population, and the present study aimed to investigate sick-leave patterns after Covid-19, and potential factors predicting longer sick leave in hospitalised and non-hospitalised people with Covid-19. Methods The present study is a comprehensive national registry-based study in Sweden with a 4-month follow-up. All people who started to receive sickness benefits for Covid-19 during March 1 to August 31, 2020, were included. Predictors of sick leave ≥1 month and long Covid (≥12 weeks) were analysed with logistic regression in the total population and in separate models depending on inpatient care due to Covid-19. Results A total of 11,955 people started sick leave for Covid-19 within the inclusion period. The median sick leave was 35 days, 13.3% were on sick leave for long Covid, and 9.0% remained on sick leave for the whole follow-up period. There were 2960 people who received inpatient care due to Covid-19, which was the strongest predictor of longer sick leave. Sick leave the year prior to Covid-19 and older age also predicted longer sick leave. No clear pattern of socioeconomic factors was noted. Conclusions A substantial number of people are on sick leave due to Covid-19. Sick leave may be protracted, and sick leave for long Covid is quite common. The severity of Covid-19 (needing inpatient care), prior sick leave, and age all seem to predict the likelihood of longer sick leave. However, no socioeconomic factor could clearly predict longer sick leave, indicating the complexity of this condition. The group needing long sick leave after Covid-19 seems to be heterogeneous, indicating a knowledge gap.