COVID-19 inequalities in England: a mathematical modelling study of transmission risk and clinical vulnerability by socioeconomic status

BACKGROUND

The COVID-19 pandemic resulted in major inequalities in infection and disease burden between areas of varying socioeconomic deprivation in many countries, including England. Areas of higher deprivation tend to have a different population structure-generally younger-which can increase viral transmission due to higher contact rates in school-going children and working-age adults. Higher deprivation is also associated with a higher presence of chronic comorbidities, which were convincingly demonstrated to be risk factors for severe COVID-19 disease. These two major factors need to be combined to better understand and quantify their relative importance in the observed COVID-19 inequalities.

METHODS

We used UK Census data on health status and demography stratified by decile of the Index of Multiple Deprivation (IMD), which is a measure of socioeconomic deprivation. We calculated epidemiological impact using an age-stratified COVID-19 transmission model, which incorporated different contact patterns and clinical health profiles by decile. To separate the contribution of each factor, we considered a scenario where the clinical health profile of all deciles was at the level of the least deprived. We also considered the effectiveness of school closures and vaccination of over 65-year-olds in each decile.

RESULTS

In the modelled epidemics in urban areas, the most deprived decile experienced 9% more infections, 13% more clinical cases, and a 97% larger peak clinical size than the least deprived; we found similar inequalities in rural areas. Twenty-one per cent of clinical cases and 16% of deaths in England observed under the model assumptions would not occur if all deciles experienced the clinical health profile of the least deprived decile. We found that more deaths were prevented in more affluent areas during school closures and vaccination rollouts.

CONCLUSIONS

This study demonstrates that both clinical and demographic factors synergise to generate health inequalities in COVID-19, that improving the clinical health profile of populations would increase health equity, and that some interventions can increase health inequalities.

Study protocol: improving response to malaria in the Amazon through identification of inter-community networks and human mobility in border regions of Ecuador, Peru and Brazil

INTRODUCTION

Understanding human mobility's role in malaria transmission is critical to successful control and elimination. However, common approaches to measuring mobility are ill-equipped for remote regions such as the Amazon. This study develops a network survey to quantify the effect of community connectivity and mobility on malaria transmission.

METHODS

We measure community connectivity across the study area using a respondent driven sampling design among key informants who are at least 18 years of age. 45 initial communities will be selected: 10 in Brazil, 10 in Ecuador and 25 in Peru. Participants will be recruited in each initial node and administered a survey to obtain data on each community's mobility patterns. Survey responses will be ranked and the 2-3 most connected communities will then be selected and surveyed. This process will be repeated for a third round of data collection. Community network matrices will be linked with each country's malaria surveillance system to test the effects of mobility on disease risk.

ETHICS AND DISSEMINATION

This study protocol has been approved by the institutional review boards of Duke University (USA), Universidad San Francisco de Quito (Ecuador), Universidad Peruana Cayetano Heredia (Peru) and Universidade Federal Minas Gerais (Brazil). Results will be disseminated in communities by the end of the study.

The fortunes and misfortunes of social life across the life course: A new era of research from field, laboratory and comparative studies

Social gradients in health and aging have been reported in studies across many human populations, and - as the papers included in this special collection highlight - also occur across species. This paper serves as a general introduction to the special collection of Neuroscience and Biobehavioral Reviews entitled "Social dimensions of health and aging: population studies, preclinical research, and comparative research using animal models". Authors of the fourteen reviews are primarily members of a National Institute of Aging-supported High Priority Research Network on "Animal Models for the Social Dimensions of Health and Aging". The collection is introduced by a foreword, commentaries, and opinion pieces by leading experts in related fields. The fourteen reviews are divided into four sections: Section 1: Biodemography and life course studies; Section 2: Social behavior and healthy aging in nonhuman primates; Section 3: Social factors, stress, and hallmarks of aging; Section 4: Neuroscience and social behavior.

On the estimation of genome-average recombination rates

The rate at which recombination events occur in a population is an indicator of its effective population size and the organism's reproduction mode. It determines the extent of linkage disequilibrium along the genome and, thereby, the efficacy of both purifying and positive selection. The population recombination rate can be inferred using models of genome evolution in populations. Classic methods based on the patterns of linkage-disequilibrium provide the most accurate estimates, providing large sample sizes are used and the demography of the population is properly accounted for. Here, the capacity of approaches based on the sequentially Markov coalescent (SMC) to infer the genome-average recombination rate from as little as a single diploid genome is examined. SMC approaches provide highly accurate estimates even in the presence of changing population sizes, providing that (1) within genome heterogeneity is accounted for and (2) classic maximum-likelihood optimization algorithms are employed to fit the model. SMC-based estimates proved sensitive to gene conversion, leading to an overestimation of the recombination rate if conversion events are frequent. Conversely, methods based on the correlation of heterozygosity succeed in disentangling the rate of crossing over from that of gene conversion events, but only when the population size is constant and the recombination landscape homogeneous. These results call for a convergence of these two methods to obtain accurate and comparable estimates of recombination rates between populations.

Cause-Specific Mortality and Racial Differentials in Life Expectancy, Chicago 2018-2019

BACKGROUND

In Chicago in 2018, the average life expectancy (ALE) for NH Blacks was 71.5 years, 9.1 fewer years than for NH Whites (80.6 years). Inasmuch as some causes of death are increasingly recognized products of structural racism, in urban areas, such causes may have potential for reducing racial inequities through public health intervention. Our purpose is to allocate racial inequities in ALE in Chicago to differentials in cause-specific mortality.

METHODS

Using multiple decrement processes and decomposition analysis, we examine cause-specific mortality in Chicago to determine the causes of death that contribute to the gap in life expectancy between NH Blacks and NH Whites.

RESULTS

Among females, the racial difference in ALE was 8.21 years; for males, it was 10.53 years. We find that cancer and heart disease mortality account for 3.03 years or 36% of the racial gap in average life expectancy among females. Differences in homicide and heart disease mortality rates comprised over 45% of the disparity among males.

CONCLUSIONS

Strategies for improving inequities in life expectancy should account for differences between males and females in cause-specific mortality rates. In urban areas with high levels of segregation, reducing inequities in ALE may be possible by dramatically reducing mortality rates from some causes.

CONTRIBUTION

This paper illustrates the state of inequities in ALE between NH Blacks and NH Whites in Chicago for the period just prior to the onset of the COVID-19 pandemic, using a well-established method of decomposing mortality differentials for sub-populations.

Return rate following a live birth obtained with ART: frequency and determinants

PURPOSE

To understand how often couples return to ART centres for a second child.

METHODS

Retrospective monocentric cohort study including women who had a first live birth with IVF. The primary objective was to assess the rate of those returning for a second child within five years of the previous pregnancy. The secondary aim was to disentangle the determinants of this rate.

RESULTS

A total of 374 patients were included, of whom 188 returned (50%, 95% CI 45-55%). Among those who did not return (n = 186), four (2%) referred to another ART Center and 24 were unreachable. Of the 158 contacted subjects that did not refer for ART, 53 (34%, 95% CI 27-41%) conceived naturally, 57 (36%, 95% CI 29-44%) abandoned their intent of parenthood, and 48 (30%, 95% CI 24-38%) unsuccessfully attempted natural conception. These 48 women (13%) who expressed interest in a second child but did not undergo ART were compared to those seeking a second pregnancy through ART. Baseline characteristics were similar except for an older age (Median 36, IQR: 34-38 vs 34, IQR: 32-36, p = 0.001). Additionally, in terms of IVF cycle characteristics, women who did not return were more likely to achieve their first pregnancy with a fresh transfer rather than a frozen transfer (75% vs 59%, p = 0.05). They also had a higher number of retrieved oocytes (Median 10, IQR: 7-13 vs 9, IQR: 5-12) and less frequently cryopreserved embryos (27% vs 52%, p = 0.003).

CONCLUSION

The proportion of couples who have conceived with ART and who are interested in having a second child is high. Our results underline the importance of paying more attention to the number of intended children, as this information could influence clinical management.

Population diversity, admixture, and demographic trend of the Sumba Ongole cattle based on genomic data

OBJECTIVE

Sumba Ongole (SO) cattle are valuable breed due to their important role in the development of Indonesian cattle. Despite rapid advances in molecular technology, no genomic studies on SO cattle have been conducted to date. The aim of this study is to provide genomic profile related to the population diversity, admixture, and demographic trends of SO cattle.

METHODS

Genomic information was gathered from 79 SO cattle using the Illumina Bovine SNP50 v3 Beadchip, and for comparative purposes, additional genotypes from 209 cattle populations worldwide were included. The expected and observed heterozygosity, inbreeding coefficient, pairwise fixation indices between-population, and Nei's genetic distance were examined. Multidimensional scaling, admixture, and treemix analyses were used to investigate the population structure. Based on linkage disequilibrium and effective population size calculations, the demographic trend was observed.

RESULTS

The findings indicated that the genetic diversity of SO cattle was similar to that of other indicine breeds. SO cattle were genetically related to indicines but not to taurines or Bali cattle. The study further confirmed the close relationship between SO, Ongole, and Nellore cattle. Additionally, a small portion of the Ongole mixture were identified dominant in the SO population at the moment. The study also discovered that SO and Bali cattle (Bos javanicus) could have been ancestors in the development of Ongole Grade cattle, which corresponds to the documented history of Ongolization. Our finding indicate that SO cattle have maintained stability and possess unique traits separate from their ancestors.

CONCLUSION

In conclusion, the genetic diversity of the SO cattle has been conserved as a result of the growing significance of the present demographic trend. Consistent endeavors are necessary to uphold the fitness of the breed.

Gender distribution in surgical pathology journal publications and editorial boards

AIMS

To investigate trends in representation of women among authors and editorial boards of surgical pathology journals over the last two decades.Secondary aims: to identify barriers and potential solutions.

METHODS

The names and gender of first, middle, last authors and editorial board members were obtained from original articles from seven pathology journals from various geopolitical regions in 2002, 2011 and 2021. The proportion of women first, middle, last authors and editorial board members were compared over time.

RESULTS

1097 publications and 8012 individual authors were extracted. In 2002, 2011 and 2021, respectively, the percentage of women first authors were 28.3% (257 of 907), 31.9% (566 of 1773) and 41.1% (1421 of 3457); women middle authorship rates were 30.0% (159 of 530), 32.8% (375 of 1145) and 40.9% (1067 of 2609) and women last authors were 18.0% (34 of 188), 26.0% (82 of 315) and 36.0% (152 of 422). Women representation on editorial boards has increased (11.3%, 15.8%, 26.5%), but of the chief editors, there was only one woman in 2021, while all were men in 2002 and 2011.

CONCLUSIONS

To our knowledge, this study is the first to document under-representation of women among authors and editorial boards of surgical pathology journals. While women representation has increased over time, predominance of men remains relative to workforce proportions. Our findings are comparable to those from other medical fields and prompt the need to investigate the underlying causes for this imbalance and implement strategies to promote diversity, equity and inclusion in academic surgical pathology.

Untwisting healthcare access disparities: A comprehensive analysis of demographic, socio-economic and racial disparities impacting patient outcomes in myocardial infarction patients

INTRODUCTION

Myocardial infarction (MI) is one of the most life-threatening pathologies characterized by sudden cardiac death and is among the leading causes of mortality in the developed world.

AIMS

This study investigates the demographic, socio-economic, and healthcare access disparities in the US among patients with myocardial infarction (MI).

METHODOLOGY

This was a retrospective original research study conducted using the BRFSS (Behavioural risk factor surveillance system) database of CDC (Centers for disease control and prevention).Data was extracted from the BRFSS on 3rd January 2024 to identify patients with MI in the year 2021 and multivariate models were used to assess the relationship between factors such as age, gender, income levels, and education in patients with myocardial infarction.

RESULTS

Individuals in the age group of 65 years or older constituted the highest percentage of MI cases at 66.33% (OR, 16.66; 95% CI, 10.27-27.02; p-value <0.0001).Males showed a higher prevalence of MI, accounting for 61.19% of cases, and females demonstrated lower susceptibility (OR, 0.46; 95% CI, 0.43-0.50; p-value <0.0001).High school graduates (Grade 12 or GED) exhibited the highest incidence at 32.08% (OR, 1.44; 95% CI, 0.81-2.56; p-value 0.2084). Retirees accounted for the highest incidence at 56.06%, with significantly increased odds compared to those employed for wages (OR, 1.93; 95% CI, 1.71-2.19; p-value <0.0001).The analysis of income levels indicated the highest MI incidence in the $25,000 <= Income < $35,000 group (17.31% of cases).

CONCLUSIONS

Additional research is necessary to further disentangle the interaction between MI and factors such as age, gender, education level, race, employment status, and income level, and as the findings of this study suggest, retired individuals and individuals from lower-income groups indicate a disparity in access to timely treatment regarding MI. Thus, the determination of such discrepancies needs to be addressed regarding how such factors affect access to timely healthcare, especially in matters of widely prevalent diseases such as MI.

Machine learning study using 2020 SDHS data to determine poverty determinants in Somalia

Extensive research has been conducted on poverty in developing countries using conventional regression analysis, which has limited prediction capability. This study aims to address this gap by applying advanced machine learning (ML) methods to predict poverty in Somalia. Utilizing data from the first-ever 2020 Somalia Demographic and Health Survey (SDHS), a cross-sectional study design is considered. ML methods, including random forest (RF), decision tree (DT), support vector machine (SVM), and logistic regression, are tested and applied using R software version 4.1.2, while conventional methods are analyzed using STATA version 17. Evaluation metrics, such as confusion matrix, accuracy, precision, sensitivity, specificity, recall, F1 score, and area under the receiver operating characteristic (AUROC), are employed to assess the performance of predictive models. The prevalence of poverty in Somalia is notable, with approximately seven out of ten Somalis living in poverty, making it one of the highest rates in the region. Among nomadic pastoralists, agro-pastoralists, and internally displaced persons (IDPs), the poverty average stands at 69%, while urban areas have a lower poverty rate of 60%. The accuracy of prediction ranged between 67.21% and 98.36% for the advanced ML methods, with the RF model demonstrating the best performance. The results reveal geographical region, household size, respondent age group, husband employment status, age of household head, and place of residence as the top six predictors of poverty in Somalia. The findings highlight the potential of ML methods to predict poverty and uncover hidden information that traditional statistical methods cannot detect, with the RF model identified as the best classifier for predicting poverty in Somalia.

Women's Empowerment and Infant Mortality: Evidence from Rwanda

INTRODUCTION

Rwanda stands out in East Africa with the lowest infant mortality ratio at 29 per 1000 live births. It also leads in gender equality on the African continent, ranking sixth globally according to the 2022 Global Gender Gap Report. This makes Rwanda an ideal case for studying the link between women's empowerment and infant mortality.

METHOD

This study aims to assess the impact of women's empowerment on infant mortality using data obtained from the Rwanda Demographic and Health Survey conducted in 2005, 2010, and 2015. A three-category women's empowerment index was created using the principal component analysis method. The statistical analysis employed in this study is multivariate binary logistic regression.   RESULTS: Results demonstrate a significant impact of women's empowerment on reducing infant mortality, considering regional and residential inequalities, bio-demographic factors, and healthcare variables.

CONCLUSION

The findings contribute to existing literature and highlight the importance of empowering women to improve maternal and child health outcomes. Such empowerment not only enhances health but also supports sustainable development and social progress. Policymakers, healthcare providers, and organizations should prioritize investing in women's empowerment to achieve maternal and child health goals, as empowered women play a pivotal role in driving positive change for a healthier and more equitable society.

Untwisting healthcare access disparities: A comprehensive analysis of demographic, socio-economic and racial disparities impacting patient outcomes in myocardial infarction patients

INTRODUCTION

Myocardial infarction (MI) is one of the most life-threatening pathologies characterized by sudden cardiac death and is among the leading causes of mortality in the developed world.

AIMS

This study investigates the demographic, socio-economic, and healthcare access disparities in the US among patients with myocardial infarction (MI).

METHODOLOGY

This was a retrospective original research study conducted using the BRFSS (Behavioural risk factor surveillance system) database of CDC (Centers for disease control and prevention).Data was extracted from the BRFSS on 3rd January 2024 to identify patients with MI in the year 2021 and multivariate models were used to assess the relationship between factors such as age, gender, income levels, and education in patients with myocardial infarction.

RESULTS

Individuals in the age group of 65 years or older constituted the highest percentage of MI cases at 66.33% (OR, 16.66; 95% CI, 10.27-27.02; p-value <0.0001).Males showed a higher prevalence of MI, accounting for 61.19% of cases, and females demonstrated lower susceptibility (OR, 0.46; 95% CI, 0.43-0.50; p-value <0.0001).High school graduates (Grade 12 or GED) exhibited the highest incidence at 32.08% (OR, 1.44; 95% CI, 0.81-2.56; p-value 0.2084). Retirees accounted for the highest incidence at 56.06%, with significantly increased odds compared to those employed for wages (OR, 1.93; 95% CI, 1.71-2.19; p-value <0.0001).The analysis of income levels indicated the highest MI incidence in the $25,000 <= Income < $35,000 group (17.31% of cases).

CONCLUSIONS

Additional research is necessary to further disentangle the interaction between MI and factors such as age, gender, education level, race, employment status, and income level, and as the findings of this study suggest, retired individuals and individuals from lower-income groups indicate a disparity in access to timely treatment regarding MI. Thus, the determination of such discrepancies needs to be addressed regarding how such factors affect access to timely healthcare, especially in matters of widely prevalent diseases such as MI.

Early post-settlement events, rather than settlement, drive recruitment and coral recovery at Moorea, French Polynesia

Understanding population dynamics is a long-standing objective of ecology, but the need for progress in this area has become urgent. For coral reefs, achieving this objective is impeded by a lack of information on settlement versus post-settlement events in determining recruitment and population size. Declines in coral abundance are often inferred to be associated with reduced densities of recruits, which could arise from mechanisms occurring at larval settlement, or throughout post-settlement stages. This study uses annual measurements from 2008 to 2021 of coral cover, the density of coral settlers (S), the density of small corals (SC), and environmental conditions, to evaluate the roles of settlement versus post-settlement events in determining rates of coral recruitment and changes in coral cover at Moorea, French Polynesia. Coral cover, S, SC, and the SC:S ratio (a proxy for post-settlement success), and environmental conditions, were used in generalized additive models (GAMs) to show that: (a) coral cover was more strongly related to SC and SC:S than S, and (b) SC:S was highest when preceded by cool seawater, low concentrations of Chlorophyll a, and low flow speeds, and S showed evidence of declining with elevated temperature. Together, these results suggest that changes in coral cover in Moorea are more strongly influenced by post-settlement events than settlement. The key to understanding coral community resilience may lie in elucidating the factors attenuating the bottleneck between settlers and small corals.

Medical demography at stroke centers: Current situation in France

INTRODUCTION

Following the 2010-2014 French national stroke action plan, the number of stroke center (SC) has gradually increased in France, allowing a homogeneous coverage and access to neurovascular care in organized and territorially defined structures. However, operational difficulties within SCs have been progressively reported over the last few years. The objective of this study was to identify the medical staff shortages in SC that may contribute to these difficulties.

METHODS

A survey on the medical staffing level as of January 1, 2021 was sent to all French SC managers. Specific questions related on vacancies, need of interim medical staff, and participation in out-of-hour healthcare services.

RESULTS

Among the 139 SC managers contacted, 122 (88%) filled in the questionnaire. Analysis of the data showed that over 879 physician positions opened, 163 (18.5%) remained vacant for a mean of two years, and that in 51 SCs (41.9%), more than two positions were unfilled. In 13 of these 51 SCs, the out-of-hour healthcare services relied on less than four practitioners, defining a critical situation, and three other SCs had to close temporarily (2) or permanently (1). Moreover, 39.2% of SCs with at least one vacancy used interim physicians, for a median period of 12.5 weeks/year (IQR 5-18).

CONCLUSION

This study highlights the significant medical staff shortage in French SCs. In the absence of urgent measures, more SCs will close, jeopardizing the regional network and access to care for stroke patients.

Differences in health-related quality of life between native and foreign-born gynaecological cancer patients in Sweden: a five-year cross-sectional study

PURPOSE

To examine differences in health-related quality of life (HRQoL) between native and foreign-born gynaecological cancer patients in Sweden, taking into account clinical, demographic, and socioeconomic factors.

METHODS

The 30-item European Organisation for Research and Treatment of Cancer quality of life questionnaire (QLQ-C30) and a study-specific questionnaire covering demographic and socioeconomic factors were answered by 684 women aged ≥ 18 years old, diagnosed in 2014, 2016, or 2018 with gynaecological cancer in the Stockholm-Gotland health care region, Sweden. Clinical data were obtained from the Swedish Cancer Register. Data were analysed using the Kruskal-Wallis test and linear regression.

RESULTS

The women had a mean age of 65.4 years, with 555 (81.1%) born in Sweden, 54 (7.9%) in other Nordic countries (ONC), 43 (6.3%) in other European countries (OEC), and 32 (4.7%) in non-European countries (NEC). HRQoL differed significantly between the four groups for 14 of the 15 QLQ-C30 scales/items. On average, Swedish-born women scored 2.0, 15.2, and 16.7 points higher for QoL/functioning scales/items and 2.2, 14.1, and 18.7 points lower for symptom scales/items, compared with ONC-, OEC-, and NEC-born women, respectively. In adjusted analyses, none of the differences between Swedish-born and ONC-born women were significant, while for OEC- and NEC-born women the differences were significant for most QLQ-C30 scales/items.

CONCLUSION

HRQoL differs between native and foreign-born gynaecological cancer patients in Sweden, with lower HRQoL the further from Sweden the women are born. A more individualised cancer care, with tailored support to optimize HRQoL is needed for this vulnerable group of patients.

Religion and Fertility: A Longitudinal Register Study Examining Differences by Sex, Parity, Partner's Religion, and Religious Conversion in Finland

We use longitudinal data on religious affiliation in Finland to examine childbearing behavior. All analyses are based on detailed fertility information from the Finnish national register of each person's religious denomination for men and women born in 1956-1975. We identify higher fertility according to parity among members of the Evangelical Lutheran state church and other Protestant churches, and lower fertility among individuals with no religious affiliation. Most other religious groups-Orthodox Christians, Jews, Muslims, and adherents of Eastern religions-have intermediate levels of fertility. We also find that religious converts, that is, those observed with more than one religious denomination over their life course, typically are similar to the non-converts of the group they convert to, though with more distinct deviations from the Finnish population. Women show larger differences by religious affiliation than men. We find the largest differences across religions when we examine the proportion of childless men and women. Overall, differences between religious groups are rather modest, and childbearing patterns are quite similar. Our results provide, to our knowledge, the first examination of religion and fertility using national-level longitudinal data.

Clinical profile of 1208 newly diagnosed colorectal cancer patients in Tamil Nadu-A multi-centric survey

BACKGROUND

An increasing incidence of colorectal cancer (CRC) is being reported in developing countries, including India. Most Indian studies on CRC are retrospective and single-centered. The present study is an attempt to understand the current clinical profile and stage of newly diagnosed CRCs across multiple centers in Tamil Nadu, India.

METHODS

A multi-centric observational survey was conducted between September 1, 2021, and August 31, 2022, under the aegis of the Indian Society of Gastroenterology - Tamil Nadu chapter. Patients 18 years of age and older with a recent diagnosis of CRC fulfilling the inclusion criteria were prospectively recruited at the participating centers. Their demographic, clinical, biochemical, endoscopic, histopathologic, radiologic and risk factor details were systematically collected and analyzed.

RESULTS

Across 23 centers in Tamil Nadu, 1208 patients were recruited. The male:female ratio was 1.49:1, while mean (SD) age was 57.7 (13.5) years. A majority (81.9%) were Tamils and 78.5% belonged to lower socioeconomic classes. The predominant symptoms were hematochezia (30.2%) and a change in bowel habits (27.5%). The most common locations were the rectum (34.3%) and rectosigmoid (15.1%). Synchronous CRCs were seen in 3.3% and synchronous colorectal polyps in 12.8%. Predisposing factors for CRC were seen in 2%. A past history of any cancer among CRC patients was obtained in 3.1% and a family history of any cancer was found in 7.6%. Patients who were either overweight or obese constituted 46.4% of the study population. At presentation, the predominant stages were stage III (44.7%) and stage IV (20.8%).

CONCLUSIONS

A majority of patients with newly diagnosed CRC in Tamil Nadu belonged to the lower socioeconomic classes. About 60% had CRCs located within the reach of the flexible sigmoidoscope. Two-thirds of the patients exceeded stage II disease at presentation.

TRIAL REGISTRATION

Not applicable.

Jump dispersal drives the relationship between micro- and macroevolutionary dynamics in the Sicydiinae (Gobiiformes: Oxudercidae) of Sundaland and Wallacea

Insular biodiversity hotspots of Southeast Asia are remarkable for their biodiverse faunas. With a marine larval phase lasting up to several months, the freshwater fish subfamily Sicydiinae has colonized most islands of these hotspots. However, Sicydiinae diversity is still poorly understood in Southeast Asia. With the objective to estimate intraspecific genetic diversity and infer past demography, we conducted the molecular inventory of Sicydiinae species in Sundaland and Wallacea using 652 bp of the mitochondrial cytochrome oxidase I gene, species delimitation methods and Bayesian Skyline plot reconstructions. In total, 24 Molecular Operational Taxonomic Units are delimited among the 603 sequences belonging to 27 species and five genera. Two cases of discordance between morphology and mitochondrial sequence are observed suggesting ongoing speciation and/or introgression in two genera. Multiple new occurrences are reported, either for a single biodiversity hotspot or both, some of which corresponding to observations of a few individuals far from the range distribution of their conspecifics. Among the ten species or species group whose intraspecific diversity was examined, high levels of genetic diversity and past population expansion are revealed by Tajima's D tests and Bayesian Skyline Plot reconstructions. Together these results indicate that long-distance dispersal is common and suggest that most endemic species originated through founder events followed by population expansion. Patterns of sexual dimorphism and males' coloration among diverging species pair seem to point to sexual selection as an important mechanism contributing to speciation in the Sicydiinae of Sundaland and Wallacea.

[Change in the age spectrum in strabismus surgery]

BACKGROUND

The proportion of children undergoing strabismus surgery in the total volume of eye muscle operations appears to have decreased. To verify this we analyzed the age of patients who underwent extraocular muscle (EOM) surgery.

METHODS

The data of patients who underwent EOM surgery at the University Eye Hospital Giessen between 1991 and 2019 were reviewed and the numbers of operations in decadal age groups were compared to the German population in the respective period. In addition, the types of strabismus which led to surgery were evaluated. The data pool comprised > 25,000 surgeries involving > 60,000 muscles.

RESULTS

In comparison to 1991, in 2019 the proportion of children aged ≤ 10 years decreased from 50.2% to 31.8%, corresponding to a relative decrease of more than one third. The proportion of patients aged > 50 years increased from 6.5% to 22.5%, i.e., by a factor > 3, while the population ≤ 10 years in 2019 was 13% smaller than in 1991 and the population aged > 50 years increased by 37%. The major reason for the decreasing proportion of children was a 53% reduction in surgery for esotropia. We found no apparent changes in the 2nd-5th decades of life.

DISCUSSION AND CONCLUSION

The lower proportion of children undergoing EOM surgery appears to indicate an improvement in vision screening during the past 4 decades. The increasing proportion of older patients may result from better information on potential treatment and increased incidence of acquired strabismus with corresponding complaints. The demographic shift played a secondary role. Due to the population structure in Germany, a further increase in the demand for EOM surgery is to be expected.

Pattern and Severity of Allergic Rhinitis Correlated with Patient Characteristics: A Rural Hospital-Based Cross-Sectional Study

Allergic Rhinitis (AR) is rising in incidence in both developed and developing countries. Genetics and epigenetics have a potential role to play. The pattern and severity of AR have implications with regard to choice of treatment, which itself could be related to patient specific genetic and epigenetic factors. Hence, the present study was undertaken to correlate the patient characteristics with AR pattern and severity, in order to understand the pathophysiology of AR. The study also aimed to find out the allergen sensitivity pattern among patients attending a tertiary care centre of rural central India, where climatic variations make it a high prevalence zone. Prospective Observational study on 90 patients with clinically diagnosed Allergic Rhinitis confirmed by Skin Prick Tests. Patient characteristics like demographic data, data relevant to allergen exposure, occupation, family history of atopy and gender; and Disease characteristics like severity (mild, mod-severe), pattern (continuous/ intermittent), type of disease (seasonal/perennial) were noted, analysed and correlation studied. Majority of the patients with AR were in the age group of 15-40 years. Medical students (52%) suffered from moderate to severe type of Allergic Rhinitis, with Persistent disease in approximately 80%. Similarly, 70.59% of farmers had moderate to severe type of the disease, with persistent disease in 70%. In the present study, in clinically diagnosed allergic rhinitis patients, Mite was the commonest allergen found on Skin Prick Test overall and in Medical students, whereas Pollen sensitivity was more common among farmers. 56.66% of the patients had negative family history of atopy. Severity and type of AR depend on allergen exposure. In farmers and medical professionals, persistent and moderate to severe type of disease was more common, as they were persistently exposed to different type of allergens, mites in case of medical professionals and pollens in farmers. Hence, the Disease characteristics, as defined by ARIA guidelines, should not be taken in isolation and management should consider the Patient characteristics for deciding and devising protocols. In the present study, more than 50% patients were without family history of atopy. Hence, the role of various environmental factors, leading to epigenetic changes could be a major contributor in the increase in incidence of allergic rhinitis in recent times. Occurrence of perennial moderate to severe form of disease, in majority of farmers, defies the phenomenon of "Hygiene Hypothesis", focusing on the role of epigenetic changes and various outdoor allergens in the development of allergic rhinitis in them.

The impact of austerity on children: Uncovering effect heterogeneity by political, economic, and family factors in low- and middle-income countries

Which children are most vulnerable when their government imposes austerity? Research tends to focus on either the political-economic level or the family level. Using a sample of nearly two million children in 67 countries, this study synthesizes theories from family sociology and political science to examine the heterogeneous effects on child poverty of economic shocks following the implementation of an International Monetary Fund (IMF) program. To discover effect heterogeneity, we apply machine learning to policy evaluation. We find that children's average probability of falling into poverty increases by 14 percentage points. We find substantial effect heterogeneity, with family wealth and governments' education spending as the two most important moderators. In contrast to studies that emphasize the vulnerability of low-income families, we find that middle-class children face an equally high risk of poverty. Our results show that synthesizing family and political factors yield deeper knowledge of how economic shocks affect children.

Epidemiology of Traumatic Spinal Cord Injury in the Himalayan Range and Sub-Himalayan region: A Retrospective Hospital Data-Based Study

OBJECTIVE

To compile epidemiological characteristics of traumatic spinal cord injury (TSCI) in the Northern Indian Himalayan regions and Sub-Himalayan planes.

METHODS

The present study is a retrospective, cross-sectional descriptive analysis based on hospital data conducted at the Department of Physical Medicine and Rehabilitation and Spine Unit of Trauma Centre in a tertiary care hospital in Uttarakhand, India. People hospitalized at the tertiary care center between August 2018 and November 2021 are included in the study sample. A prestructured proforma was employed for the evaluation, including demographic and epidemiological characteristics.

RESULTS

TSCI was found in 167 out of 3,120 trauma patients. The mean age of people with TSCI was 33.5±13.3, with a male-to-female ratio of 2.4:1. Eighty-three participants (49.7%) were from the plains, while the hilly region accounts for 50.3%. People from the plains had a 2.9:1 rural-to-urban ratio, whereas the hilly region had a 6:1 ratio. The overall most prevalent cause was Falls (59.3%), followed by road traffic accidents (RTAs) (35.9%). RTAs (57.2%) were the most common cause of TSCI in the plains' urban regions, while Falls (58.1%) were more common in rural plains. In both urban (66.6%) and rural (65.3%) parts of the hilly region, falls were the most common cause.

CONCLUSION

TSCI is more common in young males, especially in rural hilly areas. Falls rather than RTAs are the major cause.

The burden of young-onset pancreatic cancer and its risk factors from 1990 to 2019: A systematic analysis of the global burden of disease study 2019

OBJECTIVE

To investigate worldwide incidence, deaths, disability-adjusted life years (DALYs) and risk factors for young-onset pancreatic cancer (YOPC) using the Global Burden of Disease Study 2019-20 data.

METHODS

We queried the Global Health Data Exchange tool for "pancreatic cancer" and "incidence", "deaths" as the "measure", and "DALYs" as the "cause" for the age group of 15-49 years to determine global, regional, and national trends in the incidence, deaths, and DALYs of YOPC. Sociodemographic index (SDI) was used to evaluate the associations between socioeconomic development and YOPC. Risk factors including smoking, tobacco use, hi2gh body mass index (BMI), and high fasting plasma glucose (FPG) were evaluated, and their attributable burden was estimated.

RESULTS

Global incidence, death, and DALY rates of YOPC significantly increased from 1990 to 2019 ((0.30 (p = 0.001), 0.25 (p = 0.001), and 11.18 (p = 0.002), respectively). Regions with the highest and lowest incidence, death, and DALY rates of YOPC were Eastern Europe and Central Sub-Saharan Africa, respectively. Incidence, death, and DALY rates increased with increasing age and SDI. Leading risk factors for YOPC in 2019 were smoking and tobacco use. DALYs attributable to smoking and tobacco use decreased from 1990 to 2019, especially in females, while those attributable to high BMI and FPG increased during the same period.

CONCLUSIONS

The global incidence, death and DALY rates of YOPC have significantly increased over 3 decades. Certain regions and nations are witnessing a higher increase in this trend. There is an urgent need for global efforts targeting preventable causes of YOPC.

Ecosystem productivity drives the breeding success of an endangered top avian scavenger in a changing grazing pressure context

Environmental conditions and resource availability shape population dynamics through direct and indirect effects of climate, biological interactions and the human modification of landscape. Even when a species seems dependent on predictable anthropogenic food resources or subsidies, ecosystem-level factors can still determine population dynamics across taxa. However, there is still a knowledge gap about the cascade effects driven by climate, vegetation functioning, resource availability and governmental policies on key aspects of species reproduction for top scavengers. Here we put to good use 22 years (2000-2021) of extensive population monitoring from the endemic Canary Egyptian vulture (Neophron percnopterus majorensis) on the Fuerteventura Island (Canary Islands, Spain) to study the relative importance of demographic factors, ecosystem conditions and availability of anthropogenic food sources on breeding success. Our results suggest that ecosystem-level primary productivity, the number of livestock animals present on the island and Density-dependent processes determine the temporal changes in the breeding success of this species. We firstly accounted for a top-down effect of livestock on island vegetation, where overgrazing directly reduces landscape-level vegetation biomass. We, consequently, found a bottom-up effect between vegetation and the Egyptian vulture's breeding success. In this context, minimal changes in ecological conditions can impact the species inhabiting these ecosystems, with direct consequences on a key population stage, such as breeding season, when energy requirements are higher. These results are especially relevant because cascading and indirect effects of ecosystem processes and governmental policies are often overlooked when pursuing conservation goals of endangered species.

Population

Repeated claims that a dwindling supply of potential caregivers is creating a crisis in care for the U.S. aging population have not been well-grounded in empirical research. Concerns about the supply of family care do not adequately recognize factors that may modify the availability and willingness of family and friends to provide care to older persons in need of assistance or the increasing heterogeneity of the older population. In this paper, we set forth a framework that places family caregiving in the context of older adults' care needs, the alternatives available to them, and the outcomes of that care. We focus on care networks, rather than individuals, and discuss the demographic and social changes that may alter the formation of care networks in the future. Last, we identify research areas to prioritize in order to better support planning efforts to care for the aging U.S. population.

Demographic and imaging features of oral squamous cell cancer in Serbia: a retrospective cross-sectional study

BACKGROUND

The mortality of oral squamous cell cancer (OSCC) in Serbia increased in the last decade. Recent studies on the Serbian population focused mainly on the epidemiological aspect of OSCC. This study aimed to investigate the demographic and imaging features of OSCC in the Serbian population at the time of diagnosis.

METHODS

We retrospectively analyzed computed tomography (CT) images of 276 patients with OSCC diagnosed between 2017 and 2022. Age, gender, tumor site, tumor volume (CT-TV, in cm3), depth of invasion (CT-DOI, in mm), and bone invasion (CT-BI, in %) were evaluated. TNM status and tumor stage were also analyzed. All parameters were analyzed with appropriate statistical tests.

RESULTS

The mean age was 62.32 ± 11.39 and 63.25 ± 11.71 for males and females, respectively. Male to female ratio was 1.63:1. The tongue (36.2%), mouth floor (21.0%), and alveolar ridge (19.9%) were the most frequent sites of OSCC. There was a significant gender-related difference in OSCC distribution between oral cavity subsites (Z=-4.225; p < 0.001). Mean values of CT-TV in males (13.8 ± 21.5) and females (5.4 ± 6.8) were significantly different (t = 4.620; p < 0.001). CT-DOI also differed significantly (t = 4.621; p < 0.001) between males (14.4 ± 7.4) and females (10.7 ± 4.4). CT-BI was detected in 30.1%, the most common in the alveolar ridge OSCC. T2 tumor status (31.4%) and stage IVA (28.3%) were the most dominant at the time of diagnosis. Metastatic lymph nodes were detected in 41.1%.

CONCLUSION

Our findings revealed significant gender-related differences in OSCC imaging features. The predominance of moderate and advanced tumor stages indicates a long time interval to the OSCC diagnosis.

Genetic approaches reveal a healthy population and an unexpectedly recent origin for an isolated desert spring fish

Foskett Spring in Oregon's desert harbors a historically threatened population of Western Speckled Dace (Rhinichthys klamathensis). Though recently delisted, the dace's recruitment depends upon regular removal of encroaching vegetation. Previous studies assumed that Foskett Dace separated from others in the Warner Valley about 10,000 years ago, thereby framing an enigma about the population's surprising ability to persist for so long in a tiny habitat easily overrun by plants. To investigate that persistence and the effectiveness of interventions to augment population size, we assessed genetic diversity among daces inhabiting Foskett Spring, a refuge at Dace Spring, and three nearby streams. Analysis revealed a robust effective population size (Ne) of nearly 5000 within Foskett Spring, though Ne in the Dace Spring refuge is just 10% of that value. Heterozygosity is slightly lower than expected based on random mating at all five sites, indicating mild inbreeding, but not at a level of concern. These results confirm the genetic health of Foskett Dace. Unexpectedly, genetic differentiation reveals closer similarity between Foskett Dace and a newly discovered population from Nevada's Coleman Creek than between Foskett Dace and dace elsewhere in Oregon. Demographic modeling inferred Coleman Creek as the ancestral source of Foskett Dace fewer than 1000 years ago, much more recently than previously suspected and possibly coincident with the arrival of large herbivores whose grazing may have maintained open water suitable for reproduction. These results solve the enigma of persistence by greatly shortening the duration over which Foskett Dace have inhabited their isolated spring.

A quasi-cohort trend analysis of adult obesity in Colombia

In Colombia, the prevalence of obesity has been increasing in recent years due to changes in dietary and nutritional patterns. While previous studies have focussed on describing obesity and its associated factors, they have mainly used a cross-sectional methodology. Accordingly, this study aims to conduct a descriptive quasi-cohort analysis to capture age-specific cohort trends in body mass index (BMI) according to sex and ethnicity (indigenous, Afro-Colombian, and the remaining population). The study utilised data from the National Survey of the Nutritional Situation in Colombia (ENSIN) conducted in 2005, 2010, and 2015 that included 214,136 individuals aged 20-64 years after screening. Data on ethnicity were only available from the 2010 and 2015 surveys. Overall, the prevalence of obesity increased by 6.1 percentage points (from 15.2% to 21.3%) between 2005 and 2015 (men from 10.4% to 15.7%; women from 18.2% to 25.7%). Among Afro-Colombians, obesity rose 6.6 percentage points (from 19.4% to 26.0%), again more so in women than in men (2015: 35.2% versus 17.8%). Among indigenous people, the proportion increased by 5.3 percentage points (from 13.5% to 18.8%), with women reporting highest rates (2015: 23.7% against 12.6% in men). Age- and cohort-specific results also indicate that recent adult cohorts are experiencing sharp increases in BMI, for example, while 25-29-year-old males born in 1975-1979 had a BMI of 24.2 kg/m2, among 40-44-year-olds of the same cohort, this equalled 26.8 kg/m2. In the case of women, these age differences in BMI among the same cohort are even greater (24.4 and 28.0 kg/m2). In summary, the results of this study indicate that Colombia is still in the early stages of the obesity transition, urging the need to monitor obesity trends in Colombia from both an age and cohort perspective. To achieve this, longitudinal surveys or repeated cross-sectional surveys like the ENSIN could be utilised.

Life-expectancy changes from 2019 to 22: A case study of Japan using provisional death count

Many countries struggled with suppressing the incidence of COVID-19 caused by SARS-CoV-2 Omicron variant (B.1.1.529). As the epidemic size of COVID-19 in 2022 became bigger than earlier years in Japan, the present study aimed to estimate life expectancy at birth at the end of 2022, using provisional death datasets in Aichi and Fukui prefectures. We collected monthly death count from 2019 to the end of 2022, computing the period life table. While the life expectancy at birth in Aichi, 2019 was 84.6 years, it was very slightly extended to 84.7 years in 2020 and 2021, followed by a shortening for nearly 0.4 years in 2022. In Fukui, monotonous extension pattern was seen, i.e., 85.5 years in 2019, 85.6 in 2020, followed by 85.8 and 86.2 years in 2021 and 2022, respectively. Although decades-long trend of extending life expectancy at birth was partly discontinued from 2020 due to the pandemic at the national level, we have shown that the pandemic impact was still small in Japan by the end of 2022. First Omicron wave occurred shortly after primary series vaccination, and even real time booster program was underway during that wave. Different demographic consequences between Aichi and Fukui are explained by differential epidemic sizes prior to vaccination.

Uneven demographic consequences of the 2022 disease outbreak for the sea urchin Diadema antillarum in Puerto Rico

Pervasive epizootic events have had a significant impact on marine invertebrates throughout the Caribbean, leading to severe population declines and consequential ecological implications. One such event was the regional collapse of herbivory, partly caused by the Diadema antillarum mortality event in 1983-84, resulting in a trophic cascade and altering the structure of reef communities. Consequently, there was a notable decrease in coral recruitment and an increase in the coverage of macroalgae. Nearly four decades later, in early 2022, the Caribbean basin experienced another widespread mass mortality event, further reducing the populations of D. antillarum. To assess the effects of this recent mortality event on the current demographics of D. antillarum, we surveyed eight populations along the eastern, northeastern, northern, and northwestern coast of Puerto Rico from May to July 2022, estimating their population density, size distribution, and disease prevalence. Additionally, the study compared these population parameters with data from four sites previously surveyed in 2012 and 2017 to understand the impact of the recent mortality event. The survey conducted in 2022 showed varying population densities at the surveyed reefs. Some populations exhibited mean densities of nearly one individual per square meter, while others had extremely low or no living individuals per square meter. The four populations with the highest density showed no evidence of disease, whereas the four populations with the lowest D. antillarum densities exhibited moderate to high disease prevalence. However, when considering all sites, the estimated disease prevalence remained below 5%. Nevertheless, the comparison with data from 2012 and 2017 indicated that the recent mortality event had a negative impact on D. antillarum demographics at multiple sites, as the densities in 2022 were reduced by 60.19% compared to those from the previous years. However, it is still too early to determine the severity of this new mortality event compared to the 1983-84 mortality event. Therefore, it is imperative to continue monitoring these populations.

Population ageing and sustainability of healthcare financing in China

BACKGROUND

In China, the healthcare financing structure involves multiple parties, including the government, society and individuals. Medicare Fund is an important way for the Government and society to reduce the burden of individual medical costs. However, with the aging of the population, the demand of Medicare Fund is increasing. Therefore, it is necessary to explore the sustainability of the healthcare financing structure in the context of population ageing.

OBJECTIVE

The purpose of this paper is to organize the characteristics of population ageing as well as healthcare financing in China. On this basis, it analyzes the impact mechanism of population ageing on healthcare financing and the sustainability of existing healthcare financing.

METHODS

This paper mainly adopts the method of literature research and inductive summarization. Extracting data from Health Statistics Yearbook of China and Labor and Social Security Statistics Yearbook of China. Collected about 60 pieces of relevant literature at home and abroad.

RESULTS

China has already entered a deeply ageing society. Unlike developed countries in the world, China's population ageing has distinctive feature of ageing before being rich. A healthcare financing scheme established by China, composing of the government, society, and individuals, is reasonable. However, under the pressure of population ageing, China's current healthcare financing scheme will face enormous challenges. Scholars are generally pessimistic about the sustainability of China's healthcare financing scheme.

CONCLUSIONS

Population ageing will increase the expenditure and reduce the income of the Medicare Fund. This will further affect the sustainability of the healthcare financing structure. As a consequence, the state should pay particular attention to this issue and take action to ensure that the Fund continues to operate steadily.

Immune indices and oral health in patients infected with the human immunodeficiency virus

BACKGROUND

The human immunodeficiency virus (HIV) is the causative agent of acquired immunodeficiency syndrome (AIDS). During the incubation period of AIDS, oral manifestations may precede systemic symptoms; therefore, it is vitally important to explore the relationship between HIV and oral health and other indicators. This study aimed to further assess the correlation between demographic risk factors, the dental health of HIV-infected patients, and the correlation of oral health indicators with CD4+ T-cell counts (CTCCs) and HIV viral loads (HIV-VLs).

METHODS

Demographic data on 108 HIV-infected patients were first recorded by questionnaire from March 2016 to November 2018. Patients' dental health and oral lesions were assessed by a dental specialist; in addition, they were tested for CTCCs and HIV-VLs by flow cytometry and NucliSENS EasyQ® HIV-1 virometer. Finally, the links between CTCC, HIV-VL, and the dental health (including oral lesions) of the patients were analyzed.

RESULTS

We found that age, marital status, and body mass index (BMI) were relevant to the patient's dental health (P < 0.05) and that their oral hygiene was relevant to their dental health (P < 0.05). However, HIV-VL was not directly related to periodontal/dental clinical indicators (P > 0.05). We discovered that the oral lesions in HIV-infected patients were related to decreased CTCCs and increased HIV-VLs (P < 0.05).

CONCLUSIONS

We concluded that HIV-infected patients with severely impaired immune function tend to have poor dental health. Moreover, the prevalence of oral lesions was negatively correlated with CTCC and positively correlated with HIV-VL.

Forecasting the mortality burden of coronary heart disease and stroke in Germany: National trends and regional inequalities

BACKGROUND

The decline of cardiovascular disease (CVD) mortality has slowed in many countries, including Germany. We examined the implications of this trend for future coronary heart disease (CHD) and stroke mortality in Germany considering persistent mortality inequalities between former East and West Germany.

METHODS

We retrieved demographic and mortality data from 1991 to 2019 from the German Federal Statistical Office. Using a Bayesian age-period-cohort framework, we projected CHD and stroke mortality from 2019 to 2035, stratified by sex and German region. We decomposed annual changes in deaths into three components (mortality rates, population age structure and population size) and assessed regional inequalities with age-sex-standardized mortality ratios.

RESULTS

We confirmed that declines of CVD mortality rates in Germany will likely stagnate. From 2019 to 2035, we projected fewer annual CHD deaths (114,600 to 103,500 [95%-credible interval: 81,700; 134,000]) and an increase in stroke deaths (51,300 to 53,700 [41,400; 72,000]). Decomposing past and projected mortality, we showed that population ageing was and is offset by declining mortality rates. This likely reverses after 2030 leading to increased CVD deaths thereafter. Inequalities between East and West declined substantially since 1991 and are projected to stabilize for CHD but narrow for stroke.

CONCLUSIONS

CVD deaths in Germany likely keep declining until 2030, but may increase thereafter due to population ageing if the reduction in mortality rates slows further. East-West mortality inequalities for CHD remain stable but may converge for stroke. Underlying risk factor trends need to be monitored and addressed by public health policy.

Effect of Nintedanib in Patients with Progressive Pulmonary Fibrosis in Subgroups with Differing Baseline Characteristics

INTRODUCTION

In the INBUILD trial in patients with progressive pulmonary fibrosis other than idiopathic pulmonary fibrosis (IPF), nintedanib slowed the rate of decline in forced vital capacity (FVC; mL/year) over 52 weeks compared with placebo. We assessed the efficacy of nintedanib across subgroups in the INBUILD trial by baseline characteristics.

METHODS

We assessed the rate of decline in FVC over 52 weeks and time to progression of interstitial lung disease (ILD) (absolute decline from baseline in FVC % predicted > 10%) or death over the whole trial in subgroups based on sex, age, race, body mass index (BMI), time since diagnosis of ILD, FVC % predicted, diffusing capacity of the lungs for carbon monoxide (DLco) % predicted, composite physiologic index (CPI), GAP (gender, age, lung physiology) stage, use of anti-acid therapy and use of disease-modifying antirheumatic drugs (DMARDs) at baseline.

RESULTS

The effect of nintedanib versus placebo on reducing the rate of decline in FVC over 52 weeks was consistent across the subgroups by baseline characteristics analysed. Interaction p values did not indicate heterogeneity in the treatment effect between these subgroups (p > 0.05). Over the whole trial (median follow-up time ∼19 months), progression of ILD or death occurred in similar or lower proportions of patients treated with nintedanib than placebo across the subgroups analysed, with no heterogeneity detected between the subgroups.

CONCLUSIONS

In the INBUILD trial, no heterogeneity was detected in the effect of nintedanib on reducing the rate of ILD progression across subgroups based on demographics, ILD severity or use of anti-acid therapy or DMARDs. These data support the use of nintedanib as a treatment for progressive pulmonary fibrosis.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Identifier: NCT02999178.

Inferring the age and sex of ancient potters from fingerprint ridge densities: A data-driven, Bayesian mixture modelling approach

The density of epidermal ridges in a fingerprint varies predictably by age and sex. Archaeologists are therefore interested in using recovered fingerprints to learn about the ancient people who produced them. Recent studies focus on estimating the age and sex of individuals by measuring their fingerprints with one of two similar metrics: mean ridge breadth (MRB) or ridge density (RD). Yet these attempts face several critical problems: expected values for adult females and adolescent males are inherently indistinguishable, and inter-assemblage variation caused by biological and technological differences cannot be easily estimated. Each of these factors greatly decreases the accuracy of predictions based on individual prints, and together they condemn this strategy to relative uselessness. However, information in fingerprints from across an assemblage can be pooled to generate a more accurate depiction of potter demographics. We present a new approach to epidermal ridge density analysis using Bayesian mixture models with the following key benefits:•Age and sex are estimated more accurately than existing methods by incorporating a data-driven understanding of how demographics and ridge density covary.•Uncertainty in demographic estimates is automatically quantified and included in output.•The Bayesian framework can be easily adapted to fit the unique needs of different researchers.

Predicting optimal endotracheal tube size and depth in pediatric patients using demographic data and machine learning techniques

BACKGROUND

Use of endotracheal tubes (ETTs) with appropriate size and depth can help minimize intubation-related complications in pediatric patients. Existing age-based formulae for selecting the optimal ETT size present several inaccuracies. We developed a machine learning model that predicts the optimal size and depth of ETTs in pediatric patients using demographic data, enabling clinical applications.

METHODS

Data from 37,057 patients younger than 12 years who underwent general anesthesia with endotracheal intubation were retrospectively analyzed. Gradient boosted regression tree (GBRT) model was developed and compared with traditional age-based formulae.

RESULTS

The GBRT model demonstrated the highest macro-averaged F1 scores of 0.502 (95% CI 0.486, 0.568) and 0.669 (95% CI 0.640, 0.694) for predicting the uncuffed and cuffed ETT size (internal diameter [ID]), outperforming the age-based formulae that yielded 0.163 (95% CI 0.140, 0.196, P < 0.001) and 0.392 (95% CI 0.378, 0.406, P < 0.001), respectively. In predicting the ETT depth (distance from tip to lip corner), the GBRT model showed the lowest mean absolute error (MAE) of 0.71 cm (95% CI 0.69, 0.72) and 0.72 cm (95% CI 0.70, 0.74) compared to the age-based formulae that showed an error of 1.18 cm (95% CI 1.16, 1.20, P < 0.001) and 1.34 cm (95% CI 1.31, 1.38, P < 0.001) for uncuffed and cuffed ETT, respectively.

CONCLUSIONS

The GBRT model using only demographic data accurately predicted the ETT size and depth. If these results are validated, the model may be practical for predicting optimal ETT size and depth for pediatric patients.

Dysphonia in Pediatric Professional Voice Users: Is It Just Nodules?

OBJECTIVES/HYPOTHESIS

Professional voice users of any age are often concerned about nodules, particularly in pediatric singers. However, an accurate diagnosis allows formulation of an optimal management plan and a successful continuation of these young patients' careers. There is very little literature regarding pediatric professional singers; we aimed to share our experience of over a decade of referrals to our tertiary pediatric voice clinic.

STUDY DESIGN

This was a retrospective review.

METHODS

A retrospective review was undertaken of all consecutive patients aged 0-18 years who self-identified as professional voice users and attended our tertiary pediatric voice clinic between December 2010 and December 2021. We analyzed demographics, professional singing status, diagnosis, management, and clinical voice scores. The patients were subdivided into those aged 0-9, 10-16, and 17-18 years.

RESULTS

A total of 113 pediatric professional voice users attended the tertiary voice clinic in the study period. The commonest self-reported voice use was as a singer. Within the 0-9 years age group, there was a strong male predominance (22 males and three females) and mostly organic (52%) causes. For ages 10-16 years, there was a noted female predominance (15 males and 29 females). In the 17-18 years age group, there was a strong female predominance (10 males and 34 females), with predominantly functional diagnoses (48%). Of significance, only five of the 113 patients had nodules (4.4%).

CONCLUSIONS

We present a large data set of pediatric professional voice users and demonstrate the numerous underlying diagnoses for their dysphonia, particularly functional disorders. Our experience highlights the need for adequate vocal training for pediatric professional voice users and the need for a multidisciplinary diagnostic and management approach.

Modelling the spread of cystic fibrosis in Brittany using genealogical data over five centuries

BACKGROUND

The French region of Brittany presents one of the highest cystic fibrosis (CF)-causing allele frequency in Europe. Here, we tested two hypotheses: i) CF-causing allele carriers arrived by sea in the middle of the 1st millennium AD, and ii) a selective advantage for healthy carriers explains this high rate.

METHODS

From the census of cystic fibrosis patients, frequency maps of the most widespread alleles were established. A mathematical model was developed, based on birth date and place of the ancestors of these patients over 5 centuries, to determine the distribution of local migrations and their parameters for inter-generational intervals of 32 years. This model was applied to simulate the spread of CF-causing variant carriers, according to different scenarios that corresponded to the immigration of a given number of variant carriers at different times (year) and places, and to compare their results to current frequency maps.

RESULTS

Migrants carrying a CFTR variant settled in several locations, around which they spread, notably in Central Brittany (F508del variant), Léon (G551D variant) and Cornouaille (1078delT variant). Until the end of the 18th century, the spreading of disease-causing allele carriers was relatively slow, and allele frequencies progressively increased. Then, the mean migration distances increased rapidly, leading to a decline in local frequencies.

CONCLUSIONS

The main CFTR variants could only have reached their current frequencies through a selective advantage for healthy carriers of the order of 4-6 % at each generation. For the most widespread variant (F508del), the model supports the hypothesis that it appeared around 190 generations ago.

Measuring under-5 mortality and fertility through mobile phone surveys: an assessment of selection bias in 34 low-income and middle-income countries

OBJECTIVES

This study aims to assess sample selection bias in mobile phone survey estimates of fertility and under-5 mortality.

DESIGN

With data from the Demographic and Health Surveys, we use logistic regressions to identify sociodemographic correlates of mobile phone ownership and access, and Poisson regressions to estimate the association between mobile phone ownership (or access) and fertility and under-5 mortality estimates. We evaluate the potential reasons why estimates by mobile phone ownership differ using a set of behavioural characteristics.

SETTING

34 low-income and middle-income countries, mostly in sub-Saharan Africa.

PARTICIPANTS

534 536 women between the ages of 15 and 49.

OUTCOME MEASURES

Under-5 mortality rate (U5MR) and total fertility rate (TFR).

RESULTS

Mobile phone ownership ranges from 23.6% in Burundi to 96.7% in Armenia. The median TFR ratio and U5MR ratio between the non-owners and the owners of a mobile phone are 1.48 and 1.29, respectively. Fertility and mortality rates would be biased downwards if estimates are only based on women who own or have access to mobile phones. Estimates of U5MR can be adjusted through poststratification using age, educational level, area of residence, wealth and marital status as weights. However, estimates of TFR remain biased even after adjusting for these covariates. This difference is associated with behavioural factors (eg, contraceptive use) that are not captured by the poststratification variables, but for which there are also differences between mobile phone owners and non-owners.

CONCLUSIONS

Mobile phone surveys need to collect data on sociodemographic background characteristics to be able to weight and adjust mortality estimates ex post facto. Fertility estimates from mobile phone surveys will be biased unless further research uncovers the mechanisms driving the bias.

Sequencing of Births by Wantedness: Implications for Changes in Mid-Life Health Among Aging NLSY79 Women

OBJECTIVES

As life course frameworks highlight and gerontological studies confirm, the health implications of early birth timing (e.g., adolescent births) and unplanned births (e.g., unwanted or mistimed births) extend years after those births into mid and later life. Yet past research often overlooks the considerable diversity in sequencing and timing of unplanned births even within the same individual (e.g., having both wanted and unwanted births), which are likely fundamental for women's long-term health trajectories. We develop a holistic understanding of birth timing and wantedness to provide insight into when and how childbearing histories matter for aging women's health.

METHODS

We use sequence analysis with hierarchical cluster method and estimate regression models using the 1979 National Longitudinal Survey of Youth (N = 3,231) to examine how timing and patterning of births by wantedness are associated with changes in physical and mental health from ages 40 to 50.

RESULTS

We identify 7 clusters of childbearing sequences. Of those 7 clusters, respondents with sequences characterized by wanted births in their 20s and 30s had the smallest declines in health in mid-life, whereas respondents with sequences with mainly unwanted births at any age or with mainly mistimed births beginning in adolescence had the greatest health declines. Adjusting for social and economic variables accounted for some, but not all, health differences across childbearing clusters.

DISCUSSION

This project demonstrates the need for comprehensive life course perspectives on long-term health implications of birth wantedness and timing, recognizing diversity within and between individuals.

Coping strategies in postpartum women: exploring the influence of demographic and maternity factors

BACKGROUND

Postpartum depression is a frequent mental health issue that affects many women due to this stressful phase. The aim of the study is to gain insight into the coping strategies employed by postpartum women and to explore how these strategies are influenced by various demographic and maternity factors.

METHODS

The study adopted a quantitative, cross-sectional design. Data were collected from 239 postpartum women receiving care at a Gynecology and Obstetrics Clinic using self-reported tools, which include the Brief COPE survey and the socio-demographics and obstetric/maternal history form from October 2022 to April 2023.

RESULTS

The study findings indicate that individuals aged over 40 tend to use more emotional-focused coping compared to those aged 21-30 (p = 0.002) and 31-40. Additionally, both genders of children were associated with more emotional-focused coping (p = 0.007) compared to only having boys. Cesarean section delivery (p = 0.001) was associated with more avoidant-focused coping than normal vaginal delivery. Avoidant-focused coping was significantly predicted by problem-focused coping (p < 0.001), emotional-focused coping (p = 0.034), age (p = 0.003), and gender of children (only boys, p < 0.001; both boys and girls, p = 0.019). Furthermore, problem-focused coping was significantly predicted by age (p = 0.004), gender of children (male child, p = 0.002; both boy and girl: p = 0.014), and avoidant-focused coping (p < 0.001).

CONCLUSIONS

The study examined how postpartum women cope with the challenges of motherhood and how this relates to their demographic and maternity factors. The results suggest that healthcare professionals should promote effective coping strategies and discourage avoidance-oriented approaches in postpartum interventions.

Trends in the Incidence of End-Stage Kidney Disease in Type 1 and Type 2 Diabetes in Australia, 2010-2019

RATIONALE & OBJECTIVE

Trends in end-stage kidney disease (ESKD) among people with diabetes may inform clinical management and public health strategies. We estimated trends in the incidence of ESKD among people with type 1 and type 2 diabetes in Australia from 2010-2019 and evaluated their associated factors.

STUDY DESIGN

Cohort study.

SETTING & PARTICIPANTS

71,700 people with type 1 and 1,112,690 people with type 2 diabetes registered on the Australian National Diabetes Services Scheme (NDSS). We estimated the incidence of kidney replacement therapy (KRT) via linkage to the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and the incidence of KRT or death from ESKD by linking the NDSS to the ANZDATA and the National Death Index for Australia.

PREDICTORS

Calendar time, sex, age, and duration of diabetes.

OUTCOME

Incidence of KRT and KRT or death from ESKD.

ANALYTICAL APPROACH

Incidence of ESKD, trends over time, and associations with factors related to these trends were modeled using Poisson regression stratified by diabetes type and sex.

RESULTS

The median duration of diabetes increased from 15.3 to 16.8 years in type 1 diabetes, and from 7.6 to 10.2 years in type 2 diabetes between 2010 and 2019. The incidence of KRT and KRT or death from ESKD did not significantly change over this time interval among people with type 1 diabetes. Conversely, the age-adjusted incidence of KRT and KRT or death from ESKD increased among males with type 2 diabetes (annual percent changes [APCs]: 2.52% [95% CI, 1.54 to -3.52] and 1.27% [95% CI, 0.53 2.03], respectively), with no significant change among females (0.67% [95% CI, -0.68 to 2.04] and 0.07% [95% CI, -0.81 to 0.96], respectively). After further adjustment for duration of diabetes, the incidence of ESKD fell between 2010 and 2019, with APCs of-0.09% (95% CI, -1.06 to 0.89) and-2.63% (95% CI, -3.96 to-1.27) for KRT and-0.97% (95% CI, -1.71 to-0.23) and-2.75% (95% CI, -3.62 to-1.87) for KRT or death from ESKD among males and females, respectively.

LIMITATIONS

NDSS only captures 80%-90% of people with diabetes; lack of clinical covariates limits understanding of trends.

CONCLUSIONS

While the age-adjusted incidence of ESKD increased for males and was stable for females over the last decade, after adjusting for increases in duration of diabetes the risk of developing ESKD has decreased for both males and females.

PLAIN-LANGUAGE SUMMARY

Previous studies showed an increase in new cases of kidney failure among people with type 2 diabetes, but more recent data have not been available. Here, we report trends in the rate of kidney failure for people with type 2 diabetes from 2010 to 2019 and showed that while more people with type 2 diabetes are developing kidney failure, accounting for the fact that they are also surviving longer (and therefore have a higher chance of kidney failure) the growth in this population is not caused by a higher risk of kidney failure. Nevertheless, more people are getting kidney failure than before, which will impact health care systems for years to come.

BatTool: projecting bat populations facing multiple stressors using a demographic model

Bats provide ecologically and agriculturally important ecosystem services but are currently experiencing population declines caused by multiple environmental stressors, including mortality from white-nose syndrome and wind energy development. Analyses of the current and future health and viability of these species may support conservation management decision making. Demographic modeling provides a quantitative tool for decision makers and conservation managers to make more informed decisions, but widespread adoption of these tools can be limited because of the complexity of the mathematical, statistical, and computational components involved in implementing these models. In this work, we provide an exposition of the BatTool R package, detailing the primary components of the matrix projection model, a publicly accessible graphical user interface ( https://rconnect.usgs.gov/battool ) facilitating user-defined scenario analyses, and its intended uses and limitations (Wiens et al., US Geol Surv Data Release 2022; Wiens et al., US Geol Surv Softw Release 2022). We present a case study involving wind energy permitting, weighing the effects of potential mortality caused by a hypothetical wind energy facility on the projected abundance of four imperiled bat species in the Midwestern United States.

Stationary status of discrete and continuous age-structured population models

From Leonhard Euler to Alfred Lotka and in recent years understanding the stationary process of the human population has been of central interest to scientists. Population reproductive measure NRR (net reproductive rate) has been widely associated with measuring the status of population stationarity and it is also included as one of the measures in the millennium development goals. This article argues how the partition theorem-based approach provides more up-to-date and timely measures to find the status of the population stationarity of a country better than the NRR-based approach. We question the timeliness of the value of NRR in deciding the stationary process of the country. We prove associated theorems on discrete and continuous age distributions and derive measurable functional properties. The partitioning metric captures the underlying age structure dynamic of populations at or near stationarity. As the population growth rates for an ever-increasing number of countries trend towards replacement levels and below, new demographic concepts and metrics are needed to better characterize this emerging global demography.

Explaining the U.S. rural disadvantage in COVID-19 case and death rates during the Delta-Omicron surge: The role of politics, vaccinations, population health, and social determinants

The Delta-Omicron wave of the COVID-19 pandemic (Wave 4) in the United States occurred in Fall of 2021 through Spring of 2022. Although vaccinations were widely available, this was the deadliest period to date in the U.S., and the toll was especially high in rural areas, exacerbating an existing rural mortality penalty. This paper uses county-level multilevel regression models and publicly available data for 47 U.S. states and the District of Columbia. We describe differences in COVID-19 case and mortality rates across the rural-urban continuum during Wave 4 of the COVID-19 pandemic. Using a progressive modeling approach, we evaluate the relative contribution of a range of explanatory factors for the rural disadvantage we observe, including: pre-pandemic population health composition, vaccination rates, political partisanship, socioeconomic composition, access to broadband internet rate, and primary care physicians per capita. Results show that rural counties had higher observed burdens of cases and deaths in Wave 4 compared to more urban counties. The most remote rural counties had Wave 4 COVID-19 mortality rates 52% higher than the most urban counties. Older age composition, worse pre-pandemic population health, lower vaccination rates, higher share of votes cast for Donald Trump in the 2020 Presidential election, and lower socioeconomic composition completely explained the rural disadvantage in reported COVID-19 case rates in Wave 4, and accounting for these factors reversed the observed rural disadvantage in COVID-19 mortality. In models of mortality rate, Trump vote share had the largest effect size, followed by the percentage of the population age 50 or older, the poverty rate, the pre-pandemic mortality rate, the share of residents with a 4-year college degree, and the vaccination rate. These findings add to a growing literature describing the disproportionate toll of the COVID-19 pandemic on rural America, highlighting the combined effect of multiple sources of rural disadvantage.

The large Hellenic Study of Uveitis: epidemiology, etiologic factors and classification

PURPOSE

To analyse the demography, etiology, and classification of uveitis at a tertiary academic referral center.

METHODS

An observational study was conducted on the archives of uveitic patients at the Ocular Inflammation Service of the Department of Ophthalmology at the University Hospital of Ioannina (Greece) from 1991 to 2020. This study aimed to investigate the epidemiological profile of patients, including their demographics and the main etiologic factors of uveitis.

RESULTS

Out of 6191 cases with uveitis, 1925 were infectious, 4125 were non-infectious, and an overall of 141 masquerade syndromes were recorded. Among these cases, 5950 patients were adults, with a slight female predominance, while 241 were children (< 18 years old). Interestingly, 24.2% of cases (1500 patients) were associated with 4 specific microorganisms. Herpetic uveitis (HSV-1 and VZV/HZV) was the most common cause of infectious uveitis (14.87%), followed by toxoplasmosis (6.6%) and tuberculosis (2.74%). In 49.2% of non-infectious uveitis cases, no systematic correlation was found. The most frequent causes of non-infectious uveitis included sarcoidosis, white dot syndromes, ankylosing spondylitis, lens-induced uveitis, Adamantiades-Behçet disease, and idiopathic juvenile arthritis. Infectious uveitis was more common in the rural population, whereas non-infectious uveitis was more frequently recorded in the urban population CONCLUSIONS: Although our study was conducted on a predominantly white Caucasian population, it also reflects the effect of increasing immigration, improvements of diagnostic techniques, changes in referral patterns, and various actual changes in disease incidence.

Life Course Patterns of Prescription Drug Use in the United States

Prescription drug use has reached historic highs in the United States-a trend linked to increases in medicalization, institutional factors relating to the health care and pharmaceutical industries, and population aging and growing burdens of chronic disease. Despite the high and rising prevalence of use, no estimates exist of the total number of years Americans can expect to spend taking prescription drugs over their lifetimes. This study provides the first estimates of life course patterns of prescription drug use using data from the 1996-2019 Medical Expenditure Panel Surveys, the Human Mortality Database, and the National Center for Health Statistics. Newborns in 2019 could be expected to take prescription drugs for roughly half their lives: 47.54 years for women and 36.84 years for men. The number of years individuals can expect to take five or more drugs increased substantially. Americans also experienced particularly dramatic increases in years spent taking statins, antihypertensives, and antidepressants. There are also important differences in prescription drug use by race and ethnicity: non-Hispanic Whites take the most, Hispanics take the least, and non-Hispanic Blacks fall in between these extremes. Americans are taking drugs over a wide and expanding swathe of the life course, a testament to the centrality of prescription drugs in Americans' lives today.

Drivers of longevity of wild-caught Aedes albopictus populations

BACKGROUND

Age structure and longevity constitute fundamental determinants of mosquito populations' capacity to transmit pathogens. However, investigations on mosquito-borne diseases primarily focus on aspects such as abundance or dispersal rather than survival and demography. Here, we examine the post-capture longevity of wild-caught populations of the Asian tiger mosquito Aedes albopictus to investigate the influence of environmental factors and individual frailty on longevity.

METHODS

We captured females of Ae. albopictus from June to November 2021 in a vegetated and an urban area by two methods of capture (BG traps and Human Landing catch). They were kept in semi-controlled conditions in the field, and survival was monitored daily across the 859 individuals captured. We studied the differences in longevity per capture method and location and the influence on longevity of seasonal, climatic and individual factors.

RESULTS

Photoperiod, GDD, minimum and maximum temperature and relative humidity showed an effect on the risk of death of females in the field. Females captured in urban area with Human Landing catch methods had greater longevity than females captured in non-urban areas with BG traps. Individual variance, reflecting individual frailties, had an important effect on the risk of death: the greater the frailty, the shorter the post-capture longevity. Overall, longevity is affected not only by climate and seasonal drivers like temperature and photoperiod but also by the individual frailty of mosquitoes.

CONCLUSION

This work unravels environmental drivers of key demographic parameters such as longevity, as modulated by individual frailty, in disease vectors with strong seasonal dynamics. Further demographic understanding of disease vectors in the wild is needed to adopt new surveillance and control strategies and improve our understanding of disease risk and spread.