Modeling potential distribution of newly recorded ant, Brachyponera nigrita using Maxent under climate change in Pothwar region, Pakistan

Climate change has been discussed as to exert shifts in geographical range of plants, animals or insect species by increasing, reducing or shifting its appropriate climatic habitat. Globally, Pakistan has been ranked at 5^th position on the list of countries most vulnerable to climate change in 2020. Climate change has resulted in the losses of biodiversity and alteration in ecosystem as a result of depletion of natural habitats of species in Pakistan as well as in the world. Ants have been regarded as indicators of environmental change and ecosystem processes. Brachyponera nigrita (Emery, 1895) was reported for the first time from Pakistan (Pothwar region). Objective of our studies was to model geographic distribution of newly recorded ant species, B. nigrita based on two representative concentration pathways (RCP) (RCP4.5 and RCP8.5) for 2050s using maximum entropy model (Maxent) in Pakistan. In modeling procedure, 21occurrence records and 8 variables namely Bio4 (Temperature seasonality), Bio8 (Mean temperature of wettest quarter), Bio10 (Mean temperature of warmest quarter), Bio12 (Annual precipitation), Bio13 (Precipitation of wettest month), Bio15 (Precipitation seasonality), Bio17 (Precipitation of driest quarter) and Bio18 (Precipitation of warmest quarter) were used to determine the current and future distributions. Performance of the model was evaluated using AUC (area under curves) values, partial ROC, omission rates (E = 5%) and AICc (Model complexity).The results showed the average AUC value of the model was 0.930, which indicated that the accuracy of the model was excellent. The jackknife test also showed that Bio4, Bio18, Bio17 and Bio15 contributed 98% for the prediction of potential distribution of the species as compared to all other variables. Maxent results indicated that distribution area of B. nigrita under future predicted bioclimatics 2050 (RCP 4.5 and RCP8.5) would be increased in various localities of Pakistan as compared to its current distribution. In Pothwar region, moderately suitable and highly suitable areas of this species would increase by 505.932321km²and 572.118421km²as compared to current distribution under 2050 (RCP 4.5), while under 2050 (RCP 8.5), there would be an increase of 6427.2576km²and 3765.140493km² respectively in moderately suitable and highly suitable areas of B. nigrita. This species was associated with termites, collembolans and larval stages of different insects. White eggs, creamy white pupae and many workers of this species were observed in a variety of habitats. Unknown nesting ecology, species identification characters supported with micrographs has been given which will help researchers for further ecological studies.

Disruptive Demographics: Their Effects on Nursing Demand, Supply and Academic Preparation

The nursing profession faces both a labor shortage and a diversity problem. Nine proactive strategies-rooted in the disruptive demographic trends that are transforming our nation-are advanced to address these 2 critical issues.

The changing health needs of the UK population

The demographics of the UK population are changing and so is the need for health care. In this Health Policy, we explore the current health of the population, the changing health needs, and future threats to health. Relative to other high-income countries, the UK is lagging on many health outcomes, such as life expectancy and infant mortality, and there is a growing burden of mental illness. Successes exist, such as the striking improvements in oral health, but inequalities in health persist as well. The growth of the ageing population relative to the working-age population, the rise of multimorbidity, and persistent health inequalities, particularly for preventable illness, are all issues that the National Health Service (NHS) will face in the years to come. Meeting the challenges of the future will require an increased focus on health promotion and disease prevention, involving a more concerted effort to understand and tackle the multiple social, environmental, and economic factors that lie at the heart of health inequalities. The immediate priority of the NHS will be to mitigate the wider and long-term health consequences of the COVID-19 pandemic, but it must also strengthen its resilience to reduce the impact of other threats to health, such as the UK leaving the EU, climate change, and antimicrobial resistance.

Climate change and anthropogenic food manipulation interact in shifting the distribution of a large herbivore at its altitudinal range limit

Ungulates in alpine ecosystems are constrained by winter harshness through resource limitation and direct mortality from weather extremes. However, little empirical evidence has definitively established how current climate change and other anthropogenic modifications of resource availability affect ungulate winter distribution, especially at their range limits. Here, we used a combination of historical (1997-2002) and contemporary (2012-2015) Eurasian roe deer (Capreolus capreolus) relocation datasets that span changes in snowpack characteristics and two levels of supplemental feeding to compare and forecast probability of space use at the species' altitudinal range limit. Scarcer snow cover in the contemporary period interacted with the augmented feeding site distribution to increase the elevation of winter range limits, and we predict this trend will continue under climate change. Moreover, roe deer have shifted from historically using feeding sites primarily under deep snow conditions to contemporarily using them under a wider range of snow conditions as their availability has increased. Combined with scarcer snow cover during December, January, and April, this trend has reduced inter-annual variability in space use patterns in these months. These spatial responses to climate- and artificial resource-provisioning shifts evidence the importance of these changing factors in shaping large herbivore spatial distribution and, consequently, ecosystem dynamics.

Estimated Projection of US Cancer Incidence and Death to 2040

IMPORTANCE

Coping with the current and future burden of cancer requires an in-depth understanding of trends in cancer incidences and deaths. Estimated projections of cancer incidences and deaths will be important to guide future research funding allocations, health care planning, and health policy efforts.

OBJECTIVE

To estimate cancer incidences and deaths in the United States to the year 2040.

DESIGN AND SETTING

This cross-sectional study's estimated projection analysis used population growth projections and current population-based cancer incidence and death rates to calculate the changes in incidences and deaths to the year 2040. Cancer-specific incidences and deaths in the US were estimated for the most common cancer types. Demographic cancer-specific delay-adjusted incidence rates from the Surveillance, Epidemiology, and End Results Program were combined with US Census Bureau population growth projections (2016) and average annual percentage changes in incidence and death rates. Statistical analyses were performed from July 2020 to February 2021.

MAIN OUTCOMES AND MEASURES

Total cancer incidences and deaths to the year 2040.

RESULTS

This study estimated that the most common cancers in 2040 will be breast (364 000 cases) with melanoma (219 000 cases) becoming the second most common cancer; lung, third (208 000 cases); colorectal remaining fourth (147 000 cases); and prostate cancer dropping to the fourteenth most common cancer (66 000 cases). Lung cancer (63 000 deaths) was estimated to continue as the leading cause of cancer-related death in 2040, with pancreatic cancer (46 000 deaths) and liver and intrahepatic bile duct cancer (41 000 deaths) surpassing colorectal cancer (34 000 deaths) to become the second and third most common causes of cancer-related death, respectively. Breast cancer (30 000 deaths) was estimated to decrease to the fifth most common cause of cancer death.

CONCLUSIONS AND RELEVANCE

These findings suggest that there will be marked changes in the landscape of cancer incidence and deaths by 2040.

Trends in the epidemiology of inflammatory bowel disease in Colombia by demographics and region using a nationally representative claims database and characterization of inflammatory bowel disease phenotype in a case series of Colombian patients

The incidence of inflammatory bowel disease (IBD) is on the rise in Latin America. The aims of this study were to examine epidemiologic trends of IBD in Colombia by demographics, region, urbanicity, and to describe the IBD phenotype in a large well-characterized Colombian cohort.We used a national database of 33 million adults encompassing 97.6% of the Colombian population in order to obtain epidemiologic trends of IBD using International Classification of Diseases 10codes for adults with ulcerative colitis (UC) and Crohn disease (CD). We calculated the incidence and prevalence of UC and CD from 2010-2017 and examined epidemiologic trends by urbanicity, demographics, and region. We then examined the IBD phenotype (using Montreal Classification), prevalence of IBD-related surgeries, and types of IBD-medications prescribed to adult patients attending a regional IBD clinic in Medellin, Colombia between 2001 and 2017.The incidence of UC increased from 5.59/100,000 in 2010 to 6.3/100,000 in 2017 (relative risk [RR] 1.12, confidence interval (CI) (1.09-1.18), P < .0001). While CD incidence did not increase, the prevalence increased within this period. The Andes region had the highest incidence of IBD (5.56/100,000 in 2017). IBD was seen less in rural regions in Colombia (RR=.95, CI (0.92-0.97), p < .01). An increased risk of IBD was present in women, even after adjusting for age and diagnosis year (RR 1.06 (1.02-1.08), P = .0003). The highest IBD risk occurred in patients 40 to 59 years of age. In the clinic cohort, there were 649 IBD patients: 73.7% UC and 24.5% CD. Mean age of diagnosis in CD was 41.0 years and 39.9 years in UC. UC patients developed mostly pancolitis (43%). CD patients developed mostly ileocolonic disease and greater than a third of patients had an inflammatory, non-fistulizing phenotype (37.7%). A total of 16.7% of CD patients had perianal disease. CD patients received more biologics than UC patients (odds ratio: 3.20, 95% CI 2.19-4.69 P < .001).Using both a national representative sample and a regional clinic cohort, we find that UC is more common in Colombia and is on the rise in urban regions; especially occurring in an older age cohort when compared to Western countries. Future studies are warranted to understand evolving environmental factors explaining this rise.

Past and future potential range changes in one of the last large vertebrates of the Australian continent, the emu Dromaius novaehollandiae

In Australia, significant shifts in species distribution have occurred with the loss of megafauna, changes in indigenous Australian fire regime and land-use changes with European settlement. The emu, one of the last megafaunal species in Australia, has likely undergone substantial distribution changes, particularly near the east coast of Australia where urbanisation is extensive and some populations have declined. We modelled emu distribution across the continental mainland and across the Great Dividing Range region (GDR) of eastern Australia, under historical, present and future climates. We predicted shifts in emu distribution using ensemble modelling, hindcasting and forecasting distribution from current emu occurrence data. Emus have expanded their range northward into central Australia over the 6000 years modelled here. Areas west of the GDR have become more suitable since the mid-Holocene, which was unsuitable then due to high precipitation seasonality. However, the east coast of Australia has become climatically sub-optimal and will remain so for at least 50 years. The north east of NSW encompasses the range of the only listed endangered population, which now occurs at the margins of optimal climatic conditions for emus. Being at the fringe of suitable climatic conditions may put this population at higher risk of further decline from non-climatic anthropogenic disturbances e.g. depredation by introduced foxes and pigs. The limited scientific knowledge about wild emu ecology and biology currently available limits our ability to quantify these risks.

A 29-year retrospective analysis of koala rescues in New South Wales, Australia

The koala (Phascolarctos cinereus) is currently listed by both the IUCN and the Australian Governments' Threatened Species Scientific Committee as vulnerable to extinction with an overall decreasing population trend. It is unknown exactly how many koalas remain in the wild, but it is known that habitat fragmentation and bushfires have ultimately contributed to the decline of the koala all over Australia. This novel study is a retrospective analysis of data over a 29-year period (1989-2018) using records for 12,543 sightings and clinical care admissions for wild koalas from the major koala hot-spots (Port Stephens, port Macquarie and Lismore) in New South Wales, Australia. This study aims to understand the long-term patterns and trends of key stressors that are contributing to the decline of koalas in New South Wales, and the synergic interactions of factors such as rescue location, sex and age of the koala, and if their decline is influenced progressively by year. The main findings of this retrospective analysis indicated that between all 3 rescue sites, the most common prognosis was disease, the most common disease was signs of chlamydia, and the most common outcome was release. The location where the highest number of koalas were found prior to being reported as sighted or admitted into clinical care was within the regional area of Lismore. Furthermore, sex was not a discriminating factor when it came to prognosis or outcome, but age was significant. Finally, incidents of disease were found to increase over long-term, whereas release decreased over time and euthanasia increased. The wealth of data available to us and the retrospective analysis enabled us in a way to 'zoom out' and reveal how the key environmental stressors have fluctuated spatially and temporally. In conclusion, our data provides strong evidence of added pressures of increased human population growth in metropolitan zones, which increases risks of acute environmental trauma and proximate stressors such as vehicle collisions and dog-attacks as well as increased sightings of virtually healthy koalas found in exposed environments. Thus our 'zoom out' approach provides support that there is an urgent need to strengthen on-ground management, bushfire control regimes, environmental planning and governmental policy actions that should hopefully reduce the proximate environmental stressors in a step wise approach. This will ensure that in the next decade (beyond 2020), NSW koalas will hopefully start to show reversed trends and patterns in exposure to environmental trauma and disease, and population numbers will return towards recovery and stability.

Species distribution models advance our knowledge of the Neanderthals' paleoecology on the Iranian Plateau

Neanderthals (Homo neanderthalensis) were distributed across a vast region from Europe to western and Central Asia. The Neanderthals' paleoecology and distribution has been extensively studied in Europe where the species originated. However, very little is known about their paleoecology in south-western Asia. Here, we employed species distribution modelling and 45 Middle Palaeolithic (c. 200,000-40,000 years BCE) sites location associated with fossil and/or lithic artefacts made by the Neanderthals to examine the expansion of the Neanderthals on the Iranian Plateau in south-western Asia. We estimated the niche overlap between Neanderthals and wild goat, wild sheep and Persian gazelle by modelling their past distribution using 200, 143 and 110 occurrence records respectively. The results show that Neanderthals had highest niche overlap with wild goat in the study area. This analysis revealed that the most suitable Neanderthals' habitats in south-western Asia were located in the Zagros Mountains stretches from north-western and western and some isolated patches in the central parts of the Iranian Plateau. The annual precipitation and maximum temperature of the warmest month were the most important predictor of the species' distribution. This finding shows that the southern edge of the Neanderthals distribution was limited by warm summer. Our results provide important information for future field investigations and excavations in the area.

The 2010 structural-demographic forecast for the 2010-2020 decade: A retrospective assessment

This article revisits the prediction, made in 2010, that the 2010-2020 decade would likely be a period of growing instability in the United States and Western Europe Turchin P. 2018. This prediction was based on a computational model that quantified in the USA such structural-demographic forces for instability as popular immiseration, intraelite competition, and state weakness prior to 2010. Using these trends as inputs, the model calculated and projected forward in time the Political Stress Indicator, which in the past was strongly correlated with socio-political instability. Ortmans et al. Turchin P. 2010 conducted a similar structural-demographic study for the United Kingdom. Here we use the Cross-National Time-Series Data Archive for the US, UK, and several major Western European countries to assess these structural-demographic predictions. We find that such measures of socio-political instability as anti-government demonstrations and riots increased dramatically during the 2010-2020 decade in all of these countries.

Sex-specific effects of reproductive season on bobcat space use, movement, and resource selection in the Appalachian Mountains of Virginia

Across taxa, sex-specific demands vary temporally in accordance with reproductive investments. In solitary carnivores, females must provision and protect young independently while meeting increased energetic demands. Males seek to monopolize access to females by maintaining large territories and defending them from other males. For many species, it is poorly understood how these demands relate to broad-scale animal movements. To investigate predictions surrounding the reproductive strategies of solitary carnivores and effects of local conditions on bobcat (Lynx rufus) spatial ecology, we examined the effects of sex and reproductive season on home range size, movement rate, and resource selection of bobcats in the central Appalachian Mountains. Male seasonal home ranges were approximately 3 times larger than those of females (33.9 ± 2.6 vs. 12.1 ± 2.4 km2, x±SE), and male movement rates were 1.4 times greater than females (212.6 ± 3.6 vs. 155 ± 8.2 m/hr), likely reflecting male efforts to maximize access to females. Both sexes appear to maintain relatively stable seasonal home ranges despite temporally varying reproductive investments, instead adjusting movements within home ranges. Males increased movements during the dispersal period, potentially reflecting increased territoriality prior to breeding. Females increased movements during the kitten-rearing period, when foraging more intensively, and frequently returning to den sites. Both sexes selected home ranges at higher elevations. However, females selected deciduous forest and avoided fields, whereas males selected fields and avoided deciduous forest, perhaps explained by male pressure to access multiple females across several mountain ridges and higher risk tolerance. Seasonal changes in home range selection likely reflect changes in home range shape. Increased female avoidance of fields during kitten rearing may indicate female avoidance of presumably resource rich, yet risky, fields at the time when kittens are most vulnerable. Our results indicate that while reproductive chronology influences the spatial ecology of solitary carnivores, effects may be constrained by territoriality.

The association of obesity with health insurance coverage and demographic characteristics: a statewide cross-sectional study

We evaluated the statewide burden of obesity and its complications among government and state funded programs (Medicare and Medicaid) and commercial insurance.We calculated the prevalence of obesity and the prevalence of relevant comorbidities among different demographic groups and based on health insurance, among adults (18-65 years old) who visited a statewide health network in the state of Rhode Island, in 2017.The overall prevalence of obesity among 74,089 individuals was 38.88% [Asians 16.77%, Whites 37.49%, Hispanics 44.23%, and Blacks 48.44%]. Medicare or Medicaid beneficiaries were 26% and 27%, respectively, more likely to have obesity than those who had commercial insurance (Odds Ratio:1.26, 95% confidence interval [CI]:1.20-1.32; Odds Ratio:1.27, 95%CI:1.22-1.32). Moreover, Medicaid and Medicare beneficiaries with obesity had a higher prevalence of diabetes compared with privately insured with obesity (10.58% and 10.44% vs 4.45%). Medicare beneficiaries with obesity had a statistically higher prevalence of ischemic heart disease (4.34%, 95%CI: 3.77-4.91) than privately insured (3.21%, 95%CI: 2.94-3.47).Based on statewide data among 18 to 65 years old adults, Medicare and Medicaid provide health coverage to 40% of individuals with obesity and 46% of those with the obesity-related comorbidities and complications. State and federal health care programs need to support and expand obesity-related services and coverage.

National Trends in the Prevalence of Chronic Kidney Disease Among Racial/Ethnic and Socioeconomic Status Groups, 1988-2016

IMPORTANCE

The overall prevalence of chronic kidney disease (CKD) has stabilized in the United States in recent years. However, it is unclear whether all major sociodemographic groups experienced this trend.

OBJECTIVE

To examine trends in CKD prevalence across major sociodemographic groups as defined by race/ethnicity and socioeconomic status.

DESIGN, SETTING, AND PARTICIPANTS

This repeated cross-sectional study used data from the National Health and Nutrition Examination Surveys for 1988 to 1994 and every 2 years from 1999 to 2016 on individuals 20 years or older with information on race/ethnicity, socioeconomic status, and serum creatinine levels. Statistical analysis was conducted from May 1, 2017, to April 6, 2020.

EXPOSURES

Race/ethnicity and socioeconomic status.

MAIN OUTCOMES AND MEASURES

Prevalence of CKD was defined as an estimated glomerular filtration rate of 15 to 59 mL/min/1.73 m2.

RESULTS

A total of 54 554 participants (mean [SE] age, 46.2 [0.2] years; 51.7% female) were examined. The age-, sex- and race/ethnicity-adjusted overall prevalence of stage 3 and 4 CKD increased from 3.9% in 1988-1994 to 5.2% in 2003-2004 (difference, 1.3%; 95% CI, 0.9%-1.7%; P < .001 for change) and remained relatively stable thereafter at 5.1% in 2015-2016 (difference, -0.1%; 95% CI, -0.7% to 0.4%; P = .61 for change). The trend in adjusted CKD prevalence differed significantly by race/ethnicity (P = .009 for interaction). In non-Hispanic white and non-Hispanic black persons, CKD prevalence increased between 1988-1994 and 2003-2004 and remained stable thereafter. Among Mexican American persons, CKD prevalence was lower than in other racial/ethnic groups and remained stable between 1988-1994 and 2003-2004 but nearly doubled (difference, 2.1%; 95% CI, 0.9%-3.3%; P = .001 for change) between 2003-2004 and 2015-2016 to rates similar to those in other racial/ethnic groups. There were higher rates of CKD prevalence among groups with lower educational level and income (eg, 5.8% vs 4.3% and 4.3% vs 3.1% in low vs high education and income, respectively, in 1988-1994), but trends in CKD prevalence mirrored those for the overall population. The higher CKD prevalence among individuals with lower educational level and income remained largely consistent throughout the entire period. Results were similar in most subgroups when including albuminuria to define CKD.

CONCLUSIONS AND RELEVANCE

The prevalence of CKD in the United States has stabilized overall in recent years but has increased among Mexican American persons. More important, gaps in CKD prevalence across racial/ethnic groups and levels of socioeconomic status largely persisted over 28 years. There is a need to identify and address causes of increasing CKD prevalence among Mexican American persons and a need to renew efforts to effectively mitigate persistent disparities in CKD prevalence.

Pilot Site Deployment of an IoT Solution for Older Adults' Early Behavior Change Detection

The world demography is continuously changing. During the last decade, we noticed a regular variation in the world demography leading to a nearly balanced society share between the young and aging population. This increasing older adult population is facing many problems. In fact, the transition to the aging period is associated with physical, psychological, cognitive, and societal changes. Negative behavior changes are considered as indicators of older adults’ frailty. This is why it is important to detect such behavior changes early in order to prevent isolation, sedentary lifestyle, and even diseases, and therefore delay the frailty period. This paper exhibits a proof-of-concept pilot site deployment of an Internet of Thing (IoT) solution for the continuous monitoring and detection of older adults’ behavior changes. The objective is to help geriatricians detect sedentary lifestyle and health-related problems at an early stage.

Demographic Characteristics of Participants in Rheumatoid Arthritis Randomized Clinical Trials: A Systematic Review

IMPORTANCE

Racial/ethnic minority groups, women, and elderly people experience a disproportionate burden of disease in rheumatoid arthritis (RA), making it particularly important to examine drug therapies in these populations. Despite a national health agenda to improve representation of diverse populations in randomized clinical trials (RCTs), there have been few large-scale analyses examining RCT demographic characteristics within rheumatology and none focusing on RA.

OBJECTIVE

To characterize the representation of racial/ethnic minority groups, women, and elderly people through a comprehensive systematic review of RA RCTs.

DATA SOURCES

A literature search of PubMed's MEDLINE database was conducted to identify RA RCTs in adults 19 years and older published in English between January 1, 2008, and January 1, 2018.

STUDY SELECTION

Randomized double-blind RCTs examining any systemic, disease-modifying therapy were included. Secondary analyses of previously published RCTs were excluded. Of 1195 identified records, 240 articles (20.1%) met final selection criteria. The analysis focused on RCTs with at least 1 US-based site.

DATA EXTRACTION AND SYNTHESIS

Data were extracted and synthesized according to the PRISMA guidelines for systematic reviews. Studies were screened for eligibility criteria. Demographic data on the age, sex, and race/ethnicity of RCT participants were extracted. Data analysis was conducted from October 25, 2018, to March 15, 2019.

MAIN OUTCOMES AND MEASURES

Representation of race/ethnicity and sex, defined as the proportion of total participants that belonged to each racial/ethnic group or sex. Trends in proportions over time were examined and compared with US demographic data.

RESULTS

A total of 240 RCTs with 77 071 participants were included. Of 126 RCTs with at least 1 US-based site (52.5%), the enrollment of minority racial/ethnic groups was significantly lower than their representation within the US Census population (16% vs 40%; P < .001), and the enrollment of men was significantly lower than the incidence of RA in men nationally (20.4% vs 28.6%; P < .001). There was no trend toward improved representation of racial/ethnic minority groups or men over time.

CONCLUSIONS AND RELEVANCE

Given the disproportionate burden of RA among racial/ethnic minority groups, it is imperative that policy makers better incentivize the inclusion of racial/ethnic minority groups in RA RCTs.

The effects of seat width, load factor, and passenger demographics on airline passenger accommodation

The objective of this work is to demonstrate a method for examining the competing effects of secular trends in body size, seat size and configuration, and the increased load factor of aeroplanes. The method uses statistical modelling and virtual fit testing to provide a flexible environment for exploring the impact of various parameters on passenger accommodation. A case study demonstrates the method by exploring the effect of seat width on the accommodation of US civilians (based on seated hip breadth). The case study demonstrates that recent trends of decreasing seat widths and increasing load factors lead to higher disaccommodation. Based on anthropometry and virtual fit, women are also shown to be disproportionately disaccommodated compared to men. Practitioner summary: Airlines are reducing seat width at the same time that individuals worldwide are getting larger. Flights are increasingly crowded, with load factor at a record high. This paper explores the effects of seat width on passenger accommodation under several scenarios involving load factor, demographics, and passenger seating allocation strategies.

Past, present and future of Aedes aegypti in its South American southern distribution fringe: What do temperature and population tell us?

Aedes aegypti (Diptera: Culicidae) (Linnaeus) is currently the major threat among arbovirus vectors in the Americas. We examined its past, present, and future distribution patterns in the South American fringe in association with environmental and demographic variables at two spatial scales. We updated the database of the occurrence of Ae. aegypti per locality and modelled by GLMM the past occurrence (until 2000) and its expansion (2001-2017) as a function of air temperature, precipitation, altitude, and population. We also conducted a field survey in 7 pairs of urban/rural cemeteries along the entire temperature range within the expansion region. At both scales, mean annual air temperature and human population were significantly associated with the distribution of Ae. aegypti. Projection of the expansion models for 2030 under two climatic change scenarios showed a vast infestation, mainly driven by the shift of the 16 °C isotherm. We postulate a quantitative compromise between air temperature and human population associated with vector occurrence, along with potential thresholds for their mutual favourability.

[Prevalence of autism spectrum disorders in USA, Europe and Spain: coincidences and discrepancies]

Autism spectrum disorders are a heterogeneous group of disorders that share the presence of two core symptoms: problems in social interaction / communication and the tendency to present restricted interests and repetitive behavior. Over the last years, several epidemiologic studies have been published by different authors in diverse countries, having all of them shown two common characteristics: a global increase in the prevalence rates of autism spectrum disorders, and the existence of a great geographical variability no only between geographical areas, but also within the same geographical areas. At the present manuscript, we analyze some of the most recent prevalence data published in USA and some European countries (including Spain). All of them show different prevalence rates, ranging from 1/59 children with autism spectrum disorders in the USA to 1/806 in Portugal. In a second part, we briefly describe some of the current scientific hypotheses that try to explain this variability.

Forecasting the incidence of salmonellosis in seniors in Canada: A trend analysis and the potential impact of the demographic shift

Salmonella infections remain an important public health issue in Canada and worldwide. Although the majority of Salmonella cases are self-limiting, some will lead to severe symptoms and occasionally severe invasive infections, especially in vulnerable populations such as seniors. This study was performed to assess temporal trends of Salmonella cases in seniors over 15 years (2014–2028) and assess possible impact of demographic shift on national incidence; taking into account of trends in other age groups. The numbers of reported Salmonella cases in seniors (60 years and over) in eight provinces and territories for a period of fifteen years were analysed (1998–2013) using a time-adjusted Poisson regression model. With the demographic changes predicted in the age-structure of the population and in the absence of any targeted interventions, our analysis showed the incidence of Salmonella cases in seniors could increase by 16% by 2028 and the multi-provincial incidence could increase by 5.3%. As a result, the age distribution amongst the Salmonella cases is expected to change with a higher proportion of cases in seniors and a smaller proportion in children (0–4 years old). Over the next decades, cases of infection, hospitalizations and deaths associated with Salmonella in seniors could represent a challenge to public health due to an aging population in Canada. As life expectancy increases in Canada, identification of unique risk factors and targeted prevention in seniors should be pursued to reduce the impact of the demographic shift on disease incidence.

Population health in an era of rising income inequality: USA, 1980-2015

Income inequality in the USA has increased over the past four decades. Socioeconomic gaps in survival have also increased. Life expectancy has risen among middle-income and high-income Americans whereas it has stagnated among poor Americans and even declined in some demographic groups. Although the increase in income inequality since 1980 has been driven largely by soaring top incomes, the widening of survival inequalities has occurred lower in the distribution-ie, between the poor and upper-middle class. Growing survival gaps across income percentiles since 2001 reflect falling real incomes among poor Americans as well as an increasingly strong association between low income and poor health. Changes in individual risk factors such as smoking, obesity, and substance abuse play a part but do not fully explain the steeper gradient. Distal factors correlated with rising inequality including unequal access to technological innovations, increased geographical segregation by income, reduced economic mobility, mass incarceration, and increased exposure to the costs of medical care might have reduced access to salutary determinants of health among low-income Americans. Having missed out on decades of income growth and longevity gains, low-income Americans are increasingly left behind. Without interventions to decouple income and health, or to reduce inequalities in income, we might see the emergence of a 21st century health-poverty trap and the further widening and hardening of socioeconomic inequalities in health.

Impact of Nutrition Transition and Resulting Morbidities on Economic and Human Development

INTRODUCTION

Nutrition transition is an adverse outcome of rapid economic development and globalization. The present review documents the pattern of nutrition and health transition among different food groups leading to the growing global and national epidemic of non-communicable diseases (NCDs).

METHOD

Studies published in various national and international journals were searched using PubMed and Google Scholar search engines from the year 2000 to 2015. Literature was reviewed to gather data pertaining to nutrition and health transition and economic burden of non-communicable disease (NCDs).

RESULTS

Diets are changing globally towards higher intakes of simple and refined carbohydrates (including sugar), fat and lower intake of complex carbohydrates. The upsurge of co-morbidities arising from nutrition transition is a serious threat worldwide especially in developing countries like India, which in turn poses a huge impact on economic development of the nation.

CONCLUSION

Better awareness and encouragement of using healthier diet option can help to combat the epidemic of NCDs in the developing world.

Long-term care and births timing<sup/>

Due to the aging process, the provision of long-term care (LTC) to the dependent elderly has become a major challenge of our epoch. But our societies are also characterized, since the 1970s, by a postponement of births, which, by raising the intergenerational age gap, can affect the provision of LTC by children. In order to examine the impact of those demographic trends on the optimal policy, we develop a four-period OLG model where individuals, who receive children's informal LTC at the old age, must choose, when being young, how to allocate births along their life cycle. It is shown that, in line with empirical evidence, early children provide more LTC to their elderly parents than do late children, because they face a lower opportunity cost of providing LTC. When comparing the laissez-faire with the long-run social optimum, it appears that individuals have, at the laissez-faire, too few early births, and too many late births. We then study, in first-best and second-best settings, how the social optimum can be decentralized by encouraging early births, in such a way as to reduce the social burden of LTC provision.

Future malaria spatial pattern based on the potential global warming impact in South and Southeast Asia

We used the Model for Interdisciplinary Research on Climate-H climate model with the A2 Special Report on Emissions Scenarios for the years 2050 and 2100 and CLIMEX software for projections to illustrate the potential impact of climate change on the spatial distributions of malaria in China, India, Indochina, Indonesia, and The Philippines based on climate variables such as temperature, moisture, heat, cold and dryness. The model was calibrated using data from several knowledge domains, including geographical distribution records. The areas in which malaria has currently been detected are consistent with those showing high values of the ecoclimatic index in the CLIMEX model. The match between prediction and reality was found to be high. More than 90% of the observed malaria distribution points were associated with the currently known suitable climate conditions. Climate suitability for malaria is projected to decrease in India, southern Myanmar, southern Thailand, eastern Borneo, and the region bordering Cambodia, Malaysia and the Indonesian islands, while it is expected to increase in southern and south-eastern China and Taiwan. The climatic models for Anopheles mosquitoes presented here should be useful for malaria control, monitoring, and management, particularly considering these future climate scenarios.

A Comparative Analysis of Selected Demographic Parameters for Evaluating Parity of Women in Poland, Spain, England and Wales for the Period 1996-2011

BACKGROUND

The Central Statistical Offices in Europe indicate an increase of women's parity age and extramarital births.

OBJECTIVES

The aim of this study was to analyze the chosen demographics of parity in European countries of Poland, Spain, England and Wales in 1996-2011.

MATERIAL AND METHODS

Statistical packet: women's average age at the time of their first and subsequent births, newborns' average body weight in relation to the age of mother; live marital and extramarital births. The age of mothers giving birth to their first and subsequent children in 1998-2011 in all of the researched countries is presented, and next compared in 1999, 2005 and 2011. An analysis of the births of children in marital and extramarital relationships as well as the body weight of live newborns is presented in detail in 1996-2006, and next in 6 year periods: 1999, 2005 and 2011.

RESULTS

The average age of the mother giving birth to her first baby in 1996-2011 oscillates around: 26-27 years in England and Wales, 28-30 years in Spain and 23-26 years in Poland. In Poland, the highest average children's body weight, 3394 g, was achieved by children born by mothers at the age of 25-29. In Spain, however, at the mothers' age of 20-24, it was 3317 g. In England and Wales, at 30-34 years, it was 3262 g. The number of extramarital births in comparison to marital births is increasing. England and Wales has the lowest percentage of marital births, whereas Poland, the highest. In Spain, England and Wales we can observe an increase of extramarital births, while in Poland this number is stable at around 21.3%.

CONCLUSIONS

The age of women having their first baby, the parity of later children, and extramarital births are increasing. In Poland, infant body weight is significantly bigger than in Spain, England and Wales.

Population Distributions of Thymic Function in Adults: Variation by Sociodemographic Characteristics and Health Status

The thymus is critical for mounting an effective immune response and maintaining health. However, epidemiologic studies characterizing thymic function in the population setting are lacking. Using data from 263 adults in the Detroit Neighborhood Health Study, we examined thymic function as measured by the number of signal joint T-cell receptor excision circles (sjTREC) and assessed associations with established indicators of physiological health. Overall, increasing age and male gender were significantly associated with reduced thymic function. Adjusting for covariates, individuals with elevated levels of the pro-inflammatory biomarkers C-reactive protein (β: -0.50 [95% CI: -0.82, -0.18] for moderate elevation, β: -0.29 [95% CI: -0.59, 0.00] for high elevation) and interleukin-6 (β: -0.60 [95% CI: -0.92, -0.28] for moderate elevation, β: -0.43 [95% CI: -0.77, -0.08] for severe elevation) also had lower thymic function. Compared to individuals with a BMI < 25, individuals who were overweight (β: 0.36 [95% CI: 0.07, 0.64]) or obese (β: 0.27 [95% CI: -0.03, 0.56]) had higher thymic function. Differences by self-rated health were not statistically significant. Our findings underscore demographic- and health-related gradients in thymic function among adult residents of Detroit, suggesting thymic function may be an important biomarker of health status in adults at the population level.

The well-being of young adults in the "Next America"

Demographic change is a drama in slow motion, and the America of the early 21st century is undergoing two such dramas at the same time. Our population is en route to becoming majority non-White at the same time a record share of us are going gray. Either of these trends would be the dominant demographic story of this era. The fact that they are occurring simultaneously has created significant generation gaps. The paradox of these sorts of dramas is that even though they are happening all over, they can sometimes be hard to see. As Millennials assert themselves in the economy and the electorate, let's hope they press their elected leaders on these issues. And as Boomers cross over into their golden years, let's hope they do their share as well. If we want the American experiment to thrive at a time of sweeping demographic change, we must all rediscover our roots as a nation of planters

Aging in Poland

With 38 million residents, Poland has the eighth-largest population in Europe. A successful transition from communism to democracy, which began in 1989, has brought several significant changes to the country's economic development, demographic structure, quality of life, and public policies. As in the other European countries, Poland has been facing a rapid increase in the number of older adults. Currently, the population 65 and above is growing more rapidly than the total population and this discrepancy will have important consequences for the country's economy. As the population ages, there will be increased demands to improve Poland's health care and retirement systems. This article aims to provide a brief overview of the demographic trends in Poland as well a look at the country's major institutions of gerontology research. The article also describes key public policies concerning aging and how these may affect the well-being of Poland's older adults.

Explaining the Rapid Increase in Nigeria's Sex Ratio at Birth: Factors and Implications

This paper examines the rapid increase in Nigeria's sex ratio at birth from 1.03 boys born for every 1 girl born in each year from 1996-2008 to 1.06 in each year from 2009-2014, second only to Tunisia in Africa at 1.07. The average sex ratio at birth in the world in 2014 was 1.07. In most Black African nations or Black majority nations, it is 1.03 or less. Among the factors presented for this development are: historical fluctuations of sex ratio at birth; geography and ethnicity; male preference/chasing a son; Age of parents; high death rates of male infants and males in general; and wealth/socioeconomic status. Among the potential implications are: young and poor men in Nigeria may not be able to find brides and form families due to a potential shortage of females; emigration of young and poor Nigerian men to West (Africa) and elsewhere to seek brides and form families; immigration of marriage age women from West (Africa) and around the world to Nigeria to seek husbands; and low contraceptive use and high fertility rates in Nigeria.

Geographical Inequalities in Alcohol-Related Mortality Rates in Taiwan due to Socio-Demographic Differences

AIMS

To assess the relationships between alcohol-related mortality and socio-demography in Taiwan.

METHODS

Using 2002-2006 data from the national death-diagnosis registration system, we calculated the alcohol-attributed disease mortality of those aged 15 and older in 348 townships in Taiwan. This study provides spatial clustering of alcohol-attributed disease mortality rates and area socio-demographic conditions across townships, examining the relationship between the two using a spatial autoregressive model.

RESULTS

The relative risk of death due to alcohol-attributed diseases was estimated to increase by 2.1 and 0.9% as a result of a 1% increase in the percentage of men and aboriginal residents, respectively. The risk of death was estimated to decrease by 25% for every 1 year increase in education level. Industrialization and labor participation were also found to be predictors of the outcome measure in areas with differing levels of urbanization.

CONCLUSIONS

This study provides significant evidence that township-level relationships between alcohol-related mortality and socioeconomic variables exist in Taiwan. Public health policymakers should better prioritize the specific areas in which comprehensive intervention should be undertaken accordingly.

Hawai'i's nursing workforce: keeping pace with healthcare

Nursing is the largest segment of the healthcare workforce, but over the next decade even more nurses will be required. Changing population demographics, new technologies, and evolving models of healthcare will stimulate expansion of nursing roles and the need for a highly educated nursing workforce. The current nursing workforce is aging, and large numbers of retirements are anticipated. By 2025, the United States is expected to experience a nursing shortage; in Hawai'i this shortfall is forecast to be 3,311 professional nurses. Currently there are nine nursing programs across the state in public and private universities and colleges. These programs are partnering to implement the Institute of Medicine's recommendations for the future of nursing. In Hawai'i, nursing practice is being expanded; different pathways to advanced nursing education are being implemented; and nurses are partnering with other groups to reshape healthcare. The Hawai'i State Center for Nursing collects ongoing data on the nursing workforce to inform strategic planning. Current gaps in nursing specialty education include school health and mental health. The purpose of this paper is to provide an overview of Hawai'i's nursing workforce in relationship to statewide population demographics, healthcare needs and gaps, and then outline steps being taken by the profession to address these needs and gaps while implementing the Institute of Medicine recommendations.

Memory-endowed US cities and their demographic interactions

A quantitative understanding of cities' demographic dynamics is becoming a potentially useful tool for planning sustainable growth. The concomitant theory should reveal details of the cities' past and also of its interaction with nearby urban conglomerates for providing a reasonably complete picture. Using the exhaustive database of the Census Bureau in a time window of 170 years, we exhibit here empirical evidence for time and space correlations in the demographic dynamics of US counties, with a characteristic memory time of 25 years and typical distances of interaction of 200 km. These correlations are much larger than those observed in a European country (Spain), indicating more coherent evolution in US cities. We also measure the resilience of US cities to historical events, finding a demographical post-traumatic amnesia after wars (such as the American Civil War) or economic crisis (such as the 1929 Stock Market Crash).

[Diagnostics of Regional Healthcare Management System in Russia Basing on Modeling and Forecasting of Health and Demographic Indicators]

BACKGROUND

Justification of the study direction of public health improving is quite general. But the identification of the most effective indicators of the healthcare system improvement remains unexplored.

OBJECTIVE

Our aim was to determine the interaction between the basic demographic indicators of the region (Smolensk region) and efficacy endpoints of the Healthcare management identified in the study.

METHODS

The study reviewed the demographic changes of the Smolensk region at present and the forecast for 2015, 2016, 2017. The forecast of demographic and health indicators was based on exponential smoothing models and autoregressive model.

RESULTS

The study identified the most appropriate medical and demographic indicators. 1) The ratio of physicians (per 10,000 people in population, the rate maximum was 62 in 2004, in 2015 this figure has fallen to 52, and it is supposed to decrease to 49 by 2017). 2) The overall mortality rate (per 1000 people in population). Reduction of the resident population of the Smolensk region is 8.2 thousand people in annual average. This fact shows a stable depopulation of the region. 3) The average load on the ambulance. It has been found that the increase and decrease of these parameters directly affect the population rate.

CONCLUSION

The study revealed a stable downtrend of average resident population number which confirms the long regional depopulation. It is associated in particular with the lack of stimulation of the health and demographic indicators' increase including but not limited to inefficient healthcare management arrangements.

[Demographic aspects of population aging in Saint-Petersburg at the end of XX-the beginning of XXI century. Part I. Conventional aging measures]

The paper represents the first part of the series of two articles on demographic aspects of population aging in Saint-Petersburg in 1990-2010 compared to the situation in the Russian Federation as a whole. In the first part, the situation with the population aging in Saint-Petersburg and Russia is considered based on traditional aging measures - the proportion of elderly in the total population, aging index, old age dependency rate and the parents support ratio. In the second part, a number of prospective aging indicators that take account of remaining life expectancy, will be studied. The analysis also includes the consideration of gender imbalance of aging indicators. Accelerating of population aging in Saint-Petersburg and Russia leads to a new demographic situation requiring a number of economic and socially oriented measures.

Climate change and the potential global distribution of Aedes aegypti: spatial modelling using GIS and CLIMEX

We examined the potential added risk posed by global climate change on the dengue vector Aedes aegypti abundance using CLIMEX, a powerful tool for exploring the relationship between the fundamental and realised niche of any species. After calibrating the model using data from several knowledge domains, including geographical distribution records, we estimated potential distributions of the mosquito under current and future potential scenarios. The impact of climate change on its potential distribution was assessed with two global climate models, the CSIRO-Mk3.0 and the MIROC-H, run with two potential, future emission scenarios (A1B and A2) published by the Intergovernmental Panel on Climate Change. We compared today's climate situation with two arbitrarily chosen future time points (2030 and 2070) to see the impact on the worldwide distribution of A. aegypti . The model for the current global climate indicated favourable areas for the mosquito within its known distribution in tropical and subtropical areas. However, even if much of the tropics and subtropics will continue to be suitable, the climatically favourable areas for A. aegypti globally are projected to contract under the future scenarios produced by these models, while currently unfavourable areas, such as inland Australia, the Arabian Peninsula, southern Iran and some parts of North America may become climatically favourable for this mosquito species. The climate models for the Aedes dengue vector presented here should be useful for management purposes as they can be adapted for decision/making regarding allocation of resources for dengue risk toward areas where risk infection remains and away from areas where climatic suitability is likely to decrease in the future.

Demographic trends in alcohol use: the value of a surveillance system

OBJECTIVE

To determine trends in alcohol consumption in South Australia.

METHODS

Data collection from 2003 to 2011. Time series trends overall and by age, sex, education level, and income by proportion of drinkers, mean number of drinks, drinking less than one day, drinking on six or more days per week, lifetime alcohol risk and injury risk.

RESULTS

An overall decline in the proportion of alcohol drinkers, an increase in the overall proportion of adults drinking alcohol less than one day per week. No overall change in mean number of drinks consumed per day but with differences by demographic groups.

CONCLUSION

This study presents multiple consumption-related variables over time and has highlighted important demographic variations in alcohol consumption.

[The dynamics of heath indicators of population of industrial town]

The article presents the results of analysis of dynamics of health indicators of population of industrial town (medical demographic indicators, disability, morbidity of social hygienically important diseases) during 1970-2010. The classified administrative territorial municipality of Seversk constructed near the Siberian chemical industrial center, the internationally first-rate complex of nuclear industry enterprises was used as a research base. It is demonstrated that dynamics of health indicators of studied population had such negative tendencies as rapid population ageing, population loss due to decrease of natality and increase of mortality (population of able-bodied age included), prevalence of cardio-vascular diseases, malignant neoplasms and external causes, chronization of diseases. The established tendencies are to be considered in management decision making targeted to support and promote population health in industrial towns.

Maternal age demographic trends in Greece from 1980 to 2008

OBJECTIVE

To identify maternal age trends in Greece over a 29-year period from 1980 to 2008.

STUDY DESIGN

Data concerning live births after 24 gestational weeks was collected from the Hellenic Vital Statistics records and analyzed. Mothers were categorized into age groups. Data was further sorted according to birth in urban or non-urban areas, and the relative contribution of each group was estimated.

RESULTS

In contrast to 1980, when the most prevalent maternal age group was 20-24 years, in 1990 the prevalent maternal age group was 25-29 years. In 2008 the prevalent maternal age group shifted to 30-34 years of age. Adolescent births do not pose a major problem in Greece and present a steadily declining trend throughout the years studied. Urban population exhibited an earlier and more intense shift towards older maternal ages. Demand for assisted reproductive technology methods showed an increase among women > or = 40 years of age.

CONCLUSION

Maternal age patterns in Greece over the past 3 decades are described. The differences in birth patterns in women giving birth in urban areas are identified and compared to birth patterns in the rest of the country. The adolescent pregnancy rate in Greece was found to be very low.

Demographics and the social reckoning in the Arab region

Demographic transitions in the Arab countries, due to declining birth rates and mortality rates since the 1980s, are reflected in a low proportion of children, a relatively stable proportion of elderly and a high proportion of people of working age. This "youth bulge" of young, active, working-age individuals in the current population may open a demographic window for countries to benefit from increased savings and investment. This paper reviews the demographic situation in the Arab region and the impact of education, employment, migration, health status and participation in society on the further development of the region, including the impact of these factors on ageing and gender issues. The intent is to draw attention to the importance of these demographic changes and highlight the need for action to maximize the potential benefit to the population in this region.

Demography of medical students at the University of Otago, 2004-2008: a changing spectrum?

AIMS

To review the demography of University of Otago Year 2 medical students for the period 2004-2008 to determine whether our graduates reflect the changing demography of New Zealand society.

METHOD

A demographic questionnaire was completed by students entering Year 2. This paper reviews data collected from 2004-2008 and compares the results with data collected between 1987-2000 and also with New Zealand census data.

RESULTS

The demographic spectrum of the University of Otago Medical School Year 2 students does not show a general shift towards the demography of the New Zealand community. However, there have been specific positive changes for entrants with a rural background and the proportion of students who are New Zealand citizens. Of concern Maori and Pacific Island students and students from families with lower socioeconomic and educational status are under-represented in the reported period although there has been more recent improvement. In addition the proportion of students with a parent as a doctor has risen compared to the 1987-2000 cohort.

CONCLUSIONS

Further initiatives are needed to improve the numbers of Maori and Pacific Island students and students from lower socioeconomic backgrounds.

Characteristics, availability and uses of vital registration and other mortality data sources in post-democracy South Africa

The value of good-quality mortality data for public health is widely acknowledged. While effective civil registration systems remains the 'gold standard' source for continuous mortality measurement, less than 25% of deaths are registered in most African countries. Alternative data collection systems can provide mortality data to complement those from civil registration, given an understanding of data source characteristics and data quality. We aim to document mortality data sources in post-democracy South Africa; to report on availability, limitations, strengths, and possible complementary uses of the data; and to make recommendations for improved data for mortality measurement. Civil registration and alternative mortality data collection systems, data availability, and complementary uses were assessed by reviewing blank questionnaires, death notification forms, death data capture sheets, and patient cards; legislation; electronic data archives and databases; and related information in scientific journals, research reports, statistical releases, government reports and books. Recent transformation has enhanced civil registration and official mortality data availability. Additionally, a range of mortality data items are available in three population censuses, three demographic surveillance systems, and a number of national surveys, mortality audits, and disease notification programmes. Child and adult mortality items were found in all national data sources, and maternal mortality items in most. Detailed cause-of-death data are available from civil registration and demographic surveillance. In a continent often reported as lacking the basic data to infer levels, patterns and trends of mortality, there is evidence of substantial improvement in South Africa in the availability of data for mortality assessment. Mortality data sources are many and varied, providing opportunity for comparing results and improved public health planning. However, more can and must be done to improve mortality measurement by improving data quality, triangulating data, and expanding analytic capacity. Cause data, in particular, must be improved.

The demographics and prevalence of youth (15-24 year olds) with type 1 diabetes in the Canterbury District Health Board catchment area in 2010: has the prevalence changed since 2003?

AIM

The aim of the present study was to provide up-to-date descriptive information in relation to youth (15-24 years) with type 1 diabetes, residing within the Canterbury District Health Board (CDHB) catchment area. This included calculating the prevalence of type 1 diabetes in youth, and investigating whether there was an increase in the prevalence since a previous study reporting the prevalence of type 1 diabetes in youth in the CDHB in 2003.

METHODS

Data were collected from multiple clinical and research sources. Descriptive information and demographic characteristics, including age, gender, ethnicity, deprivation level, and diabetes duration were gathered. The prevalence, stratified by age and ethnicity, was calculated using the 2006 population census data.

RESULTS

There were 248 people with type 1 diabetes aged between 15 and 24 years residing within the CDHB area at the time of present study, giving a prevalence of 426 per 100,000 European youth with type 1 diabetes. The prevalence is found to have increased by 45 per 100,000 (12%) since 2003, but was statistically insignificant.

CONCLUSIONS

There was no statistically significant increase in the prevalence of type 1 diabetes in youth in the CDHB catchment area between 2003 and 2010. However, the absolute figures of adolescents and young adults with type 1 diabetes have increased, which implies an increased demand on health care associated with diabetes compared to 7 years ago.

Malthusian dynamics in a diverging Europe: Northern Italy, 1650-1881

Recent empirical research questions the validity of using Malthusian theory in preindustrial England. Using real wage and vital rate data for the years 1650-1881, I provide empirical estimates for a different region: Northern Italy. The empirical methodology is theoretically underpinned by a simple Malthusian model, in which population, real wages, and vital rates are determined endogenously. My findings strongly support the existence of a Malthusian economy wherein population growth decreased living standards, which in turn influenced vital rates. However, these results also demonstrate how the system is best characterized as one of weak homeostasis. Furthermore, there is no evidence of Boserupian effects given that increases in population failed to spur any sustained technological progress.

Changes in the demography of Australia and therefore general practice patient populations

BACKGROUND

The population of Australia is ageing. We sought to examine the impact of this demographic trend on the demography of general practices.

METHODS

Descriptive statistics of Medicare claims and census data, 1996-2010.

RESULTS

There have been changes in the demography of general practice patients commensurate with changes in the national demography. The proportion of patient visits made by those aged >65 years increased from 18.3% to 23.3%, an absolute increase of 5% but a relative increase of 27.3%. In contrast, the proportion of patient visits to general practices decreased by 16.4% (relative decrease) for those aged 0-4 years and 28.9% (relative decrease) for those aged 5-14 years.

DISCUSSION

As visits for children become a smaller fraction of overall general practice visits, the continued comfort level and competency to provide primary care of acute and chronic illness in children as well as recognition of abnormal development may be affected. To ensure the adequate provision of services to this paediatric population, careful ongoing monitoring of general practices, referral patterns and comfort levels in the care of children must be undertaken.