Outcomes after definitive radiation therapy for localized prostate cancer in a national health care delivery system

PURPOSE

Accurate information regarding real-world outcomes after contemporary radiation therapy for localized prostate cancer is important for shared decision-making. Clinically relevant end points at 10 years among men treated within a national health care delivery system were examined.

METHODS

National administrative, cancer registry, and electronic health record data were used for patients undergoing definitive radiation therapy with or without concurrent androgen deprivation therapy within the Veterans Health Administration from 2005 to 2015. National Death Index data were used through 2019 for overall and prostate cancer-specific survival and identified date of incident metastatic prostate cancer using a validated natural language processing algorithm. Metastasis-free, prostate cancer-specific, and overall survival using Kaplan-Meier methods were estimated.

RESULTS

Among 41,735 men treated with definitive radiation therapy, the median age at diagnosis was 65 years and median follow-up was 8.7 years. Most had intermediate (42%) and high-risk (33%) disease, with 40% receiving androgen deprivation therapy as part of initial therapy. Unadjusted 10-year metastasis-free survival was 96%, 92%, and 80% for low-, intermediate-, and high-risk disease. Similarly, unadjusted 10-year prostate cancer-specific survival was 98%, 97%, and 90% for low-, intermediate-, and high-risk disease. The unadjusted overall survival was lower across increasing disease risk categories at 77%, 71%, and 62% for low-, intermediate-, and high-risk disease (p < .001).

CONCLUSIONS

These data provide population-based 10-year benchmarks for clinically relevant end points, including metastasis-free survival, among patients with localized prostate cancer undergoing radiation therapy using contemporary techniques. The survival rates for high-risk disease in particular suggest that outcomes have recently improved.

Relationship of Daily Step Counts to All-Cause Mortality and Cardiovascular Events

BACKGROUND

The minimal and optimal daily step counts for health improvements remain unclear.

OBJECTIVES

A meta-analysis was performed to quantify dose-response associations of objectively measured step count metrics in the general population.

METHODS

Electronic databases were searched from inception to October 2022. Primary outcomes included all-cause mortality and incident cardiovascular disease (CVD). Study results were analyzed using generalized least squares and random-effects models.

RESULTS

In total, 111,309 individuals from 12 studies were included. Significant risk reductions were observed at 2,517 steps/d for all-cause mortality (adjusted HR [aHR]: 0.92; 95% CI: 0.84-0.999) and 2,735 steps/d for incident CVD (aHR: 0.89; 95% CI: 0.79-0.999) compared with 2,000 steps/d (reference). Additional steps resulted in nonlinear risk reductions of all-cause mortality and incident CVD with an optimal dose at 8,763 (aHR: 0.40; 95% CI: 0.38-0.43) and 7,126 steps/d (aHR: 0.49; 95% CI: 0.45-0.55), respectively. Increments from a low to an intermediate or a high cadence were independently associated with risk reductions of all-cause mortality. Sex did not influence the dose-response associations, but after stratification for assessment device and wear location, pronounced risk reductions were observed for hip-worn accelerometers compared with pedometers and wrist-worn accelerometers.

CONCLUSIONS

As few as about 2,600 and about 2,800 steps/d yield significant mortality and CVD benefits, with progressive risk reductions up to about 8,800 and about 7,200 steps/d, respectively. Additional mortality benefits were found at a moderate to high vs a low step cadence. These findings can extend contemporary physical activity prescriptions given the easy-to-understand concept of step count. (Dose-Response Relationship Between Daily Step Count and Health Outcomes: A Systematic Review and Meta-Analyses; CRD42021244747).

Comprehensive evaluation of the incidence and prevalence of surgically diagnosed pelvic endometriosis in a complete population

INTRODUCTION

The incidence and prevalence of pelvic endometriosis is still being debated. Population-based studies have shown annual incidences between 0.1% and 0.3%, which translates to a prevalence of symptom-giving disease of between 2% and 6% over a 20-year span in the reproductive years. However, a prevalence of 10% or higher is often assumed. We used Iceland's extensive record linkage possibilities, secure access to patient data and personal identification numbers to search for all cases with a surgical and/or histological first diagnosis over a 15-year study period.

MATERIAL AND METHODS

Information was obtained from all healthcare facilities where an operative and/or histological diagnosis of pelvic endometriosis might have been made during 2001-2015. Hospital discharge diagnostic data and private clinic data sources were scrutinized and double-checked through a central register. Individual medical records, operation notes and pathology records were inspected. Visually and pathologically diagnosed cases were included. The data covered women aged 15-69 years, but the age range 15-49 (reproductive years) was specifically considered. Annual incidence was estimated per 10 000 person-years and prevalence possibilities calculated for varying disease durations. Disease severity was staged (revised American Society for Reproductive Medicine classification) and main lesion sites determined.

RESULTS

A total of 1634 women 15-69 years old were diagnosed; 1487 of them between 15 and 49 years old. Histological verification was obtained for 57.1%. The age-standardized annual incidence for all confirmed endometriosis diagnoses was 12.5/10 000 person-years among women in their reproductive years. The overall estimate of prevalence was 0.6%-3.6%, dependent on duration of symptoms from 5 up to 30 years. The most common sites by order of frequency were ovaries, deep pelvis, central pelvis, vesicouterine pouch and uterine appendages. Of the women, 1080 (66.1%) had minimal/mild and 553 (33.8%) moderate/severe disease.

CONCLUSIONS

We have in a comprehensive study covering a recent 15-year period confirmed an annual incidence of pelvic endometriosis of between 0.1% and 0.15% in the female population of reproductive age. Endometriosis is variably severe but, depending on the duration of symptomatic disease, the approximated prevalence during women's reproductive years could range from 1% to 4%.

Drug and alcohol intoxication in major trauma: Associations, trends and outcomes over a decade

OBJECTIVES

Drug and alcohol intoxication is common among injured patients altering trauma presentation and characteristics. However, uncertainty exists regarding the effect of intoxication on injury severity, as well as outcomes. The present study aims to provide an update on substance-use patterns and their association with traumatic presentation and outcome within a contemporary Australian context.

METHODS

All major trauma patients captured in our centre's Trauma Registry between July 2010 and June 2020 were included. Demographic, injury characteristic, outcome and substance-use data were collected. Differences in injury severity and characteristics were explored using χ2 tests, while outcomes were modelled using adjusted binomial logistic regression.

RESULTS

Among 9700 patients, 9% were drug-intoxicated prior to injury, while 9.4% were alcohol-intoxicated. Drug use almost tripled between 2010 (4.8%) and 2020 (13.3%), while alcohol intoxication fell, from 11.7% to 7.3%, over the same period. Although there were significant differences in trauma mechanism among intoxicated patients, group comparison found no difference in Injury Severity Score for any group. Regarding outcomes, all intoxication resulted in significantly greater odds (odds ratio 1.62-2.41) of ICU admission. No difference in mortality was found among individual substance-use groups; however, polysubstance-intoxicated patients had 3.52 times greater odds of dying (95% confidence interval 1.21-10.23) compared to non-intoxicated patients.

CONCLUSION

Within this contemporary Australian population, we demonstrate escalating rates of drug intoxication and declining rates of alcohol intoxication prior to trauma. Intoxication was associated with more frequent violent and non-accidental injury, and despite no difference in severity, it was associated with worse outcomes.

Awareness and Knowledge About Glaucoma in the Western Region of Saudi Arabia: A Population-Based Survey

Background Glaucoma is a leading cause of irreversible blindness worldwide. This study aimed to assess the Saudi population's levels of awareness and knowledge regarding glaucoma risk factors, symptoms, treatment, and outcomes. Methods A cross-sectional study was conducted among the Glaucoma Awareness Campaign attendees during the World Glaucoma Week (2015-2016). A structured questionnaire was used, and a knowledge score (0-25) was calculated as the sum of all correct answers. Sociodemographic factors, personal and family history of glaucoma, and the presence of risk factors were investigated and analyzed as factors affecting knowledge. Results The study included 1751 participants, with a mean age of 40.23 (SD ±13.86) years; 51.5% were males, 3.7% had glaucoma and 22.6% had a family history of glaucoma. The overall awareness rate was 65.6%, which was moderately higher among females (71.6%), older participants (≥40 years, 69.7%), and highly educated participants (70.6%). Concerning knowledge, 15.4% had fair to good knowledge (score 15-25). Participants with a personal history of glaucoma had relatively greater knowledge regarding glaucoma-specific questions, such as optic nerve damage (p=0.001) and the requirement of lifetime treatment (p<0.001). Conclusion Awareness and knowledge about glaucoma are limited among the Saudi population, regardless of socioeconomic class or educational status. Knowledge about glaucoma should be further promoted to enable early screening and prevention.

[PUBLIC AWARENESS ABOUT INTELLECTUAL DISABILITY, ITS CAUSES AND EFFECTIVENESS OF INTERVENTIONS BY SPECIALISTS]

The purpose of the study is to analyze perception of the adult population about intellectual disability (ID), its causes and effectiveness of specialist interventions.

MATERIAL AND METHODS

1119 people were interviewed (men - 441, women - 678) aged 18 to 85 years (mean age - 34.3 ± 14.5 years). Urban residents - 851 people (76.1%), rural dwellers - 268 (23.9%). Each respondent was offered one vignette describing a sick child aged 8-10 with ID: typical, dyslalic, bradypsychic and dysphoric. Mathematical and statistical processing included descriptive statistics and calculation of the χ2 distribution.

RESULTS

49.1% of the respondents have correctly recognized ID in vignettes. Out of the incorrect answers, various psychological characteristics prevailed (25.3%) of the child; negative character traits with pessimistic assessments (23.2%); illness, including mental disorders (18.6%); defects in education and upbringing (15.6%). The respondents most often (38.5%) suggested assistance by psychologists, especially to patients with a bradypsychic variant of ID, a speech therapist - with a dyslalic one, teachers - with a typical one, psychiatrists - with a dysphoric one. 85.3% of the respondents expected improvement in the child's condition after the specialist intervention. The probable causes of ID included improper upbringing and disharmonious family relations, more often in case of a typical variant, hereditary burden and early childhood diseases - in dyslalic, alcohol consumption, poverty - in dysphoric, all of the above - in case of a bradypsychic variant.

CONCLUSION

The study has identified an insufficient level of public awareness of ID, reflecting its delayed diagnosis in children, peculiarities of the "channels" for seeking assistance with excessively high expectations of the condition improvements.

Population-level analysis of natural control of HIV infection in Zambia and South Africa: HPTN 071 (PopART)

INTRODUCTION

HIV controllers have low viral loads (VL) without antiretroviral treatment (ART). We evaluated viraemic control in a community-randomized trial conducted in Zambia and South Africa that evaluated the impact of a combination prevention intervention on HIV incidence (HPTN 071 [PopART]; 2013-2018).

METHODS

VL and antiretroviral (ARV) drug testing were performed using plasma samples collected 2 years after enrolment for 4072 participants who were HIV positive at the start of the study intervention. ARV drug use was assessed using a qualitative laboratory assay that detects 22 ARV drugs in five drug classes. Participants were classified as non-controllers if they had a VL ≥2000 copies/ml with no ARV drugs detected at this visit. Additional VL and ARV drug testing was performed at a second annual study visit to confirm controller status. Participants were classified as controllers if they had VLs <2000 with no ARV drugs detected at both visits. Non-controllers who had ARV drugs detected at either visit were excluded from the analysis to minimize potential confounders associated with ARV drug access and uptake.

RESULTS

The final cohort included 126 viraemic controllers and 766 non-controllers who had no ARV drugs detected. The prevalence of controllers among the 4072 persons assessed was 3.1% (95% confidence interval [CI]: 2.6%, 3.6%). This should be considered a minimum estimate, since high rates of ARV drug use in the parent study limited the ability to identify controllers. Among the 892 participants in the final cohort, controller status was associated with biological sex (female > male, p = 0.027). There was no significant association between controller status and age, study country or herpes simplex virus type 2 (HSV-2) status at study enrolment.

CONCLUSIONS

To our knowledge, this report presents the first large-scale, population-level study evaluating the prevalence of viraemic control and associated factors in Africa. A key advantage of this study was that a biomedical assessment was used to assess ARV drug use (vs. self-reported data). This study identified a large cohort of HIV controllers and non-controllers not taking ARV drugs, providing a unique repository of longitudinal samples for additional research. This cohort may be useful for further studies investigating the mechanisms of virologic control.

Populational Variations of Cheiloscopy Patterns: A cross-sectional observation pilot study

Purpose Lip prints are unique and have potential for use as a human identifier. The purpose of this study was to observe possible cheiloscopy differences of individuals with and without parafunctional oral habits such as smoking, vaping, playing a wind instrument or using an asthma inhaler.Methods This IRB approved blinded cross-sectional observation pilot study collected lip prints from sixty-six individuals, three of which were excluded. Participants cleansed their lips, then lipstick was applied to the vermillion zones of the upper and lower lips. Adhesive tape was applied to the lips and prints were transferred to white bond paper for viewing purposes. Each set of included lip prints was divided into quadrants and dichotomized into a group of those with an oral parafunctional habit or with no such habits. Each quadrant sample was then manually analyzed and classed according to the gold standard Suzuki and Tsuchihashi system.Results A total of 252 dichotomized lip print quadrants (with habits n=76, 30.2%, and without habits n=176, 69.8%) were analyzed. Type II patterns were the most common for examined quadrant samples; however, no statistically significant differences (Pearson's chi-squared test, p=0.366) were observed between pattern classifications of samples with and without parafunctional oral habits.Conclusion There is no statistically significant difference of lip print patterns between individuals with and without parafunctional oral habits. Further research on populational variations is needed for cheiloscopy to aid in human identifications.

[Behavior patterns of the population in relation to health]

In order to identify the basic patterns of behavior that reflect the attitude of Russians to their health, a large corpus of relevant scientific literature was analyzed, as well as actual statistical data and the results of representative sociological studies concerning various aspects of both self-preserving and self-destructive behavior of Russians. As a result, four basic models of behavior were formed and described, which differ in a set of positive and negative attitudes and characteristic lines of behavior in relation to one's health («a convinced healthy lifestyle person», «a beginner healthy lifestyle person», «irresponsible» and «self-destructive»). Based on the analysis of statistics and sociological information, it was concluded that even the behavioral model of a «beginner healthy lifestyle person» is implemented by a very minority of Russians. At best, the majority of the population adheres to the «irresponsible» pattern of behavior that involves refusing or reducing the consumption of alcohol and tobacco, but not assuming a rational diet, adequate sleep, physical and medical activity. Hence the task of everyone who has the opportunity to influence citizens, including medical workers, to convey to them the idea that health and longevity are achieved only through systematic and comprehensive efforts. In addition, a number of common misconceptions and unrealistic expectations related to healthy lifestyles were highlighted. Attention is drawn to the fact that subjects capable of exerting an educational impact on citizens, including medical specialists, should not only provide patients with useful knowledge, but also try to protect them from misconceptions and unfounded expectations.

Reference change values of FIB-4

When comparing two analytical results for the same analyte, the clinicians may benefit from knowing the reference change values (RCVs) of the analyte. For Fibrosis-4 Index (FIB-4), a noninvasive test used for assessing the risk of liver fibrosis, no RCVs have been published for non-cirrhotic individuals. Therefore, we estimated RCVs for adults, using retrospectively collected data from outpatients with AST, ALT, and thrombocytes within the respective reference intervals. FIB-4 was calculated as (age × AST)/(thrombocytes × ALT0.5). From two FIB-4 values in each patient we calculated the RCVs parametrically and non-parametrically. For both methods, we estimated the limits of the central 90% of the distribution of the ratio between the second and the first measurement. We obtained data on 599 outpatients with two blood tests taken 3 - 972 (median 258) days apart. The RCVs were 0.72 - 1.40 and 0.72 - 1.43, respectively, using the parametric and non-parametric methods. The 5 and 95 percentiles were not statistically significantly associated with sex, age, level of analyte, or the time between the measurements. The within-subject biological variation of FIB-4 was estimated to be 13.9%. Conclusion: In 90% of the patients the ratio between the second and the first FIB-4 result was approximately 0.7 - 1.4.

Population Pharmacogenomics for Health Equity

Health equity means the opportunity for all people and populations to attain optimal health, and it requires intentional efforts to promote fairness in patient treatments and outcomes. Pharmacogenomic variants are genetic differences associated with how patients respond to medications, and their presence can inform treatment decisions. In this perspective, we contend that the study of pharmacogenomic variation within and between human populations-population pharmacogenomics-can and should be leveraged in support of health equity. The key observation in support of this contention is that racial and ethnic groups exhibit pronounced differences in the frequencies of numerous pharmacogenomic variants, with direct implications for clinical practice. The use of race and ethnicity to stratify pharmacogenomic risk provides a means to avoid potential harm caused by biases introduced when treatment regimens do not consider genetic differences between population groups, particularly when majority group genetic profiles are assumed to hold for minority groups. We focus on the mitigation of adverse drug reactions as an area where population pharmacogenomics can have a direct and immediate impact on public health.

REPCAN: Guideline for REporting Population-based CANcer Registry Data

Background: The objective of this study was to develop a guideline on how to report result of a population-based cancer registry. Methods: The guideline's development involved a core working committee and a scientific committee comprising experts from diverse domains. The process comprised three steps: 1) a comprehensive review of existing tools and guidelines and the development of the initial draft of the guideline based on a review of literature, 2) refinement items through several rounds of focus group discussion among the core group, and development initial draft, and 3) Evaluation of the initial draft by scientific committee members. Items in the guideline were organized to accommodate reports of population-based cancer registries as a scientific manuscript. Results: The core committee developed 47 items distributed in the major heading of a scientific manuscript presented as a checklist. The evaluation of the scientific committee led to a consensus on the majority of the items included in the checklist. Among 10 committee members, 7 provided unreserved approval, validating each item's necessity, applicability, and comprehensibility in the checklist. Feedback from the remaining 3 members was carefully analyzed and integrated to enhance the guideline's robustness. Incorporating feedback, a first final draft was presented in a meeting of scientific and core working committee members. Collaborative discussion ensured clarity of expression for each items and a final checklist was developed. Conclusion: The guideline abbreviated as REPCAN offers a standardized framework for reporting population-based cancer registry, fostering transparency, comparability, and comprehensive data presentation. The guideline encourages flexibility while promoting comprehensive and robust reporting practices.

In models we trust: preregistration, large samples, and replication may not suffice

Despite discussions about the replicability of findings in psychological research, two issues have been largely ignored: selection mechanisms and model assumptions. Both topics address the same fundamental question: Does the chosen statistical analysis tool adequately model the data generation process? In this article, we address both issues and show, in a first step, that in the face of selective samples and contrary to common practice, the validity of inferences, even when based on experimental designs, can be claimed without further justification and adaptation of standard methods only in very specific situations. We then broaden our perspective to discuss consequences of violated assumptions in linear models in the context of psychological research in general and in generalized linear mixed models as used in item response theory. These types of misspecification are oftentimes ignored in the psychological research literature. It is emphasized that the above problems cannot be overcome by strategies such as preregistration, large samples, replications, or a ban on testing null hypotheses. To avoid biased conclusions, we briefly discuss tools such as model diagnostics, statistical methods to compensate for selectivity and semi- or non-parametric estimation. At a more fundamental level, however, a twofold strategy seems indispensable: (1) iterative, cumulative theory development based on statistical methods with theoretically justified assumptions, and (2) empirical research on variables that affect (self-) selection into the observed part of the sample and the use of this information to compensate for selectivity.

The Association between Parkinson's Disease and Congestive Heart Failure in Korea: A Nationwide Longitudinal Cohort Study

The purpose of this nationwide longitudinal follow-up study is to investigate the relationship between Parkinson's disease (PD) and congestive heart failure (CHF) patients in Korea. Patient data were collected using the National Health Insurance Service (NHIS) Health Screening (HEALS) cohort. The International Classification of Diseases 10-CM code G-20 distinguished 6475 PD patients who were enrolled in the PD group. After removing 1039 patients who were not hospitalized or attended an outpatient clinic less than twice, the total number of participants was reduced to 5436 individuals. Then, 177 patients diagnosed before 1 January 2004 were removed for relevancy, leaving us with 5259 PD patients. After case-control matching was completed using 1:5 age- and gender-coordinated matching, 26,295 people were chosen as part of the control group. The Cox proportional hazards regression analysis and the Kaplan-Meier technique were used to assess the risk of CHF in patients with Parkinson's disease. After controlling for age and gender, the hazard ratio of CHF in the PD group was 5.607 (95% confidence interval (CI), 4.496-6.993). After that, the hazard ratio of CHF in the PD group was modified against for comorbid medical disorders, resulting in a value of 5.696 (95% CI, 4.566-7.107). In subgroup analysis, CHF incidence rates were significantly increased in the PD group compared to the control group (males and females; aged ≥ 65 and <65; the non-diabetes and diabetes, hypertension and non-hypertension, and dyslipidemia and non-dyslipidemia subgroups). This nationwide longitudinal study shows a higher incidence rate of CHF in PD patients.

Mapping children by ALT 4-5 years after liver transplant: Potential individual and population applications

INTRODUCTION

Although clinicians repeatedly measure ALT to assess allograft health in children with liver transplants, they generally make decisions based on single values or qualitative trends without quantitative aggregation or synthesis. We therefore aimed to derive and test a holistic ALT metric for the 5th post-transplant year (Yr 4-5) that may better guide clinical decision-making and/or population comparisons.

METHODS

We derived the "adjusted mean Yr 4-5 ALT" for children transplanted in 2005-2016 by averaging the median ALT from each month. Patients in quartiles (Q1-4) defined by the adjusted mean Yr 4-5 ALT were compared by clinical variables, Yr 5-8 outcomes, and tacrolimus standard deviation (MLVI).

RESULTS

For 97 children [49 male; 77 deceased donors; median (IQR) age at LT 2.5 (0.8-11.7) years], the 25th, 50th, and 75th percentile thresholds for adjusted mean Yr 4-5 ALT were 19, 28, and 47 U/L, respectively. Age, donor type, LT indication, rejection history, and mean tacrolimus levels did not differ between quartiles (Q). Children in Q4 had more Yr 4-5 acute rejection episodes (p < .01), higher Yr 4-5 MLVI (p < .01), and more Yr 5-8 for-cause liver biopsies (p < .01) than those in Q1 + Q2. Children in Q3 also had higher Yr 4-5 MLVI than Q1 + Q2 (p = .047). Rates of chronic rejection and therapeutic liver-related procedures were higher in Q4 but the difference did not reach significance.

CONCLUSION

An integrated ALT metric calculated utilizing all available ALT values correlates with MLVI and future for-cause biopsies. Further study of this novel ALT metric as a predictor of clinical outcomes and descriptor of populations is warranted.

An Overview of Survey Research

Surveys provide evidence for the social sciences for knowledge, attitudes, and other behaviors, and, in health care, to quantify qualitative research and to assist in policymaking. A survey-designed research project is about asking questions of individuals, and, from the answers, the researcher can generalize the findings from a sample of respondents to a population. Therefore, this overview can serve as a guide to conducting survey research that can provide answers for practitioners, educators, and leaders, but only if the right questions and methods are used. The main advantage of using surveys is their economical access to participants online. A major disadvantage of survey research is the low response rates in most situations. Online surveys have many limitations that should be expected before conducting a search, and then described after the survey is complete. Any conclusions and recommendations are to be supported by evidence in a clear and objective manner. Presenting evidence in a structured format is crucial but well-developed reporting guidelines are needed for researchers who conduct survey research.

Insights into the Aggressiveness of the Emerging North American Population 3 (NA3) of Fusarium graminearum

In the United States and Canada, Fusarium graminearum (Fg) is the predominant etiological agent of Fusarium head blight (FHB), an economically devastating fungal disease of wheat and other small grains. Besides yield losses, FHB leads to grain contamination with trichothecene mycotoxins that are harmful to plant, human, and livestock health. Three genetic North American populations of Fg, differing in their predominant trichothecene chemotype (i.e., NA1/15ADON, NA2/3ADON, and NA3/NX-2), have been identified. To improve our understanding of the newly discovered population NA3 and how population-level diversity influences FHB outcomes, we inoculated heads of the moderately resistant wheat cultivar Alsen with 15 representative strains from each population and evaluated disease progression, mycotoxin accumulation, and mycotoxin production per unit Fg biomass. Additionally, we evaluated population-specific differences in induced host defense responses. The NA3 population was significantly less aggressive than the NA1 and NA2 populations but posed a similar mycotoxigenic potential. Multiomics analyses revealed patterns in mycotoxin production per unit Fg biomass, expression of Fg aggressiveness-associated genes, and host defense responses that did not always correlate with the NA3-specific severity difference. Our comparative disease assay of NA3/NX-2 and admixed NA1/NX-2 strains indicated that the reduced NA3 aggressiveness is not due solely to the NX-2 chemotype. Notably, the NA1 and NA2 populations did not show a significant advantage over NA3 in perithecia production, a fitness-related trait. Together, our data highlight that the disease outcomes were not due to mycotoxin production or host defense alone, indicating that other virulence factors and/or host defense mechanisms are likely involved.

Population, workforce, and organisational characteristics affecting appointment rates: a retrospective cross-sectional analysis in primary care

BACKGROUND

The recent publication of data on appointment volumes for all general practices in England has enabled representative analysis of factors affecting appointment activity rates for the first time.

AIM

To identify population, workforce, and organisational predictors of practice variations in appointment volume.

DESIGN AND SETTING

A multivariable cross-sectional regression analysis of 6284 general practices in England was undertaken using data from August-October 2022.

METHOD

Multivariable regression analyses was conducted. It related population age and deprivation, numbers of GPs, nurses, and other care professionals, and organisation characteristics to numbers of appointments by staff type and to proportions of appointments on the same or next day after booking.

RESULTS

Appointment levels were higher at practices serving rural areas. Practices serving more deprived populations had more appointments with other care professionals but not GPs. One additional full-time equivalent (FTE) GP was associated with an extra 175 appointments over 3 months. Additional FTEs of other staff types were associated with larger differences in appointment rates (367 appointments per additional nurse and 218 appointments per additional other care professional over 3 months). There was evidence of substitution between staff types in appointment provision. Levels of staffing were not associated with proportions of same-or next-day appointments.

CONCLUSION

Higher staffing levels are associated with more appointment provision, but not speed of appointment availability. New information on activity levels has shown evidence of substitution between GPs and other care professionals in appointment provision and demonstrated additional workload for practices serving deprived and rural areas.

Comparison of metabolic rate between two genetically distinct populations of lake sturgeon

Environmental temperatures differ across latitudes in the temperate zone, with relatively lower summer and fall temperatures in the north leading to a shorter growing season prior to winter. As an adaptive response, during early life stages, fish in northern latitudes may grow faster than their conspecifics in southern latitudes, which potentially manifests as different allometric relationships between body mass and metabolic rate. In the present study, we examined if population or year class had an effect on the variation of metabolic rate and metabolic scaling of age-0 lake sturgeon (Acipenser fulvescens) by examining these traits in both a northern (Nelson River) and a southern (Winnipeg River) population. We compiled 6 years of data that used intermittent flow respirometry to measure metabolic rate within the first year of life for developing sturgeon that were raised in the same environment at 16°C. We then used a Bayesian modeling approach to examine the impacts of population and year class on metabolic rate and mass-scaling of metabolic rate. Despite previous reports of genetic differences between populations, our results showed that there were no significant differences in standard metabolic rate, routine metabolic rate, maximum metabolic rate, and metabolic scaling between the two geographically separated populations at a temperature of 16°C. Our analysis implied that the lack of metabolic differences between populations could be due to family effects/parental contribution, or the rearing temperature used in the study. The present research provided insights for conservation and reintroduction strategies for these populations of lake sturgeon, which are endangered or threatened across most of their natural range.

[The molecular genetic aspects of basal cell carcinoma from the position of population health preservation]

The exploration of molecular genetic mechanisms that underlie carcinogenesis, hereditary factors of various oncological diseases, including basal cell carcinoma, the most common type of skin cancer is especially actual and significant for target strategies of public health. The diagnosis of basal cell carcinoma is based on complex clinical, radiologic and genetic examination data. The further research in the field of somatic or hereditary mutations in genes associated with basal cell carcinoma, including Patched 1 (PTCH1), Patched 2 (PTCH2), Smoothed (SMO) continue to be topical. The strategies of primary prevention of basal cell carcinoma, discussions of complex issues of decision-making concerning treatment at primary health care level, training courses and development of guidelines for general practitioners and interdisciplinary recommendations for effective early diagnosis and comprehensive care of basal cell carcinoma are to be suggested.

Public awareness of side effects of systemic steroids in Asir region, Saudi Arabia

Background

Corticosteroids have been used since the 50s and it represent the most important and frequently used class of anti-inflammatory and immunosuppressive drugs for the treatment of several diseases such as numerous neoplastic, asthma, allergy, rheumatoid arthritis, and dermatological disorders. This study aims to determine the public awareness of side effects of systemic steroids in Asir region, Saudi Arabia.

Methods

A descriptive cross-sectional web-based study was used. An online questionnaire was developed by the study researchers based on the literature review and consultations of the field experts. The questionnaire included the following components: Participants demographic data, medical history, and steroids use. Also, it covered participants awareness regarding systemic steroids and side effects.

Results

A total of 439 participants fulfilling the inclusion criteria completed the study questionnaire. Ages ranged from 18 to 65 years with mean age of 26.1 ± 13.9 years old, of those, 227 (51.7%) respondents were males. Around 346 (78.8%) had poor overall awareness level while only 93 (21.2%) had good awareness regarding systematic steroids. The study also showed that awareness was significantly higher among young aged participants in the health care field and among those who previously used steroids. Two hundred and eighty two (64.2%) of the respondents reported previous use of steroids.

Conclusion

In conclusion, the current study showed that nearly one out of each five people know about systemic steroids and related side effects which is below the satisfactory level. Higher awareness was observed with regards drug associated side effects and long-term use consequences.

UK research data resources based on primary care electronic health records: review and summary for potential users

BACKGROUND

The range and scope of electronic health record (EHR) data assets in the UK has recently increased, which has been mainly in response to the COVID-19 pandemic. Summarising and comparing the large primary care resources will help researchers to choose the data resources most suited to their needs.

AIM

To describe the current landscape of UK EHR databases and considerations of access and use of these resources relevant to researchers.

DESIGN & SETTING

Narrative review of EHR databases in the UK.

METHOD

Information was collected from the Health Data Research Innovation Gateway, publicly available websites and other published data, and from key informants. The eligibility criteria were population-based open-access databases sampling EHRs across the whole population of one or more countries in the UK. Published database characteristics were extracted and summarised, and these were corroborated with resource providers. Results were synthesised narratively.

RESULTS

Nine large national primary care EHR data resources were identified and summarised. These resources are enhanced by linkage to other administrative data to a varying extent. Resources are mainly intended to support observational research, although some can support experimental studies. There is considerable overlap of populations covered. While all resources are accessible to bona fide researchers, access mechanisms, costs, timescales, and other considerations vary across databases.

CONCLUSION

Researchers are currently able to access primary care EHR data from several sources. Choice of data resource is likely to be driven by project needs and access considerations. The landscape of data resources based on primary care EHRs in the UK continues to evolve.

European Corn Borer (Ostrinia nubilalis Hbn.) Bioecology in Eastern Romania

Between 2020 and 2021, we conducted research in eastern Romania to monitor the bioecology of the European corn borer (Ostrinia nubilalis Hbn.), an important pest of corn. The bioecology research established the pest stage duration (egg, larva, pupa, and moth), the flight curve, and the flight peak. The bioecological study occurred in the experimental corn field and a field cage. According to our findings, the insect has one generation per year. The European corn borer hibernates as a mature larva in corn residues and continues developing in the spring, when the weather warms. It pupates from May to July over 37 days. Analyzing the data recorded during the winters of 2020 and 2021, we observed that the warming trend favored the high survival of hibernating larvae (60.7%). Due to the large number of mature larvae that had favorable conditions during the winter, there is an intense flight, starting in June and ending in September. When the first moth was caught in the light trap, the ∑(tn-10) °C (sum of degree days) was 245.6 °C. In 2020, the flight was recorded for 94 days. In 2021, the European corn borer flight lasted 104 days. The initial egg masses were detected when the total of ∑(tn-10) °C reached 351.5 °C. Moths laid the eggs for 25 days, mostly during peak flight in late June and early July. The first larvae hatched when ∑(tn-10) °C totaled 438.4 °C, and stages III-V were recorded in the harvested crop. Understanding the bioecology of the European corn borer can offer valuable insights into managing population levels and identifying optimal timing for addressing infestations in corn crops.

Six Express Sequence Tag-Simple Sequence Repeat Primers Reveal Genetic Diversity in the Cultivars of Three Zanthoxylum Species

Zanthoxylum (Sichuan pepper), with its rich cultivars, has long been widely cultivated in China for its unique seasoning and medicinal uses, but most of its cultivars have similar morphological characteristics. Therefore, we hypothesized that the genetic diversity of Zanthoxylum cultivars is low because of their apomixis and long cultivation history. In this study, we aimed to investigate the genetic diversity of three Zanthoxylum species on the cultivar level based on express sequence tag-simple sequence repeat (EST-SSR) primers. In total, 121 samples of three Zanthoxylum species (Z. bungeanum, Z. armatum and Z. piperitum) were collected from different areas in China for genetic diversity analysis. A total of six specificity and polymorphism EST-SSR primers, which we selected from among 120 primers based on two transcriptomes (Z. bungeanum, Z. armatum) in our earlier study, were used to evaluate genetic diversity based on capillary electrophoresis technology. The results of our analysis using the unweighted pair group method with arithmetic mean (UPGMA) indicated that most of the samples are clustered in one clade in the UPGMA dendrogram, and the average genetic distance was 0.6409. Principal component analysis (PCA) showed that Z. piperitum may have a closer genetic relationship with Z. bungeanum than with Z. armatum. An analysis of molecular variation (AMOVA) showed that the genetic variation mainly stemmed from individuals within populations; the genetic differentiation coefficient (PhiPT) was 0.429, the gene flow (Nm) between populations was 0.333, and the differences among populations were not significant (p > 0.001). For the intraspecific populations of ZB, the percentage of genetic variation was 53% among populations and 47% within populations, with non-significant differences between populations (p > 0.001). The genetic differentiation coefficient (PhiT) was 0.529, and the gene flow (Nm) was 0.223. For the intraspecific populations of ZA, the results indicated that the percentage of genetic variation was 29% among populations and 71% within populations, with non-significant differences between populations (p > 0.001); the genetic differentiation coefficient (PhiPT) was 0.293, and the gene flow (Nm) was 0.223. Through genetic structure analysis (GSA), we predicted that these 121 samples belonged to two optimal subgroups, which means that all the samples probably originated from two gene pools. Above all, this indicated that the genetic diversity of the 121 Zanthoxylum samples was relatively low at both the species and cultivar levels, a finding which was consistent with our initial assumptions. This study provides a reference, with molecular-level data, for the further identification of Zanthoxylum species.

Applicability of Diagnostic Criteria and High Prevalence of Familial Dysbetalipoproteinemia in Russia: A Pilot Study

Familial dysbetalipoproteinemia (FD) is a highly atherogenic genetically based lipid disorder with an underestimated actual prevalence. In recent years, several biochemical algorithms have been developed to diagnose FD using available laboratory tests. The practical applicability of FD diagnostic criteria and the prevalence of FD in Russia have not been previously assessed. We demonstrated that the diagnostic algorithms of FD, including the diagnostic apoB levels, require correction, taking into account the distribution of apoB levels in the population. At the same time, a triglycerides cutoff ≥ 1.5 mmol/L may be a useful tool in identifying subjects with FD. In this study, a high prevalence of FD was detected: 0.67% (one in 150) based on the ε2ε2 haplotype and triglycerides levels ≥ 1.5 mmol/L. We also analyzed the presence and pathogenicity of APOE variants associated with autosomal dominant FD in a large research sample.