Medicine use in people with intellectual disabilities: a Finnish nationwide register study

BACKGROUND

People with intellectual disability (ID) are a vulnerable group in our society; many of them depend on other people for assistance in their everyday lives. Compared with the general population, people with ID have poorer general health and, therefore, need more healthcare services and use more medicines. The aim of this study is to define the population of all Finnish people with ID using administrative data and to compare their medicine use and expenditure on medicines to those of the age-matched and sex-matched controls.

METHODS

People with ID and their age-matched and sex-matched controls (1:1) were extracted from nationwide healthcare and social allowance registers. Administrative register data on all prescription medicine purchases in 2019 were used to determine the prevalence of medicine use in both groups on a general level and by medicine categories. The differences in the prevalence of medicine use between the two groups were analysed using the logistic regression model. In addition, we studied the total expenditure on reimbursable medicine purchases covered by the National Health Insurance between people with ID and control group.

RESULTS

The subpopulation of people with ID consisted 37 196 individuals, of whom 82.7% purchased prescription medicines in 2019. The corresponding share of individuals purchasing prescription medicines in the control group was 70.3%. The differences in the prevalence of medicine use between the two populations were highest in the younger age groups (0-6, 7-12 and 13-17). In the study population, 28.1% (OR = 12.28; 95% CI: 11.54-13.07) of the people used antipsychotics, making it the most used medicine category in people with ID. In the control group, 3.3% of people used antipsychotics. Compared with the control group, the use of antiepileptics, drugs for constipation, mineral supplements and anxiolytics was four to seven times higher among people with ID. Furthermore, the median expenditure on medicine use among people with ID was four times higher than in the control group.

CONCLUSIONS

Compared with the control group, people with ID used more medicines, especially psychotropics, and their expenditure on medicine use was higher.

Local eukaryotic and bacterial stream community assembly is shaped by regional land use effects

With anticipated expansion of agricultural areas for food production and increasing intensity of pressures stemming from land-use, it is critical to better understand how species respond to land-use change. This is particularly true for microbial communities which provide key ecosystem functions and display fastest responses to environmental change. However, regional land-use effects on local environmental conditions are often neglected, and, hence, underestimated when investigating community responses. Here we show that the effects stemming from agricultural and forested land use are strongest reflected in water conductivity, pH and phosphorus concentration, shaping microbial communities and their assembly processes. Using a joint species distribution modelling framework with community data based on metabarcoding, we quantify the contribution of land-use types in determining local environmental variables and uncover the impact of both, land-use, and local environment, on microbial stream communities. We found that community assembly is closely linked to land-use type but that the local environment strongly mediates the effects of land-use, resulting in systematic variation of taxon responses to environmental conditions, depending on their domain (bacteria vs. eukaryote) and trophic mode (autotrophy vs. heterotrophy). Given that regional land-use type strongly shapes local environments, it is paramount to consider its key role in shaping local stream communities.

Distance decay 2.0 - A global synthesis of taxonomic and functional turnover in ecological communities

AIM

Understanding the variation in community composition and species abundances (i.e., β-diversity) is at the heart of community ecology. A common approach to examine β-diversity is to evaluate directional variation in community composition by measuring the decay in the similarity among pairs of communities along spatial or environmental distance. We provide the first global synthesis of taxonomic and functional distance decay along spatial and environmental distance by analysing 148 datasets comprising different types of organisms and environments.

LOCATION

Global.

TIME PERIOD

1990 to present.

MAJOR TAXA STUDIED

From diatoms to mammals.

METHOD

We measured the strength of the decay using ranked Mantel tests (Mantel r) and the rate of distance decay as the slope of an exponential fit using generalized linear models. We used null models to test whether functional similarity decays faster or slower than expected given the taxonomic decay along the spatial and environmental distance. We also unveiled the factors driving the rate of decay across the datasets, including latitude, spatial extent, realm and organismal features.

RESULTS

Taxonomic distance decay was stronger than functional distance decay along both spatial and environmental distance. Functional distance decay was random given the taxonomic distance decay. The rate of taxonomic and functional spatial distance decay was fastest in the datasets from mid-latitudes. Overall, datasets covering larger spatial extents showed a lower rate of decay along spatial distance but a higher rate of decay along environmental distance. Marine ecosystems had the slowest rate of decay along environmental distances.

MAIN CONCLUSIONS

In general, taxonomic distance decay is a useful tool for biogeographical research because it reflects dispersal-related factors in addition to species responses to climatic and environmental variables. Moreover, functional distance decay might be a cost-effective option for investigating community changes in heterogeneous environments.

Threshold effects of climate change on benthic diatom communities: Evaluating impacts of salinity and wind disturbance on functional traits and benthic biomass

The responses of biotic communities and ecosystems to climate change may be abrupt and non-linear. Thus, resolving ecological threshold mechanisms is crucial for understanding the consequences of climate change and for improving environmental management. Here, we present a study on the threshold responses of benthic diatom communities that are an important component of all aquatic environments and strongly contribute to global primary production. We reach beyond the taxonomic perspective by focusing on the diversity and functions of diatom communities and benthic biomass along gradients of salinity and wind disturbance, whose climate-change-induced changes have been predicted to strongly affect biotic communities in the marine and brackish systems in the future. To improve the generality of our results, we examine three self-collected datasets from different spatial scales (6-830 km) and ecosystem types. We collected samples from rock pools or from littoral stones and studied taxonomic thresholds using Threshold Indicator Taxa Analysis (TITAN2). We investigated threshold responses of community diversity, community functions, and benthic biomass using t-tests and regression analyses. Our results indicated that decreasing salinity may result in increasing diversity but decreasing biomass of brackish communities, while the effects of increasing wind disturbance were contradictory among spatial scales. Benthic biomass correlated with the taxonomic and functional diversity, as well as with the body size distribution of communities, highlighting the importance of considering community functions and organismal size when predicting ecosystem functions. The most pronounced effects of decreasing salinity and increasing wind disturbance on community functions were changes in the abundance of low-profile diatom species, which, due to the high resilience of low-profile diatoms, may lead to changes in ecosystem functioning and resilience. To conclude, decreasing salinity and increasing wind disturbance may lead to threshold responses of biotic communities, and these changes may have profound effects on ecosystem functioning along marine coastal areas.

Studying biodiversity-ecosystem function relationships in experimental microcosms among islands

Ecological studies on islands have provided fundamental insights into the mechanisms underlying biodiversity of larger organisms, but we know little about the factors affecting island microbial biodiversity and ecosystem function. We conducted a field experiment on five Baltic Sea islands where we placed aquatic microcosms with different levels of salinity mimicking environmental stress and allowed diatoms to colonize the microcosms via the air. Using structural equation models (SEM), we investigated the interconnections among environmental and dispersal‐related factors, diatom biodiversity, and ecosystem productivity (represented by chlorophyll a concentration). We also tested whether the body size structure of the community influences productivity together with biodiversity. In SEMs, we found no relationship between species richness or evenness and productivity. However, productivity increased with increasing mean body size of species in the communities. The effects of environmental stress on both biodiversity and ecosystem productivity were highlighted as species richness and evenness declined, whereas productivity increased at the highest salinity levels. In addition to salinity, wind exposure affected both biodiversity metrics and productivity. This study provides new insights into microbial community assembly in a field experimental setting and the relationship between biodiversity and ecosystem function. Our results indicate that salinity presents a strong abiotic filter, leading to communities that may be species poor, yet comprise salinity‐tolerant and relatively productive species at high salinity. Our findings also emphasize the importance of mean community body size in mediating the effects of environmental conditions on productivity and suggest that this trait should be considered more broadly in biodiversity–ecosystem function studies.

Exploring Multiple Aspects of Taxonomic and Functional Diversity in Microphytobenthic Communities: Effects of Environmental Gradients and Temporal Changes

Biodiversity has traditionally been quantified using taxonomic information but the importance of also considering its functional characteristics has recently gained an increasing attention among microorganisms. However, studies exploring multiple aspects of taxonomic and functional diversity and their temporal variations are scarce for diatoms, which is one of the most important microbial groups in aquatic ecosystems. Here, our aim was to examine the taxonomic and functional alpha and beta diversities of diatoms in a coastal rock pool system characterized by a naturally high environmental heterogeneity. We also investigated the temporal differences in the diversity patterns and drivers. The relationship between the species richness and functional dispersion was temporally coherent, such that species-poor communities tended to be functionally clustered. The trend between the species richness and taxonomic uniqueness of community composition was temporally inconsistent, changing from negative to non-significant over time. Conductivity or distance to the sea or both were key determinants of species richness, functional dispersion, and uniqueness of community composition. The increase of community dissimilarity with an increasing environmental distance was stronger for the taxonomic than the functional composition. Our results suggest that even minor decreases in the species richness may result in a lowered functional diversity and decreased ecosystem functioning. Species-poor ecosystems may, however, have unique species compositions and high contributions to regional biodiversity. Despite changing the species compositions along the environmental gradients, communities may remain to have a high functional similarity and robustness in the face of environmental changes. Our results highlight the advantage of considering multiple biodiversity metrics and incorporating a temporal component for a deeper understanding of the effects of environmental changes on microbial biodiversity.

Factors influencing the biodiversity of three microbial groups within and among islands of the Baltic Sea

Islands provide ideal model systems to examine the factors influencing biodiversity, yet knowledge of microbial biodiversity on islands remains scarce. We collected a dataset from 101 rock pools along a freshwater to brackish water transition on islands of the Baltic Sea and investigated the patterns and drivers of community composition and species richness of diatoms, cyanobacteria and non-cyanobacteria bacteria among islands. We also examined whether environmental heterogeneity increased beta diversity and species richness within islands. Among islands, the patterns in community composition were concordant among the microbial groups, with distinct changes along the freshwater-brackish gradient. The patterns in species richness were context-dependent for each microbial group. In general, richness patterns were most strongly associated with nutrient concentrations or the distances to potential sources of immigrants, whereas no positive relationships between ecosystem size and richness were found. Within islands, environmental heterogeneity was positively correlated with the beta diversity of each microbial group, but not species richness. Our findings provide novel insights into the factors influencing microbial biodiversity. The results suggest that island microbial biodiversity patterns are influenced by species sorting and dispersal-related mechanisms and highlight the importance of environmental heterogeneity for beta diversity.

Elevational patterns and hierarchical determinants of biodiversity across microbial taxonomic scales

Microbial biogeography is gaining increasing attention due to recent molecular methodological advance. However, the diversity patterns and their environmental determinants across taxonomic scales are still poorly studied. By sampling along an extensive elevational gradient in subarctic ponds of Finland and Norway, we examined the diversity patterns of aquatic bacteria and fungi from whole community to individual taxa across taxonomic coverage and taxonomic resolutions. We further quantified cross-phylum congruence in multiple biodiversity metrics and evaluated the relative importance of climate, catchment and local pond variables as the hierarchical drivers of biodiversity across taxonomic scales. Bacterial community showed significantly decreasing elevational patterns in species richness and evenness, and U-shaped patterns in local contribution to beta diversity (LCBD). Conversely, no significant species richness and evenness patterns were found for fungal community. Elevational patterns in species richness and LCBD, but not in evenness, were congruent across bacterial phyla. When narrowing down the taxonomic scope towards higher resolutions, bacterial diversity showed weaker and more complex elevational patterns. Taxonomic downscaling also indicated a notable change in the relative importance of biodiversity determinants with stronger local environmental filtering, but decreased importance of climatic variables. This suggested that niche conservatism of temperature preference was phylogenetically deeper than that of water chemistry variables. Our results provide novel perspectives for microbial biogeography and highlight the importance of taxonomic scale dependency and hierarchical drivers when modelling biodiversity and species distribution responses to future climatic scenarios.

Variation in stream diatom communities in relation to water quality and catchment variables in a boreal, urbanized region

Intensive anthropogenic land use such as urbanization alters the hydrological cycle, water chemistry and physical habitat characteristics, thus impairing stream physicochemical and biological quality. Diatoms are widely used to assess stream water quality as they integrate water chemistry temporally and reflect the joint influence of multiple stressors on stream biota. However, knowledge of the major community patterns of diatoms in urban streams remains limited especially in boreal regions. The aim of this study was to examine the effects of water chemistry and catchment characteristics on stream diatom communities, and to test the performance of the Index of Pollution Sensitivity (IPS) as a stream water quality indicator across an urban-to-rural gradient in southern Finland. Diatom community structure and species richness were related to local-scale variables such as water temperature, aluminium concentration, and electrical conductivity, which were in turn influenced by patterns in catchment land use and land cover. Diatoms reflected the intensity of human activities as more intensive land use increased the occurrence of pollution-tolerant species. The change in community structure along the land use intensity gradient was accompanied by a distinct decline in species richness. On the contrary, the IPS index failed to indicate differences in water quality along the urban-to-rural gradient as no consistent differences in the IPS values were found. Our results highlight the joint influence of multifaceted factors that underlie diatom patterns, and show that diatom biodiversity can be used as cost-effective metric indicating urban stream conditions. However, the IPS index turned out to be an unsuitable tool for assessing water quality among these streams.