Population Data Research Articles

Safety and Efficacy of Selective Internal Radiation Therapy for Portal Vein Tumour Thrombus in Advanced Hepatocellular Carcinoma: A Single‐Centre Experience in Australia

ABSTRACTIntroductionPortal vein tumour thrombus (PVTT) is a common complication of hepatocellular carcinoma (HCC) and has a poor prognosis. Selective internal radiation therapy (SIRT) with Yttrium‐90 (Y90) microspheres is a minimally invasive treatment option that has shown promise in treating PVTT. Studies have suggested a survival advantage of SIRT in this population, but data in the Australasian population are lacking. The aim of this study was to evaluate the safety and efficacy of SIRT in a series of patients at an Australian hospital with advanced HCC and PVTT.MethodAll patients underwent pre‐treatment imaging with MRI or CT, and immediate post‐treatment imaging with Y90 PET CT and MRIs at 3‐, 6‐, 9‐ and 12‐months. The primary endpoints were time to progression (TTP) and overall survival (OS) post‐SIRT. The secondary endpoint was safety.ResultsOf the 698 patients who underwent SIRT at our institution between 2007 and 2023, 64 patients had HCC and PVTT. 59/64 (92%) were male, with a median age of 61 years (range 37–86 years). The majority of patients had Child–Pugh a cirrhosis (87%), and the majority were ECOG 0 (91%). The majority had main PVTT at the time of SIRT. All patients underwent SIRT with Y90‐coated resin microspheres (SIR‐Spheres, Sirtex Medical, Australia). Personalised dosimetry planning was performed by the treating interventional radiologist. SIRT was well tolerated by most patients, with major complications reported in a minority of cases (19/64 patients had an episode of biochemical decompensation within 90 days following treatment). The median TTP was 4.8 months (range 1–48 months). The median OS was 11.5 months (range 1–80 months), with those with a favourable MAAPE score having a median OS of 21.2 months (12.6–29.7 months).ConclusionsOur cohort suggests that SIRT is a safe and effective treatment option for a difficult‐to‐treat patient population. Our data suggest a longer OS for those with preserved liver function, good functional status and low AFP levels at 21.2 months. Poor pre‐treatment liver function and functional status are predictors of decompensation, and decompensation is a predictor of poor survival. These data provide an Australasian perspective and support the expanding role of SIRT in HCC treatment guidelines. Further prospective studies with larger sample sizes and longer follow‐up are warranted to confirm these findings.

Achondroplasia and obstructive sleep apnea: surgical outcomes and comparison to general population.

The objective was to compare demographics between children with achondroplasia and OSA with the general pediatric population with OSA, as well as present treatment outcomes for children with achondroplasia. Retrospective chart review of 22 children with achondroplasia and OSA and 141 children with OSA without achondroplasia. Parameters from polysomnography were analyzed. Values before and after surgery were compared for the achondroplasia group, while baseline values were compared between the control group and achondroplasia group. Pre-intervention in the T&A achondroplasia group, 0 children had mild OSA, 1 had moderate OSA, and 10 had severe OSA. In the comparative group 16 had mild OSA, 11 had moderate OSA, and 114 had severe OSA. The achondroplasia population had a much younger age at T&A compared to the control population - 3.1 versus 6.8 years. When comparing baseline data in the achondroplasia population with respective T&A outcomes, oAHI and SpO2 were improved. For the adenoidectomy group, there were no significant changes in OSA after surgery. For the Cervicomedullary decompression (CMD) group, there was a decrease in oAHI after surgery. Patients with achondroplasia and OSA have an earlier age of onset compared to children without achondroplasia. For these patients with moderate to severe OSA, treatment with adenotonsillectomy leads to significant improvement. Treatment with adenoidectomy showed no significant change in OSA. CMD also led to an improvement in oAHI.

Geography and Environment Shape Spatial Genetic Variation and Predict Climate Maladaptation Across Isolated and Disjunct Populations of Pinus muricata.

Assessing the evolutionary potential of rare species with limited migration amidst ongoing climate change requires an understanding of patterns of genetic variation and local adaptation. In contrast to the large distributions and population sizes of most pines, Pinus muricata (bishop pine) occurs in a few isolated populations along coastal western North America and is listed as threatened by the IUCN. To quantify how current genetic variation is influenced by distribution and environment, we generated reduced representation DNA sequencing data for most extant populations of P. muricata (12 locations, 7828 loci). We assessed geographic variation in differentiation and diversity and used genetic-environment association (GEA) analyses to characterise the contribution of environmental variables to local adaptation and genetic structure. Based on these inferences, we quantified genomic offset as a relative estimate of potential maladaptation under mild (SSP1-2.6) and severe (SSP5-8.5) climate change scenarios across 2041-2060 and 2081-2100. Despite occurring in small, isolated populations, genetic diversity was not low in P. muricata. Population differentiation was, however, defined across a hierarchy of spatial scales, with stands generally forming genetically identifiable groups across latitude and environments. GEA analyses implicated temperature- and soil-related variables as most strongly contributing to local adaptation. Estimates of maladaptation to future climate varied non-linearly with latitude, increased with severity of projections and over time, and were predicted by increases in annual temperature. Our results suggest that isolation and local adaptation have shaped genetic variation among disjunct populations and that these factors may shape maladaptation risk under projected climate change.

Analysis of Runoff Variation Characteristics and Influencing Factors in the Typical Watershed of Miyun Reservoir, China

As an important drinking water source for Beijing, the capital of China, the water inflow of Miyun Reservoir has been decreasing year by year, which has affected the urban water supply security. To understand the variation trend of the inflow and analyze the main factors influencing the runoff change, this research focused on the watershed of Miyun Reservoir as the target. Based on the runoff data from 1984 to 2020 at the outlet of the basin, as well as the precipitation, potential evaporation intensity, NDVI (normalized difference vegetation index), population, and GDP (Gross Domestic Product) data, combined with correlation analysis methods, empirical statistical methods, the SCRCQ (Slope Change Ratio of Cumulative Quantity) method, and the GIS, the interannual variation characteristics of various elements in the basin were analyzed, the correlation between runoff and other factors was studied, and the influencing degrees of precipitation, water surface evaporation intensity, human activities, and other factors on the runoff change in the basin were quantitatively separated. The research results showed that the runoff exhibited a distinct decreasing trend, and there were two mutation points in the basin runoff from 1984 to 2020, which were 1995 and 2014, respectively. The runoff change was divided into three stages: 1984–1995 (upward trend in T1), 1995–2014 (downward trend in T2), and 2014–2020 (stable trend in T3). Runoff was significantly correlated with four indicators: the summer leaf area index of the Chaohe River and Baihe River, the regional GDP and population, among which the correlation of the summer leaf area index was the largest. Compared with the period T1, the contribution rates of climate change to the runoff reduction in T2 and T3 were 6.38% and 5.73%, and the contribution rates of human activities to the runoff reduction were 93.62% and 94.27%, respectively. Therefore, the change in annual runoff in the Miyun Reservoir watershed is mainly affected by human activities, and the contribution of climate change to the runoff attenuation is weak. This study is significant in the maintenance and enhancement of runoff in typical watershed.

Patient- and fraction-specific magnetic resonance volume reconstruction from orthogonal images with generative adversarial networks.

Although deep learning (DL) methods for reconstructing 3D magnetic resonance (MR) volumes from 2D MR images yield promising results, they require large amounts of training data to perform effectively. To overcome this challenge, fine-tuning-a transfer learning technique particularly effective for small datasets-presents a robust solution for developing personalized DL models. A 2D to 3D conditional generative adversarial network (GAN) model with a patient- and fraction-specific fine-tuning workflow was developed to reconstruct synthetic 3D MR volumes using orthogonal 2D MR images for online dose adaptation. A total of 2473 3D MR volumes were collected from 43 patients. The training and test datasets were separated into 34 and 9 patients, respectively. All patients underwent MR-guided adaptive radiotherapy using the same imaging protocol. The population data contained 2047 3D MR volumes from the training dataset. Population data were used to train the population-based GAN model. For each fraction of the remaining patients, the population model was fine-tuned with the 3D MR volumes acquired before beam irradiation of the fraction, named the fine-tuned model. The performance of the fine-tuned model was tested using the 3D MR volume acquired immediately after the beam delivery of the fraction. The model's input was a pair of axial and sagittal MR images at the isocenter level, and the output was a 3D MR volume. Model performance was evaluated using the structural similarity index measure (SSIM), peak signal-to-noise ratio (PSNR), root mean square error (RMSE), and mean absolute error (MAE). Moreover, the prostate, bladder, and rectum in the predicted MR images were manually segmented. To assess geometric accuracy, the 2D Dice Similarity Coefficient (DSC) and 2D Hausdorff Distance (HD) were calculated. A total of 84 3D MR volumes were included in the performance testing. The mean±standard deviation (SD) of SSIM, PSNR, RMSE, and MAE were 0.64±0.10, 93.9±1.5dB, 0.050±0.009, and 0.036±0.007 for the population model and 0.72±0.09, 96.2±1.8dB, 0.041±0.007, and 0.028±0.006 for the fine-tuned model, respectively. The image quality of the fine-tuned model was significantly better than that of the population model (p<0.05). The mean±SD of DSC and HD of the population model were 0.79±0.08 and 1.70±2.35mm for prostate, 0.81±0.10 and 2.75±1.53mm for bladder, and 0.72±0.08 and 1.93±0.59mm for rectum. Contrarily, the mean±SD of DSC and HD of the fine-tuned model were 0.83±0.06 and 1.29±0.77mm for prostate, 0.85±0.07 and 2.16±1.09mm for bladder, and 0.77±0.08 and 1.57±0.52mm for rectum. The geometric accuracy of the fine-tuned model was significantly improved than that of the population model (p<0.05). By employing a patient- and fraction-specific fine-tuning approach, the GAN model demonstrated promising accuracy despite limited data availability.

Antidiabetic Medicines Utilisation During Pre-Pandemic, Pandemic and Post-Pandemic Period of COVID-19—Data for Bulgarian Population

Background: Type 2 diabetes is a chronic disease with high global prevalence and significant social and economic burden. The pandemic affected patients’ diagnostics and medicines dispensing. Diabetes was among the most-affected conditions during lockdown due to the limited resources and unaffordable medicines. The impact of the pandemic on utilisation and cost has not been thoroughly studied, which inspired us to conduct the current study. Objectives: The study explored cost dynamics, changes in antidiabetic medicines utilisation, and public expenditure of pharmacotherapy in three periods: pre-pandemic (2018–2019), during the pandemic (2020–2021), and post-pandemic (2022–2023).Methods: It is a retrospective, observational, macroeconomic analysis. Reimbursed cost and utilisation were analysed as a crude sum and as indexes of the average value. Results: The result shows that five new INNs have been included in the Positive Medicines List (PML), two of these being fixed dose combinations (FDCs). During the pandemic, a slow tendency of increase of the crude sum of public expenditure was observed, followed by a sharp increase in the post-pandemic period. The public spending increased more than twice, and we found a 30,018,982 Euro growth. The highest public spending is found for dapagliflozine in post-pandemic vs. pandemic period (index = 1.67), as well as empagliflozin/metformin and dapagliflozine in pandemic vs. pre-pandemic period (index =0.21). Total utilisation increases from 58.16 to 71.78 DDD/1000 inh/day during 2018–2023. The most significant rise of utilisation is found for canagliflozin (index = 0.68) pandemic vs. pre-pandemic and dapagliflozin (index = 3.66) post-pandemic vs. pandemic. Conclusions: Analysis of the antidiabetic medicines market reveals the rising of reimbursed cost and utilisation in pre-, post-, and during the pandemic. In conclusion, organisation of the supply and financing of antidiabetic medicines was not affected during the pandemic.

Cell Population Data Parameters in Dengue-Is There Any Significance? A Single-Center Study.

To assess the significance of cell population data parameters (CPD) in dengue positive individuals. A retrospective cross-sectional study was conducted at the National Institute of Blood Disease and Bone Marrow Transplantation (NIBD and BMT), Karachi, Pakistan from July 2022 to September 2022 (in a period of 3 months of peak dengue fever outbreak). Dengue fever is a viral infection that is transmitted from mosquitoes to humans. It is more prevalent in tropical and subtropical environments. A total of 389 individuals, who presented with febrile illness at the NIBD clinics, were screened for dengue and malaria with Complete Blood Count (CBC), Dengue nonstructural protein 1 (NS1) antigen test and Malaria Parasite Immunochromatographic test (MP-ICT). Whole blood samples were collected and analyzed for CBC on Sysmex XN hematology analyzers. All 65 CPD and standard CBC parameters were analyzed. Statistical analysis was performed using SPSS version 25.0. Descriptive analysis of all the parameters was performed and a p value < 0.001 was considered significant. Positive and negative correlation was also evaluated within the parameters to assess their significance. Furthermore, cut-off values of CPD parameters were evaluated plotting their receiver operating characteristic (ROC) curves. Out of the 389 febrile patients, 137 were diagnosed as dengue-positive. Descriptive analysis for mean and median values of parameters revealed statistically significant difference for seven parameters (namely WBC, PLT-F, NEUT, LYMP, MONO, HFLC, and LY-WY) in the comparison of the two groups which were then further assessed for positive and negative correlation. Multivariate logistic regression analysis revealed High Fluorescence Lymphocyte Count (HFLC) to be the distinguishing parameter among dengue positive and negative cases. Compared to all the CPD parameters of our data set, the area under curve for lymphocytes cell size and the width of dispersion (LY-WZ) displayed a borderline value of 0.582. Sysmex XN hematology analyzers can provide extensive information about CPD parameters, allowing for the prompt differentiation among febrile illnesses and dengue infection. HFLC and other significant parameters demonstrate promise as rapid, adjunctive diagnostic tools. Further research is needed to validate these findings and optimize the clinical utility of CPD parameters in dengue management.

An integrative framework to combine migratory connectivity and demographic data

Abstract Migratory species experience various conditions and events throughout their annual cycle that influence their spatial and demographic dynamics. To understand these dynamics, it is essential to describe the origin and destination of individuals. Migratory connectivity, which is defined as the geographic linkage between populations across the annual cycle, is increasingly incorporated in population models to relate population trends to environmental variables at different stages of the cycle. However, such information on migratory movements is obtained independently from the study of population dynamics despite the interaction between both processes. Expanding on the growing use of integrated modelling approaches, we developed an integrated framework that allows the sharing of information between migratory connectivity and population data. We first assembled an integrated migratory connectivity model and an integrated population model to join the analysis of GPS, live‐reencounter, dead‐recovery, capture–mark–recapture, and population count data within a unified framework. Based on simulated data, we assessed the ability of the resulting integrated connectivity and population model to produce unbiased and precise connectivity and demographic estimates. We then applied the same assessment to real data using the Eurasian Curlew (Numenius arquata) as a case study. On simulated data, the integrated connectivity and population model estimated connectivity and survival parameters with no bias and similar precision to the connectivity model alone. However, it outperformed the population model in estimating fecundity in the absence of explicit productivity data. When applied to the Eurasian Curlew, the integrated connectivity and population model produced overall similar migratory connectivity and more accurate demographic estimates than the connectivity model alone, consistent with previous studies. Additionally, the model was able to estimate fecundity, whereas the data were too sparse for the population model alone to disentangle juvenile survival and fecundity. The sharing of information between migratory connectivity and population data improved the estimation of demographic parameters by the population model and improved connectivity parameter estimates when data were scarce. This flexible framework can be generalised to include diverse data on migration movements, population structure, individual heterogeneity or environmental variables, allowing further investigation of the interaction between migration patterns and population dynamics.

The Impact of Weather on the Spread of COVID-19: The Case of the Two Largest Cities in Greece

The new global pandemic of COVID-19, declared on 11 March 2020 by the World Health Organization, has already had an unprecedented impact on health and socioeconomic activities worldwide. The second wave of the COVID-19 pandemic swept through the United States of America and Europe in late September 2020. Compared with other southern countries, such as Greece, where there was a significant increase in cases at the end of October 2020, Northern European countries (Germany, France, Austria, Finland, and Sweden) experienced this second wave of the pandemic earlier in September 2020. To understand the epidemiological behavior of the virus from an environmental perspective, we examined the effects of air temperature, humidity, and wind on the spread of COVID-19 in two of the largest population Regional Units (R.U.) of Greece, namely the R.U. of the Central Sector of Athens in Central Greece and the R.U. of Thessaloniki in Northern Greece. We applied Pearson correlation analysis and generalized linear models (GLM) with confirmed COVID-19 Intensive Care Unit (ICU) admissions from the National Public Health Organization as dependent variables and the corresponding air temperature, humidity, and wind speed from the Greek National Meteorological Service as independent covariates. The study focused on the period from 4 May 2020 to 3 November 2020 to investigate the impact of weather on the spread of COVID-19, in a period where human activities had partially returned to normal after the gradual lifting of the restrictive measures of the first lockdown (23 March 2020). The end date of the study period was set as the date of imposition of a new local lockdown in the R.U. of Thessaloniki (3 November 2020). Our findings showed that COVID-19 ICU admissions in both Regional Units decreased significantly with the temperature (T) and wind speed (WS) increase. In the R.U. of the Central Sector of Athens, this picture is reflected in both the single and cumulative lag effects of meteorological parameters. In the R.U. of Thessaloniki, this correlation was differentiated only in terms of the cumulative lag effect of the average daily temperature, where an increase (+17.6%) in daily confirmed COVID-19 ICU admissions was observed. On the other hand, relative humidity (RH) was significantly associated with an increase in cases in both R.U. This study, in addition to its contribution to the global research effort to understand the effects of weather on the spread of COVID-19, aims to highlight the need to integrate meteorological parameters as predictive factors in surveillance and early warning systems for infectious diseases. The combination of weather and climate factors (e.g., humidity, temperature, wind) and other contagious disease surveillance indicators (e.g., wastewater, geographic and population data, human activities) would make the early identification of potential epidemic risks more effective and would contribute to the immediate initiation of public health interventions and the more rational allocation of resources.

Helmet protection paradox for powered two-wheeler users: Concerns in data misinterpretation and need for improved data systems

The protective efficacy of helmets may be misconstrued due to shortcomings in crash data collection systems. This paper aims to decipher the reasons behind the “helmet protection paradox,” using Bengaluru, India, as a case study. Official reports indicated that three-fourths of fatal two-wheeler crashes in Bengaluru city involved riders who were wearing helmets, leading to a paradoxical interpretation of the protective efficacy of helmets. Understanding helmet use patterns in the source population and crash data systems is key to resolving this paradox. Our findings suggest that the paradox arises from a combination of a high prevalence of non-standard helmet use in Bengaluru and shortcomings in recording the “type of helmet use” in data systems. It is recommended that existing crash and fatality data systems capture information regarding the “type of helmet use” to prevent erroneous interpretations of the protective efficacy of helmets.

Cardiac Surgery to Manage Rheumatic Heart Disease in Africa Is Complex &amp;mdash; a Geographic Perspective

Background: Rheumatic heart disease (RHD) is the most common form of acquired heart disease in Africa, often requiring surgical intervention. Previous studies have demonstrated the need for more cardiac surgeons in Africa but have not outlined their distribution relative to populations and incident cases. Objective: We estimate rheumatic heart disease incidence and cardiac surgical capacity to manage RHD in Africa. By characterizing geographic catchment areas served by the nearest cardiac surgeon(s), we estimate patient travel distance and the unmet surgical need. Methods: Subnational population, RHD incidence, cardiac surgeon, and geographic data were collected from credible, publicly accessible sources. Quantum Geographic Information System (QGIS 3.32) was used to create a subnational map of Africa and conduct nearest neighbor analyses to determine the location and distance of each subnational region’s nearest cardiac surgeon. Catchment areas were defined and characterized. Incident RHD case-to-capacity ratios (ICCR) and surgical need were calculated. Incident RHD and surgical need were mapped at the subnational level across Africa. The human development index (HDI) of each region was then incorporated to assess the impact of socioeconomic disparities. Results: A total of 779 subnational regions from 54 countries were included in the analysis. The African continent has an estimated 509 cardiac surgeons practicing in 74 subnational regions (corresponding to 74 catchment areas) and 1,027,974 incident cases of RHD annually. The average distance to travel for care by a cardiac surgeon was found to be 312.01 km (193.87 miles). The ICCR due to RHD for the African continent was 10.64. Conclusions: Access to cardiac surgical care is limited across Africa despite the high incidence of RHD. While nearly all areas of the continent would benefit from increasing cardiac surgical capacity, attention should be paid towards strategic development of geographically accessible cardiac surgical centers to equitize care for RHD.

Developmental Eye Movement (DEM) Test in Adults: Age-Related Changes and Italian Normative Data

The developmental eye movement (DEM) test is a paper-based tool used to assess ocular motor skills in children. By naming numbers in a simple and easy simulated reading task, the DEM test provides an oculomotor efficiency score without complex eye-tracking equipment. Studies have shown that its usefulness can be extended to adults, despite its name suggesting that it is used primarily for developmental ages. However, for a broader application in the adult population in a clinical setting, there are no adult-specific norms. This study aimed to develop adult normative data for the Italian-speaking population and assess whether the DEM scores were influenced by age. In this study, 521 healthy Italian adults, aged 20 to 79 years, participated. Normative data were obtained by using a regression-based framework with demographic variables as predictors. Results show that age influences all sub-measures of time such as Vertical Time (VT), Adjusted Horizontal Time (AHT), and the Ratio score, but did not influence the error score. This is in line with the processing speed reduction in aging. Errors were influenced by education and gender. DEM norms, defined and scored using percentiles and equivalent scores, allow the assessment of oculomotor efficiency in adults, making this test suitable for use in all clinical settings, particularly in neuropsychological and neurological ones.

Utilisation of nursing home care before and after the 2015 Dutch national reform: an interrupted time series analysis.

The Netherlands introduced abrupt, large-scale, long-term care (LTC) reforms in 2015 that promoted ageing-in-place. However, there has been no comprehensive population-level study evaluating how these reforms have impacted nursing home (NH) utilisation. This study examines the association between the 2015 reforms with national monthly rates of NH admissions and survival time amongst newly admitted older adults. We analysed population data from Statistics Netherlands (2011-2019), conducting an interrupted time-series analysis to compare monthly NH admission rates before and after the 2015 reforms amongst adults aged 65 and older (N = 402350). A Cox proportional hazards model was used to assess the reform's impact on mortality risk amongst newly admitted residents. The adjusted NH admission rate before the reform was 88.80 per 100000 older adults (95% CI (confidence interval): 82.36-95.83), compared to 69.82 per 100000 after the reform (95% CI: 65.91-73.78), indicating a significant reduction (incident rate ratio: 0.80, 95% CI: 0.74-0.86). Over a 3-year follow-up, the average survival time for those admitted after the reform was 608days (95% CI: 608.72-610.74), compared to 622.52days (95% CI: 620.59-624.45) for those admitted before the reform. The reform was associated with a slightly increased mortality risk (hazard ratio: 1.05, 95% CI: 1.02-1.07). The 2015 Dutch LTC reform is associated with a reduction in national NH admissions and a decrease in average survival time of 2weeks.

Identification of shrinkage patterns in Japan’s four major metropolitan areas based on nighttime light and population data

Identification of shrinkage patterns in Japan’s four major metropolitan areas based on nighttime light and population data

Variability and social patterning of cancer mortality in 343 Latin American cities: an ecological study.

Understanding between-city variations in cancer mortality is crucial to inform national and subnational cancer prevention strategies. However, studies at the city level in Latin America are scarce. As part of the Salud Urbana en América Latina (SALURBAL) project, we aimed to describe the variability in cancer mortality rates across 343 cities in nine Latin American countries and the associations of these rates with city-level socioeconomic development. This ecological study used data from cities in Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico, and Panama. Vital registration and population data from Jan 1, 2015 to Dec 31, 2019 were used to estimate sex-specific and age-standardised cancer mortality rates for each city, overall and for seven cancer sites (breast, lung, colorectal, stomach, liver, prostate, and cervical), and the associations of these rates with city-level socioeconomic development. We found wide variability in cancer mortality by city (overall age-adjusted cancer mortality rates varied by almost three times), sex, and cancer site. Variability between cities within the same country was highest for cervical and prostate cancer. The most common causes of cancer deaths were breast cancer (305 cities) for females and prostate cancer (167 cities) and lung cancer (132 cities) for males. Liver and cervical cancer were the primary cause of cancer mortality in fewer than ten cities each, most of which were in Guatemala and Mexico. Lower city-level socioeconomic development was associated with higher mortality from liver, stomach, cervical, and prostate cancers and lower mortality from breast, colorectal, and lung cancers, with variations by sex. We found considerable heterogeneity in cancer mortality between cities, geographical patterning, and associations between cancer mortality rates and socioeconomic development. Our results highlight the need to consider city contexts when planning interventions to reduce cancer mortality and when guiding future cancer prevention and control efforts in urban areas within the region. Wellcome Trust. For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.

The role of citizenship in the acceptance and completion of COVID-19 vaccine cycle in the resident population with foreign citizenship registered with the Umbrian Health Care System - An analysis of regional data.

Non-italian citizens experienced less access to anti-COVID-19 vaccination, compared to the native population. Literature has found differences in adherence to anti-COVID-19 vaccination among these groups; however, there are apparently no studies that investigated the role of citizenship. Our objective was to investigate the role of citizenship in vaccine hesitancy toward anti-COVID-19 vaccination and the completion of vaccine cycle, in the non-Italian citizens resident in the Umbria Region. This is a population study, performed on resident population in Umbria. Population data were obtained thanks to a record linkage between the Regional Health Information System and the regional DBCOVID Umbria database. On this dataset, a descriptive and logistic regression analyses were performed. The 19.2% of non-Italian citizens did not take even one dose, 2.1% did not complete it and 40.6% did not take the additional dose. The range of values of which these results are an average, however, is very wide, suggesting important differences in COVID-19 vaccine up taking, among different citizenships. The logistic regression shows that citizenships with the highest probability of non-adherence to vaccination, compared to Philippine, was Romanian (OR=7.8), followed by Macedonian (OR=7.3) and Polish (OR=5.9). The study provides evidence of differences among citizenships that pinpoint the importance of understanding the reasons behind these behaviours, to support decisions around health policies tailored to each citizenship.

Pharmacokinetics, safety and efficacy of elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide in children with HIV aged from 2 years and weighing at least 14 kg.

Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF) was efficacious and well tolerated in children/adolescents with HIV (aged ≥6years, weighing ≥25kg) in a Phase 2/3 study. Here, we report data from children aged ≥2years and weighing ≥14-<25kg. This is an analysis of data from the youngest cohort in an open-label, multicentre, multi-cohort, single-group, international study of children/adolescents with HIV. Participants in this cohort were children aged ≥2years, weighing ≥14-<25kg at screening and able to swallow tablets, on stable antiretroviral therapy with virologic suppression (HIV-1 RNA <50 copies/ml for ≥6 consecutive months) and a CD4 count ≥400 cells/µl. Eligible participants received low-dose E/C/F/TAF (90/90/120/6 mg) once daily through Week 48. The study included pharmacokinetic evaluation of the low-dose E/C/F/TAF tablet at Week 2. Safety, efficacy, palatability and acceptability were also evaluated. Between 16 January and 25 November 2019, 27 participants were enrolled with a median (quartile [Q]1, Q3) age of 6 (4, 8)years, body weight of 19.3 (17.0, 20.5)kg, CD4 count of 1061 (895, 1315) cells/µl and CD4 cell percentage of 37.4 (30.6, 40.3). Most (92.6%) participants acquired HIV through vertical transmission. On 6 October 2020 (data-cut), median (Q1, Q3) exposure to E/C/F/TAF was 48.3 (48.0, 60.1) weeks. Pharmacokinetic parameters were within the safe and efficacious range of previous data in adult and paediatric populations. Drug-related treatment-emergent adverse events occurred in 4/27 (15%) participants. There were no Grade 3/4 adverse events, or adverse events leading to E/C/F/TAF discontinuation. One participant experienced a serious treatment-emergent adverse event (Grade 2 pneumonia not considered E/C/F/TAF related). Virologic suppression (US FDA Snapshot algorithm) was maintained by 26/27 (96%) participants at Weeks 24 and 48. At Week 48, most children reported positive palatability (84.6%) and acceptability (96.2%). These data support the use of single-tablet E/C/F/TAF (90/90/120/6 mg) regimen for the treatment of HIV in children aged ≥2years and weighing ≥14-<25kg. NCT01854775.

Anal Cancer Screening Practices Among Higher-Risk Populations in an Academic Medical System.

Although some experts recommend anal cancer screening for disproportionally affected populations including people living with HIV (PWH), condyloma acuminata, human papillomavirus-associated gynecologic dysplasia and cancers, and solid organ transplants, actual screening practices remain understudied. Our objective was to characterize anal cancer screening practices among higher-risk populations in an academic medical system with access to high-resolution anoscopy. We extracted outpatient clinical data for the aforementioned populations from January 1, 2015, to August 1, 2022, at 3 sites of an academic medical system. Data included patients' demographics, medical comorbidities, and anal cytology and human papillomavirus testing results. We used χ2 tests and logistic regression to assess for associations between patient characteristics and anal cancer screening. Of 7654 patients, 6.3% received anal cytology screening at least once including 21.7% of PWH, 13.8% of people with condyloma acuminata, 1.1% of people with gynecologic cancers, and 0.5% of people with solid organ transplants. In multivariable analysis, Black patients were 46% less likely to receive screening than White patients (95% confidence interval [CI], 0.40-0.71), and cisgender women were 73% less likely to receive screening than cisgender men (95% confidence interval, 0.20-0.38). Of 485 individuals who received anal cytology screening, 37.5% were only screened once and 70.5% had abnormal cytology on one or more screenings. Only one-fifth of PWH received anal cancer screening, and other higher-risk populations had even lower screening rates. Black patients and women were also less likely to be screened. Strategies to improve equitable screening practices for anal cancer are needed.

Prevention of Infections Among Pediatric Solid Organ Transplant Recipients With Asplenia or Hyposplenism.

Pediatric solid organ transplant (SOT) recipients with splenic dysfunction are at increased risk for infections, and tailored guidance on the management of asplenia/hyposplenism among SOT recipients is often lacking. The purpose of this article is to provide practice recommendations via a frequently asked questions (FAQs) format that focuses on three main domains: the identification of asplenia/hyposplenism among SOT recipients/candidates, prophylactic strategies for mitigating the risk of invasive disease associated with splenic dysfunction in the context of transplantation, and the provision of appropriate patient counseling on the risks associated with asplenia/hyposplenism. Answers to the FAQs are based on international expert opinion informed by practices for managing splenic dysfunction and associated data in other populations with asplenia. Gaps in the existing literature and relevant research aims are emphasized.

Essential micronutrients in children and adolescents with a focus on growth and development: a narrative review.

This comprehensive review examines the crucial role of micronutrients in the health of children and adolescents, focusing on their growth and development. Micronutrients, including vitamins and trace elements, are essential for various biochemical processes and biological functions. We explored the roles, assessment methods, deficiency patterns, and intervention strategies for six essential micronutrients: iron, zinc, vitamin A, vitamin D, iodine, and folate. These nutrients were selected based on their fundamental importance in pediatric development. By analyzing the current literature from PubMed, Embase, and Web of Science databases, we synthesized findings regarding the impact of these micronutrients on health outcomes in children and adolescents, examining both regional and global prevalence data, with particular attention paid to Korean population data. This review provides evidence-based insights into the assessment and management of micronutrient status in children and adolescents and offers recommendations for clinical practice.