Distinct Population Groups Research Articles

Time and cause of death in patients after acute coronary syndrome

Abstract Background Acute coronary syndrome (ACS) remains a substantial mortality burden despite enormous progress achieved in treatment and prevention in recent decades, yet systematic investigation of detailed causes of death among ACS patients remains limited. Objective This study aimed to describe the association between time and cause of death in patients after ACS using data from a large, multicenter, contemporary cohort. Methods Patients’ data from the China Chest Pain Database between 2015 and 2021 were linked to the China National Death Registration System Database using unique national IDs to obtain accurate vital status. Patients with documented death records were extracted into a merged database, which encompassed all deaths that occurred in the hospital and post-discharge out-of-hospital. Patients were enrolled with a discharge diagnosis of ACS. Cardiovascular (CV) mortality was defined as a death certificate with a CV diagnosis using the ICD-10 classification listed as the primary cause of death. A trend chi-square test was performed to assess the causes of death at different times after ACS. Results Among the 126,704 eligible patients, the mean age at baseline was 74 (66, 81) years old, 39.3% were women. Of these patients, 16,546 (13.1%) died during hospitalisation, 53,980 (42.6%) within the first six months after discharge, 19,664 (15.5%) from 6 to12 months after discharge, and 36,514 (28.8%) beyond 12 months after discharge. The most common cause of CV death was ischemic heart disease (70.1%), followed by ischemic stroke (7.1%) and hemorrhagic stroke (6.8%). The main causes of non-CV death were malignant tumours (37.1%) and respiratory disease (21.5%). For death in-hospital, within the first six months, from 6 to 12 months post-discharge, and beyond 12 months, the proportion of CV causes was 86.3%, 78.3%, 70.7%, and 67.9%, respectively (P<0.001). The proportion of deaths due to haemorrhagic stroke and aortic aneurysm/dissection increased progressively with time to death increasing (P<0.001). Meanwhile, the proportion of non-CV deaths continuously increased, reaching 13.7%, 21.7%, 29.3%, and 32.1%, respectively. Conclusion Despite cardiovascular diseases being the primary cause of death in patients after ACS, the causes of death vary among patients with different times of death, highlighting the importance of categorising patients into distinct population groups according to time after ACS for targeted cause-specific preventive strategies.

Internet usage time and trust in doctors: evidence from China

BackgroundThe growth of internet use has greatly impacted many societal sectors, including healthcare. However, current evidence about the relationship between internet usage time and public trust on doctors is insufficient.ObjectiveTo examine the relationship between the time spent on the internet and the level of trust in doctors, and explore its mechanism.MethodsMultiple regression models are employed, utilizing a sample of 19,193 observations from the China Family Panel Studies (CFPS) in 2020. First, we regress the relative trust in doctors compared to trust in strangers on internet usage time. Subsample results across distinct population groups are explored. Second, we examine the mechanism of using the internet as an information channel through the mediation method, and further investigate the role of the internet as a communication platform by analyzing the moderation effects of socializing activity as well as social media engagement.ResultsWe find a significant negative relationship between increased internet usage time and trust in doctors. This correlation remains robust across different model specifications and variable measurements. The negative correlation is more pronounced among population groups who are elderly, male, married, with low educational levels, insured and residing in urban areas. The role of the internet as a source of information is validated as a mechanism producing the negative influence. The role of the internet as a communication platform tends to mitigate the negative consequences of internet usage, as engaging in online socializing activity can have a positive moderation effect. However, for social media engagement, its overall effect on trust in doctors is negative, potentially due to social media’s dual function as a communication platform and an information source.ConclusionsAlthough individual-focused literature tends to demonstrate a positive impact of the internet on trust in doctors in China, our study, which focuses on the general public, reveals contrasting results. Our findings imply that the primary manner in which internet usage, encompassing social media usage, influences public trust in doctors is by molding a collective perception of them. Consequently, the medical community may need to take a more proactive approach in expanding online communication channels for interacting with patients and the wider public.

Dynamic strategies and optimal control analysis for hepatitis C management: non-invasive liver fibrosis diagnosis

This study proposes a novel model employing nonlinear ordinary differential equations to dissect HCV dynamics. Six distinct population groups are delineated: Susceptible, Treatment, Responder, Non-Responder, Cured, and Fibrosis. A detailed numerical analysis of this model was conducted, tracking the predicted trends over a span of 20 years. The primary objective of this analysis is to assess and confirm the model’s predictive accuracy and its potential to supplant invasive diagnostic methods in monitoring the progression of liver fibrosis. By incorporating various control parameters, namely u 1 ( t ) , u 2 ( t ) , and u 3 ( t ) , the model offers a nuanced perspective on disease progression and treatment outcomes. Parameter u 1 ( t ) modulates treatment-induced fibrosis progression, providing a crucial lever for mitigating treatment-related side effects. u 2 ( t ) reflects treatment effectiveness, capturing the proportion of responders within the treatment cohort. Meanwhile, u 3 ( t ) governs fibrosis progression in non-responders, shedding light on the disease’s natural trajectory without effective treatment.

Demanda por serviços de saúde durante a pandemia de Covid-19: estudos de base populacional

Objective: To evaluate the demand for health services during the Covid-19 pandemic and its associated factors. Methods: A population-based cross-sectional study was conducted in two cities in southern Brazil: Criciúma, in the state of Santa Catarina, and Rio Grande, in the state of Rio Grande do Sul. The study included individuals aged 18 years and older residing in urban areas of these municipalities. Participants self-reported their health service utilization and the type of service sought. Sociodemographic, behavioral, and health-related variables were examined as exposures. Poisson regression was used to analyze the adjusted associationsbetween service demand and exposure variables. Results were presented as prevalence ratios (PR) with 95% confidence intervals (95% CI). Results: A total of 2,167 individuals were analyzed. Approximately 25% of participants reported experiencing at least one Covid-19-related symptom. Among these, 51.3% soughthealth services, with Basic Health Units being the most frequently sought (46.7%). Health service demand was higher among individuals aged 50 to 59 years (PR=1.60; 95% CI 1.18, 2.17), those with higher education (PR=1.52; 95% CI 1.13, 2.03), those who engaged in physical activity (PR=1.29; 95% CI 1.07, 1.59), and those who had contact with someone who tested positive for Covid-19 (PR=1.76; 95% CI 1.40, 2.21). Conclusion: The results highlight two distinct population groups: those with greater exposureto Covid-19 and those more attentive to health care. Additionally, the Basic Health Unit was the most sought-after service, underscoring the importance of Primary Care and the Unified Health System in addressing the pandemic in Brazil.

Stature estimation in male and female populations of India and Nigeria depending on other anthropometric parameters using multiple regression analysis

In cases of mass disasters, accidents, or criminal investigations where the identity of victims is unknown certain basic anthropological parameters are helpful in ascertaining these like race, sex, age and stature. Estimating stature using multiple body measurements such as shoulder breadth, foot length, thigh length, and knee height is a common approach in anthropometry and forensic anthropology. The presence of sex and population differences in anthropometric indicators allows these measurements to be used not only to estimate the stature of an individual, but also to determine sex, different races or populations based on skeletal remains. The purpose of the study is to develop and practically verify the work of regression equations for estimating stature depending on other anthropometric indicators of men and women of two ethnically diverse populations. For this study, anthropometric data were gathered from two distinct population groups: Indian (n=102) and Nigerian (n=205). Basic demographic details along with measurements of shoulder breadth, sitting shoulder height, sitting foot length, sitting knee height, and sitting thigh length were obtained using standardized techniques as per the established anthropometric protocols. Statistical analysis was performed using appropriate software packages such as SPSS, R, or SAS. The multiple regression method was used to estimate body length depending on other anthropometric indicators. As a result of the conducted multiple linear regression analysis, reliable relationships between stature and specific anthropometric measurements in Nigerian and Indian men and women were established. It was found that stature is highly likely to depend on knee height in a sitting position in Nigerian women (R2=0.531, p<0.001), as well as hip length, foot length, and shoulder height in a sitting position in Indian men (R2=0.725, p <0.001). Stature in Indian women reliably depends on hip length and foot length in a sitting position, and in Nigerian men - on hip length, foot length, shoulder width and shoulder height in a sitting position, but the regression equations have a coefficient of determination less than 0.5 (respectively, R2=0.463, p<0.001 and R2=0.405, p<0.001) and therefore do not have much significance for forensic purposes. Additional groups (30 people for each category) were used to test the obtained regression equations. The high correlation coefficients (0.6<r<0.75) observed in both test groups indicate the reliability of the regression models and the suitability of the selected anthropometric measurements for the estimation of stature in these populations. The obtained data emphasize the importance of taking into account factors specific to the population when developing regression equations for the estimation of stature and emphasize the usefulness of anthropometric measurements in predicting this indicator for different gender and demographic groups of the population, although their further verification on larger and more diverse samples is necessary.

Liver Cancer Mortality Disparities at a Fine Scale Among Subpopulations in China: Nationwide Analysis of Spatial and Temporal Trends.

China has the highest number of liver cancers worldwide, and liver cancer is at the forefront of all cancers in China. However, current research on liver cancer in China primarily relies on extrapolated data or relatively lagging data, with limited focus on subregions and specific population groups. The purpose of this study is to identify geographic disparities in liver cancer by exploring the spatial and temporal trends of liver cancer mortality and the years of life lost (YLL) caused by it within distinct geographical regions, climate zones, and population groups in China. Data from the National Death Surveillance System between 2013 and 2020 were used to calculate the age-standardized mortality rate of liver cancer (LASMR) and YLL from liver cancer in China. The spatial distribution and temporal trends of liver cancer were analyzed in subgroups by sex, age, region, and climate classification. Estimated annual percentage change was used to describe liver cancer trends in various regions, and partial correlation was applied to explore associations between LASMR and latitude. In China, the average LASMR decreased from 28.79 in 2013 to 26.38 per 100,000 in 2020 among men and 11.09 to 9.83 per 100,000 among women. This decline in mortality was consistent across all age groups. Geographically, Guangxi had the highest LASMR for men in China, with a rate of 50.15 per 100,000, while for women, it was Heilongjiang, with a rate of 16.64 per 100,000. Within these regions, the LASMR among men in most parts of Guangxi ranged from 32.32 to 74.98 per 100,000, whereas the LASMR among women in the majority of Heilongjiang ranged from 13.72 to 21.86 per 100,000. The trend of LASMR varied among regions. For both men and women, Guizhou showed an increasing trend in LASMR from 2013 to 2020, with estimated annual percentage changes ranging from 10.05% to 29.07% and from 10.09% to 21.71%, respectively. Both men and women observed an increase in LASMR with increasing latitude below the 40th parallel. However, overall, LASMR in men was positively correlated with latitude (R=0.225; P<.001), while in women, it showed a negative correlation (R=0.083; P=.04). High LASMR areas among men aligned with subtropical zones, like Cwa and Cfa. The age group 65 years and older, the southern region, and the Cwa climate zone had the highest YLL rates at 4850.50, 495.50, and 440.17 per 100,000, respectively. However, the overall trends in these groups showed a decline over the period. Despite the declining overall trend of liver cancer in China, there are still marked disparities between regions and populations. Future prevention and control should focus on high-risk regions and populations to further reduce the burden of liver cancer in China.

Host population structure and rare dispersal events drive leptospirosis transmission patterns among Rattus norvegicus in Boston, Massachusetts, US.

Leptospirosis (caused by pathogenic bacteria in the genus Leptospira ) is prevalent worldwide but more common in tropical and subtropical regions. Transmission can occur following direct exposure to infected urine from reservoir hosts, such as rats, or a urine-contaminated environment, which then can serve as an infection source for additional rats and other mammals, including humans. The brown rat, Rattus norvegicus , is an important reservoir of leptospirosis in urban settings. We investigated leptospirosis among brown rats in Boston, Massachusetts and hypothesized that rat dispersal in this urban setting influences the movement, persistence, and diversity of Leptospira . We analyzed DNA from 328 rat kidney samples collected from 17 sites in Boston over a seven-year period (2016-2022); 59 rats representing 12 of 17 sites were positive for Leptospira . We used 21 neutral microsatellite loci to genotype 311 rats and utilized the resulting data to investigate genetic connectivity among sampling sites. We generated whole genome sequences for 28 Leptospira isolates obtained from frozen and fresh tissue from some of the 59 Leptospira -positive rat kidneys. When isolates were not obtained, we attempted Leptospira genomic DNA capture and enrichment, which yielded 14 additional Leptospira genomes from rats. We also generated an enriched Leptospira genome from a 2018 human case in Boston. We found evidence of high genetic structure and limited dispersal among rat populations that is likely influenced by major roads and/or other unknown dispersal barriers, resulting in distinct rat population groups within the city; at certain sites these groups persisted for multiple years. We identified multiple distinct phylogenetic clades of L. interrogans among rats, with specific clades tightly linked to distinct rat populations. This pattern suggests L. interrogans persists in local rat populations and movement of leptospirosis in this urban rat community is driven by rat dispersal. Finally, our genomic analyses of the 2018 human leptospirosis case in Boston suggests a link to rats as the source. These findings will be useful for guiding rat control and human leptospirosis mitigation efforts in this and other urban settings.

Assessment of hypercholesterolemia prevalence and its demographic variations in the Republic of Kazakhstan

Hypercholesterolemia is a major risk factor for cardiovascular disease, the leading cause of death in Kazakhstan. Understanding its prevalence is vital for effective public health planning and interventions. This study aimed to assess the scale of hypercholesterolemia in the Republic of Kazakhstan and to identify differences among distinct population groups. A cross-sectional study involving 6720 participants (a nationally representative survey.) aged 18–69 was conducted from October 2021 to May 2022 across all 17 regions of Kazakhstan. The magnitude of hypercholesterolemia was 43.5%. Cholesterol levels were determined through blood biochemical analysis. Age, sex, geographic location, and ethnicity served as covariates. The majority of participants (65.49%) were from urban areas with an almost equal gender distribution (50.07% male and 49.93% female). The predominant age groups were 18–29 years (25.71%) and 30–39 years (25.12%), and 65.09% identified as Kazakh. The prevalence increased with age, with the 60–69 age group showing the highest rate at 71.14%. Women had slightly higher rates than men. Geographical differences were evident, with regions like Astana city and Almaty region showing significant disparities. Kazakhs had a lower rate compared to other ethnicities. Age, region, and BMI were significant predictors for hypercholesterolemia in both binary and multivariate logistic regression analyses. The study revealed a significant prevalence of hypercholesterolemia in Kazakhstan, with increasing age as a major determinant. Women, especially those over 50, and certain regions showed higher cholesterol levels. The disparities observed across regions and ethnicities suggest the need for targeted public health interventions to address this pressing health concern.

Addressing Digital and AI Skills Gaps in European Living Areas: A Comparative Analysis of Small and Large Communities

As Artificial Intelligence (AI) continues to permeate various aspects of societies, understanding the disparities in AI knowledge and skills across different living areas becomes imperative. Small living areas have emerged as significant contributors to Europe's economy, offering an alternative to the bustling environment of larger cities for those seeking an improved quality of life. Nonetheless, they often encounter challenges related to digital infrastructure, access to financial resources, and digital skills gaps, limiting their economic and social growth prospects. This study investigates the digital and AI skills gaps in the context of small and large European living areas, shedding light on the potential hindrances to unleashing the full economic and social potentials of these regions in an AI-enabled economy. Drawing from a comprehensive dataset encompassing 4,006 respondents across eight EU countries, this research examines the current perceptions and understandings of AI and digital skills within two distinct population groups: residents of smaller living areas and their counterparts in larger communities. Through bivariate analysis, notable insights are revealed concerning trust in AI solutions and entities, self-assessed digital skills, AI Awareness, AI Attitudes and demography variables in both population groups. These insights may refer to the significance of addressing digital and AI skills gaps in fostering growth and preparedness for the AI-driven future. As AI becomes increasingly integral to various aspects of society, targeted interventions and policies are essential to bridge these gaps and enable individuals and communities to harness the transformative potential of AI-enabled economies.

"Opportunistic Care": A Focus Group Study of Nurses' Perspective on Caring for Long-term Cancer Survivors and Their Families.

The global population of long-term cancer survivors is increasing, thanks to advances in treatments and care. Healthcare systems are working to address the unique needs of these individuals. However, there remains a knowledge gap concerning nurses' view on cancer survivorship care. To identify nurses' perspective of care for long-term cancer survivors and their families. This qualitative descriptive study used 5 focus groups comprising 33 nurses from primary healthcare and specialized oncology care. Data analysis was conducted through thematic analysis, and the study received ethical approval. Long-term cancer survivors and their families often remained unrecognized as a distinct group within the healthcare system. Consequently, nurses provide what can be termed as "opportunistic care" during nurse-survivor encounters, addressing health needs beyond the purpose of the initial healthcare visit. This absence of a systematic or structured approach for this patient group has prompted nurses to seek the establishment of a comprehensive framework through survivorship care plans, thus ensuring a continuum of care for this specific population. The lack of a structured approach to caring for long-term cancer survivors and their families, often invisible as a distinct population group, results in nurses providing care on an opportunistic basis. It is crucial to develop and implement survivorship care plans tailored to this population's needs. Simultaneously, it is important to advance research in this area and establish an educational framework for nurses, enabling them to effectively address the care of long-term cancer survivors and their families.

Cranial measurements obtained by three-dimensional computed tomography technique in the estimation of sex of contemporary Black South Africans

Human identification forms an integral part of forensic and biological anthropology. For proper identification, a biological profile made up of biodata such as age, sex, ancestry, antemortem stature, and factors of individualization, is obtained and stored for use by anthropologists. A correct sex estimation can help unravel other anthropological parameters. South Africa has a multi-dimensionally high crime rate and its largest distinct population group (Black South Africans) is most affected by such crimes. Several authors have in the past used cranial measurements to carry out sex discrimination among South Africans, such attempts have largely been done using direct assessment of post-mortem specimens and on subjects of European Descent. This study, therefore, attempted to overcome these drawbacks by using a non-invasive method, the three-dimensional computed tomography (3DCT) to obtain population-specific data from a contemporary Black South African population group. It obtained measurements from cranial CT records of 350 Black South Africans (50 % sex ratio) housed in the Radiology Department of Charlotte Maxeke Johannesburg Academic Hospital. The Xiris and IntelliSpace software were used to reconstruct the images into three-dimensional forms from which measurements were taken. Evaluation of previously derived equations using data from the current study yielded low average classification accuracies which necessitated the formulation of new equations. Discriminant function analysis yielded acceptably high average classification accuracies for sex estimation which ranged from 78.3 % to 82.9 %.

The Perceived Stress Scale is essentially unidimensional: Complementary evidence from ancillary bifactor indices and Mokken analysis

Stress is a significant contributor to physical and mental health. However, there is considerable variability in response to stress, underscoring the role of stress perception in health outcomes. Perceptions of stress are influenced by socio-demographic and cultural factors. The Perceived Stress Scale (PSS) has been used extensively to assess stress among different populations and for cross-cultural comparisons. Given its wide-ranging application, the rigorous assessment of its psychometric properties is necessary to solidify its standing as a dependable measure. The scale was originally conceptualized as unidimensional but there has been controversy regarding its factor structure, leading to various factor models. Conclusions about the structure of the PSS were largely based on fit indices in confirmatory factor analysis and often did not go beyond fit indices. In addition, classical test theory indices are sample dependent and it is not surprising that instruments can exhibit different properties in different samples. Over reliance on fit indices can lead to overly simplistic interpretations of underlying dimensionality. Hence, the current study extends this research by using item response theory and examining ancillary bifactor indices to determine the amount of variance explained by the total scale and subscales. Participants were students (n = 322) at a South African institution who completed the PSS and a demographic questionnaire. Fit indices in confirmatory factor analysis indicated that a one-factor model, a bifactor model and a correlated-two factor model fit the data to an acceptable degree (GFI > 0.95, CFI > 0.90, RMSEA <0.08). Ancillary bifactor indices supported the essential unidimensionality of the scale as the two subscales accounted for 18.9 % and 17.2 %, of the variance, respectively, while the total scale accounted for 63.9 % of the variance. This was confirmed by Mokken analysis, which indicated that all the items loaded on one scale. The unidimensionality of the PSS suggests that it can be an effective clinical screening tool and that it is easily adaptable across different populations and contexts, enabling standardized comparisons. However, it may lose sensitivity to cultural differences in how stress is perceived and experienced. Hence, integrating the PSS with tailored assessments would facilitate a more robust and inclusive approach to stress assessment in various settings and populations. The study did not take specific sources of stress into account and was conducted among a distinct population group. Future studies undertaken among diverse populations and linking global stress with the impact of stressful life events are needed to further confirm our results and understand the interconnection between these factors.

Seroprevalence and indexes of IgG antibodies for SARS-CoV-2 infection among People Living With HIV, tuberculosis patients and healthcare workers, in Salvador, Brazil.

COVID-19 can trigger different clinical presentations in distinct population groups, some of which are considered at higher risk of SARS-CoV-2 infection. Little is known about the susceptibility of certain populations to the infection. We aimed to determine the prevalence of COVID-19 among People Living With HIV/AIDS (PLWH) attending a tertiary public hospital in Salvador, Brazil, patients with active pulmonary tuberculosis and Hospital's Healthcare Workers (HCW), and to compare their SARS-CoV-2 antibody levels. In this observational study we included 2294 participants from June 9, 2020 to August 10, 2021. IgG SARS-CoV-2 antibodies from all participants (275 PLWH, 42 with active tuberculosis and 1977 healthcare workers) were measured. Prevalence of COVID-19 and antibodies indexes were compared across groups. We detected a higher prevalence of COVID-19 in patients with active tuberculosis (42.9%) than in PLWH (22.5%) or HCW (11.7%). Previously vaccinated participants with a COVID-19 history had median higher IgG antibody indexes (8.2; IQR: 5.5‒10) than those vaccinated who did not have COVID-19 until the time of this study (4.1; IQR: 1.6‒6.2, p < 0.001). Prevalence of previous SARS-CoV-2 infection was higher among tuberculosis patients than that found in HCW and PLWH, but antibodies levels were similar across groups.

Development and validation of COEWS (COVID-19 Early Warning Score) for hospitalized COVID-19 with laboratory features: A multicontinental retrospective study.

The emergence of new SARS-CoV-2 variants with significant immune-evasiveness, the relaxation of measures for reducing the number of infections, the waning of immune protection (particularly in high-risk population groups), and the low uptake of new vaccine boosters, forecast new waves of hospitalizations and admission to intensive care units. There is an urgent need for easily implementable and clinically effective Early Warning Scores (EWSs) that can predict the risk of complications within the next 24-48 hr. Although EWSs have been used in the evaluation of COVID-19 patients, there are several clinical limitations to their use. Moreover, no models have been tested on geographically distinct populations or population groups with varying levels of immune protection. We developed and validated COVID-19 Early Warning Score (COEWS), an EWS that is automatically calculated solely from laboratory parameters that are widely available and affordable. We benchmarked COEWS against the widely used NEWS2. We also evaluated the predictive performance of vaccinated and unvaccinated patients. The variables of the COEWS predictive model were selected based on their predictive coefficients and on the wide availability of these laboratory variables. The final model included complete blood count, blood glucose, and oxygen saturation features. To make COEWS more actionable in real clinical situations, we transformed the predictive coefficients of the COEWS model into individual scores for each selected feature. The global score serves as an easy-to-calculate measure indicating the risk of a patient developing the combined outcome of mechanical ventilation or death within the next 48 hr.The discrimination in the external validation cohort was 0.743 (95% confidence interval [CI]: 0.703-0.784) for the COEWS score performed with coefficients and 0.700 (95% CI: 0.654-0.745) for the COEWS performed with scores. The area under the receiver operating characteristic curve (AUROC) was similar in vaccinated and unvaccinated patients. Additionally, we observed that the AUROC of the NEWS2 was 0.677 (95% CI: 0.601-0.752) in vaccinated patients and 0.648 (95% CI: 0.608-0.689) in unvaccinated patients. The COEWS score predicts death or MV within the next 48 hr based on routine and widely available laboratory measurements. The extensive external validation, its high performance, its ease of use, and its positive benchmark in comparison with the widely used NEWS2 position COEWS as a new reference tool for assisting clinical decisions and improving patient care in the upcoming pandemic waves. University of Vienna.

Patterns of suboptimal antipsychotic use and misuse in Australia: What can routinely collected data tell us?

There are increasing concerns about harms related to suboptimal antipsychotic use. Here we describe recent population-based trends in antipsychotic use and harms in Australia and identify population groups exhibiting patterns of use likely to contribute to these harms. Using population-based data from the Australian Pharmaceutical Benefits Scheme (2015-2020), poisoning calls to the New South Wales (NSW) Poisons Information Centre (2015-2020) and poisoning deaths in all coronial records (2005-2018) in Australia, we measured trends in the prevalence of antipsychotic use and related deaths and poisonings. We applied latent class analyses to identify patterns of antipsychotic use that may contribute to harms. Quetiapine and olanzapine had the highest prevalence of use between 2015 and 2020. Noteworthy trends included increases of 9.1% and 30.8% in quetiapine use and poisonings, while olanzapine use decreased by 4.5% but poisonings increased by 32.7%. Quetiapine and olanzapine poisonings and related deaths had the highest rates of co-ingestion of opioids, benzodiazepines and pregabalin compared to other antipsychotics. We identified six distinct population groups using antipsychotics: (i) ongoing high-dose use with sedatives (8%), (ii) ongoing use (42%), (iii) ongoing use with analgesics and sedatives (11%), (iv) long-term low-dose use (9%), (v) sporadic use (20%) and (vi) sporadic use with analgesics (10%). Ongoing potentially suboptimal antipsychotic use and associated harms highlight the need to monitor such patterns of use, for example through prescription monitoring systems.

Extent of intraspecific trait variability in ecologically central and marginal populations of a dominant alpine plant across European mountains.

Studying trait variability and restricted gene flow between populations of species can reveal species dynamics. Peripheral populations commonly exhibit lower genetic diversity and trait variability due to isolation and ecological marginality, unlike central populations experiencing gene flow and optimal conditions. This study focused on Carex curvula, the dominant species in alpine acidic meadows of European mountain regions. The species is sparser in dry areas such as the Pyrenees and Balkans, compared to the Central-Eastern Alps and Carpathians. We hypothesized that distinct population groups could be identified based on their mean functional trait values and their correlation with the environment; we predicted that ecologically marginal populations would have stronger trait correlations, lower within-population trait variability (intraspecific trait variability, ITV) and lower genetic diversity than populations of optimal habitats. Sampling was conducted in 34 populations that spanned the entire distribution range of C. curvula. We used hierarchical clustering to identify emergent functional groups of populations, defined by combinations of multiple traits associated with nutrient economy and drought tolerance (e.g. specific leaf area, anatomy). We contrasted the geographical distribution of these groups in relation to environment and genetic structure. We compared pairwise trait relationships, within-population trait variation (ITV) and neutral genetic diversity between groups. Our study identified emergent functional groups of populations. Those in the southernmost ranges, specifically the Pyrenees and Balkan region, showed drought-tolerant trait syndromes and correlated with indicators of limited water availability. While we noted a decline in population genetic diversity, we did not observe any significant changes in ITV in ecologically marginal (peripheral) populations. Our research exemplifies the relationship between ecological marginality and geographical peripherality, which in this case study is linked to genetic depauperation but not to reduced ITV. Understanding these relationships is crucial for understanding the biogeographical factors shaping trait variation.

ECONOMY AND SOCIETY IN THE OTTOMAN ERA TLEMCEN (10-13 AH / 16-19 AD) -STUDY MODELS IN ARCHIVAL DOCUMENTS

Like other cities, the city of Tlemcen enjoyed a distinguished geographical location that was evident in the prosperity of economic life, as well as the diversity of social life, where the Tlemcen society knew several different and distinct population groups and classes that had their impact and presence on the general situation in Algeria throughout the ages and the Ottoman period in particular. The student of the history of Tlemcen during the Ottoman era faces a number of difficulties in covering the history of this region during the Ottoman era, including the lack of scientific source material that dates it, especially if the subject is related to the economic and social aspects. In the face of this scarcity of scientific material, the researcher resorts to knocking on the door of archival documents, which are among the most important sources that allow the historian and researcher to investigate facts about this city, including what relates to crafts and industries, commercial exchanges, agricultural and agricultural activity, as well as customs, traditions, celebrations, and sales and purchase contracts. Marriage, inheritance...etc. The documents represent one of the most important sources against which the nature of economic and social activity in Tlemcen during the Ottoman period is measured in order to extract historical facts. Even more than that, these models of Ottoman documents allow us to delve deeper into the extent of the repercussions of these two activities on the general situation. In Tlemcen, despite the difficult political and military conditions that Tlemcen experienced during this era. On the other hand, archival documents are important in codifying history with a scientific methodology to ensure the diversity of visions and dissertations through the historical material contained in these documents, and the raw material from which the historian derives the facts on which the historical discourse is based, because it is the material evidence of them, in addition to providing new data. For historical writing and giving a regional and international dimension to Algerian historical studies in general and Tlemcen in particular

Cataract services for all: Strategies for equitable access from a global modified Delphi process.

Vision loss from cataract is unequally distributed, and there is very little evidence on how to overcome this inequity. This project aimed to engage multiple stakeholder groups to identify and prioritise (1) delivery strategies that improve access to cataract services for under-served groups and (2) population groups to target with these strategies across world regions. We recruited panellists knowledgeable about cataract services from eight world regions to complete a two-round online modified Delphi process. In Round 1, panellists answered open-ended questions about strategies to improve access to screening and surgery for cataract, and which population groups to target with these strategies. In Round 2, panellists ranked the strategies and groups to arrive at the final lists regionally and globally. 183 people completed both rounds (46% women). In total, 22 distinct population groups were identified. At the global level the priority groups for improving access to cataract services were people in rural/remote areas, with low socioeconomic status and low social support. South Asia and Sub-Saharan Africa were the only regions in which panellists ranked women in the top 5 priority groups. Panellists identified 16 and 19 discreet strategies to improve access to screening and surgical services, respectively. These mostly addressed health system/supply side factors, including policy, human resources, financing and service delivery. We believe these results can serve eye health decision-makers, researchers and funders as a starting point for coordinated action to improve access to cataract services, particularly among population groups who have historically been left behind.

Setup of Consumer Wearable Devices for Exposure and Health Monitoring in Population Studies

Wearable sensors, which are often embedded in commercial smartwatches, allow for continuous and non-invasive health measurements and exposure assessments in clinical studies. Nevertheless, the real-life application of these technologies in studies involving a large number of participants for a significant observation period may be hindered by several practical challenges. In this study, we present a modified protocol from a previous intervention study for the mitigation of health effects from desert dust storms. The study involved two distinct population groups: asthmatic children aged 6-11 years and elderly patients with atrial fibrillation (AF). Both groups were equipped with a smartwatch for the assessment of physical activity (using a heart rate monitor, pedometer, and accelerometer) and location (using GPS signals to locate individuals in indoor "at home" or outdoor microenvironments). The participants were required to wear the smartwatch equipped with a data collection application on a daily basis, and data were transmitted via a wireless network to a centrally administered data collection platform for the near real-time assessment of compliance. Over a period of 26 months, more than 250 children and 50 patients with AF participated in the aforementioned study. The main technical challenges identified included restricting access to standard smartwatch features, such as gaming, internet browser, camera, and audio recording applications, technical issues, such as loss of GPS signal, especially in indoor environments, and the internal smartwatch settings interfering with the data collection application. The aim of this protocol is to demonstrate how the use of publicly available application lockers and device automation applications made it possible to address most of these challenges in a simple and cost-effective way. In addition, the inclusion of a Wi-Fi received signal strength indicator significantly improved indoor localization and largely minimized GPS signal misclassification. The implementation of these protocols during the roll-out of this intervention study in the spring of 2020 led to significantly improved results in terms of data completeness and data quality.

Setup of Consumer Wearable Devices for Exposure and Health Monitoring in Population Studies.

Wearable sensors, which are often embedded in commercial smartwatches, allow for continuous and non-invasive health measurements and exposure assessments in clinical studies. Nevertheless, the real-life application of these technologies in studies involving a large number of participants for a significant observation period may be hindered by several practical challenges. In this study, we present a modified protocol from a previous intervention study for the mitigation of health effects from desert dust storms. The study involved two distinct population groups: asthmatic children aged 6-11 years and elderly patients with atrial fibrillation (AF). Both groups were equipped with a smartwatch for the assessment of physical activity (using a heart rate monitor, pedometer, and accelerometer) and location (using GPS signals to locate individuals in indoor "at home" or outdoor microenvironments). The participants were required to wear the smartwatch equipped with a data collection application on a daily basis, and data were transmitted via a wireless network to a centrally administered data collection platform for the near real-time assessment of compliance. Over a period of 26 months, more than 250 children and 50 patients with AF participated in the aforementioned study. The main technical challenges identified included restricting access to standard smartwatch features, such as gaming, internet browser, camera, and audio recording applications, technical issues, such as loss of GPS signal, especially in indoor environments, and the internal smartwatch settings interfering with the data collection application. The aim of this protocol is to demonstrate how the use of publicly available application lockers and device automation applications made it possible to address most of these challenges in a simple and cost-effective way. In addition, the inclusion of a Wi-Fi received signal strength indicator significantly improved indoor localization and largely minimized GPS signal misclassification. The implementation of these protocols during the roll-out of this intervention study in the spring of 2020 led to significantly improved results in terms of data completeness and data quality.