Geographic Variation Research Articles

Re-Engagement in Physical Activity Slows the Decline in Older Adults' Well-Being - A Longitudinal Study.

Physical activity is recommended for older adults; however, the benefits of previous active engagement in physical activity that can be sustained after one becomes inactive remain to be determined. This study investigated the longitudinal associations between physical activity engagement patterns and older adults' well-being. This population-based cohort study used data from the China Health and Retirement Longitudinal Study between 2015 and 2020. People aged 60 years and above were included, and they were categorized as active engagers if they reported engaging in at least 10 min of moderate and/or vigorous exercise consecutively per week in each survey year. Older adults' well-being was evaluated using the healthy aging score, and geographical variations were visualized. The generalized estimating equations model was adopted to examine the differences between various physical activity engagement patterns and older adults' well-being. Among the 3300 older adults (50.5% men; age 66.9 ± 5.7 years) during the five years of follow-up, engagement in physical activity increased from 31.7% to 59.6%. However, their well-being decreased gradually, especially among those who were inactive engagers (beta = -0.20 to -0.21). Physical activity engagement patterns appeared to slow decline in well-being. Geographical variations were noted, with more favorable healthy aging scores observed in northern China than in southern China. As older adults age, well-being deteriorates, and disengagement of physical activity accelerates the rate of decline. Re-engagement in physical activity can slow the rate of decline in well-being. Early identification of and intervention in inactive engagement in physical activity reduce the detrimental effects on older adult's well-being. A national health initiative is an effective strategy to create a supportive environment for older adults to continue and engage in physical activity. The participation of healthcare professionals and community parties is important to encourage and engage older adults in physical activity.

Distribution and composition of seafloor macrolitter in the trawlable fishing areas along the Algerian coast (Western Mediterranean).

A total of 254 fishing hauls were sampled with a GOC73 bottom trawl during the four demersal resource assessment research cruises, respectively, in 2016, 2019, 2021 and 2022, carried out on board the BELKACEM GRINE research vessel (R/V). We performed the hauls between 22 and 660m of depth, after which we counted and weighed each piece of marine litter separately to the nearest 0.5g. The results show that marine litter densities varied between 1350 and 5813 item/km2. Thus, plastic is the most abundant litter, it represents a mean rate of 76% of the whole marine litter. Among this plastic, 3.8% was identified as fishing gears or fishing related objects. Therefore, the average loss in catch was estimated at 7% over the study period. However, the highest density of marine litter was found in the region of Bejaia located in the Center part of the Algerian coast. Moreover, the bathymetric and geographical variability had a significant impact on both density and weight of marine litter. A marine litter monitoring program is necessary for offering a more effective solutions.

International benchmarking of stage at diagnosis for six childhood solid tumours (the BENCHISTA project): a population-based, retrospective cohort study.

International variation in childhood cancer survival might be explained by differences in stage at diagnosis, among other factors. As part of the BENCHISTA project, we aimed to assess geographical variation in tumour stage at diagnosis through the application, by population-based cancer registries working with clinicians, of the international consensus Toronto Childhood Cancer Stage Guidelines. This population-based, retrospective cohort study involved 67 cancer registries from 23 European countries, Australia, Brazil, Japan, and Canada. Participating cancer registries applied the Toronto Guidelines to stage all incident cases of six childhood solid tumours-neuroblastoma, medulloblastoma, and Wilms tumour (age 0-14 years) and Ewing sarcoma, rhabdomyosarcoma, and osteosarcoma (age ≤19 years)-diagnosed between Jan 1, 2014, and Dec 31, 2017. Eligible cancer registries were those able to assign stage according to the Toronto Guidelines; information on the staging investigations conducted was collected where available. European countries were grouped by geographical area and non-European countries were considered individually. We used χ2 tests to compare stage distribution across these geographical areas and multivariable logistic models to estimate odds ratios (ORs) for metastatic stage at diagnosis, using central Europe (Austria, Belgium, France, Germany, the Netherlands, and Switzerland) as the comparison. Sensitivity analyses were conducted to overcome potential bias from non-random missing stage information for some geographical areas and cancer types. Data from 10 937 patients with cancer (6031 [55·1%] male and 4906 [44·9%] female) were analysed. Tumour staging was complete for 93·1% (10 180 of 10 937) of patients, ranging from 88·7% (1347 of 1518 patients) with medulloblastoma to 96·5% (1083 of 1122 patients) with Ewing sarcoma. Stage distribution differed statistically by geographical area for neuroblastoma, Wilms tumour, osteosarcoma, and rhabdomyosarcoma, but not for Ewing sarcoma or medulloblastoma. After excluding patients with missing stage information and, for the sarcomas, patients aged 18-19 years, the proportions of patients with metastases detected at diagnosis were 50·3% with neuroblastoma (1435 of 2852 patients; including 1159 [40·6%] stage M and 276 [9·7%] stage MS), 35·1% with medulloblastoma (473 of 1347 patients; stages M1-M4), 32·6% with Ewing sarcoma (335 of 1028 patients), 29·0% with rhabdomyosarcoma (368 of 1267 patients), 25·5% with osteosarcoma (345 of 1353 patients), and 18·2% with Wilms tumour (384 of 2114 patients). After adjusting by age group, significant differences in the proportions of patients with metastases detected at diagnosis were found between geographical areas for neuroblastoma, Wilms tumour, osteosarcoma, and rhabdomyosarcoma. Assessed at a population level, the stage at diagnosis shows significant variation between geographical areas for several childhood tumours. This finding highlights the need for earlier diagnosis and standardisation of investigations for distant metastases. To enable ongoing comparisons, further cooperation efforts are required between cancer registries and clinicians regarding the sustainable and standardised use of the Toronto Guidelines at diagnosis. Children with Cancer UK and Associazione Italiana per la Ricerca sul Cancro.

Analysis of longitudinal patterns of child maltreatment reports in the United States.

Child maltreatment is a continuous and prevalent issue, and victims of maltreatment often suffer adverse effects well into adulthood. Since child maltreatment rates tend to be clustered geographically and temporally, intervention programs are best implemented at a local level, targeting local risk factors for sustained and effective reduction over time. Quantifying geographic variation in child maltreatment rate trajectories can help states identify local risk factors to guide program development and resource allocation. National child maltreatment data from 2011 to 2020 from the National Child Abuse and Neglect Data System (NCANDS) was used to quantify child maltreatment rates (overall and substantiated) over time. Latent trajectory analysis was conducted to identify groups of states in the United States that share distinct temporal patterns of child maltreatment rates. Child maltreatment data was linked to the American Community Survey data to obtain community-level characteristics. Three groups of states with distinct child maltreatment trajectories were identified: 43 states with stable trajectory, 4 states with increasing number of reports over time, and 5 states with decreasing reports over time. Although states with a stable trajectory had some characteristics associated with higher socioeconomic status, such as lower percentage of families below poverty level, and lower percentage of unemployed laborers, there was not a consistent trend in socioeconomic characteristics between the three groups. Our results indicate there to be three groups of states with distinct child maltreatment trajectories, with majority of the states following a stable trajectory over time. There was not a consistent trend in socioeconomic characteristics between the three groups. While the results do not allow us to draw firm conclusions about socioeconomic characteristics associated with maltreatment trajectories, it does provide data-driven evidence for the existing assumption of a national average maltreatment trajectory.

Coalescence characteristics of free-living and particle-attached bacteria in a cascade river-reservoir system: A case study of the Jinsha River.

Microbial coalescence plays a crucial role in shaping aquatic ecosystems by facilitating the merging of neighboring microbial communities, thereby influencing ecosystem structure. Although this phenomenon is commonly observed in natural environments, comprehensive quantitative comparative studies on different lifestyle bacteria involved in this process are still lacking. The study focuses on 16S rRNA Amplicon Sequence Variants (ASVs) at the Jinsha River hydropower stations (Wudongde [WDD], Baihetan [BHT], Xiluodu [XLD], Xiangjiaba [XJB]), specifically examining free-living (FL) and particle-attached (PA) bacteria. Minimal differences in microbial composition were observed across water layers (surface, middle, and bottom). Analyses of overlapping ASVs, Bray-Curtis dissimilarity, and the SourceTracker algorithm revealed a significant difference in the coalescence ability of FL and PA bacteria, particularly in the surface water of XJB (FL: 31.1%±2.0%, PA: 27.6%±2.5%, p<0.05). The coalescence of FL bacteria was primarily influenced by the mixing of adjacent water layers, while PA bacteria exhibited significant geographical variations across water layers (p<0.05), displaying lower coalescence compared to FL bacteria. Using a cohesion metric, 12 keystone species in PA bacteria were identified and 7 in FL bacteria. Proteobacteria and Bacteroidetes were the most abundant phyla at the keystone species in PA and FL bacteria, respectively. The abundance of keystone ASVs decreased with distance in PA bacteria, whereas FL bacteria showed the opposite trend. At the genus level, Brevundimonas and Chryseobacterium were identified as keystone species in both lifestyles. Moreover, the impact of community coalescence on the stability tends to exhibit differences downstream in cascade stations. This study provides novel insights into the dynamic variations of microbial communities with diverse lifestyles in stratified aquatic environments and assesses the impact of dam construction on microbial coalescence and the alteration of keystone species.

Genomic evidence for demographic fluctuations, genetic burdens and adaptive divergence in fourfinger threadfin Eleutheronema rhadinum

Abstract Declining populations and bottlenecks lead to the accumulation of deleterious mutations in fish populations. These processes also trigger genetic purging, which is a key genetic factor in reducing the deleterious burdens and increasing population viability. However, there is a lack of empirical evidence on the interaction between demographic history and the genome-wide pattern of deleterious variations. Here, we generated genome resequencing data of Eleutheronema rhadinum from China and Thailand, representing the major distribution of the species’ southern regions. E. rhadinum had exceptionally low genome-wide variability and experienced dramatic population expansions followed by continuous declines. The geographical divergence, which occurred ~ 23,000 years ago, shaped different demographic trajectories and generated different regional patterns of deleterious mutations in China and Thailand populations. Several lines of evidence revealed that this geographical pattern of deleterious mutation was driven by the purging of highly deleterious mutations. We showed that purifying selection had inbreeding-associated fitness costs and was more efficient against missense mutations in the Thailand population, which had the lowest genetic burden of homozygous deleterious mutations. Multiple evolutionarily conserved protein domains were disrupted by the loss-of-function mutations, posing a high probability of gene functionality elimination. Moreover, thermal and salinity genes (Trpm3, Nek4, Gtf2f2, Cldn14) were identified in genomic divergence regions of E. rhadinum among China and Thailand populations. Our findings highlight the importance of demographic history factors shaping the geographical patterns of deleterious mutations. The results serve to deepen our understanding of the adaptive evolution and divergence of E. rhadinum with implications for other marine fish.

Spatial analysis of teen births near the New Bedford Harbor Superfund site

Abstract Few studies have examined teen births at an individual-level to identify sociodemographic and environmental risk factors that may contribute to geographically high-risk areas. Communities around the New Bedford Harbor (NBH) Superfund site in southeast Massachusetts are racially and socioeconomically diverse and face potential environmental burdens. These psychosocial, chemical and physical stressors may be associated with behaviors that increase risk of teen birth. We examined associations between teen births (age &lt; 20 years) from 1993–2009 and maternal residence at time of birth among mothers living in towns adjacent to the NBH Superfund site. We used generalized additive models with a smooth of residential location to predict teen birth risk among 29 472 births, adjusted for maternal race/ethnicity, birth country, and source of payment for prenatal care. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated by location across the study area. Approximately 13% of births were to teen mothers. Residential location was significantly associated with teen birth. However, both the strength of associations and areas of elevated risk were attenuated after adjustment. The highest risk was observed north and northeast of the harbor (OR: 95% CI—3.19: 2.08, 4.88 and 2.93: 1.47, 5.82), which aligns with the prevailing wind direction from the harbor. Our study illustrates the importance of assessing the independent contributions of sociodemographic factors to geographic variation in teen birth risk. After accounting for maternal characteristics, results highlight areas within the study region where high-risk individuals may have also experienced environmental stressors.

Impact of geographical variation on nutritional and antioxidant properties of Basella alba L. from Sri Lanka

BackgroundBasella alba L. (Malabar spinach) is a widely consumed leafy vegetable, well known for its nutritional and therapeutic properties. These properties arise from the availability of essential nutrients, phytochemicals, and antioxidant potential, which may vary depending on environmental factors induced by the geographical location. In this study our aim is to investigate the correlation between the geographical location and proximate composition, phytochemical content, and antioxidant activity of B. alba harvested from fifteen locations in Sri Lanka.ResultsAccording to the statistical analysis by ANOVA and Tukey test, the results of proximate analysis confirmed that samples from different locations showed statistically significant variance in nutritional content. Furthermore, phytochemical content and antioxidant potential varied showing a significant difference between locations in total chlorophyll (27.53 to 6.69 µg/g dry weight), carotene (4.54 to 1.15 µg/g dry weight), total flavonoid content (10.54 to 3.94 mg/g dry weight in Quercetin equivalents), total phenolic content (8.33 to 0.46 mg/g dry weight in gallic acid equivalents), 1,1-diphenyl-2-picrylhydrazyl radical scavenging activity (38.03–11.4% inhibition), and ferric ion-reducing antioxidant power (1.23 to 3.76 mg/g dry weight in ascorbic acid equivalents) (p < 0.05). The Pearson correlation showed a strong positive correlation between total phenolic content and antioxidant activity. Principal component analysis indicates the role of antioxidant activity and chlorophyll content in location differentiation, forming distinct clusters. Cluster analysis categorized samples into four groups, linking biochemical traits to agro-climatic zones. The principal component analysis and cluster analysis showed a close relationship between some locations due to their high antioxidant and phytochemical accumulation.ConclusionThis study exhibits the importance of geographical location on the phytochemical profile and antioxidant properties of B. alba. These findings can be used to refine optimal cultivation sites for B. alba to enhance the efficacy of its nutraceutical and pharmaceutical potential.

SARS-CoV-2 Infection and the Risk of New Chronic Conditions: Insights from a Longitudinal Population-Based Study

Background: The post-acute impact of SARS-CoV-2 infections on chronic conditions remains poorly understood, particularly in general populations. Objectives: Our primary aim was to assess the association between SARS-CoV-2 infections and new diagnoses of chronic conditions. Our two secondary aims were to explore geographic variations in this association and to assess the association between SARS-CoV-2 infections and the exacerbation of pre-existing conditions. Methods: This longitudinal study used data from 8086 participants of the Specchio-COVID-19 cohort in the canton of Geneva, Switzerland (2021–2023). Mixed-effects logistic regressions and geographically weighted regressions adjusted for sociodemographic, socioeconomic, and healthcare access covariates were used to analyze self-reported SARS-CoV-2 infections, new diagnoses of chronic conditions, and the exacerbation of pre-existing ones. Results: Participants reporting a SARS-CoV-2 infection were more likely to be diagnosed with a new chronic condition compared to those who did not report an infection (adjusted odds ratio [aOR] = 2.15, 95% CI 1.43–3.23, adjusted p-value = 0.002). Notable geographic variations were identified in the association between SARS-CoV-2 infections and new diagnoses. While a positive association was initially observed between SARS-CoV-2 infections and exacerbation of pre-existing chronic conditions, this association did not remain significant after adjusting p-values for multiple comparisons. Conclusions: These findings contribute to understanding COVID-19’s post-acute impact on chronic conditions, highlighting the need for targeted health management approaches and calling for tailored public health strategies to address the pandemic’s long-term effects.

Modeling the determinants of cigarette consumption in Iranian households with children under 5 years of age using the Income and Expenditure Survey 2021

BackgroundCigarette smoking remains a significant public health concern, with detrimental effects on both smokers and those exposed to secondhand smoke. This study investigates the factors influencing smoking behaviors in Iranian households, focusing on households with children under five years old.MethodsWe conducted a cross-sectional analysis of 8751 Iranian households using data from the Iranian Household Income and Expenditure Survey (HIES) collected by the Statistical Center of Iran (SCI) in 2021. A variety of count regression models were examined, including Poisson (P), Negative Binomial (NB), Generalized Poisson (GP) and their zero-inflated counterparts. The best fitting model was selected based on goodness-of-fit indices.ResultsApproximately 87% of households were non-smokers, with a mean daily cigarette consumption of 14.29 (SD = 8.64) among smokers. The three-level Zero-Inflated Generalized Poisson (TL-ZIGP) model was considered a suitable model for the interpretation of the data. Key predictors of smoking included older age, male gender, lower education, higher income, and larger homes. Homeownership was negatively associated with smoking. Considerable geographic variation in smoking prevalence was observed.ConclusionsSocioeconomic and demographic factors, including lifestyle and geographic regions, are associated with smoking behavior among Iranian households. A three-level ZIGP regression model is appropriate for analyzing these complex relationships. This study reveals different patterns of smoking prevalence in different population subgroups and emphasizes the need for targeted interventions to effectively reduce smoking rates.

The Epidemiology and Clinical Burdens of Human Parainfluenza Virus Infections Amongst Hospitalized Children Under 5 Years of Age in Jordan: A National Multi-Center Cross-Sectional Study

Human parainfluenza virus (HPIV) is a major cause of respiratory illnesses in children under five years, with clinical manifestations ranging from mild upper respiratory tract infections to severe lower respiratory tract diseases. This multi-center, cross-sectional study investigated the burden, clinical features, and predictors of respiratory viral infections in hospitalized children across four sites in Jordan. Nasopharyngeal specimens from 1000 eligible children were analyzed. In this article, we focused on HPIV infections. The overall HPIV positivity rate was 22.6%, with HPIV-3 accounting for 90.3% of cases. Significant geographic variability was observed, with higher positivity rates in the southern region. HPIV-positive cases frequently presented with symptoms like nasal congestion, tachypnea, and poor feeding. Co-infections with respiratory syncytial virus (RSV) or influenza were associated with worse outcomes, including an increased need for invasive ventilation. The logistic regression identified male gender, asthma, and respiratory acidosis as predictors of complications. Geographic differences in HPIV prevalence and severity were notable, emphasizing the influence of environmental and socioeconomic factors. These findings underscore the urgent need for enhanced HPIV surveillance, targeted public health interventions, and vaccine development to mitigate the disease burden. This study provides critical insights that guide healthcare strategies and improve outcomes in young children at risk of severe HPIV infections.

Geographical variation in antimicrobial resistant Salmonella Schwarzengrund from chicken meat in Japan.

Chicken meat is a major source of foodborne salmonellosis. In Japan, fluoroquinolones and third-generation cephalosporins are the first- and second-choice treatments for Salmonella gastroenteritis, respectively. We investigated the prevalence and antimicrobial resistance of Salmonella in 154 chicken meat products from Hokkaido (42), Tohoku (45), Kanto (5), and Kyushu (62), Japan. Salmonella was isolated from 133 products (86.4%). High resistance rates were observed for streptomycin (56.5%), tetracycline (50.7%), and kanamycin (47.8%), while all isolates were susceptible to cefazolin, cefotaxime, gentamicin, ciprofloxacin, colistin, and chloramphenicol. The most common serovar, Salmonella Schwarzengrund (83.3%), showed clear regional differences in multidrug resistance: 100% in Kyushu, 41.5% in Tohoku, and 0% in Hokkaido. These findings highlight significant geographical variation in antimicrobial resistance among Salmonella Schwarzengrund isolates.

Empirical Insights into Centroid Optimization in Transportation Planning: A Novel Approach

In complex urban environments, sophisticated analytical techniques are essential to improve the accuracy of transportation modeling and the precision of travel time predictions. This research endeavors to critically examine various multi-zone centroid positioning strategies, with the goal of unveiling the method that most authentically represents the dynamics of urban travel. Anchored by a comprehensive case study of the city of Istanbul in Turkey, the investigation utilizes various analytical tools meticulously tailored to account for the intricate interplay of demographic and geographic variables. This methodical approach enables the identification of optimal centroid locations by evaluating various methods, including a novel approach called kernel density estimation (KDE), as well as five other established other methods. The results are then aligned with real-world travel time data through rigorous statistical analysis to ensure accurate predictions of travel times. The KDE method demonstrated its more acceptable correlation coefficient and lower mean absolute error, root mean square error, and mean absolute percentage error metrics, establishing its superiority in model performance. By highlighting the paramount importance of accurately placed centroids within urban transportation models, this research’s findings contribute significantly to the evolution of transportation planning methodologies and the advancement of urban mobility models through a comparative analysis of optimal methods.

The differences in injury patterns and outcomes of thoracic trauma between rural and urban level two trauma centers in a single country.

Equal level trauma centers in the same country might have significant differences regarding their demographics and types of trauma. Understanding geographic variations in injury patterns are essential for optimal care. Here we describe the differences in injury patterns and associated outcomes of thoracic trauma patients between rural and urban level-II trauma centers in a single country. A retrospective analysis of patients with thoracic trauma over a three-year period in a rural level-II and an urban level-II in Israel were compared. Demographics, mechanism of injury, prehospital care, transport, hospitalization course, discharge disposition, and outcomes were all analyzed. There were significant differences between the demography, mechanisms of injury, and sustained injuries. The urban population was older, with more pedestrians hit by motor vehicles, falls from standing or sitting, and penetrating injuries. The rural population suffered from more motor vehicle crashes and falls from heights, with injuries related to higher velocity mechanisms such as lung contusions, sternal fractures, and liver injuries. There was no significant difference in transportation time or injury severity scores. More advanced life support ambulances were utilized in the rural setting together with more transfers to a higher level of care, while more patients in the urban center were lost to follow-up. Understanding the differences between geographic locations is crucial towards optimizing trauma care. The complexities of thoracic trauma patients are an important example of the variations between rural and urban trauma centers. Respecting these differences will help to improve preparedness and treatment for trauma patients.

Insights from Optimized Non-Landslide Sampling and SHAP Explainability for Landslide Susceptibility Prediction

The quality of sampling data critically influences landslide susceptibility prediction accuracy. Current studies commonly use a 1:1 ratio of landslide to non-landslide samples, failing to reflect natural geographical variability. This study develops a region-specific framework by integrating SHAP (SHapley Additive exPlanation) analysis with twelve landslide conditioning factors (LCFs) and three progressive sampling strategies, aiming to create adaptive non-landslide point selection criteria tailored to unique environmental and geological characteristics. The strategies include (1) multi-ratio random sampling (1:1 to 1:200), (2) susceptibility-based sampling adjustments derived from pre-susceptibility analysis, and (3) LCF-based correction using the NDVI threshold identified through SHAP analysis. Results show that LCF-based correction achieved the highest performance, while a 1:5 ratio proved optimal in random sampling, aligning with regional characteristics. This framework demonstrates the importance of region-specific sampling strategies in improving landslide susceptibility prediction.

Analysing regional and sectoral productivity changes in the Indian economy

AbstractMotivationNumerous domestic and international studies have shown that India's business environment has shortcomings that have hindered and distorted investment, reducing growth and job creation. There is geographical variation in the distribution of sectoral and regional production in India. Therefore, it is necessary to investigate the role geography plays in evaluating the effects of shifts in aggregate and disaggregate productivity.PurposeThis research attempts to build a unified framework to consider regional and sectoral changes as heterogeneous factors affecting productivity in India. It explores whether the fundamental changes in productivity are locational or sectoral.Approach and MethodsThis article focuses on three aspects: (1) It identifies variables based on previous literature. The aggregate industry analysis for both Punjab and India is based on independent variables. The study uses the 2SLS‐estimator using STATA in a single‐step endogeneity problem. (2) For disaggregate or sectoral analysis, it identifies four industries across India and Punjab. We confine our analysis to these four industries since the present study is done at both aggregate and disaggregate levels covering national and state level analysis. (3) It sets out separate interpretations for the aggregate analysis, setting it apart from disaggregate analysis.FindingsFor aggregate industry analysis, the results for Indian and Punjab industry adhere to Verdoorn's law which states that in the long run productivity generally grows proportionally to the square root of output. In that value‐added growth is a major factor affecting total factor productivity for Indian firms across both regions. The Punjab group shows non‐linearity between productivity and concentration. Concentration leads to some increase in productivity but this then declines.Policy ImplicationsPolicy‐makers should promote the establishment of more medium‐sized firms to enhance productivity across all regions in India.The skilled‐labour ratio emerged as significant for the Punjab group, though this is because the state has a higher proportion of small‐scale industries which are more labour intensive than the overall India group. As such, specific policies should be aimed at the manufacturing sector at state level to enhance productivity, taking into consideration unique features of each group.Policy‐makers should address the inefficiency of the industrial policy overseen by the Ministry of Micro, Small and Medium Enterprises.

Altitudinal Variation of Limb Size of a High-Altitude Frog

Geographical variation in morphological traits represents a significant ecological phenomenon. According to Allen’s rule, animals inhabiting cooler environments typically exhibit shorter extremities compared to those in warmer regions. While Allen’s rule has been extensively validated along latitudinal gradients, its applicability to altitudinal variation in morphological traits remains less well understood. In this study, we analyzed morphological data—including forelimb length and hindlimb length—from 492 individuals of Rana kukunoris from 26 populations to assess whether relative limb size in both sexes declines with altitude, aligning with Allen’s rule. However, this pattern exhibited geographical regional variation. In the northern and central regions, relative limb length consistently followed the predictions of Allen’s rule. In contrast, the southern region showed no significant altitudinal variation in limb proportions. These results highlight that the applicability of Allen’s rule may be modulated by regional environmental factors and altitude vertical differences, underscoring the need for a nuanced understanding of how local contexts influence morphological adaptations.

Prognostic Indicators and Comparative Treatment Outcomes in High-Risk Thyroid Cancer with Laryngotracheal Invasion.

Laryngotracheal invasion occurs in a subset of patients with well-differentiated thyroid cancer (WDTC) and is associated with a poor prognosis. We aimed to analyze patterns and predictors/outcomes related to this high-risk manifestation. This population-based analysis utilized the Surveillance, Epidemiology, and End Results (SEER) registry (2000 to 2015) to identify WDTC patients. Temporal trends and geographic variation in invasion rates were assessed. Logistic regression and propensity score matching were employed to identify predictors of secondary malignancy, mortality, and treatment impact on overall and thyroid cancer (TC)-specific survival. Of 131,721 WDTC patients, 1,662 (1.3%) had tracheal invasion and 976 (0.7%) had laryngeal invasion at diagnosis. Tracheal and laryngeal invasion rates declined from 3.7%-0.7% and 1.5%-0.6%, respectively, from 2000 to 2015. Compared to 98,835 noninvasive cases, patients with laryngotracheal invasion were older and more often male, Asian, and Hispanic (all P<0.001). This group had larger tumors with higher rates of nodal (N1: 61.8% vs. 15.1%) and distant metastases (M1: 9.3% vs. 0.4%). Age ≥55 years (hazard ratio [HR], 1.19; P=0.004) and metastases (HR, 1.75; P<0.001) increased TC-specific mortality, whereas the converse pattern was found for Asian race (HR, 0.63; P=0.002) and surgery (HR, 0.35; P<0.001). In rigorously matched groups to control confounding, adding radioactive iodine to surgery reduced mortality by 30% (P<0.001). However, external beam radiation and systemic therapy did not improve survival over surgery alone. Laryngotracheal invasion is present in 0.7% to 1.3% of cases, conferring over double the mortality risk. Radioactive iodine with surgery improves outcomes in this aggressive WDTC subset.

Nationwide study on multimorbidity prevalence: 7.64 million primary healthcare users in Portugal with multiple chronic conditions.

The goal of this study was to explore the prevalence of multimorbidity, its geographic variation, and changes from 2022 to 2024 in Portugal. Information regarding the chronic health conditions active in the primary healthcare patients' health problems lists on the electronic health records are derived from the digital platform Identity Card of Primary Healthcare (Bilhete de Identidade dos Cuidados de Saúde Primários, BI CSP) data for the period of 2022 and 2024. BI CSP nationwide data from May 2024 of the 10,366,861 registered users in Portuguese primary healthcare were used to determine the prevalence of multimorbidity (presence of 2 or more chronic health conditions) and analize differences to 2022. By May 2024, 73.7% of the population (7.64 million out of 10.37 million registered users in primary healthcare) were living with multimorbidity, indicating a 4.7% increase from 2022. The most common chronic conditions in 2024 included lipid disorders, hypertension, obesity, and tobacco abuse. Regionally, multimorbidity exceeded 65% in all zones, with the North (78.9%) and Alentejo (78.3%) regions having the highest rates. The prevalence increased across all regions, with the North region showing the smallest increase from 2022 to 2024. The prevalence of multimorbidity in Portugal is increasingly high across all the regions considered. Additional studies will be helpful in determining the extent to which the now-reported high prevalence of multimorbidity will impact the healthcare system in Portugal.

A Perspective on Wastewater and Environmental Surveillance as a Public Health Tool for Low- and Middle-Income Countries

Geographical variations in infectious diseases create differences in public health priorities between high- and low-income countries. Low- and middle-income countries (LMICs) face resource constraints that limit adherence to international monitoring standards for wastewater-based epidemiology (WBE). The development of low-cost WBE programs, such as those to detect SARS-CoV-2, offers LMICs a promising tool for monitoring pathogens of local concern. In this work, we summarize important wastewater biomarkers for LMICs and their associated public health challenges, ranging from pathogens causing gastroenteritis to putative markers for plant diseases linked to food safety, as well as antimicrobial resistance. We raise awareness of the great potential of WBE for LMICs and highlight the critical health markers, research needs, and strategies necessary to establish tailored wastewater surveillance programs.