Geographic Variation Research Articles

Civil Organizing in War: Evidence from Syrian Facebook Communities

Where, when, and why do civilians organize during war? We propose a research agenda that expands the scope of variation in civil organizing and identify mechanisms to explain its emergence and evolution. Drawing on a large-scale original dataset of public Facebook posts produced by Syrian organizations from 2011 to 2020 and qualitative case studies based on 10 months of field research among Syrian activists in Turkey and Jordan, we systematically examine geographic, temporal, and substantive variation in civil organizing. We find that civil organizing can persist in the face of ongoing violence and displacement, focusing not only on concerns of protection and survival, but also on governance and even contentious politics. This organizing increasingly shifts from within Syria to border states, with translocal organizations—operating both inside and outside Syria—playing a particularly active role. This work contributes to literature on conflict processes and contentious politics by emphasizing the importance of organizations, centering refugees and civilians as agential and strategic actors, and using novel evidence to describe variation in wartime organizing over time and space.

Evaluating the impact of 2011 tort reform limiting noneconomic damages in North Carolina and Tennessee on testing, imaging, and procedure utilization.

To evaluate the impact of tort reform laws passed in 2011 capping noneconomic damages in North Carolina and Tennessee on rates and adjusted per user costs of tests, imaging, and procedures in the Medicare fee-for-service population. State-level synthetic difference-in-differences, adjusting for the percent of FFS Medicare beneficiaries in the state who were female, had ever been on Medicare Advantage, were eligible for Medicaid for at least 1 month of the year, and total state risk-adjusted, standardized per-capita costs. Analyses of North Carolina and Tennessee were performed separately. We measured the average treatment effect on the treated. Centers for Medicare and Medicaid Services Geographic Variation Public Use File, 2007-2019. Our analysis showed no economically significant impact of these laws in either state, though we found a small but statistically significant increase (average treatment effect on the treated: $46, 95% confidence interval: $6-$87) in adjusted per user cost of procedures in Tennessee. Our findings suggest that caps on noneconomic damages alone may be insufficient to modify physician practice habits and impact utilization. Future work should attempt to better understand the economic and noneconomic incentives that shape physician ordering decisions.

Position statement of the World Endoscopy Organization: Role of endoscopy in screening, diagnosis, and treatment of esophageal superficial squamous neoplasia.

Esophageal squamous cell carcinoma (ESCC) remains a significant global health challenge, being the sixth leading cause of cancer mortality with pronounced geographic variability. The incidence rates range from 125 per 100,000 in northern China to 1-1.5 per 100,000 in the United States, driven by environmental and lifestyle factors such as tobacco and alcohol use, dietary habits, and pollution. Major modifiable risk factors include tobacco and alcohol consumption, with a synergistic risk increase when combined. Nonmodifiable risk factors include previous diagnoses of head and neck squamous cell carcinoma (H&N SCC), achalasia, and prior radiotherapy. Prevention strategies must be tailored to specific regional burdens to efficiently allocate medical and financial resources. Gastrointestinal endoscopy is crucial in reducing ESCC burden through early detection and characterization of neoplastic changes, such as high-grade dysplasia. Early diagnosis significantly improves survival rates, while endoscopic resection of noninvasive dysplasia can prevent ESCC onset, reducing treatment burden for advanced disease. Postresection surveillance can detect high-risk metachronous lesions. Despite these benefits, endoscopic prevention faces challenges, including the lack of high-level evidence supporting its efficacy, opportunity costs, the need for specialized training and techniques, and the requirement for advanced technology investments. This Position Statement from the World Endoscopy Organization (WEO) aims to address these challenges, supplying recommendations for the exploitation of endoscopic resources regarding the possible role of screening, quality, and training for the detection, characterization, resection, and surveillance of ESCC.

Gut Content Analysis of Oreochromis niloticus and Chanda nama of Begnas Lake, Kaski, Nepal

Gut content analysis provides insights into fish species' feeding preferences, tropical interaction, and geographical and seasonal variations in their diets. Guts of Oreochromis niloticus and Chanda nama were analyzed and index of preponderance (IP) was calculated. IP depicts that in O. niloticus, phytoplankton (61.92%) was the most commonly consumed food followed by zooplankton (24.39%), debris, sand (12.57%), nematodes (0.7%) and hatchling (0.42%), In C. nama, micro-crustaceans (48.82%) contributed the most for total volume of food items, followed by scales (37.76%), insects (13.53%), and phytoplankton (0.29%). Begnas lake supports 28 phytoplankton and 12 zooplankton species out of which 24 phytoplankton, seven zooplankton species and seven phytoplankton and four zooplankton species were found in O. niloticus gut and C. nama gut respectively. O. niloticus's diverse feeding habits and C. nama's lepidophagous behavior have caused challenges for native fish, which may be reason for decline in native fish population. Int. J. Appl. Sci. Biotechnol. Vol 12(4): 215-223.

Property crime in the South Caucasus - Panel Data Analysis

The paper aims to determine the various variables affecting property crimes (theft, robbery, burglary) in the South Caucasus (Azerbaijan, Armenia, and Georgia). For this purpose, we used panel data from three countries - registered property crimes from 1997-2018. Through the first difference estimator of the GMM, we studied the effect of deterrence, socio-economic, geographical and other variables on the property crime rates. The analysis revealed that past crime and urbanisation have a positive effect on property crime. In contrast, the clear-up rate and real wage change have negative ones. However, as for other economic variables used in the empirical analysis, the study does not confirm a statistically significant relationship, which may be explained by these countries' economic development levels.

Trajectories of biologic drug use before, during and after pregnancy: an Italian cohort study from the VALORE project

ABSTRACT Background Monitoring biologic drug therapy during pregnancy in women with immune-mediated inflammatory diseases (IMIDs) is crucial to ensure treatments align with evidence-based practices. Research design and methods A retrospective cohort study based on healthcare claims data from eight Italian regions was conducted, analyzing deliveries between 2009 and 2021. The study included women receiving biologic drugs within nine months before their last menstruation. Exposures to biologics, conventional disease-modifying anti-rheumatic drugs (DMARDs) and symptom-relieving medications were assessed in the trimesters (T) before, during and after pregnancy. Factors influencing biologic treatment persistence during pregnancy were analyzed. Results A cohort of 1,763 deliveries was considered. Biologic drugs were prescribed for rheumatic (33.6%), dermatological (32.6%), and gastrointestinal diseases (28.4%). Biologic use declined during pregnancy (TI = 37.3%; TII = 17.6%; TIII = 11.3%), increasing again postpartum. During pregnancy, there was increased use of symptom-relieving medications for rheumatic diseases and DMARDs for gastrointestinal diseases. Factors associated with continued biologic treatment included being older than 35 years and the region of delivery. Conclusions This study found a decrease in biologics drug use during pregnancy and highlights the necessity for personalized therapeutic approaches. Geographic variations in biologic drug use emphasize the need for educational initiatives about the risk-benefit profiles of these therapies during pregnancy.

Understanding online suicidal ideation in China: nationwide distribution, social determinants, and geographic variations

Understanding online suicidal ideation in China: nationwide distribution, social determinants, and geographic variations

The role of power in market control in supplier-buyer relations

This study investigates the role of power dynamics in market control within supplier-buyer relationships, with a specific focus on blockchain technology adoption in supply chain networks. Using five focus group discussions, comprising of diverse participants categorized by sector, location, gender, and company size, the research explores how power influences decision-making processes. Findings reveal that larger companies often prioritize stability over innovation, limiting their willingness to adopt disruptive technologies like blockchain. In contrast, smaller firms demonstrate greater flexibility and openness to change. Beyond company size, factors such as product uniqueness, strategic network positions, and the personalities of decision-makers play critical roles in shaping blockchain adoption. Participants also reported persistent pressure from both suppliers and buyers to accept unfavorable terms, underscoring power imbalances that constrain smaller players. The analysis is framed within the conceptual structure of a model with a focus on the nuanced interplay of power and decision-making in the context of supply networks. Qualitative analysis of the discussions, conducted with Atlas.ti software, highlights the influence of sectoral differences, geographical variations, and gender dynamics in supply chain negotiations. This study provides valuable insights into the barriers and enablers of blockchain adoption within complex supply chain networks, emphasizing the critical interplay of power and communication in shaping market control.

Measles Among the Foreign-Born Population Residing in Spain, 2014-2022: Missed Opportunities for Vaccination.

Spain has been in a measles elimination phase since 2014. No evidence exists about the distribution of measles cases among the population born outside Spain. The aim of this study was thus to describe the epidemiological situation of measles, stratified by place of birth, during the post-elimination period in Spain. This is a retrospective study of confirmed measles cases reported to RENAVE between 2014 and 2022. A descriptive analysis of case characteristics (sex, age group, vaccination status, imported case) was performed, was well as an analysis of temporal trends and geographic distribution in measles incidence rate (IR; cases/million inhabitants). All analyses were stratified by place of origin (Spain born vs. born outside Spain). We then performed a sensitivity analysis of those born outside Spain, with the representation of Kaplan-Meier curves taking into account the year of arrival in the country until the onset of measles. Between 2014 and 2022, 951 measles cases were reported in Spain (overall IR: 2.3). Among these, 18.6% (177 cases, IR: 3.0) were born outside Spain. The IRs show differences (p < 0.001) in terms of distribution by age group and origin. By age group, children under 5 years had the highest IR, but adults aged 30 years and older reported the highest proportion of cases. The incidence rate ratio (IRR) was 5-fold higher among foreign-born children under 5 years than among native-born children. The measles time trend shows the highest peak in 2019 for foreign-born and native-born (IR: 8.6 and 5.4, respectively), consistent with the European-wide scenario, while only one case of measles was reported in 2022. Geographical variability in incidence rates by region was observed: Catalonia and the Valencian Community accumulated the highest proportion of cases throughout the study period. Among those born outside Spain, the median time from arrival to onset of rash was 6 years. The incidence of measles is 40% higher in Spain's foreign-born population than in its native-born population. Taking into account the increasing migrant population in Spain, we consider that public health efforts need to be directed towards susceptible groups of people. In this context of advanced elimination, specific interventions for identifying and attending the most vulnerable populations should be designed and implemented.

The effects of environmental heterogeneity on the morphological similarity of toothed-leafed red oak species (Acutifoliae; Quercus) in Mexico and Central America

Background: In plants, environmental gradients can promote similar morphophysiological traits in species that inhabit areas with similar climatic conditions. Here, to evaluate possible causes of morphological similarity, we analyzed leaf morphological and functional variation in toothed-leaf oaks and its relationships with environmental and geographic variables. Hypotheses: We expected that species with a greater degree of environmental overlap would exhibit similar leaf morphology, and those with a broader range of environmental tolerance would exhibit greater leaf morphological variation. Studied species: Acutifoliae group (Fagaceae, Quercus) Study sites and dates: Leaf samples were collected from adult trees distributed in diverse forest types between 495 and 2,566 meters above sea level (m asl) in Mexico and Guatemala. Methods: We compared patterns of leaf variation in a total of 2,934 leaves from 640 individuals corresponding to 68 populations of ten oak species using univariate and multivariate analyses. We also characterized the environmental conditions where each of the species occurred using the available geographical records and bioclimatic variables. Results: We found morphological overlap in leaf traits in oak species occurring in similar climatic environments. Additionally, oak species with a greater range of environmental distributions showed greater leaf shape morphological variation. Conclusions: The environment influenced the generation of similar leaf morphologies among oak species despite geographical distance and phylogenetic relationships.

Epidemiological characteristics and prevention and control strategies for Eimeria spp. in sheep and goats in China: a systematic review

AbstractSheep and goat coccidiosis has a worldwide distribution and is an important disease on lambing farms. Infection with multiple Eimeria species can lead to severe intestinal damage in sheep/goats and economic losses on farms. Disease is a serious constraint to the healthy development of small ruminant farming. Studies published on PubMed, CNKI, VIP, Wanfang and the resulting references of selected studies were included. Risk factors affecting prevalence were analyzed and stratified by geographic location and climatic variables, age, sex, feeding model, season, sample year, breeds and environment. The total prevalence of coccidia in sheep and goats reached more than 60% in most regions, in which the dominant species in sheep were mainly E. parva, E. ovinoidalis, and E. parva and E. ahsata. East China had the lowest prevalence of coccidia infection in sheep (43.24%), and the dominant species were different from those in the other regions, mainly E. bakuensis and E. gonzalezi. Southwestern China and Central China had slightly less than 40.0% goat coccidia infection, and the dominant species in goats were mainly E. arloingi, E. aligevi, E. hirci and E. ninakohlyakimovae. Sheep/goats of different ages can be infected with coccidiosis, but lambs between 1 and 3 months of age are more susceptible to the disease. When lambs become infected, the pathogen spreads rapidly throughout the herd. Spring, summer and autumn are the seasons with a high incidence of this disease. Environmental pollution may be a significant factor in the development of coccidiosis in sheep raised in large-scale housing. This study provides a comprehensive overview of the species, morphology and geographic distribution of Eimeria species in sheep and goats, summary prevalence in different regions of China, risk factors affecting prevalence, and prevention and control strategies.

Correlation of Geographic Variables with the Incidence Rate of Dengue Fever in Mexico: A 38-Year Study.

Dengue is a viral disease transmitted by the mosquitoes Aedes, which is characterized by fever, myalgia and arthralgia. In some cases, it can be fatal. For many years, dengue fever has been endemic to Mexico; however, few studies have investigated the historical and current extents of dengue fever at the national level or considered the effects of variables such as temperature, precipitation and elevation on its occurrence. An ecological study was carried out to compare the incidence rates of different types of dengue fever per hundred thousand inhabitants with temperature, precipitation and elevation between 1985 and 2023 in Mexico. The sources of information were the public records of the Ministry of Health and the National Meteorological Service. Multiple linear regression analysis was performed with Pearson and Spearman correlation coefficients at an alpha of <0.05. The global linear regression presented an R2 of 0.68 between the mean temperature and the cases of haemorrhagic dengue/severe/with warning signs. The degree of rainfall was not strongly correlated with the incidence rate, except in the eastern part of the country, where average temperature was also strongly correlated with the incidence rate. Nonsevere/classic dengue was most common from 1501 to 2000 m elevation, whereas severe forms of the disease were more prevalent at elevations greater than 2000 m.

Temporal, spatial, and methodological considerations in evaluating the viability of measles wastewater surveillance.

Measles is a highly transmissible disease of increasing concern due to waning vaccination contributing to a significant rise in measles cases, with 283 reported cases and 16 outbreaks in the U.S. as of November 7, 2024. Early identification of measles cases is thus critical to disease containment and control. Wastewater-based epidemiology (WBE) represents a potential strategy for the efficient identification of measles outbreaks. We investigated the suitability of WBE for measles outbreak identification by using a model-based approach to elucidate the relationship between measles shedding, wastewater concentration, and detectability. The model reveals conditions for effective detection, specifying the optimal timing, location, and methodology needed to achieve a specific probability of detection, including accounting for geographic variability of wastewater generation and measles case rates. Measles RNA shedding, primarily from urine, contributes an average of 8.72 log10 genome copies (GC) daily per infection into sewage. At the average U.S. wastewater treatment plant (WWTP), achieving a 50% probability of detection requires approximately 78 cases per 100,000 people with a process limit of detection (PLOD) of 3.0 log10 GC/L. At a PLOD of 3.0 log10 GC/L, over half of all WWTPs in the world can detect a single hypothetical measles case at a 10% probability of detection. However, achieving a 50-90% detection rate is challenging, especially with a higher PLOD, except in areas with the highest measles cases. Some locations require case levels consistent with a complete lack of vaccination for feasible measles detection in wastewater. Future work exploring measles shedding, variable shedding behavior, and local case rates can enhance model predictions. Overall, this analysis suggests that WBE detection of measles in most locations remains challenging without a significant increase in case rates or technical improvements decreasing the PLOD.

Hepatocellular carcinoma national burden across different geographical regions in the United States between 2001 and 2020.

While prior data showed an increasing incidence of hepatocellular carcinoma (HCC) in the United States, there are limited comprehensive and comparative data on the geographical variations of HCC trends in different demographic-specific populations. To evaluate sex and age-specific incidence rates and time trends in different geographical regions in the United States. Age-adjusted HCC incidence rates were collected from the United States Cancer Statistics (USCS) database which covers approximately 98% of the population in the United States. HCC rates were stratified by sex, age, and geographical region. annual percentage change (APC) and average APC (AAPC) were estimated using Joinpoint Regression. A pairwise comparison was conducted between sex-specific trends. There were 467344 patients diagnosed with HCC in the United States in the USCS database between 2001 and 2020. The rates and trends varied by geographical region. When looking at the West region (115336 patients), incidence rates of HCC were overall increasing and also increasing in older adults. However, when evaluating younger adults, HCC incidence rates decreased in men but not in women with a sex-specific absolute AAPC-difference of 2.15 (P = 0.005). When evaluating the Midwest region (84612 patients), similar results were seen. While incidence rates were increasing in the overall population and in older adults as well, they were decreasing in younger men but not in women with a sex-specific absolute AAPC-difference of 1.61 (P < 0.001). For the Northeast region (87259 patients), the analysis showed similar results with decreasing HCC incidence rates in younger men but not counterpart women (Sex-specific AAPC-difference = 3.26, P < 0.001). Lastly, when evaluating the south (180137 patients), the results were also decreasing in younger men but not in women (Sex-specific AAPC-difference = 2.55, P < 0.001). Nationwide analysis covering around 98% of the United States population shows an increasing incidence of HCC across all geographical regions, most notably in the South. While younger men experienced decreasing HCC incidence, younger women had a stable trend and this was noted across all regions as well. Our study offers insight into the epidemiology of HCC in different demographic groups across various United States geographical regions. While the reasons contributing to our findings are unclear, they can be related to sex and regional disparities in healthcare access and utilization. Future research is warranted to characterize the temporal change in HCC risk factors across different United States regions.

Hydrological Modelling of Sediment Yield in the Upper Basin Region of Kirkuk City Watershed

Mountain sedimentation and undue erosion provide significant challenges for dams since materials accumulate within reservoirs that hold water, reducing the capacity for storing living water, which is the most important goal of dam building. Iraq is one of the nations that will have a big problem getting sufficient water because its water requirement continues to climb, and the supplying countries provide less water to Iraq. The present research focuses on the upper basin of the Kirkuk City watershed in northeastern Iraq. The largest watershed region, spanning approximately 420 km2 within Al-Sulaymaniyah and Kirkuk Provinces. The objective is to quantify and foresee the sediment yield in this basin using 43 years of daily environment information and various rainstorm events with various intensities. The model was adjusted and confirmed by comparing it to the monthly mean surface flow and sediment readings obtained at the Kirkuk gauging station. The Soil and Water Assessment Tool (SWAT) model was utilized to simulate the upper basin region of Kirkuk City. The aforementioned model uses the geographic information system (GIS) software to analyse necessary information from GIS layers of the electronic contour modelling kind of soil, using of land, and coverage by integrating it with the appropriate climatic information. The kinematic erosion (KINEROS) and runoff model can simulate intricate watershed behaviour by precisely adjusting for the geographical variation of soils, distribution of rainfall sequences, and vegetation. The hydrological features of the Kirkuk city basin reveal that the subdivisions with the highest erosion rates cannot transport the debris or deposits to the reservoir, primarily due to propagation damages, percolating, and other smaller barriers. The optimal curve number (CN) was determined to be between 84 and 88, while the land cover factor (C) ranged from 0.005 to 0.04. The model validation results indicate that the Kirkuk Dam reservoir received a total volume of water estimated at 118.7 million cubic metres (MCM) and a total silt yield of 0.85 million tonnes. The “KINEROS” simulation modelling for the sediment yield closely matches the upper basin of Kirkuk watershed's deformation and sedimentation behaviour during singular rainfall events; this is particularly true for parts of watersheds located near the watershed area entrance.

Trophic niche adaptation of mountain frogs around the Sichuan Basin: individual specialization and response to climate variations

BackgroundClimatic and geographic variations have profound effects on the resource utilization of individuals and populations. Evaluating resource use in different environments is crucial for understanding species ecological adaptation strategies and promoting biodiversity conservation. Stable isotopes are widely used to assess trophic niches, providing quantitative indicators of ecological interactions between organisms and resource use in ecosystems. This study assesses the trophic niche traits of spiny-bellied frogs (Quasipaa boulengeri) in the marginal mountains of the Sichuan Basin in southwestern China using stable isotopes. Trophic niche variation under different time periods and environmental conditions is explored.ResultsThe spiny-bellied frogs experienced a significant reduction in trophic niche width during the past breeding season. The populations in the northwestern Sichuan Basin had a greater trophic niche width than the southeastern populations, and their δ15N values showed a positive correlation with temperature seasonality and a negative correlation with annual precipitation. Despite differences between the northwestern and southeastern populations, there was a consistent trend of increased individual specialization with latitude in both the northwestern and southeastern regions.ConclusionsOntogenetic niche shifts and differences in trophic niche traits between the northwestern and southeastern populations indicate diverse adaptation strategies in mountain frogs. The findings underscore the impact of geographical and climate variations on the resource utilization of amphibians. In addition, patterns of individual specialization highlight the significance of considering intra- and interpopulational changes when studying ecological adaptation.

The global epidemiology and health burden of the autism spectrum: findings from the Global Burden of Disease Study 2021.

High-quality estimates of the epidemiology of the autism spectrum and the health needs of autistic people are necessary for service planners and resource allocators. Here we present the global prevalence and health burden of autism spectrum disorder from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 following improvements to the epidemiological data and burden estimation methods. For GBD 2021, a systematic literature review involving searches in PubMed, Embase, PsycINFO, the Global Health Data Exchange, and consultation with experts identified data on the epidemiology of autism spectrum disorder. Eligible data were used to estimate prevalence via a Bayesian meta-regression tool (DisMod-MR 2.1). Modelled prevalence and disability weights were used to estimate health burden in years lived with disability (YLDs) as the measure of non-fatal health burden and disability-adjusted life-years (DALYs) as the measure of overall health burden. Data by ethnicity were not available. People with lived experience of autism were involved in the design, preparation, interpretation, and writing of this Article. An estimated 61·8 million (95% uncertainty interval 52·1-72·7) individuals (one in every 127 people) were on the autism spectrum globally in 2021. The global age-standardised prevalence was 788·3 (663·8-927·2) per 100 000 people, equivalent to 1064·7 (898·5-1245·7) autistic males per 100 000 males and 508·1 (424·6-604·3) autistic females per 100 000 females. Autism spectrum disorder accounted for 11·5 million (7·8-16·3) DALYs, equivalent to 147·6 (100·2-208·2) DALYs per 100 000 people (age-standardised) globally. At the super-region level, age-standardised DALY rates ranged from 126·5 (86·0-178·0) per 100 000 people in southeast Asia, east Asia, and Oceania to 204·1 (140·7-284·7) per 100 000 people in the high-income super-region. DALYs were evident across the lifespan, emerging for children younger than age 5 years (169·2 [115·0-237·4] DALYs per 100 000 people) and decreasing with age (163·4 [110·6-229·8] DALYs per 100 000 people younger than 20 years and 137·7 [93·9-194·5] DALYs per 100 000 people aged 20 years and older). Autism spectrum disorder was ranked within the top-ten causes of non-fatal health burden for people younger than 20 years. The high prevalence and high rank for non-fatal health burden of autism spectrum disorder in people younger than 20 years underscore the importance of early detection and support to autistic young people and their caregivers globally. Work to improve the precision and global representation of our findings is required, starting with better global coverage of epidemiological data so that geographical variations can be better ascertained. The work presented here can guide future research efforts, and importantly, decisions concerning allocation of health services that better address the needs of all autistic individuals. Queensland Health and the Bill & Melinda Gates Foundation.

Epidemiological patterns and trends of paediatric snakebites in Sri Lanka

ObjectivesThis study aimed to analyse the epidemiological patterns of paediatric snake bites in Sri Lanka over a 4-year period (2020–2024).MethodsA multi-centre, retrospective observational study was conducted from June 2020 to June 2024 across nine governmental hospitals in seven provinces of Sri Lanka. Data were collected based on 757 children presenting with snake bites. The snake bites were analysed based on age, gender, and seasonal variations. Data on the type of snake involved, geographic variations and the temporal trends in snake bite occurrences were also analysed.ResultsThe mean age of the 757 children recruited to the study was 10.3 years (SD—5.00, range—0.1–17 years). Males (57.7%) were significantly more affected than females (42.3%) (p < 0.05). Visual identification confirmed the snake species in 58.4% of cases. The hump-nosed viper (16.7%), Russell’s viper (14.7%), and common krait (12.9%) were the most common medically important snakes identified in the study. Seasonal peaks in snake bites occurred in May–July and November–December. An increasing trend in snake bite incidence was noted over the first three years, with a slight decline in the final year.ConclusionPaediatric snake bites in Sri Lanka show significant age, gender, and seasonal patterns. Targeted public health interventions are needed to mitigate the impact on children.

Meta-Analysis: Global Prevalence and Mortality of Cirrhosis in Metabolic Dysfunction-Associated Steatotic Liver Disease.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is responsible for a significant global health burden. Despite this burden, the prevalence and mortality of MASLD-related cirrhosis remain inadequately defined, hindering effective public health strategies. This study aimed to estimate the global prevalence and mortality associated with MASLD-related cirrhosis. A systematic search of PubMed, Ovid MEDLINE, EMBASE, Web of Science and SCOPUS was conducted using keywords related to MASLD and cirrhosis from inception of each database used through June 2024. COVIDENCE was used for abstract and manuscript review. MASLD populations were categorised into 'general practice setting' and 'high risk setting', which indicated studies from inpatient setting or those referred for liver biopsy for an indication (elevated liver enzymes). Our data extraction and quality assessment followed PRISMA guidelines. A random-effects model was utilised for meta-analysis. From 7924 identified articles, 35 studies comprising 513,742 patients with MASLD met the inclusion criteria. The pooled global prevalence of cirrhosis among MASLD patients was 3.26% (95% CI: 2.47%-4.31%) in general practice settings (4 studies) and 14.51% (95% CI: 11.22%-18.57%) among those in inpatient settings or referred for liver biopsy (31 studies). Regionally, higher prevalence rates in high-risk settings were observed in North America and Australia (18.38%; 95% CI: 9.06%-33.75%), followed by Europe (10.16%; 95% CI: 5.71%-17.44%) and Asia (9.12%; 95% CI: 6.11%-13.40%) (p = 0.007). Notably, ICD-based diagnoses indicated a significantly higher prevalence of cirrhosis (27.43%) compared to those diagnosed by liver biopsy (13.24%; p < 0.001). The pooled all-cause mortality rate for MASLD-cirrhosis patients was estimated at 7.91 per 100 person-years (95% CI: 4.44-13.71) (9 studies). This meta-analysis underscores the substantial prevalence of cirrhosis among MASLD patients and highlights significant geographic and demographic variability, calling for improved screening and management strategies.

The effect of spatial variation on linkage to care and treatment rates among patients with hepatitis C: A Canadian population-based study

Introduction: Despite significant global efforts towards eliminating hepatitis C virus (HCV) infection, multiple challenges remain in achieving this goal. In this study, we assessed the impact of geographical variation on HCV diagnosis and treatment rates in Alberta, Canada. Methods: Adults aged ≥20 years with a positive HCV antibody were identified from the provincial administrative sources from the fiscal years 2012 through 2017. To assess the differences across Alberta's rural-urban continuum, high-resolution spatial analyses using global and local spatial autocorrelation were applied to the HCV age- and sex-standardized prevalence rate at the sub-local geographic area level. We compared and tested differences in HCV RNA tests, HCV RNA positivity rates, and HCV treatment status across the different areas. Results: Between 2012 and 2017, we identified 18,768 patients who had tested positive for HCV Ab. Within this cohort, only 63.1% had HCV RNA repetitive. The HCV RNA positivity rate was 42.1%, and 65.3% had received HCV treatment after testing as HCV RNA positive. HCV Ab positive case counts exhibited a spatial distribution consistent with that of the population at risk: 67.5% in metro, 11.1% in urban, 19.7% in rural, and 1.8% in remote areas. The metropolitan area of Edmonton's age-and sex-standardized prevalence of 8.2 (95% CI 8.0–8.4) per 1,000 persons was higher than Calgary's standardized prevalence of 5.0 (95% CI 5.1–5.4) per 1,000 persons ( p &lt; 0.001). HCV RNA and HCV treatment rates demonstrated significant spatial variation. Conclusions: HCV prevalence, diagnosis, and treatment exhibit significant spatial variation across rural-urban Alberta. Implementation of geographically oriented screening and treatment interventions would result in a time- and cost-efficient HCV elimination strategy.