Large Regional Variations Research Articles

Factors Associated with the Establishment of New Occupational Therapist Positions in Norwegian Municipalities after the Coordination Reform.

Community-based occupational therapy is an increasingly important domain of work for occupational therapists. In Norway, this has been emphasized by the Coordination reform (2012), which assigned municipalities increased responsibility to protect and promote the health of their inhabitants. However, even if approximately 400 positions have been established between 2012 and 2017, little is known whether they have contributed to increased and/or more equal coverage across municipalities. To explore this matter, survey data was gathered among members of the Norwegian Occupational Therapy Association during 2017. Data was analyzed statistically (descriptive, comparative and associative) with SPSS 25. Results suggest large regional variations in the establishment of new positions. Moreover, most new positions were established in medium-sized municipalities that already had (an) occupational therapist(s) in the community. Number of prior positions, as well as being in the process of merging with another municipality were the only significant predictors for the establishment of new positions during regression analysis. Findings suggest that no levelling-out of geographical distributions of OT-coverage has occurred, even if new positions might have contributed to level-out workload (number-of-patients-per-therapist). Further, we discuss implications of our findings for policy-making and recruitment of Occupational Therapists for rural positions.

Regional Variations in Diagnostic Radiology Residency Stipends Are Accentuated When Correlated With Cost of Living.

To determine and compare the relative value of diagnostic radiology resident stipends when adjusted for regional cost of living. The ACGME database was queried for a list of accredited allopathic diagnostic radiology residency programs for academic year 2017-2018. Stipend information for R1 positions (post-graduate year 2) was identified through each program's website. Data was grouped and analyzed by city, state, and geographical region. Stipends were then correlated with the 2017 annual region-specific average cost of living index (COLI). There were 194 programs identified, of which 118 (60.8%) were analyzed after exclusions for lack of stipend or correspondingCOLI data. The average annual stipend was $57,161±$4,242 (range, $49,547-$72,000). The COLI-adjusted value was$51,357±$9,927 (range, $26,915-$68,827). The average difference between stipend and cost-ofliving adjusted value was -$5,804±$12,610 (range, -$40,953-$10,958), corresponding to an average -9.1% stipend value loss (range, -58.1%-21.7%, P=.00000004). Value loss in large metropolitan cities was as high as 53.8%. Financial issues are one of the biggest challenges faced by trainees and have been correlated with increased stress as well as poor academic performance. The pressures of debt can also play a significant role in ultimate subspecialty career choice. Discrepancies between resident stipends, which are not adjusted based on the local COLI, are exacerbated by large regional variations in cost of living. Residency applicants should not discount regional cost of living when deciding where to train, and training programs should consider cost of living when setting stipend levels for their trainees.

Analysis of Investment Activities of Enterprises in Poland

The impact on the development of the economy and enterprises themselves is made possible by investments as they are one of the main components of GDP. An increase in enterprise investments demonstrates the good financial condition of economic entities, is a positive signal about the state of the economy and gives information about its development. The subject of this article is the impact of enterprises on the economy and its importance in Poland by analysing both investment itself and the investment rate. The analysis was carried out at a regional level as well as in relation to other EU member states. The aim is to analyse the investment activities of Polish enterprises, with particular emphasis on the change as well as their size and type. The research is based on a critical analysis of the literature and an analysis of secondary statistical data, covering the period from the first full EU program from 2007, and extended in accordance with the n+2 funding rule until 2015. The analyses show that despite growing investment among Polish enterprises, compared to the rest of the EU, the value of expenditure on fixed assets is still low as the average value made in the private sector among EU countries is 70% higher. At the same time, the growing level of investment value among private businesses over the nine years should be emphasized. There is also a very large regional variation in the level of investment growth per working-age capita over the period considered.

Impact of surgical resection rate on survival in gastric cancer: nationwide study.

BackgroundThere are marked geographical variations in the proportion of patients undergoing resection for gastric cancer. This study investigated the impact of resection rate on survival.MethodsAll patients with potentially curable gastric cancer between 2006 and 2017 were identified from the Swedish National Register of Oesophageal and Gastric Cancer. The annual resection rate was calculated for each county per year. Resection rates in all counties for all years were grouped into tertiles and classified as low, intermediate or high. Survival was analysed using the Cox proportional hazards model.ResultsA total of 3465 patients were diagnosed with potentially curable gastric cancer, and 1934 (55.8 per cent) were resected. Resection rates in the low (1261 patients), intermediate (1141) and high (1063) tertiles were 0–50.0, 50.1–62.5 and 62.6–100 per cent respectively. The multivariable Cox analysis revealed better survival for patients diagnosed in counties during years with an intermediate versus low resection rate (hazard ratio (HR) 0.81, 95 per cent c.i. 0.74 to 0.90; P < 0.001) and high versus low resection rate (HR 0.80, 0.73 to 0.88; P < 0.001).ConclusionThis national register study showed large regional variation in resection rates for gastric cancer. A higher resection rate appeared to be beneficial with regard to overall survival for the entire population.

Underdetection of cases of COVID-19 in France threatens epidemic control.

As countries in Europe gradually relaxed lockdown restrictions after the first wave, test-trace-isolate strategies became critical to maintain the incidence of coronavirus disease 2019 (COVID-19) at low levels1,2. Reviewing their shortcomings can provide elements to consider in light of the second wave that is currently underway in Europe. Here we estimate the rate of detection of symptomatic cases of COVID-19 in France after lockdown through the use of virological3 and participatory syndromic4 surveillance data coupled with mathematical transmission models calibrated to regional hospitalizations2. Our findings indicate that around 90,000 symptomatic infections, corresponding to 9 out 10 cases, were not ascertained by the surveillance system in the first 7 weeks after lockdown from 11May to 28June 2020, although the test positivity rate did not exceed the 5% recommendation of the World Health Organization (WHO)5. The median detection rate increased from 7% (95% confidence interval, 6-8%) to 38% (35-44%) over time, with large regional variations, owing to a strengthening of the system as well as a decrease in epidemic activity. According to participatory surveillance data, only 31% of individuals with COVID-19-like symptoms consulted a doctor in the study period. This suggests that large numbers of symptomatic cases of COVID-19 did not seek medical advice despite recommendations, as confirmed by serological studies6,7. Encouraging awareness and same-day healthcare-seeking behaviour of suspected cases of COVID-19 is critical to improve detection. However, the capacity of the system remained insufficient even at the low epidemic activity achieved after lockdown, and was predicted to deteriorate rapidly with increasing incidence of COVID-19 cases. Substantially more aggressive, targeted and efficient testing with easier access is required to act as a tool to control the COVID-19 pandemic. The testing strategy will be critical to enable partial lifting of the current restrictive measures in Europe and to avoid a third wave.

Changes in healthcare utilisation for paediatric tonsillectomy and adenoidectomy in the Netherlands: a population-based study.

ObjectivesTonsillectomy and adenoidectomy in children are controversial subjects with large regional variation in surgical rates, partly explained by cultural differences and lack of high‐quality evidence on indications for surgery. A quality of care cycle was executed on this topic in the Netherlands. The objective of this study was to estimate changes in healthcare utilisation for paediatric tonsil surgery in the Netherlands.MethodsPopulation‐based data on tonsillectomies and adenoidectomies in children up to age 10 were retrieved retrospectively from Dutch administrative databases between 2005 and 2018. A change point analysis was performed to detect the most pivotal change point in surgical rates. We performed univariate analyses to compare surgical patients’ characteristics before and after the pivotalpoint . Impact on healthcare budget and societal costs were estimated using current prices and data from cost‐effectiveness analyses.ResultsThe annual number of adenotonsillectomies reduced by 10 952 procedures (−39%; from 129 per 10 000 children to 87 per 10 000 children) between 2005 and 2018, and the number of adenoidectomies by 14 757 procedures (−49%; from 138 per 10 000 children to 78 per 10 000 children). The most pivotal change point was observed around 2012, accompanied by small changes in patient selection for surgery before and after 2012. An estimated €5.3 million per year was saved on the healthcare budget and €10.4 million per year on societal costs.ConclusionThe quality of care cycle resulted in fewer operations, with a concomitant reduction of costs. We suggest that part of these savings be invested in new research to maintain the quality of care cycle.

Screening for sickle cell disease in newborns: a systematic review

BackgroundSickle cell disease (SCD) is an inherited autosomal recessive disorder caused by the replacement of normal haemoglobin (HbA) by mutant Hb (sickle Hb, HbS). The sickle-shaped red blood cells lead to haemolysis and vaso-occlusion. Especially in the first years of life, patients with SCD are at high risk of life-threatening complications. SCD prevalence shows large regional variations; the disease predominantly occurs in sub-Saharan Africa. We aimed to systematically assess the evidence on the benefit of newborn screening for SCD followed by an earlier treatment start.MethodsWe systematically searched bibliographic databases (MEDLINE, EMBASE, Cochrane Databases, and the Health Technology Assessment Database), trial registries, and other sources to identify systematic reviews and randomised controlled trials (RCTs) or non-randomised trials on newborn screening for SCD. The last search was in 07/2020. Two reviewers independently reviewed abstracts and full-text articles and assessed the risk of bias of the studies included. Data were extracted by one person and checked by another. As meta-analyses were not possible, a qualitative summary of results was performed.ResultsWe identified 1 eligible study with direct evidence: a Jamaican retrospective study evaluating newborn screening for SCD followed by preventive measures (prevention of infections and education of parents). The study included 500 patients with SCD (intervention group, 395; historical control group, 105). Although the results showed a high risk of bias, the difference between the intervention and the control group was very large: mortality in children decreased by a factor of about 10 in the first 5 years of life (0.02% in the intervention group vs. 0.19% in the control group, odds ratio 0.09; 95% confidence interval [0.04; 0.22], p < 0.001).ConclusionThe results are based on a single retrospective study including historical controls. However, the decrease of mortality by a factor of 10 is unlikely to be explained by bias alone. Therefore, in terms of mortality, data from this single retrospective study included in our systematic review suggest a benefit of newborn screening for SCD (followed by preventive measures) versus no newborn screening for SCD (weak certainty of conclusions).

Global and regional epidemiology of HIV-1 recombinants in 1990–2015: a systematic review and global survey

Global HIV-1 genetic diversity and evolution form a major challenge to treatment and prevention efforts. An increasing number of distinct HIV-1 recombinants have been identified worldwide, but their contribution to the global epidemic is unknown. We aimed to estimate the global and regional distribution of HIV-1 recombinant forms during 1990-2015. We assembled a global HIV-1 molecular epidemiology database through a systematic literature review and a global survey. We searched the PubMed, Embase (Ovid), CINAHL (Ebscohost), and Global Health (Ovid) databases for HIV-1 subtyping studies published from Jan 1, 1990, to Dec 31, 2015. Unpublished original HIV-1 subtyping data were collected through a survey among experts in the field who were members of the WHO-UNAIDS Network for HIV Isolation and Characterisation. We included prevalence studies with HIV-1 subtyping data collected during 1990-2015. Countries were grouped into 14 regions and analyses were done for four time periods (1990-99, 2000-04, 2005-09, and 2010-15). The distribution of circulating recombinant forms (CRFs) and unique recombinant forms (URFs) in individual countries was weighted according to the UNAIDS estimates of the number of people living with HIV in each country to generate regional and global estimates of numbers and proportions of HIV-1 recombinants in each time period. The systematic review is registered with PROSPERO, CRD42017067164. Our global data collection yielded an HIV-1 molecular epidemiology database of 383 519 samples from 116 countries in 1990-2015. We found that the proportion of recombinants increased over time, both globally and in most regions, reaching 22·8% (7 978 517 of 34 921 639) of global HIV-1 infections in 2010-15. Both the proportion and the number of distinct CRFs detected increased over time to 16·7% and 57 CRFs in 2010-15. The global and regional distribution of HIV-1 recombinants was diverse and evolved over time, and we found large regional variation in the numbers (0-44 CRFs), types (58 distinct CRFs), and proportions (0-80·5%) of HIV-1 recombinants. Globally, CRF02_AG was the most prevalent recombinant, accounting for 33·9% (2 701 364 of 7 978 517) of all recombinant infections in 2010-15. URFs accounted for 26·7% (2 131 450 of 7 978 517), CRF01_AE for 23·0% (1 838 433), and other CRFs for 16·4% (1 307 270) of all recombinant infections in 2010-15. Although other CRFs accounted for small proportions of infections globally (<1% each), they were prominent in regional epidemics, including in east and southeast Asia, west and central Africa, Middle East and north Africa, and eastern Europe and central Asia. In addition, in 2010-15, central Africa (21·3% [243 041 of 1 143 531]), west Africa (15·5% [838 476 of 5 419 010]), east Africa (12·6% [591 140 of 4 704 986]), and Latin America (9·6% [153 069 of 1 586 605]) had high proportions of URFs. HIV-1 recombinants are increasingly prominent in global and regional HIV epidemics, which has important implications for the development of an HIV vaccine and the design of diagnostic, resistance, and viral load assays. Continued and improved surveillance of the global molecular epidemiology of HIV is crucial. None.

Analysis of Tick-borne Encephalitis vaccination coverage and compliance in adults in Switzerland, 2018

BackgroundOverall incidence and geographic range of Tick-borne Encephalitis (TBE), a vaccine preventable infection, have steadily increased in Switzerland over the last 50 years. While fully subsidized vaccination has been recommended in many areas for well over a decade, vaccine coverage and variables associated with vaccination compliance among Swiss adults are poorly understood. MethodsIn 2018 we conducted a national, cross-sectional survey of vaccination cards evaluating TBE vaccination coverage and compliance among adults (18-79) in Switzerland. ResultsNationwide TBE vaccination coverage was 41.7% (range 14.3% to 60.3%) for 1 dose and 32.9% (range 8.4% to 50.4%) for a complete primary series (3 doses). There was a significant correlation between average disease incidence by canton (2009-2018) and vaccine coverage at both 1 and 3 doses. Of the overall population, 9.5% had received at least one TBE booster vaccination with large regional coverage variation. We estimated that 23% of adults in Switzerland would be protected from infection based on their vaccination history and 135 (95% CI: 112-162) TBE cases were prevented in 2018. Individuals reporting previous experience with tick-associated health problems, those frequently in nature or those with “high” perceived risk of contracting TBE, were significantly more likely to have received at least one vaccine dose, indicating a positive impact of awareness on vaccination compliance. We also calculated a TBE incidence rate of 6.83/100,000 among the unvaccinated adult population in Switzerland and estimated vaccine effectiveness at 91.5% (95% CI: 90.9-92.0%). ConclusionsThese findings provide an important reference for TBE vaccination levels in Switzerland and further suggest that public health interventions promoting knowledge of TBE health impacts and risk factors may be beneficial in improving TBE vaccination coverage but should be tailored to account for heterogeneity in vaccine uptake.

Regional Differences in Opioid Prescribing in Germany - Results of an Analysis of Health Insurance Data of 57 Million Adult People.

BackgroundRegional variations of opioid use have been reported from many countries. The objective of this study was to examine opioid prescribing patterns in Germany including low- and high-potency opioids (LPO and HPO) focusing on regional differences.MethodsData source was the “Information system for health care data” comprising statutory health insurance funds data for about 70 million Germans of all ages. For 2010, we received aggregated data (by age, sex, federal state and district) of Germans (18+) who had been prescribed at least one opioid including the number of prescribed packages. For each stratum, we further received the number of insured persons. We calculated LPO and HPO prevalences and the mean number of prescribed packages.ResultsAmong 57 million adult Germans (mean age: 50.2 years, 53.8% female), opioid prevalences were 38.7 per 1000 persons for LPOs and 12.8 for HPOs. Prevalences rose with increasing age and were higher in women than in men. On average, LPO users were prescribed fewer packages than HPO users (3.5 vs 7.0). LPO use was highest in the eastern states ranging from 32.9 per 1000 persons (Hamburg) to 47.2 (Saxony-Anhalt). HPOs were most often prescribed in the North and in the East with prevalences varying between 10.6 per 1000 persons (Baden-Württemberg) and 16.9 (Mecklenburg-Western Pomerania). On the district level, prevalences varied by the factors 2.6 and 3.2 for LPOs and HPOs, respectively.ConclusionWe found large regional variations in opioid prescribing which probably cannot only be attributed to differences in patient characteristics.

Regional variation in vestibular schwannoma management and patient support group participation across the United States.

The Acoustic Neuroma Association (ANA) represents the largest existing patient support organization for those diagnosed with vestibular schwannoma (VS) in the United States. Yet, the degree to which the ANA is actually utilized across the country is unknown. Moreover, evidence suggests that there may exist significant regional variation in management practices of VS across the United States. Patient participation in the ANA by state and geographical region, as well as their management approach, was reviewed through a cross-sectional survey performed from February 2017 through January 2019, patients diagnosed with sporadic VS. Among 878 patients studied, the District of Columbia had the largest proportion of ANA patients relative to state population (0.85 per 100,000 persons), followed by New Hampshire (0.74), Maine (0.60), and New Jersey (0.42). Comparatively, Mississippi (0.03), Hawaii (0.07), and Rhode Island (0.09) harbored significantly lower participation rates (p=0.001). Significant treatment variations were observed across the United States: in Maine, Iowa, Missouri, Kansas, and New Hampshire, an average of 73% (range, 70-75) of patients underwent microsurgery, whereas only 24% (range, 0-35) of patients in Colorado, New York, Massachusetts, Connecticut, and West Virginia underwent microsurgery (p<0.001). After controlling for patient age and tumor size, patients were significantly more likely to undergo a retrosigmoid approach than the translabyrinthine approach for medium- to large-sized tumors in the Northeast (OR=4.18; p=0.001) and Western United States (OR=2.94; p=0.009). Large regional variation exists surrounding patient participation in the ANA as well as management practices across the United States.

Comparison and suggestion of indicators of concentrations associated with CO2 in seawater considering biological activity

Carbon dioxide capture and storage is expected to reduce large amount of CO2 emissions from pointwise large sources, such as coal power plants, by 2030 in Japan. For offshore CO2 storage, it is necessary to monitor concentrations associated with CO2 in seawater to ensure safe storage. To do so, it is also necessary to know the baseline concentrations in the target seas. However, such concentrations have large regional and seasonal variations, mainly because of biological activity. In this study, we compared various indicators of CO2 dissolved in seawater, using the seawater off Tomakomai, Japan, observed between 2013 and 2018. Among the indicators, we found very strong correlations between [nDIC + kDO] and T and between [DIC − 0.5TA + kDO] and T. These indicators are thought to be effective for investigating the possibility of unexpected leakage of CO2 stored in sub-seabed geological formations. However, data always contain a degree of scattering, even when their correlation is very high. In the case of the seawater off Tomakomai, the data that exceeded a criteria based on the residual standard deviation of some indicators were not necessarily the same as those of the other indicators. Therefore, it is suggested that two or more, different types of indicators should be used, such as pCO2-[DO saturation] and [nDIC + kDO]-T or [DIC − 0.5TA + kDO]-T.

Comparative analysis of completeness of death registration, adult mortality and life expectancy at birth in Brazil at the subnational level

BackgroundEstimates of completeness of death registration are crucial to produce estimates of life tables and population projections and to estimate the burden of disease. They are an important step in assessing the quality of data. In the case of subnational data analysis in Brazil, it is important to consider spatial and temporal variation in the quality of mortality data. There are two main sources of data quality evaluation in Brazil, but there are few comparative studies and how they evolve over time. The aim of the paper is to compare and discuss alternative estimates of completeness of death registration, adult mortality (45q15) and life expectancy estimates produced by the National Statistics Office (IBGE), Institute for Health Metrics and Evaluation (IHME), and estimates presented in Queiroz et al. (2017) and Schmertmann and Gonzaga (2018), for 1980 and 2010.MethodsWe provide a descriptive and comparative analysis of aforementioned estimates from four (4) sources of estimates at subnational level (26 states and one Federal District) in Brazil from two different points in time.ResultsWe found significant differences in estimates that affect both levels and trends of completeness of adult mortality in Brazil and states. IHME and Queiroz et al. (2017) estimates converge by 2010, but there are large differences when compared to estimates from the National Statistics Office (IBGE). Larger differences are observed for less developed states. We have showed that the quality of mortality data in Brazil has improved steadily overtime, but with large regional variations. However, we have observed that IBGE estimates show the lowest levels of completeness for the Northern of the country compared to other estimates. Choice of methods and approaches might lead to very unexpected results.ConclusionWe produced a detailed comparative analysis of estimates of completeness of death registration from different sources and discuss the main results and possible explanations for these differences. We have also showed that new improved methods are still needed to study adult mortality in less developed countries and at a subnational level. More comparative studies are important in order to improve quality of estimates in Brazil.

An assessment of the performance of different districts towards Sustainable Development targets in India

Sustainable development goals encapsulates 17 broad-based goals and 169 associated targets to reconcile among the three pillars of sustainability i.e. social, economic and environmental. In the present study, we sought to understand the performance of 641 districts ofIndiaon social, economic and environmental parameters and on the composite sustainability index as a whole. Our results suggest that there is a large regional variations in performance with districts of southern and western states outperforming northern and eastern states on sustainability index. There is a strong congruence between social and economic indicators. However, environment is still missing from the policy planning. Our results may provide a benchmark and help in micro-level planning at district level and may help in raising public and policy support, realignment and reorientation of the existing policy from the perspective of SDGs.

Yield increases due to fungicide control of leaf blotch diseases in wheat and barley as a basis for IPM decision-making in the Nordic-Baltic region

Fungal plant diseases driven by weather factors are common in European wheat and barley crops. Among these, septoria tritici blotch (Zymoseptoria tritici), tan spot (Pyrenophora tritici-repentis), and stagonospora nodorum blotch (Parastagonospora nodorum) are common in the Nordic-Baltic region at variable incidence and severity both in spring and winter wheat fields. In spring barley, net blotch (Pyrenophora teres), scald (Rhynchosporium graminicola, syn. Rhynchosporium commune) and ramularia leaf spot (Ramularia collo-cygni) are common yield limiting foliar diseases. We analysed data from 449 field trials from 2007 to 2017 in wheat and barley crops in the Nordic-Baltic region and explored the differences in severity of leaf blotch diseases between countries and years, and the impact of the diseases on yield. In the experiments, septoria tritici blotch dominated in winter wheat in Denmark and southern Sweden; while in Lithuania, both septoria tritici blotch and tan spot were common. In spring wheat, stagonospora nodorum blotch dominated in Norway and tan spot in Finland. Net blotch and ramularia leaf blotch were the most severe barley diseases over large areas, while scald occurred more locally and had less yield impact in all countries. Leaf blotch diseases, with severity >50% at DC 73–77, caused an average yield loss of 1072 kg/ha in winter wheat and 1114 kg/ha in spring barley across all countries over 5 years. These data verify a large regional and yearly variation in disease severity, distribution and impact on yield, emphasizing the need to adapt fungicide applications to the actual need based on locally adapted risk assessment systems.

Age-Dependent Costs and Complications in Pediatric Umbilical Hernia Repair

To characterize regional variation in the age of patients undergoing umbilical hernia repair to determine costs and subsequent care. We performed a cross-sectional descriptive study using a large convenience sample of US employer-based insurance claims from July 2012 to December 2015. We identified children younger than 18years of age undergoing uncomplicated (not strangulated, incarcerated, or gangrenous) umbilical hernia repair as an isolated procedure (International Classification of Diseases, Ninth Revision procedure codes 53.41, 53.42, 53.43, or 53.49, International Classification of Diseases, Tenth Revision procedure code 0WQF0ZZ, or Current Procedural Terminology procedure codes 49580 or 49585). In all, 5212 children met criteria for inclusion. Children younger than age 2years accounted for 9.7% of repairs, with significant variation by census region (6% to 14%, P<.001). Total payments for surgery varied by age; children younger than 2years averaged $8219 and payments for older children were $6137. Postoperative admissions occurred at a rate of 73.1 per 1000 for children younger than age 2years and 7.43 for older children; emergency department visits were 41.5 per 1000 for children younger than age 2years vs 15.9 for older children (P<.001). Umbilical hernias continue to be repaired at early ages with large regional variation. Umbilical hernia repair younger than age 2years is associated with greater costs and greater frequency of postoperative hospitalization and emergency department visits.

Large regional variation in costs for end-of-life care in Switzerland

Large regional variation in costs for end-of-life care in Switzerland

Genetic variability of human angiotensin-converting enzyme 2 (hACE2) among various ethnic populations.

BackgroundThere appears to be large regional variation for susceptibility, severity, and mortality for COVID‐19 infections. Numerous potential factors could explain the wide variability in the number of infections and death among the countries. We examined genetic differences in the human angiotensin‐converting enzyme 2 (hACE2) gene, as its receptor serves as a cellular entry for SARS‐CoV‐2. At present, there is a paucity of data regarding the differences for ACE2 polymorphisms and expression levels between ethnicities.MethodsWe compared the allele frequency of mutations between European and East Asians. Molecular dynamic simulation were performed to investigate the influences of significant mutant on protein structure. The binding free energies were calculated between S protein and hACE2. We also examined hACE2 gene expression in eight global populations from HapMap3.ResultsFour missense mutations showed significant minor allele frequency difference between Asians and Caucasians. Molecular dynamic demonstrated that two of these variants (K26R and I468V) may affect binding characteristics between S protein of the virus and hACE2 receptor. We also noted marginal differences in gene expression for some populations in HapMap3 as compared to the Chinese population.ConclusionOur studies reveal subtle changes in the genetics of hACE2 between human populations, but the magnitude of the difference was small and the significance is not clear in the absence of further in vitro and functional studies.

Sweden does not meet agreed national and international forest biodiversity targets: A call for adaptive landscape planning

Loss of forest naturalness challenges the maintenance of green infrastructure (GI) for biodiversity conservation and delivery of diverse ecosystem services. Using the Convention on Biological Diversity’s Aichi target #11 with its quantitative and qualitative criteria as a normative model, we aim at supporting landscape planning through a pioneering assessment of the extent to which existing amounts and spatial distributions of High Conservation Value Forests (HCVFs) meet these criteria. Highly forested and committed to both intensive wood production and evidence-based conservation targets of 17–20% protected areas, Sweden was chosen as a case study. Specifically, we estimated the amount, regional representation, and functional connectivity of HCVF patches using virtual bird species, validated the results using field surveys of focal bird species, and assessed conservation target fulfilment. Finally, we linked these results to the regional distribution of forest land ownership categories, and stress that these provide different opportunities for landscape planning. Even if 31% of forest land in Sweden is officially protected, voluntarily set-aside, or not used for wood production now and in the future, we show that applying the representation and connectivity criteria of Aichi target #11 reduces this figure to an effective GI of 12%. When disaggregating the five ecoregions the effective GI was 54% for the sub-alpine forest ecoregion, which hosts EU’s last intact forest landscapes, but only 3–8% in the other four ecoregions where wood production is predominant. This results in an increasing need for forest habitat and landscape restoration from north to south. The large regional variation in the opportunity for landscape planning stresses the need for a portfolio of different approaches. We stress the need to secure funding mechanisms for compensating land owners’ investments in GI, and to adapt both the approaches and spatial extents of landscape planning units to land ownership structure.

Regional Differences in Prescribing Patterns of Metamizole in Germany Based on Data from 70 Million Persons.

The non-opioid analgesic metamizole (dipyrone) is commonly used in Germany despite its narrow indications and market withdrawal from several countries. In this study we analyzed prescribing patterns of metamizole focusing on regional differences. The source of data was the “Information system for health care data” which includes data from the statutory health insurance funds for about 70 million Germans. We received aggregated data of individuals with at least one metamizole prescription in 2010 as well as the number of prescribed packages by age, sex, state and district along with the number of insured persons in each stratum. We calculated prescription prevalence stratified by age, sex, state and district. Among 68.4 million insured persons (mean age: 43.6 years; 53.0% female) 5.5 million received at least one metamizole prescription (8.1%, overall 12.2 million packages). Prevalence increased with age, and women received metamizole more often than men. In adults (total prevalence: 9.4%), levels varied between 7.0% (Saxony) and 11.1% (Schleswig-Holstein), whereas on a district level use ranged from 4.3% to 14.3%. In 2010, one of 12 individuals received metamizole at least once. Noticeable were the large regional variations which certainly cannot be explained by patient-related factors.