Population Levels Research Articles

Learning health system linchpins: information exchange and a common data model.

To demonstrate the potential for a centrally managed health information exchange standardized to a common data model (HIE-CDM) to facilitate semantic data flow needed to support a learning health system (LHS). The Rhode Island Quality Institute operates the Rhode Island (RI) statewide HIE, which aggregates RI health data for more than half of the state's population from 47 data partners. We standardized HIE data to the Observational Medical Outcomes Partnership (OMOP) CDM. Atherosclerotic cardiovascular disease (ASCVD) risk and primary prevention practices were selected to demonstrate LHS semantic data flow from 2013 to 2023. We calculated longitudinal 10-year ASCVD risk on 62,999 individuals. Nearly two-thirds had ASCVD risk factors from more than one data partner. This enabled granular tracking of individual ASCVD risk, primary prevention (ie, statin therapy), and incident disease. The population was on statins for fewer than half of the guideline-recommended days. We also found that individuals receiving care at Federally Qualified Health Centers were more likely to have unfavorable ASCVD risk profiles and more likely to be on statins. CDM transformation reduced data heterogeneity through a unified health record that adheres to defined terminologies per OMOP domain. We demonstrated the potential for an HIE-CDM to enable observational population health research. We also showed how to leverage existing health information technology infrastructure and health data best practices to break down LHS barriers. HIE-CDM facilitates knowledge curation and health system intervention development at the individual, health system, and population levels.

Rubella antibody levels in the healthy Chinese population: a meta-analysis

ObjectivesTo gain a comprehensive understanding of rubella seroprevalence in the healthy population in China and to offer data-driven support for the goal of rubella elimination.MethodsCNKI, Wanfang database, VIP database, CBM, PubMed, web of Science, and Embase databases were searched to collect studies reporting the positive rate of rubella antibody among the Chinese healthy populations between 2001 and 2022. We conducted a meta-analysis using R language, and data were combined using random effects model.ResultsA total of 97 studies were included, encompassing a sample size of 103,018. Meta-analysis showed that the overall prevalence of rubella antibody positivity in the Chinese healthy population was 77.29% (95% CI: 75.26-79.33). The prevalence of rubella antibody varied significantly based on age and vaccination status. Among the age groups studied, the <1-year-old group exhibited the lowest positivity rate for rubella antibody at 47.87% (95% CI: 41.53-54.21),while the ≥50 years old group showed the highest positivity rate at 85.43% (95% CI: 81.01-89.85); individuals with a history of vaccination demonstrated a higher antibody positivity rate compared to those without vaccination history.ConclusionsThe prevalence of rubella antibody in healthy Chinese population is relatively low. In order to establish a solid immunity threshold levels, it requires conducting timely immunization programs on key groups such as middle school students and the women of childbearing age on the basis of ensuring a high level of rubella-containing-vaccines (RCV) coverage, so as to achieve the goal of eliminating rubella.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024607949.

Studies on biodiversity of Nycticorax nycticorax- Linnaeus, 1758 at Manchar Lake, Sindh, Pakistan

The lake manchar is considered as one of the largest freshwater lakes in Pakistan, it’s located in district of Jamshoro. This wetland plays a substantial role in providing habitats to variety of resident and migratory birds. It provides shelter to the vast biodiversity that has daily and seasonal dependencies for all the life-support systems. Birds use this lake for drinking water, breeding, rearing young ones and social interactions. Meanwhile, birds play important role in balancing the ecosystem and food web of the ecosystem by conserving maintainable population levels of prey and predator species, and after death provide food to scavengers as well as decomposers. Birds are best pollinators, help in plant production through their services as pollinators or seed dispersers and increase forest growth, also help in environmental conservation. Considering the valuable role of wetlands and importance of avifaunal species in agriculture, food chains, ecosystem and pharmaceutics, a comprehensive study is carried out to evaluate diversity of socio-economically valuable avifaunal species at Manchar Lake. Monthly field surveys were conducted from January 2024 to October 2024, resulting in the collection of 80 specimens of Nycticorax nycticorax. Minor variation was recorded in body parameters including body weight, size of beak, body length, wingspan, limbs length, length of tail feathers, and width of web. Nycticorax nycticorax Weight of body 302±1.53 Length of beak 72± 1.20 Length of Wingspan 190±3.22 Length of limbs 787±140.5 Length of tail feathers 314±3.12 limbs Length of body 21.5±0.95. Nycticorax nycticorax was recorded to be the predatory bird, and their occurrence was abundant in the lake premises. The highest prevalence of recorded species occurred in January, February, and March, with the lowest richness observed in June and July. The study concluded that Manchar Lake is experiencing significant pollution due to runoff from agricultural fields, residential areas, and other sources. This pollution, combined with factors such as massive hunting, climatic changes, seasonal fluctuations, and decreasing food resources, has led to a decline in bird populations at the lake

The impact of COVID-19 on private healthcare service utilisation: time series analysis in the capital region of Finland during 2020–2022

BackgroundMost current studies on COVID-19 have focused on the first weeks or months of the pandemic or have addressed specific diseases. The long-term effects of the COVID-19 pandemic on healthcare services are insufficiently understood. We analysed the long-term effects of the COVID-19 pandemic on outpatient healthcare utilisation in the full spectrum of diseases in Uusimaa, the capital region of Finland.MethodsOur data included 632 466 individual patients between the ages of 18 and 65 and 6 521 394 visits to healthcare personnel from electronic health records. We fitted an autoregressive integrated moving average (ARIMA) model to pre-2020 data to predict the expected quantity of diagnoses for the period between 1 January 2020 and 16 June 2022. Expected and observed quantities of diagnoses were compared.ResultsThe overall quantity of diagnoses declined by one-fourth immediately following the onset of the pandemic and remained around 15% below predicted values for most of the pandemic. After the pandemic-related restrictions were lifted, the total diagnostic activity started to recover to pre-pandemic projection levels. However, this recovery has been mainly driven by upper respiratory system-related activity. The number of diagnoses for many diagnosis groups has remained below the predicted levels, even after the concurrent removal of mobility restrictions and increased coverage of vaccinations in this population.ConclusionsThe pandemic resulted in an overall reduction in outpatient healthcare utilisation which persisted for 30 months. While the overall diagnostic activity has eventually recovered to predicted levels, many classes of diagnoses display reduced levels in the study population over the follow-up period. Some diseases that may have long-lasting effects when left untreated seem to remain underdiagnosed, potentially increasing pressure on the healthcare system in the future.

Association between serum folate levels and migraine or severe headaches: A nationwide cross-sectional study.

Migraine and severe headaches are common neurological disorders with significant societal impact. Previous research indicates a potential link between serum folate levels and migraine occurrence, yet there is a lack of sufficient relevant studies and more are required. This study aimed to determine the association between a severe headache or migraine and serum folate levels in large populations. Using data from the National Health and Nutrition Examination Survey, we conducted a cross-sectional study. Using multivariable logistic regression models, we investigated the association between serum folate and severe headache or migraine. In a subsequent subgroup analysis, several confounding factors were also explored to investigate the association between migraine and serum folate. A total of 13,351 individuals participated in the study, with 2742 reporting severe headache or migraine in the previous 3 months. Serum folate was negatively associated with severe headache or migraine (odds ratio [OR] = 0.5, 95% confidence interval [CI] = 0.28-0.89, P = .018). The stratified analysis revealed this association persisted among female (OR = 0.38, 95% CI = 0.18-0.82, P < .001), individuals aged 20 to 50 years (OR = 0.53, 95% CI = 0.28-0.99, P < .001), and non-Hispanic White participants (OR = 0.38, 95% CI = 0.17-0.87, P < .001). We found that greater levels of serum folate were significantly related to a decreased likelihood of migraine onset, especially among women, young and middle-aged populations, and non-Hispanic White participants. Further research is required to validate and expand upon our results.

The association of preoperative serum free fatty acid levels with survival in breast cancer patients

Background and objectivesSerum free fatty acids (FFA) are associated with various types of cancer. However, the prognostic value of preoperative serum FFA levels and breast cancer (BC) remains unclear. This study aimed to elucidate the specific relationship between FFA levels and BC outcomes.MethodsA retrospective review was conducted on 4133 patients with BC admitted to Sun Yat-sen Memorial Hospital from January 2015 to October 2021. Preoperative serum FFA levels were detected by the enzymatic endpoint method. The relationship between serum FFA levels and clinical characteristics was analyzed based on FFA interquartile range. Restricted cubic splines and multivariate Cox regression analyses were used to assess the relationship between preoperative serum FFA levels and overall survival (OS) in patients with BC. The hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated.ResultsAccording to the FFA interquartile range, FFA levels were significantly correlated with OS (years) (p < 0.001). Restricted cubic spline analysis might reveal a U-shaped relationship between preoperative serum FFA levels and OS, after adjusting for other variables. According to the cutoff points for FFAs, multivariate Cox regression analyses showed that patients with low FFA levels (≤ 250 µmol/L) had higher rates of all-cause mortality and cancer-specific mortality than those with high FFA levels (530–700 µmol/L) in the total population and patients with a BMI of 18.5–24.0 kg/m2. A trend was observed indicating that elevated FFA levels (≥ 715 µmol/L) were associated with worse prognosis; however, this association failed to reach statistical significance.ConclusionsThere might be a nonlinear U-shaped relationship between preoperative serum FFA levels and survival in breast cancer patients, with lower FFA levels associated with worse OS. The effect of elevated FFA levels on prognosis requires further investigation.

Association between serum urea nitrogen levels and prostate-specific antigens (NHANES 2003–2010)

BackgroundIncreasing evidence suggests that serum urea nitrogen may be a risk factor for prostate cancer (PCa) and influence serum prostate-specific antigen (PSA) concentrations, but direct evidence of a relationship between PSA and serum urea nitrogen levels in the general population is still lacking. The aim of this study was to demonstrate the relationship between serum urea nitrogen levels and prostate-specific antigen (PSA) and prostate cancer.MethodsWe conducted a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES, 2003–2010) database. We performed a multifactorial regression analysis of the association between serum urea nitrogen levels and PSA and PCa, followed by subgroup analyses.ResultsA total of 5256 subjects were included in this study, and after adjusting for demographic, biological, and immunologic variables, we found that there was a threshold for blood urea nitrogen concentration below which every 1 ng/mL increase in serum urea nitrogen was associated with a 0.0325 ng/mL increase in PSA concentration (log2 transformed) (95% CI: 0.0064, 0.0586), and the P trend was was less than 0.05 and the difference was statistically significant. Sensitivity analyses using the generalized additive model (GAM) showed a linear relationship between serum urea nitrogen and serum PSA concentrations when blood urea nitrogen concentrations ranged from 0 ng/ml to 6.78 ng/ml.ConclusionSerum urea nitrogen was independently and positively correlated with serum PSA concentration when the concentration of serum urea nitrogen ranged from 0 ng/ml to 6.78 ng/ml.

Monocyte-lymphocyte ratio predicts cardiovascular diseases death in individuals with type 2 diabetes.

Previous studies have shown higher cardiovascular mortality risk with higher monocyte-lymphocyte ratio levels in general population. However, the levels of oxidative stress in individuals with type 2 diabetes are higher than those in the general population, which may affect the link between monocyte-to-lymphocyte ratio and cardiovascular disease deaths. And the association between the monocyte-to-lymphocyte ratio and mortality risk in people with type 2 diabetes still be unknown. This study aimed to investigate the prognostic significance of monocyte-to-lymphocyte ratio in type 2 diabetes. This analysis involved 2,954 individuals with type 2 diabetes from the National Health and Nutrition Examination Survey 1999-2010. The National Death Index records through December 31, 2019, was used to determine all-cause and cardiovascular mortality. The prognostic roles were determined using Cox regression models, restricted cubic spline analysis, and time-dependent receiver operating characteristic curve analysis. During an average follow-up period of 12.4 years, a total of 1,007 deaths occurred, while 252 were due to cardiovascular disease. An elevated monocyte-to-lymphocyte ratio level exhibited a significant dose-response relationship with an increased risk of all-cause mortality (1.34 [95% CI 1.12, 1.60] for all-cause mortality [Ptrend = 0.001]). The multivariable-adjusted HR was 1.81 (95% CI 1.25, 2.63) (Ptrend = 0.001) for cardiovascular mortality indicating a U-shaped relationship (Pnonlinear = 0.013). The results of this study indicate a U-shaped relationship between the monocyte-to-lymphocyte ratio and cardiovascular mortality in individuals with diabetes. Both very low and high monocyte-to-lymphocyte ratio monocyte-to-lymphocyte ratio values were found to be associated with increased cardiovascular mortality risk.

Aegilops crassa Cytotypes in Some Regions of Türkiye.

A new hexaploid cytotype of Aegilops crassa has been identified in Türkiye. To assess the ploidy levels of native populations, 50 samples from Adıyaman, Batman, Bitlis, Diyarbakır, Hakkari, Mardin, Siirt, Şanlıurfa, Şırnak, and Van were analyzed using flow cytometry and cytogenetic techniques. DNA content was determined by comparison with standard plants. Results confirmed two cytotypes in Türkiye: tetraploid populations from Batman, Bitlis, Diyarbakır, Hakkari, Mardin, Siirt, Şanlıurfa, and Şırnak, and hexaploid accessions from Adıyaman and Van. Ten metaphase plates were analyzed. The tetraploid cytotype exhibited chromosome lengths of 8.95 ± 0.27 to 13.96 ± 0.13 µm, a total genome length of 165.51 ± 0.34 µm, and nuclear DNA content of 18.53 ± 0.29 to 20.37 ± 0.49 pg. Most chromosomes were metacentric, except for chromosomes 7, 8, 10, and 12, which were submetacentric. Two satellite pairs were found on chromosomes 4 and 10. The hexaploid cytotype showed chromosome lengths of 8.90 ± 0.16 to 14.06 ± 0.06 µm, a total genome length of 230.47 ± 0.23 µm, and nuclear DNA content of 33.40 ± 0.52 to 35.01 ± 0.31 pg. Most chromosomes were also metacentric, with three satellite pairs on chromosomes 3, 6, and 10. In conclusion, both tetraploid (2n = 2x = 28) and hexaploid (2n = 6x = 42) cytotypes of Ae. crassa exist in Türkiye, with the hexaploid cytotype having potential for wheat breeding programs.

Ethnic differences in the relationship between ectopic fat deposition and insulin sensitivity in Black African and White European men across a spectrum of glucose tolerance.

To examine the hypothesis that there would be ethnic differences in the relationship between ectopic fat and tissue-specific insulin resistance (IR) across a spectrum of glucose tolerance in Black African (BA) and White European (WE) men. Fifty-three WE men (23/10/20 normal glucose tolerance [NGT]/impaired glucose tolerance [IGT]/type 2 diabetes [T2D]) and 48 BA men (20/10/18, respectively) underwent a two-step hyperinsulinaemic-euglycaemic clamp with infusion of D-[6,6-2H2]-glucose and [2H5]-glycerol to assess hepatic, peripheral and adipose tissue IR. Magnetic resonance imaging was used to measure subcutaneous adipose tissue, visceral adipose tissue (VAT) and intrahepatic lipid (IHL). Associations between ectopic fat and IR were assessed using linear regression models. There were no differences in tissue-specific IR between ethnic groups at any stage of glucose tolerance. VAT level was consistently lower in the BA population; NGT (p = 0.013), IGT (p = 0.006) and T2D (p = 0.015). IHL was also lower in the BA compared with the WE men (p = 0.013). VAT and IHL levels were significantly associated with hepatic IR in the BA population (p = 0.001) and with peripheral IR in the WE population (p = 0.027). The present study suggests that BA and WE men exhibit the same degree of IR across a glucose tolerance continuum, but with lower VAT and IHL levels in the BA population, suggesting that IR may be driven by a mechanism other than increased ectopic fat accumulation in BA men.

External validation of SCORE2-Diabetes in the Netherlands across various Socioeconomic levels in native-Dutch and non-Dutch populations.

Adults with type 2 diabetes have an increased risk of cardiovascular events (CVE), the world's leading cause of mortality. The SCORE2-Diabetes model is a tool designed to estimate the 10-year risk of CVE specifically in individuals with type 2 diabetes. However, the performance of such models may vary across different demographic and socioeconomic groups, necessitating validation and assessment in diverse populations. This study aims to externally validate SCORE2-Diabetes and assess its performance across various socioeconomic and migration origins in the Netherlands. We selected adults with type 2 diabetes, aged 40-79 years and without previous CVE from the Extramural LUMC Academic Network (ELAN) primary care data cohort from 2007 to 2023. ELAN data were linked with Statistics Netherlands registry data to obtain information about the country of origin and socioeconomic status (SES). CVE was defined as myocardial infarction, stroke, or CV mortality. Non-CV mortality was considered a competing event. Analyses were stratified by sex, Dutch versus other non-Dutch countries of origin, and quintiles of SES. Of the 26,544 included adults with type 2 diabetes, 2,518 developed CVE. SCORE2-Diabetes showed strong predictive accuracy for CVE in the Dutch population (observed-to-expected ratio (OE)=1.000, 95% CI=0.990-1.008 for men, and OE=1.050, 95% CI=1.042-1.057 for women). For non-Dutch individuals, the model underestimated CVE risk (OE=1.121, 95% CI=1.108-1.131 for men, and OE=1.100, 95% CI=1.092-1.111 for women). The model also underestimated the CVE risk (OE>1) in low SES groups and overestimated the risk (OE<1) in high SES groups. Discrimination was moderate across subgroups with c-indices between 0.6 and 0.7. SCORE2-Diabetes accurately predicted the risk of CVE in the Dutch population. However, it underpredicted the risk of CVE in the low SES groups and non-Dutch origins, while overpredicting the risk in high SES men and women. Additional clinical judgment must be considered when using SCORE2-Diabetes for different SES and countries of origin.

Application of infrared spectroscopy to study carbon-deuterium kinetics and isotopic spectral shifts at the single-cell level

Microbial communities play crucial roles in shaping natural ecosystems, impacting human well-being, and driving advancements in industrial biotechnology. However, associating specific metabolic functions with bacteria proves challenging due to the vast diversity of microorganisms within these communities. In the past decades stable isotope probing (SIP) approaches, coupled with vibrational spectroscopy, have emerged as a novel method for revealing microbial metabolic roles and interactions in complex communities. In this study, we employed various combinations of heavy stable isotopes (D, 13C, 15N, and 18O), to evaluate all possible isotopic spectral shifts in the mid-IR region using Fourier-Transform Infrared (FT-IR) and Optical Photothermal Infrared (O-PTIR) spectroscopy, at both bulk community and single-cell levels. Additionally, we conducted a time-course study to explore the kinetics of CD vibration in Escherichia coli bacteria, allowing time-based sampling and assessment of isotopic labeling kinetics. The FT-IR and O-PTIR, along with the second derivative spectra of E. coli cells cultured in minimal medium supplemented with various combinations of heavy isotopes exhibited notable similarities. Several spectral shifts in primary vibrational peaks were observed due to the incorporation of heavy isotopes into biomolecules. Remarkably, the incorporation of deuterium into amide groups, resulting in the formation of nitrogen-deuterium bonds, caused a shift in amide A and B into the silent region, overlapping with CD signature peaks. The incorporation of 18O into the ester group of lipids and the carbonyl group of proteins resulted in a notable shift to the lower wavenumber region. Additionally, the second derivative of FT-IR spectral data highlighted the integration of 18O into α-helix and β-sheet structures. Furthermore, the spectra, second derivative, and PC-DFA scores plot of FT-IR data collectively illustrated the practicality of monitoring 13C and D incorporation into E. coli bacterial cells within the first 30-min incubation period. Significance: The findings of this study suggest that FT-IR and O-PTIR can serve as efficient tools for monitoring the incorporation of heavy isotopes into bacteria at both the population and single-cell levels. Additionally, the SIP approach allowed us to assign two new deuterium-associated vibrational peaks to their corresponding functional groups, which to the best of our knowledge have not been reported previously.

Sex-dependent differences in hematopoietic stem cell aging and leukemogenic potential.

Sex influences many biological outcomes, but how sex affects hematopoietic stem cell (HSC) aging and hematological disorders is poorly understood. The widespread use of young animal models to study age-related diseases further complicates these matters. Using aged and long-lived BALB/c mouse models, we discovered that aging mice exhibit sex-dependent disparities, mirroring aging humans, in developing myeloid skewing, anemia, and leukemia. These disparities are underlined by sex-differentiated HSC aging characteristics across the population, single-cell, and molecular levels. The HSC population expanded significantly with aging and longevity in males, but this occurred to a much lesser degree in aging females that instead expanded committed progenitors. Aging male HSCs are more susceptible to BCR-ABL1 transformation with faster development of chronic myeloid leukemia (CML) than female HSCs. Additionally, the loss of the aging regulator Sirt1 inhibited CML development in aging male but not female mice. Our results showed for the first time that sex-differentiated HSC aging impacts hematopoiesis, leukemogenesis, and certain gene functions. This discovery provides insights into understanding age-dependent hematological diseases and sex-targeted strategies for the treatment and prevention of certain blood disorders and cancer.

IGF-1 levels in the general population, heart failure patients, and individuals with acromegaly: differences and projections from meta-analyses-a dual perspective.

The complex relationship between insulin-like growth factor 1 (IGF-1) levels and heart failure (HF) is not fully understood, particularly across different populations and conditions. This meta-analysis aims to elucidate the dual perspectives of IGF-1 levels in the general population, HF patients, and individuals with treatment-naïve acromegaly, highlighting IGF-1 as a biomarker and potential therapeutic target in HF management. Studies were searched across multiple electronic databases up to January 2024 and independently identified by reviewers. The outcomes were analyzed using RevMan 5.4 and STATA 15. A total of 25 articles were ultimately included in the analysis. Six studies compared IGF-1 levels between HF patients and non-HF controls, revealing significantly lower IGF-1 levels in HF patients (mean difference -20.93; 95% CI -37.88 to -3.97; p = 0.02). This reduction was consistent across various HF subtypes and severities. In addition, individuals with intermediate IGF-1 levels had a lower risk of developing HF [risk ratio (RR) 0.78; 95% CI 0.74-0.83; p < 0.01] and HF-related mortality (RR 0.98; 95% CI 0.97, 0.99; p < 0.01) compared to those with low IGF-1 levels, suggesting a protective role for maintaining adequate IGF-1 levels. Conversely, treatment-naïve acromegaly patients, characterized by excessively high IGF-1 levels, showed a significantly higher incidence of both diastolic HF [odds ratio (OR) 9.08; 95% CI 6.20-13.29; p < 0.01] and systolic HF (OR 13.1; 95% CI 6.64-25.84; p < 0.01), implicating supraphysiological IGF-1 levels in adverse cardiac outcomes. Our meta-analysis highlights the complex interplay between IGF-1 levels and HF. We found that reduced IGF-1 levels are commonly observed in HF patients and are associated with an increased risk of HF and higher HF-related mortality. Conversely, excessively high levels, as observed in acromegaly, are linked to a higher incidence of HF. Based on these results, it is recommended that cardiac function be closely monitored in patients with reduced IGF-1 levels and in those with acromegaly. These findings suggest that IGF-1 could hold potential prognostic value for risk stratification in HF.

The Critical Role of Folate in Prenatal Health and a Proposed Shift from Folic Acid to 5-Methyltetrahydrofolate Supplementation

Folate, or vitamin B9, is a water-soluble vitamin essential in periconceptional nutrition. In its active form, tetrahydrofolate, it plays a vital role in DNA methylation and homocysteine breakdown. Maintenance of normal serum folate levels is crucial during pregnancy; deviation from these levels, either in dearth or excess, can lead to various pregnancy and infant complications. This article analyzes existing literature on folate’s absorption pathway in human physiology and reviews the evidence surrounding prenatal supplementation guidelines for folic acid. Prior research supports these guidelines because, in the absence of folate during pregnancy, research has shown an increased incidence of neurodevelopmental defects, food allergies, ophthalmic deficits, and other adverse effects for both mother and child. This significant body of evidence has driven most developed countries to implement folic acid supplementation initiatives, with the World Health Organization recommending a daily 400-µg folic acid supplementation for periconceptional women. As progress continues on a global scale, further efforts should be made to improve folic acid levels in pregnant populations among demographic subgroups. Research supports the use of 5-methyltetrahydrofolate in place of traditional folic acid prenatal supplements based on the increased bioavailability, resistance to genetic polymorphisms, and avoidance of several potential risks associated with folic acid supplements. More research and product development should be done to drive and support this shift in prenatal supplementation trends.

The repatriation of wolves to Isle Royale alters the foraging of meso-carnivores

Abstract Due to the disproportionate role that large carnivores can have on communities and their global decline over the last century, carnivores are increasingly being repatriated across their historic ranges. The reintroduction of gray wolves (Canis lupus) can precipitate substantive changes to communities and ecosystems. Notably, wolves could have strong effects on smaller and subordinate carnivores, especially in altering their foraging behavior and prey selection. Past studies investigating wolf effects on other carnivores, however, have generally been conducted in relatively complex communities featuring a diverse assemblage of carnivores and prey and have lacked baseline (i.e., pre-repatriation) data. Consequently, researchers have quantified what a community looks like after wolf return, with little information on how the community behaved before. To better understand the effect of large carnivore repatriation on the foraging ecology of a carnivore community, we investigated the impact of reintroduced gray wolves on 2 meso-carnivores: Red Fox (Vulpes vulpes); and American Marten (Martes americana) within an insular and simple vertebrate community at Isle Royale National Park before and after wolf reintroduction. We analyzed &amp;gt;600 scats from 20 individual martens and 63 individual foxes as well as the stable isotopes of 9 and 22 tissue samples from martens and foxes, respectively, at both individual and population levels. We found that the wolf reintroduction had little effect on marten diet but strongly influenced fox diet depending on the analysis conducted. At the population level, our analysis revealed that both foxes and martens were dietary generalists consuming an array of food items including small prey, berries, and human food regardless of wolf presence. However, at the individual level, we found that prior to wolf repatriation foxes primarily consumed berries and small prey but following wolf repatriation the diet of foxes shifted to berries and human foods as well as large carrion. This post-wolf reintroduction shift in diet increased the dietary overlap between foxes and martens. Our work provides new insights into how the return of a large carnivore can alter the foraging ecology of small-bodied carnivores and act both to provision carrion resources as well drive other carnivores to consume more human food and increase dietary overlap.

Biological traits and biome features mediate responses of terrestrial bird demography to droughts.

Changing drought regimes are a rising threat to biodiversity, yet their impacts on wildlife vary greatly. Acknowledging the factors associated with these consequences brings novel insights into species vulnerability resulting from extreme climatic events and facilitates effective mitigation of climate change risks. Based on 319 observations from 29 peer-reviewed studies on birds-a well-monitored taxonomic group-we extract the responses of demographic metrics to droughts for 204 species across eight terrestrial biomes to examine the consequences of droughts. According to relevant studies, we chose the factors potentially moderating bird demography under droughts and compiled the data for these factors from published datasets. A meta-analysis is performed to determine the drought effect on bird demography at individual and population levels, accounting for the influence of species traits, timescale and severity of droughts, as well as biome features. The results show that droughts have an overall negative effect on bird demography, and the effect is mediated by different factors at each level. For individuals exposed to droughts, declines in demographic rates are found to be related to narrower extents of occurrence of species, and a significant overall reduction in demographic rates is identified for individuals residing in deserts and xeric shrublands. At the population level, declines in abundance or reproductive performance are generally identified for invertivores, frugivores, nectarivores and omnivores; short-lived species with small clutch sizes also show greater susceptibilities under the impacts of droughts. Our findings additionally suggest that the demographic vulnerability of bird individuals and populations could be affected by the duration and magnitude of drought episodes. Although our results are subject to publication bias, these conclusions advance the assessment of vulnerability to extreme climatic events that used to be based on equally weighted species traits and support bird conservation by prioritizing the declining populations of species with drought-susceptible traits.

Turkish Version of the Norwich Patellar Instability Score: Minimal Detectable Change among Patients with Traumatic Patellar Dislocation

Objective: This study aimed to calculate the minimal detectable change (MDC) in the Norwich Patellar Instability score (NPI) and validate the score for Turkish-speaking individuals with patellar instability. Method: Sixty-four patients (mean age 21.87 ± 9.44 years) who had experienced at least one patellar dislocation during athletic activities participated in the study. The Turkish version of the NPI (NPI-T) was evaluated for reliability and internal consistency. The Minimal Detectable Change was calculated as an overall value for the participants. MDC was calculated based on the standard error of measurement (SEM) and the selected confidence level (ICC) for the study population. Pearson's correlations were examined to assess construct validity between the Kujala Patellofemoral Disorder score and the Lysholm Knee Score. Result: The MDC for the NPI-T was 17.29, with a SEM of 6.24. The score demonstrated high internal consistency, with a Cronbach’s alpha value of 0.85, indicating substantial reliability. The consistency of measurements was excellent, with an ICC2,1 of 0.95. Additionally, the NPI-T score exhibited a strong negative correlation with both the Kujala (r = -0.85, p &lt; 0.001) and Lysholm (r = -0.89, p &lt; 0.001) scores. A floor effect was observed, but no ceiling effect was present. Conclusion: The study confirms that the NPI-T demonstrates strong psychometric properties, with high internal consistency and excellent reliability, as evidenced by its low MDC and SEM. The use of the NPI-T as a reliable and valid tool for assessing patellar instability in patients with patellar dislocation will provide valuable information to clinicians.

Forecasting cognitive functioning: an artificial intelligence approach with Dynamic Bayesian Networks

Abstract Background Several potentially modifiable risk factors are associated with subjective cognitive decline (SCD). However, developmental patterns of these risk factors have not been used before to forecast later SCD. Practical tools for the prevention of cognitive decline are needed. We examined multifactorial trajectories of risk factors, and their associations with SCD using an artificial intelligence approach to build a score that forecasts later SCD. Methods Five repeated surveys (2000-2022) of the Helsinki Health Study (n = 8960, 79% women, aged 40-60 at Phase 1) were used to build dynamic Bayesian networks (DBN) for estimating the odds of SCD. A score-based approach was implemented for learning DBN using the quotient normalized maximum likelihood criterion. The model was used to predict SCD based on the history of consumption of fruit and vegetables, smoking, alcohol consumption, leisure-time physical activity, body mass index, and insomnia symptoms, adjusting for sociodemographic covariates. Results Of the participants, 31-48% reported decline in memory, learning, and concentration in 2022. Physical activity was the strongest predictor of SCD in a 5-year interval, with an odds ratio of 0.76 (95% Bayesian credible interval 0.59-0.99) for physically active compared to inactive participants. Alcohol consumption showed a U-shaped relationship with SCD. Other risk factors had minor effects. Conclusions A new online risk score tool was developed that enables individuals to inspect their own risk profiles, as well as explore potential targets for interventions and their estimated contributions to later SCD. Dynamic decision heatmap was presented as a communication tool to be used at healthcare consultations. Key messages • Potentially modifiable health-related behaviours such as physical activity can contribute to subjective cognitive decline. • Artificial intelligence can be applied to discover the complex interactions between risk factors and subjective cognitive decline, to support preventive healthcare at individual and population levels.

Public Health Literacy: a concept to develop – Qualitative study among public health professionals

Abstract Background Health literacy can be defined as individuals’ motivation and skills to access, understand, evaluate, and utilize information to make decisions about their health. Despite Sorensen’s widely used definition encompassing both individual and population levels, also known as Public Health Literacy, it remains poorly detailed and is rarely taken into account by measurement tools. As evidenced by the Covid-19 health crisis, limited public health literacy impacts reluctance to accept government recommendations, vaccine hesitancy, and fosters mistrust of science and conspiracy theories in the health field. The main objective of this study was to derive specific public health knowledge and skills from public health professionals for the general population constituted the first step of the development of a public health literacy measurement tools. Methods A qualitative study, based on ten semi-structured interviews with public health professionals from various settings (academic, hospital, health prevention, and promotion), working across various public health fields (nutrition, sexual health, mental health), has been conducted since March 2024. Results Preliminary analysis identified three main themes: (1) fundamental concepts including identification of health determinants, epidemiology and the purpose of public health interventions, (2) critical skills including the assessment of the level of evidence and reliability of public health information, and (3) civic orientation including environmental impact on health and community approach to interventions. Conclusions These detailed insights will guide the creation of a valid measurement tool for public health literacy. This will facilitate the investigation of specific impacts on people’s adherence to public health interventions or messages and the development of actions targeting literacy in a more holistic manner. Key messages • Specific public health dimensions have been identified to enrich the existed definition of health literacy. • Public health concepts, reliability of public health information and community approach constitute the core of public health literacy.