Nationwide Coverage Research Articles

Time trends of chronic immune diseases by year of birth in Danish registries.

Chronic immune diseases are often reported to be on the rise and are speculated to share early life risk factors. Here, we investigated year of birth as a common denominator for time trends using the consistent data source of the Danish National Patient Registry with 35years nationwide coverage. Observational nationwide birth cohort registry study, where persons born in Denmark since 1953 were investigated for chronic immune diseases per person years at risk. Outcomes were defined by inpatient hospitalizations in pre-chosen age bins by year of birth in 5year bins. A population of 3.8 million persons born in Denmark since 1953 was investigated for a total sum of 68 million person years in the ages 5-34years. We found increasing trends by year of birth for juvenile arthritis age 10-14, adult asthma age 20-24, inflammatory bowel diseases age 20-24, and multiple sclerosis age 25-29, whereas type 1 diabetes age 15-19 was declining until birth year mid 1980s followed by a subsequent increase. Childhood asthma age 5-9 inpatient hospitalizations were relatively stable over time. Nationwide introduction of measles, mumps, rubella vaccine in 1987 did not alter the trends. Hospitalization for the chronic immune diseases adult asthma, juvenile arthritis, inflammatory bowel diseases and multiple sclerosis showed a general increasing trend by birth year in recent 35years while diabetes 1 and childhood asthma seemed stable in this period. These results were not affected by the introduction of vaccinations against the major childhood viral infections.

Prediction of first cardiovascular disease event in 2.9 million individuals using Danish administrative healthcare data: a nationwide, registry-based derivation and validation study.

AimsThe aim of this study was to derive and validate a risk prediction model with nationwide coverage to predict the individual and population-level risk of cardiovascular disease (CVD).Methods and resultsAll 2.98 million Danish residents aged 30–85 years free of CVD were included on 1 January 2014 and followed through 31 December 2018 using nationwide administrative healthcare registries. Model predictors and outcome were pre-specified. Predictors were age, sex, education, use of antithrombotic, blood pressure-lowering, glucose-lowering, or lipid-lowering drugs, and a smoking proxy of smoking-cessation drug use or chronic obstructive pulmonary disease. Outcome was 5-year risk of first CVD event, a combination of ischaemic heart disease, heart failure, peripheral artery disease, stroke, or cardiovascular death. Predictions were computed using cause-specific Cox regression models. The final model fitted in the full data was internally-externally validated in each Danish Region. The model was well-calibrated in all regions. Area under the receiver operating characteristic curve (AUC) and Brier scores ranged from 76.3% to 79.6% and 3.3 to 4.4. The model was superior to an age-sex benchmark model with differences in AUC and Brier scores ranging from 1.2% to 1.5% and −0.02 to −0.03. Average predicted risks in each Danish municipality ranged from 2.8% to 5.9%. Predicted risks for a 66-year old ranged from 2.6% to 25.3%. Personalized predicted risks across ages 30–85 were presented in an online calculator (https://hjerteforeningen.shinyapps.io/cvd-risk-manuscript/).ConclusionA CVD risk prediction model based solely on nationwide administrative registry data provided accurate prediction of personal and population-level 5-year first CVD event risk in the Danish population. This may inform clinical and public health primary prevention efforts.

Socioeconomic inequalities in the incidence of alcohol-related liver disease: A nationwide Danish study.

SummaryBackgroundThere is socio-economic inequality in total alcohol-related harm, but knowledge of inequality in the incidence of specific alcohol-related diseases would be beneficial for prevention. Registry-based studies with nationwide coverage may reveal the full burden of socioeconomic inequality compared to what can be captured in questionnaire-based studies. We examined the incidence of alcohol-related liver disease (ALD) according to socioeconomic status and age.MethodsWe used national registries to identify patients with an incident diagnosis of ALD and their socioeconomic status in 2009–2018 in Denmark. We computed ALD incidence rates by socioeconomic status (education and employment status) and age-group (30–39, 40–49, 50–59, 60–69 years) and quantified the inequalities as the absolute and relative difference in incidence rates between low and high socioeconomic status.FindingsOf 17,473 patients with newly diagnosed ALD, 78% of whom had cirrhosis, 86% had a low or medium-low educational level and only 20% were employed. ALD patients were less likely to be employed in the 10 years prior to diagnosis than controls. The incidence rate of ALD correlated inversely with educational level, from 181 (95% CI, 167–197) to 910 (95% CI, 764–1086) per million person-years from the highest to the lowest educational level. By employment status, the incidence rate per million person-years was 211 (95% CI, 189–236) for employed and 3449 (95% CI, 2785–4271) for unemployed. Incidence rates increased gradually with age leading to larger inequalities in absolute numbers for older age-groups. Although ALD was rare in the younger age-groups, the relative differences in incidence rates between high and low socioeconomic status were large for these ages. The pattern of socioeconomic inequality in ALD incidence was similar for men and women.InterpretationThis study showed substantial socioeconomic inequalities in ALD incidence for people aged 30–69 years.FundingThe study was supported by grants from the Novo Nordisk Foundation (NNF18OC0054612) and the Research Fund of Bispebjerg Hospital.

Survival in Primary Myelofibrosis: A Population-based Analysis in the Netherlands

Survival in Primary Myelofibrosis: A Population-based Analysis in the Netherlands

Research on the Autonomous Learning Mode of College Students Based on Mobile Terminals under the Internet Environment

the advent of the Internet era, while liberating social productivity, has brought great convenience to human social life. At present, Internet technology has been fully applied to our study, work and life. So far, the mobile terminal under the influence of the Internet environment has developed more mature, and mobile terminal and other devices have become the necessities of people's life. In the process of daily travel, people basically have a mobile device. The nationwide coverage of WiFi signals accelerates the spread of the network. Only a small mobile device can complete travel payment, online shopping, signal transmission, etc. At the same time, the advent of the information age has also brought certain factors to the reform of higher education. Taking educational informatization as the research background and mobile Internet as the media, autonomous mutual learning has become an important development direction of the next generation of digital learning. At present, colleges and universities have realized the importance of information-based teaching reform, and have designed and shared the self-learning resource system in the actual teaching reform. They have actively constructed a set of harmonious self-help learning system in the campus, constantly improved the evaluation system of College Students' autonomous learning effect, and created a good learning atmosphere of self-help in university campus, in order to cultivate students' autonomous learning ability.

Perception of health risk and compliance with preventive measures related to COVID-19 in the Czech population: preliminary results of a rapid questionnaire survey.

In the Czech Republic, an outbreak of the coronavirus disease (COVID‑19) has been decelerated by quickly adopting strict and strongly limiting government measures. In this study, the authors present the preliminary results (April 1-5, 2020) of a public risk perception study of COVID‑19. The online questionnaire survey was announced in the national TV and radio stations with the nationwide coverage. Respondents were recruited through the website of the University of Ostrava during the first 5 days of the survey (N = 7966). The data covered risk perception with a focus on physical and psychological aspects, the current socio-economic situation and adaptation to the lockdown. The authors used Mann-Whitney and Kruskal-Wallis tests, as well as ordered logistic regression, with a significance level of 5% using STATA version 15. From the total sample of the respondents aged 40 years on average (a range of 15-87 years), the present study shows that women (p < 0.001) and elderly people (p < 0.001) perceived the health risk related to COVID‑19 as significantly worse than others. Older people (>60 years) perceived their mental health as significantly better than younger participants (p < 0.001). Most of the respondents assessed the adopted measures as adequate (71%) and believed in their effectiveness (69.7%). This study contributes to understanding the risk perception as a public response to the COVID‑19 pandemic. Int J Occup Med Environ Health. 2021;34(2):165-76.

Risk Factors for Septic Arthritis After Anterior Cruciate Ligament Reconstruction: A Nationwide Analysis of 26,014 ACL Reconstructions

Background: Septic arthritis (SA) after anterior cruciate ligament reconstruction (ACLR) is a rare yet severe complication. The samples in previous studies have been small and without nationwide coverage, making analysis uncertain with a risk of bias. Conclusions to recommend preventive measures are therefore difficult to draw, and it has not been possible to perform a comprehensive risk factor analysis. Purpose: To study the incidence of SA after ACLR in a large, nationwide population and to study the risk factors for SA after ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: All ACLRs, primary and revision, in the Swedish Knee Ligament Registry between 2006 and 2013 were linked with data from the Swedish National Board of Health and Welfare. The incidence of SA events was determined using entries from the day of surgery until 90 days postoperatively based on diagnosis codes and the prescription of antibiotics. All events of SA were verified via a review of medical records. Risk factors were analyzed based on data from the registries. Descriptive statistics were used to describe the findings, while logistic regression analysis was used for the risk analysis. Results: The cohort consisted of 26,014 primary and revision ACLRs. During the study period, 298 events of SA (1.1%) were identified. The high-volume units (≥500 ACLRs during the study period) had a distribution of SA between 2 and 47 (0.2%-2.9%). Independent risk factors of SA were male sex (OR, 1.65; 95% CI, 1.28-2.13), operating time ≥70 minutes (OR, 1.83; 95% CI, 1.42-2.36), hamstring tendon autograft (OR, 2.23; 95% CI, 1.21-4.08), and clindamycin as perioperative antibiotic prophylaxis (OR, 1.94; 95% CI, 1.10-3.41). Conclusion: The incidence of SA after ACLR in this nationwide cohort was 1.1%. Male sex, hamstring tendon autografts, and a longer operating time were all independent risk factors for SA. The use of clindamycin as perioperative antibiotic prophylaxis was a risk factor compared with the use of cloxacillin. Some high-volume units had a very low infection rate (0.2%).

Accuracy, Bias, and Improvements in Mapping Crops and Cropland across the United States Using the USDA Cropland Data Layer

The U.S. Department of Agriculture’s (USDA) Cropland Data Layer (CDL) is a 30 m resolution crop-specific land cover map produced annually to assess crops and cropland area across the conterminous United States. Despite its prominent use and value for monitoring agricultural land use/land cover (LULC), there remains substantial uncertainty surrounding the CDLs’ performance, particularly in applications measuring LULC at national scales, within aggregated classes, or changes across years. To fill this gap, we used state- and land cover class-specific accuracy statistics from the USDA from 2008 to 2016 to comprehensively characterize the performance of the CDL across space and time. We estimated nationwide area-weighted accuracies for the CDL for specific crops as well as for the aggregated classes of cropland and non-cropland. We also derived and reported new metrics of superclass accuracy and within-domain error rates, which help to quantify and differentiate the efficacy of mapping aggregated land use classes (e.g., cropland) among constituent subclasses (i.e., specific crops). We show that aggregate classes embody drastically higher accuracies, such that the CDL correctly identifies cropland from the user’s perspective 97% of the time or greater for all years since nationwide coverage began in 2008. We also quantified the mapping biases of specific crops throughout time and used these data to generate independent bias-adjusted crop area estimates, which may complement other USDA survey- and census-based crop statistics. Our overall findings demonstrate that the CDLs provide highly accurate annual measures of crops and cropland areas, and when used appropriately, are an indispensable tool for monitoring changes to agricultural landscapes.

Association Between Collagenous and Lymphocytic Colitis and Risk of Severe Coronavirus Disease 2019

Association Between Collagenous and Lymphocytic Colitis and Risk of Severe Coronavirus Disease 2019

The Prevalence of Selected Potential Drug-Drug Interactions of Analgesic Drugs and Possible Methods of Preventing Them: Lessons Learned From the Analysis of the Real-World National Database of 38 Million Citizens of Poland.

Introduction: Drug-drug interactions may lead to poor health outcomes, as well as increased costs and utilization of healthcare services. Unfortunately, real-world data continuously prove high prevalence of potential drug-drug interactions (pDDIs) worldwide. Among identified drivers, ageing, multimorbidity and polypharmacy play a very important role. With these factors being widespread, the need for implementation of strategies minimizing the burden of pDDIs becomes an urgency. This, however, requires a better understanding of the prevalence of pDDIs and the underlying causative factors. Aim of study: To assess the real-world prevalence of pDDIs and its characteristics in the general population of Poland, using analgesic drugs as a model, and to find out whether pDDIs are caused by prescribing coming from the very same prescribers (co-prescribing). Methods: A retrospective analysis of the 2018 dispensation data of the National Health Fund (NHF) - the only Polish public healthcare payer organization with nationwide coverage. We searched for selected pDDIs of non-steroidal anti-inflammatory drugs (NSAIDs) with antihypertensives, other NSAIDs (double use), oral glucocorticoids, oral anticoagulants, selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors (SNRIs), and antiplatelet drugs; as well as opioides with SSRIs, SNRIs, gabapentinoids, and benzodiazepines. A pDDI was deemed present if two drugs standing in a possible conflict were dispensed within the same calendar month. Results: Out of 38.4 million citizens of Poland, 23.3 million were dispensed prescribed drugs reimbursed by NHF in 2018. In this cohort, we have identified 2,485,787 cases of analgesic drug pDDIs, corresponding with 6.47% of the Polish population. Out of these, the most prevalent pDDI was caused by “NSAIDs + antihypertensives” (1,583,575 cases, i.e., 4.12% of the Polish population), followed by “NSAIDs + NSAIDs” (538,640, 1.40%) and “NSAIDs + glucocorticoids” (213,504, 0.56%). The most persistent pDDIs among those studied were caused by “Opioids + Gabapentinoids” (2.19, 95%CI: 2.16–2.22 months). On average, 76.63% of all cases of pDDIs were caused by drugs prescribed by the very same prescribers. Conclusion: Based on high-quality, nationwide data, we have found a high prevalence of analgesic drugs-related pDDIs in Poland. Over ¾ of the identified pDDIs were caused by co-prescribing, i.e., prescriptions issued by the same prescribers. The significance of the problem, illustrated with our findings on analgesic drugs-related pDDIs in Poland, deserves much more scientific and policymaker attention.

Global surge in intimate partner violence after mandatory lockdown: Implications for Pakistan.

We are observing with great concern the global spread of the COVID19 Pandemic. What is equally alarming is a less visible, albeit serious Public health issue; one that the United Nations has dubbed as the ‘Shadow Pandemic’ [1]. This is none other than the globally prevalent issue of violence against women, particularly Intimate Partner Violence. Intimate Partner Violence (IPV) is a serious, possibly preventable public health problem globally. Pakistan ranks among the countries with the highest IPV rates [2]. On 11th March 2020, the World Health Organization declared the highly infectious and lethal Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19) to be a pandemic [3]. Drastic measures were enforced universally to curb the spread of COVID-19. Countries issued strict nationwide lockdowns to isolate the population and implemented social distancing. The economy was impacted tremendously, and many people experienced financial and emotional hardship during this mandatory confinement. While everyone was affected, one population was in a far worse situation than others. Survivors of IPV were trapped alongside their perpetrators and faced difficulty/less freedom to escape threatening situations compared to the past. It is not surprising given that historical periods of uncertainty such as war or economic crisis have resulted in increased interpersonal violence, including violence against women [4]. The Hubei province of China, the first region to undergo a lockdown, saw nearly a doubling of their rates of IPV with the start of COVID19 Pandemic. Similarly, tragic stories gained nationwide coverage in the United States. IPV may also have risen in Pakistan, even if it is not being covered as extensively. During pandemics, fear causes us to minimize our personal needs and make sacrifices we would not normally make. This could be a reasonable approach for most but should not be for survivors of IPV. IPV survivors live in constant fear for themselves and their children; they are now devoid of their only means of mitigation; avoidance. Local woman’s support groups in Pakistan should act and spread awareness about this grim reality hiding underneath the Pandemic. Resources/funding should be made available for survivors to be able to reach out for support without having to leave the watchful eyes of their perpetrators. Public health officials ought to investigate and document the rise in IPV to help identify the leading causes of the increase. These steps will assist in developing crisis-specific guidelines to provide adequate resources for the future. Continuous....

Methodological aspects of the micronutrient assessment in the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey.

This article aims to present methodological aspects on the collection, analyses, coverage, challenges, and the lessons learned from laboratory assessment of micronutrients on the Brazilian National Survey on Child Nutrition (ENANI-2019). This is a household survey on a probability sample of children under five years of age from 123 Brazilian municipalities in all 26 states and the Federal District. Blood samples were drawn by venipuncture at the homes of children 6 to 59 months of age. This procedure was performed by experienced phlebotomists from the laboratories located in the selected municipalities and scheduled in advance. Blood and serum levels were measured for biomarkers of nutritional status, using the services of a clinical test laboratory with nationwide coverage, for the following micronutrients: iron (hemoglobin and ferritin), zinc, selenium, folic acid, and vitamins A, B1, B6, B12, D, and E. C-reactive protein was analyzed as a marker of inflammation. A barcode identifier was used to track the blood samples and to link the biochemical test results to the other data collected in the survey. A total of 14,558 children were studied. Of the 12,598 eligible children, 8,829 (70.1%) had blood samples drawn. Of the total number of children who had samples drawn, 91.8% (n = 8,025) have results for at least nine of the 12 analyses performed. Coverage of the analysis varied from 95% (for vitamins A and E) to 84.2% (for folic acid). Aliquots of whole blood and serum were stored in a biorepository for future analyses. The results of this pioneering study in the country will back the formulation and, when necessary, the reorientation of public policies in food and nutrition.

From trials to clinical practice: Temporal trends in the coverage of specialized allied health services for Parkinson's disease.

Background and purposeTo determine how the coverage of specialized allied health services for patients with Parkinson's disease (PD) has developed in the Netherlands since the publication of trials that demonstrated cost‐effectiveness.MethodsWe used healthcare expenditure‐based data on all insured individuals in the Netherlands to determine the annual proportion of patients with PD who received either specialized or generic allied health services (physiotherapy, occupational therapy, speech–language therapy) in 2 calendar years separated by a 5‐year interval (2012 and 2017). Specialized allied health services were delivered through the ParkinsonNet approach, which encompassed professional training and concentration of care among specifically trained professionals.ResultsBetween 2012 and 2017, there was an increase in the number of patients with any physiotherapy (from 17,843 [62% of all patients with PD that year] to 22,282 [68%]), speech–language therapy (from 2171 [8%] to 3378 [10%]), and occupational therapy (from 2813 [10%] to 5939 [18%]). Among therapy‐requiring patients, the percentage who were treated by a specialized therapist rose substantially for physiotherapy (from 36% in 2012 to 62% in 2017; χ2 = 2460.2; p < 0.001), speech–language therapy (from 59% to 85%; χ2 = 445.4; p < 0.001), and occupational therapy (from 61% to 77%; χ2 = 231.6; p < 0.001). By contrast, the number of patients with generic therapists did not change meaningfully. By 2017, specialized care delivery had extended to regions that had been poorly covered in 2012, essentially achieving nationwide coverage.ConclusionsFollowing the publication of positive trials, specialized allied healthcare delivery was successfully scaled for patients with PD in the Netherlands, potentially serving as a template for other healthcare innovations for patients with PD elsewhere.

How Many Patients Have Congenital Neutropenia? a Population-Based Estimation from the Nationwide French Severe Chronic Neutropenia Registry

Introduction: Congenital neutropenia (CN) is characterized by chronic neutropenia caused by a constitutional genetic defect and can be considered an orphan disease. Nationwide estimations of its incidence and prevalence are poorly documented but would provide key information to better follow-up of CN patients. Notably, orphan-drug status also is accorded based on such epidemiological parameters. Methods: The French Severe Chronic Neutropenia Registry (FSCNR) has prospectively enrolled CN patients since 1993, with multiple source verifications in France of that information: pediatric and adult hemato-immunology units, diagnostic labs... We also actively collect all cases followed in France, regardless of the healthcare facility monitoring the patient. To calculate incidence at birth, we considered subjects born between 1/1/1995 and 12/31/2017, because information completeness has been validated for this 22-year period. Number of births per year was provided by the French National Institute of Statistics and Economic Studies (INSEE). We used American College of Medical Genetics class 4 and 5 variants for genetic classification and the overall CN classification developed elsewhere.1 To estimate expected prevalence, we assumed 50-year life expectancy for these patients and compared ongoing enrolment to the prevalence estimation and calculated FNSCR coverage. A Poisson distribution was assumed. Results: On 15 July 2020, the FSCNR had identified 3205 patients. Reasons for non-enrolment of 2096 were, mainly: autoimmune neutropenia (n=501), foreign residency (n=214), other diagnosis (n=882) and diagnostic work-up not completed (n=249). Among the 1109 patients who fulfilled Chronic Neutropenia criteria, 242 had idiopathic neutropenia2 and 867 patients were considered to have CN1. Global results are presented in Table 1. In France, the CN incidence at birth (all subtypes combined) was 2.6×10-5 (95% CI: 2.04-2.8×10-5), which represents a mean of 23 new cases/year in a country with ~870,000 births/year. For all CN combined, the expected prevalence, assuming 50-year life expectancy, would be 1131 cases in a country of 65×106 inhabitants while the FCSNR currently has 867 cases enrolled or an estimated 77% nationwide coverage. Based on our results and our assumptions for life expectancy, estimated prevalence of CN for 10 millions inhabitants is therefore 174 CN. Genetic subtype representation is as follows: 20% SBDS, 17% ELANE (8% cyclic, 9% permanent), 9% GATA2, 7% SLC37A4, ~4-5% each of TAZ and CXCR4 and VPS13B, while the other subtypes are even rarer. At present, no cause has been identified for 25% of the cases. Conclusion: The results of this analysis provide an estimation of the major CN-descriptive epidemiological parameters and the relative frequencies of several subtypes. Despite the FSCNR's quite large registry, we estimate that about a quarter of the prevalent cases in France were missed, mainly those followed as adults. References 1 Donadieu J, Beaupain B, Fenneteau O, Bellanne-Chantelot C. Congenital neutropenia in the era of genomics: classification, diagnosis, and natural history. Br.J.Haematol. 2017; 179(4): 557-574. 2 Sicre De Fontbrune F, Moignet A, Beaupain B et al. Severe chronic primary neutropenia in adults: report on a series of 108 patients. Blood 2015; 126(14): 1643-1650. Acknowledgments: The French SCN registry is supported by grants from Amgen, Chugai, Prolong Pharma, X4 Pharma, Inserm, the Association 111 les Arts, the Association RMHE, the Association Sportive de Saint Quentin Fallavier. The authors thank the association IRIS and Mrs Grosjean and Mr Gonnot(ASSQF), the association Barth France for their support. Disclosures Sicre de Fontbrune: Alexion Pharmaceuticals Inc.: Honoraria, Research Funding. cohen Beaussant:X4 Pharmaceuticals, Inc.: Current Employment.

Longevity and cost of care: the challenge of a self-managed health plan.

This paper aims to analyze the relationship between the cost of health care and the aging of the population assisted by a self-managed plan, reflecting on the ways to address the challenge arising from this conjunction of population demographic changes. This is a descriptive study of the 1997-2016 period based on secondary data from the management operator of the health plan under study and from another administrative database of a self-managing provider with broad nationwide coverage. Older adults (over 60 years) increased 55% during the study period. On the other hand, the so-called "very old" (over 80 years) grew 332.8%. The population above 60 years corresponds to 25.7% of the total, and accounts for 68.8% of expenses. Most of the population covered (84,6%) is located in the State of Rio de Janeiro, which has the highest per capita health care cost in Brazil. We found a relationship between aging of the beneficiary population and increased expenditure. It is imperative to invest in health promotion and disease prevention initiatives as a way of improving the quality of life and financial sustainability of the plan, and define a subsystem that delimits and regulates access to the network and is accepted by the beneficiaries.

Development of the radio market in the Slovak Republic in the years 2016 to 2019

The paper is a part of a long-term research of the mass media market in the Slovak Republic under the conditions of globalization. The main objective of the research study is to analyse the development trends of the market of selected radios in the Slovak republic in the monitored period 2016-2019. The authors focus on the analysis of the development of listening and the volume of financial resources spent on advertising (number of spots, number of broadcast hours, value of advertising broadcasts) for selected radios with nationwide coverage. Among other things, the research showed a decrease in market share for all monitored radios and a decrease in listening for most of the monitored radios. The authors think that the above is because radio managements are not able to adapt sufficiently to the time that affects the listeners. From the above, the authors also warn the management of radio stations to increase the emphasis on development, the structure of broadcasting and to try to stop the clear decline in the development of radio.

Solving the Puzzle to Lasting Impact of the National Diabetes Prevention Program.

To address the burden of type 2 diabetes, the Centers for Disease Control and Prevention (CDC) launched the National Diabetes Prevention Program (National DPP) in 2010 (1). The program promotes weight loss through lifestyle change, based on remarkable findings of 58% reduced cumulative incidence over 3 years in an efficacy trial (2). Major successes include reaching hundreds of thousands of at-risk individuals nationwide, robust outcomes, and widespread insurance coverage (1,3), but more work is needed to ensure lasting impact, and retention plays a critical part. This Commentary briefly reviews the new retention study by Cannon et al. (4), linkage to other critical pieces, and future directions. In considering solutions to a complex national problem, I seek to contribute my uniquely broad experience with the National DPP working as a lifestyle coach, securing funding, overseeing delivery, reaching disadvantaged populations, serving on state workgroups, rate setting, becoming a Medicare supplier, advocating to payers and legislators, and authoring over 20 peer-reviewed articles on the program. Beginning with doctoral training on a preceding translational study (5), I now lead a large pragmatic trial a decade later to improve retention with presessions to the National DPP (6). I am also ashamedly familiar with diabetes risks and lost over 50 pounds in my own personal journey with lifestyle change. With rigorous analysis of 41,203 participants across 581 organizations, Cannon et al. show incremental attrition that leaves only a third (32%) remaining by month 10 of the yearlong intervention (data not presented for months 11–12) (4). Racial/ethnic minority and younger individuals, and those lacking successful lifestyle change, drop out disproportionately more. The findings help replicate my early studies on retention gaps for these groups (7–9 …

The role and place of public organizations in establishment and development of the elements of civil society in Russia in late XIX – XX centuries (on the example of Perm Governorate)

This article, based on the new research paradigm of the history of post-reform Russia, gives assessment to the role of public organizations in the course of establishment of civil society as one of the crucial elements of this phenomenon, which is aimed at laying the groundwork for personal development. Perm Governorate became one of the leading centers of civil development; the events held under the full support of Zemstvo institutions and municipality received a nationwide coverage. Using the examples of the work of Ural medical institutions and academic communities, the author reveals the process of their gradual engagement into the civil society system, and elicits their civil potential. Attention is turned to the high level of social coverage of the events held by public organizations, which is associated with the peculiarities of their composition, with the leading role played by democratic elements of the participants. The novelty of this research lies in the fact that this article is first the within Ural historiography to give assessment to the level of effectiveness of the delivered events, as well as determine the peculiarities of participation of Ural intelligentsia in the work of educational and enlightenment societies. Emphasis is made on the common features of public organizations, which allow assessing their work as a manifestation of own social activity, as well as formation of favorable conditions for personal development. The conclusion is substantiation on the significant influence of public organizations and associations on further development of the elements of civil society in Ural, creation of essential prerequisites for social development of the territories, and engagement of active social elements into the system of civil relations.

Predicting stand age in managed forests using National Forest Inventory field data and airborne laser scanning

BackgroundThe aim of this study was to construct a nationwide stand age model by using National Forest Inventory (NFI) data and nationwide airborne laser scanning (ALS) data. In plantation forestry, age is usually known. While this is not the case in boreal managed forests, age is still seldom predicted in forest management inventories. Measuring age accurately in situ is also very laborious. On the other hand, tree age is one of the accurately measured sample tree attributes in NFI field data. Many countries also have a nationwide coverage of airborne laser scanning (ALS) data. In this study, we merged these data sources and constructed a nationwide, area-based model for stand age.ResultsWhile constructing the model, we omitted old forests from the data, since the correlation between ALS height metrics and stand age diminished at stands with age > 100 years. Additionally, the effect of growth conditions was considerable, so we also utilized different geographical and NFI variables such as site fertility and soil type in the modeling. The resultant nationwide model for the stand age of managed forests yielded a root mean square error (RMSE) of about 14 years. The model could be improved further by additional forest structure variables, but such information may not be available in practice.ConclusionsThe results showed that the prediction of stand age by ALS, geographical and NFI information was challenging, but still possible with moderate success. This study is an example of the joint use of NFI and nationwide ALS data and re-use of NFI data in research.

COVID-19 Infection Risk Index Estimation in Flight Destinations (case study: Kish Air destinations)

This paper proposes a risk assessment method for estimating theCOVID-19 Infection risk index in flight destinations based on the pair wise comparison method to solve the problem of health monitoring devices shortage in airlines. In this research, Kish Airlines flight destinations are considered as a case study. By considering the importance of continuing air travel during COVID-19 pandemic, one of the most effective ways for decreasing the risk of infection to COVID-19 in air travel is establishing health monitoring stations at the airport gates. Because of the enormous number of airports and airline routes, nationwide coverage of them by the establishment of the health monitoring stations is unimaginable. Therefore, in this paper, the pair wise comparison method used for evaluating COVID-19 infection risk index in selected flight destinations and to evaluate the optimal policy for allocation of health monitoring equipment in Kish Airline destinations a geostatistical map is designed based on the calculated infection risk score.