Probabilistic Sampling Approach Research Articles

A Novel Hybrid Improved RIME Algorithm for Global Optimization Problems.

The RIME algorithm is a novel physical-based meta-heuristic algorithm with a strong ability to solve global optimization problems and address challenges in engineering applications. It implements exploration and exploitation behaviors by constructing a rime-ice growth process. However, RIME comes with a couple of disadvantages: a limited exploratory capability, slow convergence, and inherent asymmetry between exploration and exploitation. An improved version with more efficiency and adaptability to solve these issues now comes in the form of Hybrid Estimation Rime-ice Optimization, in short, HERIME. A probabilistic model-based sampling approach of the estimated distribution algorithm is utilized to enhance the quality of the RIME population and boost its global exploration capability. A roulette-based fitness distance balanced selection strategy is used to strengthen the hard-rime phase of RIME to effectively enhance the balance between the exploitation and exploration phases of the optimization process. We validate HERIME using 41 functions from the IEEE CEC2017 and IEEE CEC2022 test suites and compare its optimization accuracy, convergence, and stability with four classical and recent metaheuristic algorithms as well as five advanced algorithms to reveal the fact that the proposed algorithm outperforms all of them. Statistical research using the Friedman test and Wilcoxon rank sum test also confirms its excellent performance. Moreover, ablation experiments validate the effectiveness of each strategy individually. Thus, the experimental results show that HERIME has better search efficiency and optimization accuracy and is effective in dealing with global optimization problems.

Association of physical activity with socio-economic status and chronic disease in older adults in China: cross-sectional findings from the survey of CLASS 2020 after the outbreak of COVID-19

BackgroundIn 2021, China had a population of 264·01 million individuals over the age of 60, indicating a high prevalence of chronic diseases. Among older adults, physical inactivity (PI) is a significant risk factor for chronic diseases. However, few studies have been conducted on the correlation of physical activity (PA) with the economic status, geography and chronic disease risks in Chinese elderly. The objectives of this study were to better understand the distribution of PA among older adults in China and its relationship with economic status, geography, and chronic disease risks.MethodsThis study utilized data from the China Longitudinal Aging Social Survey (CLASS) in 2020, post-COVID-19. The study employed a stratified, multistage, probabilistic sampling approach and included 11,396 adults over the age of 59 from 28 provinces in China. Data on demographics, the duration and intensity of PA, history of diseases and personalized factors influencing PA were collected via structured interviews by researchers. In this study, we conducted a comprehensive analysis, employing a range of statistical methods including descriptive analysis, Wilcoxon rank-sum tests, Bayesian networks, and chi-square tests.ResultsThe prevalence of PI among older adults over 59 in China is 28·82%. Significant regional differences were observed in the duration of PA at different intensities. Older adults residing in more economically developed areas were more likely to engage in moderate-to-vigorous physical activity (MVPA) and exhibited longer sedentary behavior. Economic status and urban-rural disparities consistently emerged as direct influential factors across all intensity types. Chronic disease risks were significantly lower in active older adults compared to inactive ones. Lack of social guidance, family support, and personal inclination towards sedentary behavior were the main personalized factors affecting PA among older adults, and these factors could be relatively easily modified.ConclusionsEconomic status, geography, and living areas (urban and rural) significantly influenced the distribution of physical activities in China. Particularly, economic status and living areas acted as direct factors. Older adults reaching the recommended standards for PA had significantly lower chronic disease risks, highlighting the importance of improving personalized factors which are crucial for promoting PA.

The continuum of violence against women: Gynecological violence within the Medical Model in Chile

ObjectiveThis study aims to investigate the presence of gynecological violence within the health system in Chile, quantify the magnitude of this problem, define its general contours, and shed light on a phenomenon that has long been silenced. Additionally, we are interested in detecting differences between public and private health services, as well as exploring the role played by variables such as sexual orientation, ethnicity, age, and educational level in contributing to the prevalence of gynecological violence. MethodsThis study employed a cross-sectional and not probabilistic sampling approach. It included a sample of 1503 women from all regions of Chile, who were of legal age and who had attended gynecological services. A questionnaire was applied between January 2021 and April 2022 using the online platform SurveyMonkey®. Data were collected through the second national survey on obstetric and gynecological violence (GinObs 2021). The study adheres to activist research methodologies and was conducted in collaboration with activists and academic researchers. Results57.9% of the women participants reported having experienced violence. Such violence appears to occur most frequently in the public health system, although not exclusively, and the victims are often people who belong to native ethnic groups, who identify as of African descent, whose sexual orientation is lesbian, who are elderly, and who have a lower level of education. ConclusionGynecological violence is an integral part of the continuum of violence against women and is consistently reported in both public and private health services. This form of violence has serious consequences for women's health and constitutes a significant public health problem.

People’s willingness to use COVID-19 self-testing in Nigeria: a cross-sectional survey

ObjectivesNigeria has been badly affected by the COVID-19 pandemic, and the poor testing coverage in the country may make controlling the spread of COVID-19 challenging. The aim of this study...

Antibiotic Prescription Patterns in Children Under 5 Years of Age With Acute Diarrhea in Quito-Ecuador.

Diarrheal disease remains a significant cause of child mortality, particularly in regions with limited access to healthcare and sanitation. Inappropriate practices, including unjustified medication prescriptions, pose challenges in the management of acute diarrhea (AD), especially in low- and middle-income countries. This study analyzed antibiotic prescription patterns and assessed compliance with Integrated Management of Childhood Illness (IMCI) guidelines in children under 5 with AD in the Ministry of Public Health (MOPH) Ambulatory Care Centers of Quito city, Ecuador. A cross-sectional design was used, collecting electronic health records (EHR) of patients diagnosed with AD from 21 health facilities in District 17D03. A probabilistic and stratified sampling approach was applied. Patient characteristics, prescriber characteristics, treatments, and compliance of IMCI guideline recommendations were evaluated. A stepwise logistic regression analysis examined the association between antibiotic prescription and patient and physician characteristics. A total of 359 children under 5 years of age were included, with 58.77% being girls. 85.24% of the cases of AD were attributed to gastroenteritis and colitis of infectious and unspecified origin. Amebiasis and other protozoal intestinal diseases accounted for 13.37% and 1.11% of the cases, respectively. The completion rates of recording various IMCI parameters varied; parameters such as duration of diarrhea, presence of blood in stool, and evidence of sunken eyes had high completion rates (100%, 100%, and 87.47%, respectively), while parameters like state of consciousness, presence of thirst, and type of diarrhea had low completion rates (0.28%, 0.28%, and 0.84%, respectively). None of the cases had all parameters fully recorded. Antimicrobials were prescribed in 38.72% of the cases. Children aged 3 to 5 years had higher odds of receiving antimicrobial prescription for AD (aOR: 4.42, 95% CI 2.13-9.18, P < .0001) compared to those under 1 year, after adjusting for the number of loose stools per day, gender, and age of the health professional. Variations in IMCI guideline compliance were observed, with no cases fully adhering to the guidelines. Antimicrobial prescription rates were notably high, especially among older children. Further research and specialized interventions are necessary to gain comprehensive insight into the factors underlying non-compliance with the IMCI guidelines.

ABOUT MEASURING THE PARAMETERS OF THE SUBJECT-METHODICAL COMPETENCE OF BIOLOGY TEACHERS IN GENERAL SECONDARY EDUCATION INSTITUTIONS

Taking into account the professional standard of the teacher in the general secondary education institution, the concept of measuring indicators of the level of the subject component of the subject-methodical competence of the biology teacher in general secondary education institutions was developed. The corresponding concept applies the idea of a probabilistic sampling approach, which has already been tested by the authors, for evaluating parameters of the educators professional competence. This idea consists in selecting a hypothetical set of tasks corresponding to a teachers potential professional activity with the appropriate probability distribution of classes of tasks and construction of a representative sample of tasks. The indicator of the corresponding level of competence is considered as the probability to successfully solve any task from the general population, therefore it is theoretically calculated according to the formula of full probability, and the indicator estimate is the average weighted relative frequency of the removed classes of tasks. When forming the profile of the general population of tasks to assess subject competence, the authors relied on the classification of tasks types of the Ukrainian Centre for Education Quality Assessment, which reflects the structure of the school course in Biology and the Principles of Ecology. When approbating the results, 231 respondents were involved, the sample of teachers is representative, reflecting the age and qualification of biology teachers in the region. The research was carried out at professional development courses for teaching staff. Measurements showed a sufficiently high level of the indicator of the subject competence of biology teachers. According to the obtained estimates, the average value is 81.1%; the distribution of points is abnormal with a clearly expressed right asymmetry. The hypothesis about the independence of the results from teaching experience was not confirmed, the deviation of this hypothesis is at the 5% significance level. A more detailed analysis shows higher results for teachers with above average experience. The corresponding analysis provides grounds for differentiation in the learning process at teacher training courses depending on the pedagogical experience.

Interspecific Sample Prioritization Can Improve QTL Detection With Tree-Based Predictive Models.

Due to increasing demand for new advanced crops, considerable efforts have been made to explore the improvement of stress and disease resistance cultivar traits through the study of wild crops. When both wild and interspecific hybrid materials are available, a common approach has been to study two types of materials separately and simply compare the quantitative trait locus (QTL) regions. However, combining the two types of materials can potentially create a more efficient method of finding predictive QTLs. In this simulation study, we focused on scenarios involving causal marker expression suppressed by trans-regulatory mechanisms, where the otherwise easily lost associated signals benefit the most from combining the two types of data. A probabilistic sampling approach was used to prioritize consistent genotypic phenotypic patterns across both types of data sets. We chose random forest and gradient boosting to apply the prioritization scheme and found that both facilitated the investigation of predictive causal markers in most of the biological scenarios simulated.

An improved method for quantitative risk assessment of unconfined offshore installations subjected to gas explosions

Previous related research has focused on consequences analysis of confined rather than unconfined structures against explosion accidents. This paper introduces an improved method for quantitative risk assessment of unconfined offshore installations subjected to gas explosions. In the present study, a floating, production, storage, and offloading unit (FPSO) is given as an example to present the proposed method. Instead of the most unfavorable scenario, lots of random scenarios are selected by the probabilistic sampling approach. The method for determining the equivalent gas cloud position is illustrated in the conversion between dispersion and explosion scenarios. Maximum and average overpressures are obtained by computational fluid dynamics (CFD) simulation. Besides overpressure exceedance curves, the combination of overpressure and probability method is adopted based on the definition of risk. This work allows finer scenarios’ sampling results and reduces the computational costs.

Social media engagement and health

Main AimThe Digital Health Survey was the first nationally representative survey in Wales aiming to understand the extent to which people use social media, disclose personal health related information through social media sites and different user patterns across population groups.&#x0D; MethodsA nationally representative household sample (n=1,252) was identified by a probabilistic sampling approach. One individual, aged 16 years and older, per household was randomly invited to complete a face-to-face questionnaire between April and June 2018. The survey collected quantitative information on use of social media platforms, perception of sharing personal health information on social media platforms, health status and socio-demographic characteristics. We tested the relationships among use, user type, demographics and health status using Chi-squared test or Fisher’s exact test correspondingly. Using estimated marginal means (and 95% confidence intervals), adjusted proportions of people who reported their use on social media platforms was calculated by adjusted mean, controlling for confounders.&#x0D; Results76.9% of the Welsh population engaged with social media, including 64.7% who used one or more form of social media platform on a daily basis. The most frequently used (i.e. daily) social media platform was Facebook (50.6% of the Welsh population including 23.4% used several times a day). Within the population sampled, controlling for confounders, significant higher proportion of women (91%) users were found compared to men (86%). 99.6% of 16-29 years old used social media with significant lower proportions for older age groups (i.e. 75.6% for 60-69 and 59.8% for 70+). No significant differences were found between social media engagement and deprivation quintiles. 9.6% shared personal health information on social media with friends and family, while only 2.7% shared health information with people they did not know.&#x0D; ConclusionPatterns in social media use are an important consideration for health promotion. The absence of a difference by deprivation groups suggests this approach may reach population more traditional routes have not. However, continued reduction in a digital divide and development of effective solutions for health via social media remains a priority.

Spatiotemporal monitoring of soil water content profiles in an irrigated field using probabilistic inversion of time-lapse EMI data

Abstract Monitoring spatiotemporal variations of soil water content (θ) is important across a range of research fields, including agricultural engineering, hydrology, meteorology and climatology. Low frequency electromagnetic induction (EMI) systems have proven to be useful tools in mapping soil apparent electrical conductivity (σa) and soil moisture. However, obtaining depth profile water content is an area that has not been fully explored using EMI. To examine this, we performed time-lapse EMI measurements using a CMD mini-Explorer sensor along a 10 m transect of a maize field over a 6 day period. Reference data were measured at the end of the profile via an excavated pit using 5TE capacitance sensors. In order to derive a time-lapse, depth-specific subsurface image of electrical conductivity (σ), we applied a probabilistic sampling approach, DREAM ( Z S ) , on the measured EMI data. The inversely estimated σ values were subsequently converted to θ using the Rhoades et al. (1976) petrophysical relationship. The uncertainties in measured σa, as well as inaccuracies in the inverted data, introduced some discrepancies between estimated σ and reference values in time and space. Moreover, the disparity between the measurement footprints of the 5TE and CMD Mini-Explorer sensors also led to differences. The obtained θ permitted an accurate monitoring of the spatiotemporal distribution and variation of soil water content due to root water uptake and evaporation. The proposed EMI measurement and modeling technique also allowed for detecting temporal root zone soil moisture variations. The time-lapse θ monitoring approach developed using DREAM ( Z S ) thus appears to be a useful technique to understand spatiotemporal patterns of soil water content and provide insights into linked soil moisture vegetation processes and the dynamics of soil moisture/infiltration processes.

A method for determining fire accidental loads and its application to thermal response analysis for optimal design of offshore thin-walled structures

More than 70% of accidents that occur on offshore installations stem from hydrocarbon fire and explosion, and as they involve heat and blast effects, they are extremely hazardous with serious consequences in terms of human health, structural safety and the surrounding environment. To prevent further accidents, substantial effort has been directed towards the management of fire and explosion in the safety design of offshore installations. The aim of this paper is to present a risk-based methodology procedure to help determine the fire accidental design load of an offshore installation (AL Living Quarter) in association with the thermal response characteristics for structural optimisation. A probabilistic sampling approach with numerical fire simulations was taken to determine the fire accidental load. To determine the optimisation of the thin-walled structures of the living quarter, an A60 based on the results of thermal response analyses was conducted and the temperature distribution calculated. The analysis results suggest incorporating both the design and safety planning aspects of offshore Living Quarter.

An Enhanced Probabilistic Posterior Sampling Approach for Synthesizing SAR Imagery With Sea Ice and Oil Spills

Although the synthesis of the synthetic aperture radar (SAR) imagery with both sea ice and oil spills can significantly benefit in improving the consistency and comprehensiveness of testing and evaluating algorithms that are designed for mapping cold ocean regions, creating such imagery is difficult due to the heterogeneity and complexity of the source images. This letter presents an enhanced region-based probabilistic posterior sampling approach to effectively synthesize SAR imagery with different ocean features. In the proposed approach, instead of relying entirely on the SAR intensity values, the posterior sampling is performed based on a number of quantitative factors, such as intensity, label field, and the prior class probability of sampling candidates, constituting a complete probabilistic framework that addresses key aspects in the synthesis of SAR imagery from heterogeneous sources. The experiments demonstrate that the proposed approach can better address the difficulties caused by the heterogeneity in the source images compared with the existing state-of-the-art ice synthesis method, and it will improve the consistency, comprehensiveness, and fairness of the evaluation of the remote sensing classification and segmentation algorithms.

A Data-Driven Network Analysis Approach to Predicting Customer Choice Sets for Choice Modeling in Engineering Design

In this paper, we propose a data-driven network analysis based approach to predict individual choice sets for customer choice modeling in engineering design. We apply data analytics to mine existing data of customer choice sets, which is then used to predict choice sets for individual customers in a new choice modeling scenario where choice set information is lacking. Product association network is constructed to identify product communities based on existing data of customer choice sets, where links between products reflect the proximity or similarity of two products in customers' perceptual space. To account for customer heterogeneity, customers are classified into clusters (segments) based on their profile attributes and for each cluster the product consideration frequency is computed. For predicting choice sets in a new choice modeling scenario, a probabilistic sampling approach is proposed to integrate product associations, customer segments, and the link strengths in the product association network. In case studies, we first implement the approach using an example with simulated choice set data. The quality of predicted choice sets is examined by assessing the estimation bias of the developed choice model. We then demonstrate the proposed approach using actual survey data of vehicle choice, illustrating the benefits of improving a choice model through choice set prediction and the potential of using such choice models to support engineering design decisions. This research also highlights the benefits and potentials of using network techniques for understanding customer preferences in product design.

Probabilistic Inference of Biochemical Reactions in Microbial Communities from Metagenomic Sequences

Shotgun metagenomics has been applied to the studies of the functionality of various microbial communities. As a critical analysis step in these studies, biological pathways are reconstructed based on the genes predicted from metagenomic shotgun sequences. Pathway reconstruction provides insights into the functionality of a microbial community and can be used for comparing multiple microbial communities. The utilization of pathway reconstruction, however, can be jeopardized because of imperfect functional annotation of genes, and ambiguity in the assignment of predicted enzymes to biochemical reactions (e.g., some enzymes are involved in multiple biochemical reactions). Considering that metabolic functions in a microbial community are carried out by many enzymes in a collaborative manner, we present a probabilistic sampling approach to profiling functional content in a metagenomic dataset, by sampling functions of catalytically promiscuous enzymes within the context of the entire metabolic network defined by the annotated metagenome. We test our approach on metagenomic datasets from environmental and human-associated microbial communities. The results show that our approach provides a more accurate representation of the metabolic activities encoded in a metagenome, and thus improves the comparative analysis of multiple microbial communities. In addition, our approach reports likelihood scores of putative reactions, which can be used to identify important reactions and metabolic pathways that reflect the environmental adaptation of the microbial communities. Source code for sampling metabolic networks is available online at http://omics.informatics.indiana.edu/mg/MetaNetSam/.

Simple, Inexpensive Approach to Sampling for Pedestrian and Bicycle Surveys

Many transportation planners undertake local surveys for a better understanding of the levels of walking and cycling of residents in their city or town. This paper explores the challenges of designing a robust sampling strategy for such surveys. A review of existing surveys on nonmotorized transportation demonstrated that many existing surveys used less than ideal sampling approaches for communities that were aiming to collect populationwide data on cycling and walking and thereby jeopardized the strength of their conclusions. Either surveys used approaches that were too expensive and complex for most communities to implement or surveys generated data that were not applicable to all residents in a community (i.e., data that were not generalizable to the full population). In response to that sampling problem, this paper presents a new method for collecting generalizable data: the sampling method developed in the Pedestrian and Bicycling Survey (PABS) project. PABS offers a rigorous, yet inexpensive, simple, and well-documented method to conduct surveys. The PABS mail-out–mail-back survey and probabilistic (generalizable) sampling approach can be performed in-house within municipal agencies. With the use of PABS, transportation professionals can obtain higher-quality data about their community as a whole than they would obtain with many of the other existing approaches. PABS is thus a useful complement to other sampling approaches such as intercept surveys (an important way to collect data on the use of specific facilities) or surveys distributed to e-mail lists (a cheap and useful way to collect qualitative data).

Triangulation based inclusion probabilities: a design-unbiased sampling approach

A probabilistic sampling approach for design-unbiased estimation of area-related quantitative characteristics of spatially dispersed population units is proposed. The developed field protocol includes a fixed number of 3 units per sampling location and is based on partial triangulations over their natural neighbors to derive the individual inclusion probabilities. The performance of the proposed design is tested in comparison to fixed area sample plots in a simulation with two forest stands. Evaluation is based on a general approach for areal sampling in which all characteristics of the resulting population of possible samples is derived analytically by means of a complete tessellation of the areal sampling frame. The example simulation shows promising results. Expected errors under this design are comparable to sample plots including a much greater number of trees per plot.

Distribution of American pikas in a low-elevation lava landscape: conservation implications from the range periphery

Predicting species distributions is increasingly important in conservation biology and, in the context of contemporary climate change, can be particularly informative for populations at the periphery of the range. Peripheral populations can exhibit unique patterns of habitat use in response to marginal conditions and can provide colonists adapted to novel or extreme environments. We conducted surveys for American pikas (Ochotona princeps) during 2007–2009 in 144 sites in Craters of the Moon National Monument and Preserve, Idaho. This species appears vulnerable to global climate change, and Craters of the Moon is an extensive area of low-elevation lava habitat situated on an interior edge of the species' range. We found pikas to be readily detectable when both direct and indirect sign were used. An estimate of detection probability from a subset of 72 sites that were visited twice was 0.92. We detected pikas in 31% of survey sites overall but only.at sites above 1,605 m. We used logistic regression to model the distribution of pikas as a function of elevation, substrate, and vegetation cover. Pikas were most likely to occur on structurally complex pahoehoe lava flows above 1,600 m. The odds of pika occurrence on pahoehoe lava was >10 times that of aa lava flows and increased by 2 times for each SD increase in elevation. Pikas were also more likely to occur on lava flow sites with higher structural complexity and forb cover. An area of pahoehoe lava encompassing >250 km2 in the northern portion of Craters of the Moon contained 91% of pika detections and all predicted site-occurrence probabilities >0.38, an optimal cutoff value determined by examining model receiver operating characteristic curves. Craters of the Moon may provide long-term refugia for the species, given the extent of lava habitat there. However, the importance of elevation in our models suggests that accelerated climate change could erode suitable pika habitat in the park. Most research on pikas has relied on censuses or nonrandom convenience surveys, but we demonstrate an efficient probabilistic sampling approach that has broad application for pika monitoring and research.

Diversity and evolution of coral fluorescent proteins.

GFP-like fluorescent proteins (FPs) are the key color determinants in reef-building corals (class Anthozoa, order Scleractinia) and are of considerable interest as potential genetically encoded fluorescent labels. Here we report 40 additional members of the GFP family from corals. There are three major paralogous lineages of coral FPs. One of them is retained in all sampled coral families and is responsible for the non-fluorescent purple-blue color, while each of the other two evolved a full complement of typical coral fluorescent colors (cyan, green, and red) and underwent sorting between coral groups. Among the newly cloned proteins are a “chromo-red” color type from Echinopora forskaliana (family Faviidae) and pink chromoprotein from Stylophora pistillata (Pocilloporidae), both evolving independently from the rest of coral chromoproteins. There are several cyan FPs that possess a novel kind of excitation spectrum indicating a neutral chromophore ground state, for which the residue E167 is responsible (numeration according to GFP from A. victoria). The chromoprotein from Acropora millepora is an unusual blue instead of purple, which is due to two mutations: S64C and S183T. We applied a novel probabilistic sampling approach to recreate the common ancestor of all coral FPs as well as the more derived common ancestor of three main fluorescent colors of the Faviina suborder. Both proteins were green such as found elsewhere outside class Anthozoa. Interestingly, a substantial fraction of the all-coral ancestral protein had a chromohore apparently locked in a non-fluorescent neutral state, which may reflect the transitional stage that enabled rapid color diversification early in the history of coral FPs. Our results highlight the extent of convergent or parallel evolution of the color diversity in corals, provide the foundation for experimental studies of evolutionary processes that led to color diversification, and enable a comparative analysis of structural determinants of different colors.

Medicine-related problems resulting in emergency department visits

Our aim was to estimate the prevalence of medicine-related problems, understood as negative clinical outcomes, that result in hospital emergency department (ED) visits and to establish relationships among risk factors and the appearance of pharmacotherapy negative outcomes. Methods A stratified two-stage probabilistic sampling approach was used which consisted of stratified random sampling of patients visiting the ED followed up by interviews. A systematic appraisal tool was used to identify pharmacotherapy negative outcomes within the framework of the information gathered. Bivariate and multivariate analyses were carried out. Cost per process was estimated. The prevalence of pharmacotherapy negative outcomes producing ED visits was 33.17% (95%CI: 31.09-35.25). These negative outcomes could be divided into three categories: ineffectiveness (19.76%; 95%CI: 17.92-21.60), necessity/use (10.52%; 95%CI: 9.48-11.56), and lack of safety (2.89%). About 73% (95%IC: 70.03-76.23) of the negative outcomes were considered to be preventable. Average cost per negative outcome was 329.5 euros (95%CI: 185.4-473.5). Factors associated with the appearance of negative outcomes were age, number of medicines taken, and the combined effect of both of these factors. Compared with those participants younger than 18 years, patients between 45 and 64 years of age presented an odds ratio (OR) of 2.52 (95%CI: 1.1-5.78), while those older than 65 years had an OR of 3.63 (95%CI: 1.27-10.35). Compared with people not using medicine(s), patients using one to two different medicines presented with an OR = 19.91 (95%CI: 8.28-47.87), and those using more than three medicines had an OR = 22.71 (95%CI: 3.05-69.26). Finally, compared with patients younger than 18 years and not using medicines, patients aged 45-64 years taking three or more different medicines presented with an OR = 64.07, while those older than 65 years taking three or more medicines presented with an OR = 31.50. The prevalence of negative clinical outcomes was 33%, of which more than 73% of these were preventable. Factors associated with their appearance were age, number of medicines, and their combined effect.