Relative Prevalence Research Articles

Methods Used in Co-Creation Within the Health CASCADE Co-Creation Database and Gray Literature: Systematic Methods Overview

Background Co-creation is increasingly recognized for its potential to generate innovative solutions, particularly in addressing complex and wicked problems in public health. Despite this growing recognition, there are no standards or recommendations for method use in co-creation, leading to confusion and inconsistency. While some studies have examined specific methods, a comprehensive overview is lacking, limiting the collective understanding and ability to make informed decisions about the most appropriate methods for different contexts and research objectives. Objective This study aimed to systematically compile and analyze methods used in co-creation to enhance transparency and deepen understanding of how co-creation is practiced. Methods To enhance transparency and deepen understanding of how co-creation is practiced, this study systematically inventoried and analyzed methods used in co-creation. We conducted a systematic methods overview, applying 2 parallel processes: one within the peer-reviewed Health CASCADE Co-Creation Database and another within gray literature. An artificial intelligence–assisted recursive search strategy, coupled with a 2-step screening process, ensured that we captured relevant methods. We then extracted method names and conducted textual, comparative, and bibliometric analyses to assess the content, relationship between methods, fields of research, and the methodological underpinnings of the included sources. Results We examined a total of 2627 academic papers and gray literature sources, with the literature primarily drawn from health sciences, medical research, and health services research. The dominant methodologies identified were co-creation, co-design, coproduction, participatory research methodologies, and public and patient involvement. From these sources, we extracted and analyzed 956 co-creation methods, noting that only 10% (n=97) of the methods overlap between academic and gray literature. Notably, 91.3% (230/252) of the methods in academic literature co-occurred, often involving combinations of multiple qualitative methods. The most frequently used methods in academic literature included surveys, focus groups, photo voice, and group discussion, whereas gray literature highlighted methods such as world café, focus groups, role-playing, and persona. Conclusions This study presents the first systematic overview of co-creation methods, providing a clear understanding of the diverse methods currently in use. Our findings reveal a significant methodological gap between researchers and practitioners, offering insights into the relative prevalence and combinations of methods. By shedding light on these methods, this study helps bridge the gap and supports researchers in making informed decisions about which methods to apply in their work. Additionally, it offers a foundation for further investigation into method use in co-creation. This systematic investigation is a valuable resource for anyone engaging in co-creation or similar participatory methodologies, helping to navigate the diverse landscape of methods.

Normal Weight Central Obesity and its Impact on Type 2 Diabetes Mellitus.

The aim of this review is to provide an updated commentary on the current literature examining the impact of normal weight obesity (NWO) and normal weight central obesity (NWCO) on type 2 diabetes mellitus in adults. Total 14 studies were included, comprising 9 cross-sectional and 5 cohort studies with 334,438 subjects. The quality of evidence was mixed. The pooled prevalence of NWO was 16.1% (95% CI: 12.7-19.4) and NWCO was 21.1% (95% CI: 12.2-30.1). The prevalence of NWO and NWCO higher in females and non-Asians. This review also showed that type 2 diabetes was significantly associated with NWO and NWCO (pooled OR: 1.82 [1.62, 2.04], p < 0.01, I2 = 64%). Subgroup analyses revealed consistent relationships between type 2 diabetes and NWO/NWCO across sex, region and definition approach. There was a relative high prevalence of NWO and NWCO, particularly in females and non-Asian populations. There was a consistent association of NWO/NWCO with type 2 diabetes. Implications for future research to guide intervention optimization in clinical practice and public health promotion are provided.

Child COVID-19 rates and migrant status: A quantitative study in the Lisbon area (Mar 2020-Jun 2022)

Abstract Introduction According to OECD data, immigrant children were over-represented among COVID-19 cases compared to non-immigrant children. However, evidence is missing on whether their migrant status is associated with testing positive for COVID-19. Therefore, we aimed to estimate COVID-19 positivity rates among children residing in five municipalities of the Lisbon metropolitan area, Portugal, and to analyze migrant status as a determinant of health. Methods We conducted a prospective cross-sequential cohort study with 989 children born in 2015, 2018, and 2020 (48.5% non-immigrants; 51.5% immigrants). Sociodemographic data were collected through interview-based questionnaires, and the child’s birth weight and gestational age were obtained from the primary health center’s information system (SClinico). COVID-19 test results (conducted between March 2020 and June 2022) were obtained from the national surveillance system (SINAVE Lab) and categorized into two primary outcomes: ever positive for COVID-19 (yes/no) and positivity frequency for COVID-19 (count). Robust and standard Poisson regressions were used to estimate the association between primary outcomes and demographic, socioeconomic, and clinical variables. We estimate relative risks (RR) and prevalence ratios (PR) with 95% confidence intervals. Results The positivity rate is lower for immigrant children (12% vs 17%). Compared with non-immigrant, and adjusting for other factors, immigrant children are 52% less likely to be ever positive for COVID-19 (PR = 0.482; IC 95%: 0.392-0.594), and the estimated number of positive tests is 54% lower (RR = 0.456; IC 95%: 0.362-0.574). Conclusions Being an immigrant is a protective factor against testing positive for COVID-19, aligning with the well-known immigrant paradox. These results underscore the need for further research into the immunological profiles of this population and are crucial for guiding strategies to manage emerging public health crises. Key messages • Immigrant children living in the Lisbon metropolitan area may have a protective factor against testing positive for COVID-19, consistent with the well-known immigrant paradox. • Understanding COVID-19 positivity rates and associated factors in children is crucial for guiding effective strategies to manage and mitigate emerging public health crises.

Using mathematical models in the assessment of the circulatory system in employees working under harmful occupational conditions

Introduction. According to the results of medical examinations of metallurgists, in the structure of newly identified somatic morbidity, circulatory system diseases (CSD) are one of the leading pathologies. To assess the prevalence of CSD in workers in harmful working conditions, it is possible to use various mathematical solutions as a tool. The objective of the study was to substantiate the possibility of using variance analysis and classification tree (CT) methods to assess the prevalence of circulatory diseases in industrial workers. Materials and methods. Data of medical examinations and a questionnaire-based survey of three hundred eight workers of steel production were input into a database. The interrelationship between CSD and individual and occupational risk factors was examined using a one- and two-way ANOVA. The classification tree method was used for a multivariate analysis. Results. The one- and two-way ANOVA revealed a statistically significant correlation between the CSD family history (p=0.001) and age, years of occupational exposure, overweight, blood glucose level, total cholesterol (p&lt;0.05) and the CSD prevalence in the steel workers. We applied the classification tree method to make decisions on referring the subjects to potentially “healthy” and “sick” workers by determining the CSD prevalence in relation to various combinations of risk factors. Limitations. This study is limited to the results of medical examinations of the workers collected over a one-year period. Conclusions. Our experience in using the analysis of variance and classification tree to evaluate the CSD prevalence in ferrous industry employees allows recommending them for use in assessing the prevalence of various diseases in workers exposed to occupational hazards.

Changes in Breast Cancer Screening Prevalence in the US During the COVID-19 Pandemic, 2018-2022.

Annual mammography screening declined year-on-year during the COVID-19 pandemic through 2021. This study examined changes in 2022 compared to 2018 in the national prevalence of self-reported up-to-date mammography. Using 2018-2022 data from the Center for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS), we assess relative changes defined as annual prevalence ratios (aPR) in the SR receipt of past-year and up-to-date (UTD) breast cancer screening (bi-annual mammography in women ages 50-74 years) during the third year of the COVID-19 pandemic overall and by sociodemographic characteristics. UTD BC screening declined for the first time since 2018 (2018 compared to 2022, from 78.7% to 76.6%; aPR, 0.97; 95% CI, 0.96-0.98), despite a small increase in past-year breast cancer screening from 2020 and 2022 (57.9% to 59.6%; aPR, 1.03; 95% CI, 1.01-1.05). This translated to 747,791 fewer women reporting UTD with recommended BC screening in 2022 vs. 2018. UTD BC screening declines between 2018-2022 were largest for American Indian/Alaska Native women (74.8% to 62.2%; aPR, 0.83; 95% CI, 0.74-0.93), women with less formal educational attainment (< high school: 73.1% to 65.5%; aPR, 0.9; 95% CI, 0.85-0.95), and women without a usual source of care (48% to 42.9%; aPR, 0.85; 95% CI, 0.78-0.92). Previously noted pandemic-related declines in past-year BC screening now reflect in women reporting being UTD, with the largest declines in AI/AN and lower SES women. Future studies should monitor screening prevalence in relation to BC diagnostic stage, overall and by sociodemographic groups.

HPV-Independent Cervical Adenocarcinoma Discovered by Cytology-Based Screening: A case report of gastric type adenocarcinoma of the uterine cervix from cytopathology to histopathology

Abstract Introduction/Objective In recent years, the relative prevalence of adenocarcinoma has increased, comprising 20–25% of all cervical carcinomas in developed countries. Approximately 15% of cervical adenocarcinomas are unrelated to human papilloma virus (HPV) infection. With the shift toward HPV primary testing, an increased understanding of HPV-independent cervical adenocarcinomas becomes more important. Methods/Case Report This case report demonstrates a rare case of gastric-type adenocarcinoma (GAS) of the cervix discovered during a routine well-woman exam. Patient-reported episodes of vaginal spotting were noted prior to screening. HPV testing by PCR on the initial pap smear was negative. Cytology findings raised concerns about endocervical glandular cell abnormalities. Subsequent cervical biopsy revealed GAS, a finding supported by positive CK7, MUC5AC, CDX2, and aberrant (mutant) p53 expression by immunohistochemistry. HPV independence was further confirmed by negative results on mRNA ISH for high-risk HPV and HPV16/18. Results (if a Case Study enter NA) NA Conclusion Here we discuss the impact of cytology-based screening on HPV-independent cervical cancers, with focus on adenocarcinoma. While the move to primary HPV screening has been shown to be effective at identifying HPV-related neoplasms, it ineffectively addresses HPV-independent malignancies. In this particular population, cytology-based screening remains indispensable. The described case demonstrated subtle cytologic features consistent with endocervical glandular abnormality, ultimately correlating with subsequent histologic findings of HPV-independent GAS. Negative HPV results combined with subtle cytomorphologic changes displayed by some adenocarcinomas on PAP smear could present a significant diagnostic pitfall. Additionally, p16+ expression attributable to aberrant p53 pathways (rather than HPV) may further contribute to potential diagnostic errors. While further research into best practices for early detection of HPV-independent cervical neoplasias should be conducted, this team suggests both clinical survey and referral for cytologic screening following reports of abnormal vaginal bleeding and/or watery discharge and screener education focused on cervical GAS.

Identifying Gaps and Barriers in Alzheimer's Disease and Related Dementia Research and Management in Low- and Middle-Income Countries: A Survey of Health Professionals and Researchers.

The significant increase in Alzheimer's disease and related dementia prevalence is a global health crisis, acutely impacting low- and lower-middle and upper-middle-income countries (LLMICs/UMICs). The objective of this study is to identify key barriers and gaps in dementia care and research in LLMICs and UMICs. We conducted an international, cross-sectional survey among clinicians and healthcare professionals (n = 249 in 34 countries) across LLMICs and UMICs, exploring patient demographics, use of clinical diagnosis, dementia evaluation, screening/evaluation tools, and care and treatment. Significant disparities were found in diagnostic practices, access to assessments, and access to care. On average, clinicians in LLMICs saw more patients, had less time for evaluations, lower use of formal screening and tools, and less access to biomarkers. They were also under-resourced compared to UMICs. The findings provide insights for policymakers, healthcare organizations, and researchers to address the complex challenges associated with dementia care in diverse settings. Addressing these challenges requires a multipronged approach involving local, national, and international stakeholders.

Simultaneous Reduction and Methylation of Nanoparticulate Mercury: The Critical Role of Extracellular Electron Transfer.

Mercury nanoparticles are abundant in natural environments. Yet, understanding their contribution to global biogeochemical cycling of mercury remains elusive. Here, we show that microbial transformation of nanoparticulate divalent mercury can be an important source of elemental and methylmercury.Geobacter sulfurreducensPCA, a model bacterium predominant in anoxic environments (e.g., paddy soils), simultaneously reduces and methylates nanoparticulate Hg(II). Moreover, the relative prevalence of these two competing processes and the dominant transformation pathways differ markedly between nanoparticulate Hg(II) and its dissolved and bulk-sized counterparts. Notably, even when intracellular reduction of Hg(II) nanoparticles is constrained by cross-membrane transport (a rate-limiting step that also regulates methylation), the overall Hg(0) formation remains substantial due to extracellular electron transfer. With multiple lines of evidence based on microscopic and electrochemical analyses, gene knockout experiments, and theoretical calculations, we show that nanoparticulate Hg(II) is preferentially associated with c-type cytochromes on cell membranes and has a higher propensity for accepting electrons from the heme groups than adsorbed ionic Hg(II), which explains the surprisingly larger extent of reduction of nanoparticles than dissolved Hg(II) at relatively high mercury loadings. These findings have important implications for the assessment of global mercury budgets as well as the bioavailability of nanominerals and mineral nanoparticles.

Nontuberculous mycobacterial pulmonary disease (NTM PD) incidence trends in the United States, 2010–2019

BackgroundNontuberculous mycobacteria (NTM) are ubiquitous environmental bacteria that cause chronic lung disease. Rates of NTM pulmonary disease (NTM PD) have increased over the last several decades, yet national estimates in the United States (US) have not been assessed since 2015.MethodsWe used a nationally representative population of Medicare beneficiaries aged ≥ 65 years to assess rates of NTM PD in a high-risk population from 2010 to 2019. Poisson generalized linear models were used to assess the annual percent change in incidence in the overall population and among key demographic groups such as sex, geography, and race/ethnicity. We evaluated the relative prevalence of various comorbid conditions previously found to be associated with NTM PD.ResultsWe identified 59,724 cases of incident NTM PD from 2010 to 2019 from an annual mean population of 29,687,097 beneficiaries, with an average annual incidence of 20.1 per 100,000 population. NTM PD incidence was overall highest in the South and among women, Asian individuals, and persons aged ≥ 80 years relative to other studied demographic groups. The annual percent change in NTM PD incidence was highest in the Northeast, at 6.5%, and Midwest, at 5.9%, and among women, at 6.5%. Several comorbid conditions were highly associated with concurrent NTM diagnosis, including allergic bronchopulmonary aspergillosis, bronchiectasis, and cystic fibrosis.ConclusionsHere we provide current estimates of NTM PD incidence and prevalence and describe increasing trends in the US from 2010 to 2019. Our study suggests a need for improved healthcare planning to handle an increased future caseload, as well as improved diagnostics and therapeutics to better detect and treat NTM PD in populations aged ≥ 65 years.

Endemic, cosmopolitan, and generalist taxa and their habitat affinities within a coastal marine microbiome

The relative prevalence of endemic and cosmopolitan biogeographic ranges in marine microbes, and the factors that shape these patterns, are not well known. Using prokaryotic and eukaryotic amplicon sequence data spanning 445 near-surface samples in the Southern California Current region from 2014 to 2020, we quantified the proportion of taxa exhibiting endemic, cosmopolitan, and generalist distributions in this region. Using in-situ data on temperature, salinity, and nitrogen, we categorized oceanic habitats that were internally consistent but whose location varied over time. In this context, we defined cosmopolitan taxa as those that appeared in all regional habitats and endemics as taxa that only appeared in one habitat. Generalists were defined as taxa occupying more than one but not all habitats. We also quantified each taxon’s habitat affinity, defined as habitats where taxa were significantly more abundant than expected. Approximately 20% of taxa exhibited endemic ranges, while around 30% exhibited cosmopolitan ranges. Most microbial taxa (50.3%) were generalists. Many of these taxa had no habitat affinity (> 70%) and were relatively rare. Our results for this region show that, like terrestrial systems and for metazoans, cosmopolitan and endemic biogeographies are common, but with the addition of a large number of taxa that are rare and randomly distributed.

Collagen-V and K-α-1 Tubulin Antibodies as Potential Markers of Unsuspected GERD-Related Lung Damage: Insights from a Cross-Sectional Analysis

PurposeOur group has proposed that aspiration of gastric contents leads to exposure of normally sequestered lung self-antigens (SAgs), specifically collagen-V (Col-V) and K-α-1-tubulin (Kα1T), which elicits an immune response characterized by increasing concentrations of self-antibodies (SAbs) anti-Col-V and anti-Kα1T. We sought to establish the point prevalence of abnormally elevated concentrations of SAbs among patients with pathological gastroesophageal reflux disease (GERD) and/or hiatal hernia undergoing antireflux surgery (ARS).MethodsFor this cross-sectional study, we retrieved a plasma aliquot from the Norton Thoracic Institute BioBank from blood samples that were taken preoperatively from patients who underwent ARS between November 2019 and August 2022. Enzyme-linked immunosorbent assays were employed to detect and quantify anti-Col-V and anti-Kα1T.ResultsSamples from 43 patients (females, n = 34 [79.1%]; mean age, 62 ± 12 years; and mean BMI, 30.5 ± 7 kg/m2) were analyzed. Before ARS, 28 (65.1%, CI95: 50.3–80.0%) patients had abnormally elevated concentrations of anti-Col-V and 19 (44.2%, CI95: 28.7–59.7%) had elevated concentrations of circulating anti-Kα1T. Overall, 13 patients (30.2%) had low (i.e., normal) concentrations of both SAbs, 13 (30.2%) were positive only for one, and 17 (39.5%) were positive for both SAbs.ConclusionA relative high point prevalence of abnormally elevated circulating SAbs (i.e., anti-Col-V and/or anti-Kα1T) before ARS was found. This result suggests clinically unsuspected pulmonary parenchymal injury secondary to GERD-related aspiration. Further studies are required to confirm this hypothesis and to identify alternative non-invasive early biomarkers of GERD-related lung damage.

Exploring Diversity of Hispanic Health Outcomes Through Prism of Environmental Justice

In environmental economics studies US Hispanics are frequently depicted as one large homogeneous group, despite diversity in their countries’ cultural traditions, genetic background and socioeconomic status (SES). This study aimed to compare Florida’s very diverse Hispanic population of Caribbean, Mexican, Central, and South American ancestry.Twelve independent variables were selected from environmental pollution, geospatial challenges, and SES categories. Dependent variables included the relative prevalence of three major chronic diseases: asthma, diabetes, and heart disease. Analysis of pairs correlations was supplemented by multi-variable linear regression. Majority-Hispanic areas have higher than average pollution, diabetes, proximity to disadvantaged neighborhoods, and lower SES. Despite lower pollution than in urban areas, Florida’s inland rural areas had higher rates of all major diseases and lower life expectancies. Cuban and Puerto Rican populations of Miami and Orlando metro areas, respectively, have less favorable SES outcomes and higher diabetes. Columbian and Venezuelan communities have significantly higher education levels than other Hispanic cohorts, and they have the best relative outcome among US Hispanics in SES and health, although still lagging US averages. African-American community in Miami-Dade County was by far the most disadvantaged, with significantly lower SES and health outcomes than any other group in the study, including the nearby Cuban-majority community. Our results confirmed the view that Hispanics are environmentally disadvantaged in Florida, with worse outcomes than the US and Florida average in health and economic factors. Furthermore, the study highlighted significant differentiation of SES and health outcomes among various regional Hispanic cohorts.

ESKAPE pathogens in pediatric cardiac surgery patients: 5-year microbiological monitoring inatertiary hospital in Kazakhstan.

Hospital acquired infections greatly affect recovery and survival in pediatric surgical patients. We evaluated prevalence and antimicrobial resistance of ESKAPE pathogens in neonates and infants subjected to cardiac surgery in a tertiary hospital in Central Kazakhstan between 2019 and 2023 (2,278 patients) using routine methods of microbiological detection. ESKAPE pathogens were found in 1,899 out of 2,957 samples (Staphylococcus aureus - 35.3%, Klebsiella pneumoniae - 27.8%, Acinetobacter baumannii - 14.5%, Pseudomonas aeruginosa - 12.4%, Enterobacter sp. - 8.8%, Enterococcus faecium - 1.2%). The total prevalence of ESKAPE increased significantly from 45.1 to 76.9% (P = 0.005) during the study period. The resistance significantly increased in methicillin-resistant S. aureus (MRSA, from13.7 to 41.9%, P = 0.041) but decreased in carbapenem-resistant P. aeruginosa (from 64.3 to 37.7%, P = 0.037) and carbapenem-resistant A. baumannii (from 48.5 to 19.1%, P = 0.039). Gradual but non-significant changes were shown in third-generation cephalosporin resistant K. pneumoniae (from 63.6 to 45.2%) and carbapenem-resistant K. pneumoniae (from 0 to 8.3%). The relative prevalence of ESKAPE pathogens steadily increased in our pediatric cardiac surgery patients in 2019-2023. The most frequent were S. aureus, K. pneumoniae, and A. baumannii, with dramatically increasing tendencies for MRSA. Our results highlight the necessity for a well-designed infection control strategy and constant microbiological monitoring in pediatric cardiac surgery departments.

Epidemiology of myasthenia gravis in Denmark, Finland and Sweden: a population-based observational study

BackgroundIncidence and prevalence rates of myasthenia gravis (MG) vary considerably across studies, and mortality risk is rarely addressed. We examined the prevalence and incidence rates, mortality and factors associated with...

Real-world impact of acupuncture on analgesics and healthcare resource utilization in breast cancer survivors with pain

BackgroundThis study evaluated the real-world impact of acupuncture on analgesics and healthcare resource utilization among breast cancer survivors.MethodsFrom a United States (US) commercial claims database (25% random sample of IQVIA PharMetrics® Plus for Academics), we selected 18–63 years old malignant breast cancer survivors experiencing pain and ≥ 1 year removed from cancer diagnosis. Using the difference-in-difference technique, annualized changes in analgesics [prevalence, rates of short-term (< 30-day supply) and long-term (≥ 30-day supply) prescription fills] and healthcare resource utilization (healthcare costs, hospitalizations, and emergency department visits) were compared between acupuncture-treated and non-treated patients.ResultsAmong 495 (3%) acupuncture-treated patients (median age: 55 years, stage 4: 12%, average 2.5 years post cancer diagnosis), most had commercial health insurance (92%) and experiencing musculoskeletal pain (98%). Twenty-seven percent were receiving antidepressants and 3% completed ≥ 2 long-term prescription fills of opioids. Prevalence of opioid usage reduced from 29 to 19% (P < 0.001) and NSAID usage reduced from 21 to 14% (P = 0.001) post-acupuncture. The relative prevalence of opioid and NSAID use decreased by 20% (P < 0.05) and 19% (P = 0.07), respectively, in the acupuncture-treated group compared to non-treated patients (n = 16,129). However, the reductions were not statistically significant after adjustment for confounding. Patients receiving acupuncture for pain (n = 264, 53%) were found with a relative decrease by 47% and 49% (both P < 0.05) in short-term opioid and NSAID fills compared to those treated for other conditions. High-utilization patients (≥ 10 acupuncture sessions, n = 178, 36%) were observed with a significant reduction in total healthcare costs (P < 0.001) unlike low-utilization patients.ConclusionsAlthough adjusted results did not show that patients receiving acupuncture had better outcomes than non-treated patients, exploratory analyses revealed that patients treated specifically for pain used fewer analgesics and those with high acupuncture utilization incurred lower healthcare costs. Further studies are required to examine acupuncture effectiveness in real-world settings.

The impact of social restrictions on the incidence and microbiology of severe acute tonsillitis.

We aimed to explore the impact of social distancing on the incidence, severity and microbiology of patients with acute tonsillitis (AT). In this single-centre study, we retrospectively included all patients with AT referred to the Ear-Nose-Throat Department, Aarhus University Hospital, Denmark, in the two years preceding versus the two years after the COVID-19 lockdown in Denmark (11 March 2020). In total, 425 patients were included. The incidence of AT was significantly lower in the post-lockdown period (n = 128) than in the pre-lockdown period (n = 297) (p less-than 0.001). Reduced incidence was observed across all age groups. No significant differences were found in patient characteristics between periods. The proportion of hospitalised patients was significantly lower in the post- than in the pre-lockdown period (36% versus 25%, p = 0.032). Prevalent culture findings were Streptococcus pyogenes (15%), S. anginosus group (11%) and Fusobacterium necrophorum (5%). No statistically significant differences in the relative prevalence of individual bacteria were found between periods. The incidence of patients with AT referred to hospital decreased by 57% in the two-year period after the COVID-19 lockdown compared with the period leading up to the lockdown. Our findings suggest that this decrease mirrored a general decline in AT incidence rather than altered referral patterns. None. The study was approved by the Danish Data Protection Agency (#1-16-02-134-23) and the Danish Patient Safety Authority (#1-45-70-41-23).

Pathophysiology and Treatment of Prediabetes and Type 2 Diabetes in Youth.

Youth-onset type 2 diabetes is a heterogeneous disease with increasing prevalence in relation to increased rates of obesity in children. It has genetic, epigenetic, social, and environmental determinants. Youth-onset type 2 diabetes is alarming given a rapidly progressive course compared with the course of adult-onset disease, early-onset vascular complications, and long-term exposure to hyperglycemia and associated complications. It is often preceded by "prediabetes," a disease phase where defects in β-cell function relative to insulin sensitivity emerge. Herein, we review the current understanding of the pathophysiology of prediabetes and type 2 diabetes in youth. We describe the mechanisms underlying insulin resistance, the precipitous decline of β-cell function, and the role of other hormonal abnormalities in the pathogenesis of the disease. We discuss the critical importance of social determinants of health in the predisposition and progression of these conditions and present current management strategies and the advances in therapeutic approaches. These must adapt to meet the unique needs of the individual patient and family. Significant knowledge gaps remain that need to be addressed in future research.

Assessing the global prevalence of wild birds in trade.

Trade represents a significant threat to many wild species and is often clandestine and poorly monitored. Information on which species are most prevalent in trade and potentially threatened by it therefore remains fragmentary. We used 7 global data sets on birds in trade to identify species or groups of species at particular risk and assessed the extent to which they were congruent in terms of the species recorded in trade. We used the frequency with which species were recorded in the data sets as the basis for a trade prevalence score that was applied to all bird species globally. Literature searches and questionnaire surveys were used to develop a list of species known to be heavily traded to validate the trade prevalence score. The score was modeled to identify significant predictors of trade. Although the data sets sampled different parts of the broad trade spectrum, congruence among them was statistically strong in all comparisons. Furthermore, the frequency with which species were recorded within data sets was positively correlated with their occurrence across data sets, indicating that the trade prevalence score captured information on trade volume. The trade prevalence score discriminated well between species identified from semi-independent assessments as heavily or unsustainably traded and all other species. Globally, 45.1% of all bird species and 36.7% of globally threatened bird species had trade prevalence scores ≥1. Species listed in Appendices I or II of CITES, species with large geographical distributions, and nonpasserines tended to have high trade prevalence scores. Speciose orders with high mean trade prevalence scores included Falconiformes, Psittaciformes, Accipitriformes, Anseriformes, Bucerotiformes, and Strigiformes. Despite their low mean prevalence score, Passeriformes accounted for the highest overall number of traded species of any order but had low representation in CITES appendices. Geographical hotspots where large numbers of traded species co-occur differed among passerines (Southeast Asia and Eurasia) and nonpasserines (central South America, sub-Saharan Africa, and India). This first attempt to quantify and map the relative prevalence in trade of all bird species globally can be used to identify species and groups of species that may be at particular risk of harm from trade and can inform conservation and policy interventions to reduce its adverse impacts.

Preoperative Atelectasis in Patients with Obesity Undergoing Bariatric Surgery: A Cross-Sectional Study.

Pulmonary atelectasis is present even before surgery in patients with obesity. We aimed to estimate the prevalence and extension of preoperative atelectasis in patients with obesity undergoing bariatric surgery and to determine if variation in preoperative Spo2 values in the seated position at room air is explained by the extent of atelectasis coverage in the supine position. This was a cross-sectional study in a single center specialized in laparoscopic bariatric surgery. Preoperative chest computed tomographies were reassessed by a senior radiologist to quantify the extent of atelectasis coverage as a percentage of total lung volume. Patients were classified as having atelectasis when the affection was ≥2.5%, to estimate the prevalence of atelectasis. Crude and adjusted prevalence ratios (aPRs) and odds ratios (aORs) were obtained to assess the relative prevalence of atelectasis and percentage coverage, respectively, with increasing obesity category. Inverse probability weighting was used to assess the total, direct (not mediated), and indirect (mediated through atelectasis) effects of body mass index (BMI) on preoperative Spo2, and to quantify the magnitude of mediation (proportion mediated). E-values were calculated, to represent the minimum magnitude of association that an unmeasured confounder with the same directionality of the effect should have to drive the observed point estimates or lower confidence intervals (CIs) to 1, respectively. In 236 patients with a median BMI of 40.3 kg/m2 (interquartile range [IQR], 34.6-46.0, range: 30.0-77.3), the overall prevalence of atelectasis was 32.6% (95% CI, 27.0-38.9) and by BMI category: 30 to 35 kg/m2, 12.7% (95% CI, 6.1-24.4); 35 to 40 kg/m2, 28.3% (95% CI, 17.2-42.6); 40 to 45 kg/m2, 12.3% (95% CI, 5.5-24.3); 45 to 50 kg/m2, 48.4% (95% CI, 30.6-66.6); and ≥50 units, 100% (95% CI, 86.7-100). Compared to the 30 to 35 kg/m2 group, only the categories with BMI ≥45 kg/m2 had significantly higher relative prevalence of atelectasis-45 to 50 kg/m2, aPR = 3.52 (95% CI, 1.63-7.61, E-value lower bound: 2.64) and ≥50 kg/m2, aPR = 8.0 (95% CI, 4.22-15.2, E-value lower bound: 7.91)-and higher odds of greater atelectasis percentage coverage: 45-50 kg/m2, aOR = 7.5 (95% CI, 2.7-20.9) and ≥50 kg/m2, aOR = 91.5 (95% CI, 30.0-279.3). Atelectasis percent alone explained 70.2% of the variation in preoperative Spo2. The proportion of the effect of BMI on preoperative Spo2 values <96% mediated through atelectasis was 81.5% (95% CI, 56.0-100). The prevalence and extension of atelectasis increased with higher BMI, being significantly higher at BMI ≥45 kg/m2. Preoperative atelectasis mediated the effect of BMI on Spo2 at room air in the seated position.

Adult rat ultrasonic vocalizations and reward: Effects of propranolol and repeated cocaine administration.

Mechanisms underlying psychostimulant euphoria remain poorly understood. In adult rats, positive emotional states are associated with alterations in 50-kHz ultrasonic vocalizations (USVs): specifically, "trill" calls are promoted over "flat" calls. Here, we investigated the effects of acute and repeated cocaine administration, and-based on previous findings with amphetamine-their possible dependence on beta-adrenergic receptors. Adult male Long-Evans rats received intraperitoneal drug or saline injections before daily USV recording. Fourteen 50-kHz call subtypes were analyzed. In Experiments 1 and 2, cocaine (1-10 mg/kg) and propranolol (10 mg/kg) were tested alone. In Experiment 3, propranolol/cocaine interactions were sought within a conditioned place preference (CPP) procedure. Experiment 4 investigated acute and chronic cocaine effects (Phase 1), and propranolol/cocaine interactions either in an open field (Phase 2) or within a CPP procedure (Phase 3). In drug-naïve animals, cocaine increased the 50-kHz call rate, with sensitization developing rapidly. After more extended exposure, cocaine now also increased the relative prevalence of trill versus flat calls; effects on other subtypes were also revealed. The beta-blocker propranolol prevented neither cocaine CPP nor cocaine effects on USV emission or locomotion but exerted significant USV-related effects when given alone. CPP magnitude and USV-related measures were uncorrelated. With long-term intraperitoneal administration, cocaine can alter the relative prevalence of several 50-kHz call subtypes; its ability to promote trill versus flat calls, in particular, is consistent with a positive affect interpretation. Cocaine's behavioral effects (i.e., USV-related, locomotor, CPP) appear independent of beta-adrenergic receptor activity.