Ecological Studies Research Articles

Results from a multi-laboratory ocean metaproteomic intercomparison: effects of LC-MS acquisition and data analysis procedures

Abstract. Metaproteomics is an increasingly popular methodology that provides information regarding the metabolic functions of specific microbial taxa and has potential for contributing to ocean ecology and biogeochemical studies. A blinded multi-laboratory intercomparison was conducted to assess comparability and reproducibility of taxonomic and functional results and their sensitivity to methodological variables. Euphotic zone samples from the Bermuda Atlantic Time-series Study (BATS) in the North Atlantic Ocean collected by in situ pumps and the autonomous underwater vehicle (AUV) Clio were distributed with a paired metagenome, and one-dimensional (1D) liquid chromatographic data-dependent acquisition mass spectrometry analysis was stipulated. Analysis of mass spectra from seven laboratories through a common bioinformatic pipeline identified a shared set of 1056 proteins from 1395 shared peptide constituents. Quantitative analyses showed good reproducibility: pairwise regressions of spectral counts between laboratories yielded R2 values averaged 0.62±0.11, and a Sørensen similarity analysis of the top 1000 proteins revealed 70 %–80 % similarity between laboratory groups. Taxonomic and functional assignments showed good coherence between technical replicates and different laboratories. A bioinformatic intercomparison study, involving 10 laboratories using eight software packages, successfully identified thousands of peptides within the complex metaproteomic datasets, demonstrating the utility of these software tools for ocean metaproteomic research. Lessons learned and potential improvements in methods were described. Future efforts could examine reproducibility in deeper metaproteomes, examine accuracy in targeted absolute quantitation analyses, and develop standards for data output formats to improve data interoperability. Together, these results demonstrate the reproducibility of metaproteomic analyses and their suitability for microbial oceanography research, including integration into global-scale ocean surveys and ocean biogeochemical models.

Quantifying the Strain: A Global Burden of Disease (GBD) Perspective on Musculoskeletal Disorders in the United States Over Three Decades: 1990–2019

Background: Musculoskeletal (MSK) disorders significantly contribute to global disability, especially in high-income countries. Yet, comprehensive studies on their epidemiological burden in the United States (US) are limited. Our study aims to fill this gap by characterizing the MSK disease burden in the US using Global Burden of Disease (GBD) data from 1990 to 2019. Methods: We conducted an ecological study using descriptive statistical analyses to examine age-standardized prevalence and disability-adjusted life years (DALY) rates of MSK disorders across different demographics and states. The study also assessed the impact of risk factors segmented by age and sex. Results: From 1990 to 2019, the burden of MSK disorders in the US increased significantly. Low back pain was the most prevalent condition. Age-standardized prevalence and DALY rates increased by 6.7% and 17.6%, respectively. Gout and other MSK disorders saw the most significant rise in DALY rates. Females experienced higher rates than males, and there were notable geographic disparities, with the District of Columbia having the lowest and North Dakota and Iowa the highest DALY rates. Smoking, high BMI, and occupational risks emerged as primary risk factors. Conclusions: Our study highlights the escalating burden of MSK disorders in the US, revealing significant geographic and sex disparities. These findings highlight the urgent need for targeted health interventions, policy formulation, and public health initiatives focusing on lifestyle and workplace modifications. Region- and sex-specific strategies are crucial in effectively managing MSK conditions, considering the influence of various risk factors.

ECOLINGUISTIC REVIEW OF THE INTERNET LINGUOCYNICISMS

The purpose. The purpose of the article is to study of the impact of Internet communication on the language behaviour of users, the identification of specific linguistic changes and their shades in this environment, as well as the analyse the ecological consequences of these phenomena. Methodology. The research is based on the use of the ecolinguistic approach, which combines the methods of linguistics, ecology and cultural studies. Methods of analysis include descriptive analysis of language means, content analysis of Internet resources, as well as observation of the language practice of users. The use of a multi-method approach allows readers to get a comprehensive picture of the phenomenon of linguistics on the Internet. Methods such as analysis and synthesis of literature on the research problem, web scraping, analysis of social networks, discourse and content analysis were also used in the research. Scientific novelty. The article reveals a new aspect of language learning in the context of the modern digital environment. The study reveals unique linguistic features that occur online, such as language abbreviations, the use of emojis, and other forms of non-standard communication. The impact of these phenomena on language culture and ways of expressing thoughts and feelings is analyzed. The article analyzes for the first time the interaction between language practice in the online environment and the natural environment, highlighting the impact of the Internet language on the language ecosystem and cultural landscape in general. Changes in the presentation of language units to the public can be clearly traced through the ecolinguistic prism. In addition, language clogging is traced and ways to overcome linguocynicisms are provided. Conclusions. The results of the study indicate that the Internet significantly affects the evolution of language, creating new linguistic realities and changing the ways of communication. Awareness of these changes is important for the further development of linguistics and society as a whole. Investigating the ecolinguistic aspects of Internet linguocynicisms can be an important contribution to understanding the interaction between language, culture, and technology.

How Much Hatchery-Reared Brown Trout Move in a Large, Deep Subalpine Lake? An Acoustic Telemetry Study

Fish movement into large, deep lakes has been rarely investigated due to the complexity and extent of such ecosystems. Among the different monitoring methods available, acoustic telemetry enables the study of the spatial ecology and behavior of aquatic organisms in lentic environments. In this study, the movement of 69 hatchery-reared adult brown trout (size 43–61 cm) marked with acoustic transmitters was monitored in the large and deep subalpine Lake Lugano (Switzerland and Italy). Trout were tracked for six consecutive months by seven acoustic receivers (March–August 2022), positioned in a non-overlapping array. Trout movement was reconstructed using R packages specific for acoustic telemetry (actel and RSP), which also allowed us to translate tracking information into utilization distribution (UD) areas for each fish. The effects of different environmental variables (rainfall, water discharge of the two main tributaries of Lake Lugano, atmospheric pressure, cloud coverage, and moon phases) on trout movement were tested, but none of these variables seemed to significantly correlate with fish movement. After release, most of the tagged fish exhibited reiterative movements during the initial month, with some maintaining this behavior throughout the entire study period. This spatial behavior can be particularly evident in hatchery-reared fish due to their aggressive and bold attitude. The association of these behavioral traits, shaped by domestication, could expose hatchery-reared fish to high risks and post-release mortality in the wild. Indeed, within a few months after the release, most of the tagged fish were no longer detected by the acoustic receivers. In addition, 26% of the total tagged fish were caught by recreational or professional fishermen.

Firearm Availability Reduces the Stability of Suicidal Ideation: Results from an Ecological Momentary Assessment Study

Firearm availability is correlated with increased risk of suicide but its link with suicidal ideation remains unclear. Previous studies are limited by retrospective reports and prospective designs with lengthy gaps between assessments that are ill-suited for measuring fluctuations in suicidal ideation. This study used ecological momentary assessment (EMA) to repeatedly assess suicidal ideation in a sample of 138 U.S. adults (81 handgun owners, 57 non-owners). Participants received six EMA prompts per day for 28 consecutive days. Results revealed no group differences in the frequency, maximum amplitude, or variability of suicidal ideation across male and female handgun owners and non-owners. Stability of suicidal ideation significantly differed across groups, however (F(1,132) = 4.5, p = 0.036); male handgun owners had the strongest stability and male non-owners had the weakest stability. Stability of suicidal ideation was significantly lower when participants reported a firearm was nearby as compared to when no firearm was nearby (F(4,17732) = 5.6, p < 0.001). Results suggest firearm availability increases reactivity to the environment, slows recovery from acutely elevated risk states, and may increase vulnerability to sudden shifts to higher risk states characterized by increased probability of suicidal behavior. Although these effects were observed in both handgun owners and non-owners, they disproportionately impact handgun owners because they report being near firearms more often.

Residual extropy in ranked set sampling: Properties, comparative analysis, and estimation

Ranked set sampling (RSS) has gained significant significance in numerous practical domains, such as environmental and ecological studies, and statistical genetics. This article focuses on investigating the concept of extropy as a measure of residual uncertainty in RSS. It is devoted to discussing various monotone properties and characterization results associated with the residual extropy of RSS. Additionally, a comparative analysis is conducted between the residual extropy of RSS and its counterpart in simple random sampling. Optimal minima and maxima values for the residual extropy of RSS are determined. To further contribute to the field, a consistent estimator for the residual extropy of RSS is proposed. The effectiveness of this estimator is demonstrated through three illustrative examples, highlighting its performance in practical scenarios.

Studying bats using a One Health lens: bridging the gap between bat virology and disease ecology.

Accumulating data suggest that some bat species host emerging viruses that are highly pathogenic in humans and agricultural animals. Laboratory-based studies have highlighted important adaptations in bat immune systems that allow them to better tolerate viral infections compared to humans. Simultaneously, ecological studies have discovered critical extrinsic factors, such as nutritional stress, that correlate with virus shedding in wild-caught bats. Despite some progress in independently understanding the role of bats as reservoirs of emerging viruses, there remains a significant gap in the molecular understanding of factors that drive virus spillover from bats. Driven by a collective goal of bridging the gap between the fields of bat virology, immunology, and disease ecology, we hosted a satellite symposium at the 2024 American Society for Virology meeting. Bringing together virologists, immunologists, and disease ecologists, we discussed the intrinsic and extrinsic factors such as virus receptor engagement, adaptive immunity, and virus ecology that influence spillover from bat hosts. This article summarizes the topics discussed during the symposium and emphasizes the need for interdisciplinary collaborations and resource sharing.

The negative impact of the COVID-19 pandemic on breast cancer care in Brazil: a time series study in regions with different human development indices

BackgroundThe impact of the COVID-19 pandemic on breast cancer care across Brazilian regions with varying Human Development Index (HDI) levels remains unclear. This study evaluates the pandemic’s effects on screening mammograms, tumor staging at diagnosis, and treatment initiation in the Brazilian Public Health System between 2017 and 2022, focusing on regions with different HDI levels.MethodsThis ecological time series study uses an inflection point regression model and monthly percentage change (MPC) to analyze an open-access Brazilian Public Healthcare System dataset. The study focuses on trends and variations in these variables among women aged 50–69 in three state groups classified by HDI: Group A (very high), Group B (medium), and Group C (high).ResultsThe average monthly rate of screening mammograms was highest in Group A (10.70) and lowest in Group B (8.38). At the onset of the COVID-19 pandemic, screening rates dropped significantly, with the most significant decline in Group B (58.6% decrease) and the smallest in Group A (45.7% decrease), lasting for three months. Subsequently, this variable recovered until December 2022 but was insufficient to restore the total series MPC to pre-pandemic levels. Group B had the lowest average rate of early-stage (0-II) diagnoses (2.88), while Group C had the highest (3.68). Early-stage diagnoses declined in the first three months of the pandemic, followed by a partial recovery that was insufficient to restore the pre-pandemic MPC levels. The proportion of advanced-stage diagnoses was highest in Group B (49.02%) and lowest in Group A (45.97%). The pandemic maintained the upward trend of advanced-stage (III-IV) diagnoses across all groups in the total time series. The average proportion of treatments initiated after 60 days of diagnosis was above 60% across all groups, with Group B at 64.50%. This variable began to rise 3 to 4 months after the pandemic and continued increasing until December 2022, with a greater intensity than the pre-pandemic period across all groups.ConclusionThe COVID-19 pandemic reduced breast cancer screening and early diagnosis in Brazil, leading to more advanced cases and treatment delays across all regions, with varying impacts according to regional HDI levels.

Field monitoring of copepodamides using a new application for solid phase adsorption toxin tracking

AbstractChemical signaling is ubiquitous in the marine environment. Plankton rely on chemical signals to find mates, hunt prey, and respond to threats, and these small‐scale interactions can propagate into community‐wide cascades and large‐scale ecological changes. The chemical signaling exchange in the open ocean is poorly understood, and fundamental information about concentrations and spatiotemporal variability is lacking. Passive sampling has been used to monitor a wide range of dissolved chemicals, including anthropogenic pollutants and harmful algal toxins, but it is not generally applied to the study of marine chemical ecology. Here we test the compatibility of two resins commonly used for passive sampling via solid phase adsorption toxin tracking (SPATT), Diaion® HP20 and Sepabeads® SP207, with copepodamides, a group of polar lipid signaling compounds produced by copepods. We developed extraction and analysis methods that align with current SPATT practices for algal toxins and show the first measurements of copepodamides from Monterey Bay in California. In lab trials, mean copepodamide recovery from HP20 resin was approximately 240% greater than SP207. In addition, copepodamides were found to have a mean half‐life of 34 h in seawater. Adsorption to HP20 stabilized dissolved copepodamides, increasing the mean recovery after 168 h from 0.62% in seawater to 65.2% from SPATT. Results suggest that SPATT is a sensitive and effective tool for obtaining integrated copepodamide concentrations, spotlighting a novel method to include information from copepod mesozooplankton in time series and field studies.

Pesticides and prostate cancer incidence and mortality: An environment-wide association study.

Prostate cancer is the most common cancer among men in the United States, yet modifiable risk factors remain elusive. In this study, the authors investigated the potential role of agricultural pesticide exposure in prostate cancer incidence and mortality. For this environment-wide association study (EWAS), linear regression was used to analyze county-level associations between the annual use of 295 distinct pesticides (measured in kg per county) and prostate cancer incidence and mortality rates in the contiguous United States. Data were analyzed in two cohorts: 1997-2001 pesticide use with 2011-2015 outcomes (discovery) and 2002-2006 use with 2016-2020 outcomes (replication). The reported effect sizes highlight how a 1-standard-deviation increase in log-transformed pesticide use (kg per county) corresponds to changes in incidence. Analyses were adjusted for county-level demographics, agricultural data, and multiple testing. Twenty-two pesticides showed consistent, direct associations with prostate cancer incidence across both cohorts. Of these, four pesticides were also associated with prostate cancer mortality. In the replication cohort, each 1-standard-deviation increase in log-transformed pesticide use corresponded to incidence increases per 100,000 individuals (trifluralin, 6.56 [95% confidence interval (CI), 5.04-8.07]; cloransulam-methyl, 6.18 [95% CI, 4.06-8.31]; diflufenzopyr, 3.20 [95% CI, 1.09-5.31]; and thiamethoxam, 2.82 [95% CI, 1.14-4.50]). Limitations included ecological study design, potential unmeasured confounding, and lack of individual-level exposure data. The results of this study suggest a potential link between certain pesticides and increased prostate cancer incidence and mortality. These findings warrant further investigation of these specific pesticides to confirm their role in prostate cancer risk and to develop potential public health interventions.

DNA sequencing reveals higher taxonomic diversity of coralline algae (Corallinales and Hapalidiales, Rhodophyta) in the tropical western North Atlantic that complicates ecological studies

Abstract Understanding of non-geniculate coralline algal (NGCA) diversity, prevalence, and distribution in the tropical western North Atlantic is currently limited by reliance on morphological and anatomical features that are inadequate for species identifications. Reef surveys from two study sites, the Florida Keys (Florida, USA) and Roatán (Honduras), provided prevalence data for the main benthic organisms as well as relative abundance for NGCA genera. NGCA collected during these surveys and from additional sites and depths were identified using DNA sequences from two plastid genes, psbA and rbcL, and two nuclear genes, SSU and LSU, and supported by morphological and anatomical descriptions. Bayesian and Maximum Likelihood phylogenetic analyses, along with species delimitation and genetic distance methods, resolved 11 genera within two orders. Within the Corallinales, the genera Dawsoniolithon, Porolithon and Spongites each had one species, Harveylithon and Lithophyllum had two, Titanoderma three, Hydrolithon four, Neogoniolithon eight, and an unknown genus within the subfamily Neogoniolithoideae had 11 putative species. Within the Hapalidiales, the genera Phymatolithon and Roseolithon each had one species. This study reinforces the inability of morphological and anatomical features to distinguish NGCA species in the tropical western North Atlantic, resulting in substantial underestimations of species richness and diversity.

Reevaluating factors in global Universal Health Coverage implementation pre-COVID-19

BackgroundUniversal Health Coverage (UHC) strives to ensure equitable access to high-quality healthcare services for all. Despite this goal, the COVID-19 pandemic exposed significant healthcare shortages worldwide. This study reevaluates key determinants of UHC implementation on a global scale before the pandemic, offering insights to shape strategies for achieving UHC by 2030 in light of current circumstances. MethodsThis ecological study analyzed data from 178 countries. UHC implementation was assessed using two indicators: Health Service Coverage (HSC) and Financial Protection (FP). Independent variables, including the Human Development Index (HDI), Health Worker Density (HWD), and Governance Effectiveness (GE), were proposed based on the Systemic Rapid Assessment Toolkit (SYSRA) framework. Data from 2000 to 2019 were sourced from open databases. Statistical analysis was performed using R version 4.3.1, with a significance level of p < 0.05. ResultsCountries with higher HDI exhibited significantly better HSC (p < 0.05) and FP (p < 0.05). Furthermore, HDI emerged as the primary contributor to HSC (accuracy = 0.77, Kappa = 0.64), while HSC played a central role in determining FP (accuracy = 0.61, Kappa = 0.21). Governance Effectiveness (GE) also significantly influenced FP in addition to HSC. ConclusionRather than solely focusing on building healthcare infrastructure and expanding the healthcare workforce, balancing progress in both development and governance is a promising approach for countries striving to attain UHC by 2030.

Modular shadowgraph imaging for zooplankton ecological studies in diverse field and mesocosm settings

AbstractVarious iterations of shadowgraph imaging have been used to quantify zooplankton in situ with high spatial resolution. Because these systems can image relatively large volumes of water, they are especially useful for resolving less common meso‐ or macrozooplankton taxa (&lt; 50 ind. m−3), such as larval fishes and gelatinous animals. However, larger volume imagers are typically integrated with heavy towed vehicles and deployed from research vessels, which introduces high costs and limits sampling approaches. Here we demonstrate that versatile configurations of shadowgraph imaging, including modular benchtop, handheld, and towed, compact vehicle systems (along with customizable software), allow for tailoring sampling to a variety of marine and freshwater settings (including mesocosms). These systems encompass a suite of possible architectures, designed for adapting the imaging depth of field, acquisition rates, sensor configuration, and deployment method to fit a wide range of sampling protocols, with high vertical resolution (~ 5 cm) and adequate taxonomic capabilities for &gt; 0.5 mm organisms. The benchtop system facilitates an interactive approach to observe and quantify zooplankton behaviors and optical properties. Video footage from the benchtop system generates thousands of regions of interest min−1 for target organisms with variable orientations and swimming postures. When used in conjunction with in situ imaging, the benchtop system can build large machine learning training libraries targeted toward rare or morphologically diverse zooplankton, which often includes the larval stages of economically valuable taxa. These modular hardware and software components increase affordability and versatility while broadening the scope of scientific questions addressed by plankton imaging systems.

A Study on Future Population Dynamics of Indigenous Earthworm Species in Golaghat District of Assam, India

This study presents a pioneering exploration into the population dynamics of indigenous earthworm species in the Golaghat district of Assam, India, through the lens of mathematical modeling. Recognizing the integral role of earthworms in enhancing soil productivity and ecosystem health, we embarked on a detailed longitudinal analysis spanning from 2018 to 2023 to assess their population trends across different seasons and subdivisions within the district. Utilizing the principles of Mathematical Biology, we employed the Malthus Growth model and the Logistic Growth model to estimate future population trajectories of earthworm species, integrating biological insights with mathematical rigor. Our methodology, combining extensive field data collection with sophisticated mathematical modeling, provides a replicable framework for similar ecological studies. This study contributes to the growing field of Mathematical Biology, offering a novel approach to understanding the complex interactions within ecosystems and the impact of environmental changes on key species. The outcomes offer valuable insights into sustainable agricultural practices and biodiversity conservation in tropical and subtropical regions, emphasizing the critical role of indigenous earthworm species in maintaining soil health and ecosystem services. Our findings reveal significant seasonal variations and highlight the resilience of these species in the face of ecological changes. The models suggest distinct population growth patterns, with the Logistic model providing a more realistic projection considering environmental constraints and resource availability. The bifurcation diagram is drawn for the Logistic map that presents the phenomena inside the chaotic region.

Associations Between Sleep Satisfaction and Physical Activity Rates Among Secondary Medical Areas in Japan: An Ecological Study

Associations Between Sleep Satisfaction and Physical Activity Rates Among Secondary Medical Areas in Japan: An Ecological Study

Linking stomatal size and density to water use efficiency and leaf carbon isotope ratio in juvenile and mature trees.

Water-use efficiency (WUE) is affected by multiple leaf traits, including stomatal morphology. However, the impact of stomatal morphology on WUE across different ontogenetic stages of tree species is not well-documented. Here, we investigated the relationship between stomatal morphology, intrinsic water-use efficiency (iWUE) and leaf carbon isotope ratio (δ13C). We sampled 190 individuals, including juvenile and mature trees belonging to 18 temperate broadleaved tree species and 9 genera. We measured guard cell length (GCL), stomatal density (SD), specific leaf area (SLA), iWUE and bulk leaf δ13C as a proxy for long-term WUE. Leaf δ13C correlated positively with iWUE across species in both juvenile and mature trees, while GCL showed a negative and SD a positive effect on iWUE and leaf δ13C. Within species, however, only GCL was significantly associated with iWUE and leaf δ13C. SLA had a minor negative influence on iWUE and leaf δ13C, but this effect was inconsistent between juvenile and mature trees. We conclude that GCL and SD can be considered functional morphological traits related to the iWUE and leaf δ13C of trees, highlighting their potential for rapid phenotyping approaches in ecological studies.

Analysis of Google users' interests in information about pacifiers: an ecological digital study.

To determine the interests of Google users from different countries about pacifier-related information over time, through a quantitative and qualitative analysis. This infodemiology longitudinal retrospective ecological study investigated pacifier-related computational metadata from 22 countries using Google Trends platform. Initially, Relative Search Volume (RSV) time series data and their respective main queries were collected employing the topic "pacifier - subject" as the search strategy from January 2004 to June 2024, considering all categories. Data were then analyzed through seasonal decomposition to determine the trend, seasonal, and residual components of the collected time series using Python 3 programming libraries in a Google Collaboratory interface. Additionally, Mann-Kendall tests were performed to access the significance level of trends observed from the seasonal decomposition. Finally, the queries were qualitatively evaluated to identify the main subjects related to users' interests. Statistical significance was determined with p values < 0.05. In general, RSV time series curves exhibited upward trends in all analyzed countries over the years, with significance levels demonstrated by the Mann-Kendall tests. Moreover, queries often centered around types of pacifiers, encompassing searches specifically for certain commercial brands. Some searches concerning newborn and baby care were also observed, particularly highlighting breastfeeding practices. Google users have shown an increasing interest in pacifier-related topics. These data can help understand the needs and concerns of parents and caregivers regarding pacifier use, ultimately supporting the development of effective educational strategies.

Meadows or asphalt road – Does momentary affective well-being vary with immediate physical environment? Results from a geographic ecological momentary assessment study in three metropolitan areas in Germany

We investigated the association between the immediate physical environment of individuals and individual fluctuations of momentary affective well-being in everyday life with a focus on medium sized metropolitan areas in Europe representing a typical living environment of a large proportion of the world’s population. The sample comprised 365 individuals (54.8 % female) with participants ranging from 14.08 to 88.27 years of age (M = 43.9, SD = 20.9). In an geographic ecological momentary assessment (GEMA), participants were prompted six times a day on at least 9 days over the course of 3 weeks, covering a total of six weekdays and three weekend days on mobile phones to report their momentary affective well-being. Urban land use categories (forest, water, urban green) were assessed with GPS-localization as environmental variables. Additionally, sunshine, rainfall, whether participants were inside or outside as well as whether they were alone or had company were included into the analyses.We used dynamic structural equation modelling to model the inter- and intraindividual differences as well as fluctuations and assess potential covariates while acknowledging the autoregressive nature of affect.The results showed that on individual level, fluctuations of momentary affective well-being were associated with sunshine, having company and travelling. No significant association emerged for urban green, forest, and water neither within individuals nor between. Methodological as well as conceptual implications are discussed and an interpretation of the present findings are provided.

The negative impact of the COVID-19 pandemic on breast cancer tackle in Brazil’s public and private healthcare system: time series study between 2014 and 2022

BackgroundThe COVID-19 pandemic has overwhelmed the healthcare systems of many countries and negatively impacted the care of other diseases.ObjectiveTo evaluate the trend of screening mammograms, oncological breast surgeries, and breast cancer hospitalizations in Brazil’s public and private healthcare system between 2014 and 2022.MethodThis ecological time series study uses the inflection point regression model and semester percentage change (SPC). We use the open-access dataset of the different healthcare systems in Brazil. We analyzed the trend of the variables in the pre-pandemic and the effect of the pandemic on the total time series.ResultsIn 2020, compared to 2019, the decrease in screening mammograms, oncological breast surgeries, and breast cancer hospitalization was − 41.44%, -23.13%, and − 10.52% (public health system) and − 29.49%, -18.96%, and − 15.35% (private healthcare system). In the public healthcare system, the pandemic has enhanced the decreasing trend of mammograms (SPC − 1.6% before and − 3.4% after), has reverted the stationary trend of oncological breast surgeries to decreasing (SPC − 1.0%), has slowed the increasing trend of breast cancer hospitalization (SPC 1.8% before and 0.9% after). In the private healthcare system, the pandemic has reverted the stationary trend of mammograms to decreasing (SPC − 1.0%), has slowed the increasing trend of breast cancer surgeries (SPC 2.3% before and 0.8% after), has reverted the growing trend of breast cancer hospitalization (SPC 3.9%) to stationary.ConclusionDuring the COVID-19 pandemic, there was an increase in inequalities between healthcare systems, especially in breast cancer screening.

Day-to-day variations and effects of urinary and fecal incontinence among adults with spina bifida: an ecological momentary assessment diary pilot study

BackgroundNo studies have evaluated the day-to-day variations in urinary incontinence (UI) and fecal incontinence (FI) among adults with spina bifida (SB). We aimed to 1) describe variations in UI/FI over 30 days, 2) assess factors associated with the negativity effects of incontinence, and 3) correlate anxiety about incontinence and health-related quality of life (HRQOL) among adults with SB (exploratory). MethodsAdults with SB participated in a larger 30-day smartphone-based ecological momentary assessment (EMA) study of well-being and incontinence. We analyzed baseline demographics, temporal variables (baseline UI/FI, incontinence, and negativity on days prior), and incontinence episode-specific variables (number of daily episodes, incontinence interval, quantity). Urinary and fecal incontinence-related anxiety (UIA/FIA) was measured on a 5-point Likert scale (“How anxious were you because of urine/stool leaks today?”), HRQOL with QUALAS-A (scores range 0-100, 0=lowest HRQOL). Mixed-effects, random intercept ordinal and linear regression was used. ResultsEighty-nine adults participated at a median age of 33 years old (71% female, 53% shunted, 49% community ambulators). Participants contributed 2578 total diary days: 61% were associated with any incontinence (41% UI only, 6% FI only, 13% both). Eighty-two (92%) adults reported UI on a median of 16 days, but experiences varied: 6% had a single episode, while 33% had UI on 28-30 days (Summary Figure). Seventy adults (79%) reported FI on a median of 5 days, less frequently than UI (p<0.001), but experiences varied: 11% had a single FI episode, while 31% had FI on 10 or more days. Fewer participants reported any UIA than FIA (50% vs. 72%, respectively, p<0.001). On multivariate regression, (1) higher UIA was reported by individuals with higher baseline UIA, higher UIA on days prior, multiple daily episodes and higher UI quantity (p<=0.02), while (2) higher FIA was reported by those with lower baseline HRQOL, fewer FI episodes on days prior, higher FIA on days prior, and higher UI quantity (p<=0.02). FIA was correlated with lower end-of-study HRQOL (p=0.03). DiscussionInstances of incontinence are not uniform experiences. Their effects vary with factors beyond the actual episode. This suggests novel potential points of intervention to improving long-term HRQOL among people with incontinence. ConclusionDay-to-day experiences of UI and FI vary among adults with SB across multiple dimensions. Anxiety about incontinence when it occurs varies not only based on individual- and episode-specific characteristics, but also on incontinence in the preceding days. Operationalizing these insights into potential clinical interventions warrants further investigation.