OBJECTIVE: This study aims to evaluate the burden, demographic profile, clinical characteristics, and management of retinoblastoma (RB) cases at a tertiary care center.
METHODS: This was a hospital-based study conducted in a tertiary care center in the Department of Ophthalmology from January 2018 to December 2022. All referred and newly diagnosed cases of RB coming to the outpatient department were included in the study after obtaining written informed consent from parents or guardians. Data collected were analyzed in terms of demographic profile, socioeconomic status, and clinical characteristics of the disease at the time of presentation and its treatment.
RESULTS: Out of 155,671 new patients seen in the outpatient eye department during the study period, 118 eyes of 94 patients were diagnosed with RB. The burden of disease was found to be 60.4 cases per 100,000 patients. Malignancy was unilateral in 74.47% and bilateral in 25.53% of cases. The male-to-female ratio was 1.7:1. The mean age at presentation was 30.86±19.5 months. A family history of RB was seen in 4.26% of cases. Of the patients, 80.85% belonged to upper-lower socioeconomic status. Most of the cases presented to us at an advanced stage of the disease (i.e., groups E and D).
CONCLUSIONS: Most of our cases present at an advanced stage of RB, resulting in poor outcomes and survival rates. It is necessary to organize awareness campaigns about the fatal nature of the disease so it can be diagnosed early, leading to better visual and survival outcomes.

The article presents a comparative analysis of the process of population aging in the context of demographic and professional risks of depopulation among working population in Russia. The values of the main medical and demographic indicators of population aging for Russia and developed countries were given. The results of UN forecasts, probabilistic forecasts of the total number and some characteristics of the age-sex structure for the population of the Russian Federation were analyzed. The state of demographic disadvantage in Russia and in the world was convincingly shown. Particular attention was paid to the consideration of the demographic risks of a reduction in the working-age population and an increase in the burden on the working-age population. The need for further research on the use of geroprotectors and modern gerontotechnologies as means and methods for preventing premature decline in work ability, slowing down the aging process of workers, reducing the mortality rate among working population and increasing professional longevity has been proven.
В статье представлен сравнительный анализ процесса старения населения в контексте демографических и профессиональных рисков депопуляции работающего населения в России. Приведены основные медико-демографические показатели старения населения для России и развитых стран. Проанализированы результаты прогнозов ООН, вероятностных прогнозов общей численности и ряда характеристик структуры по возрасту и полу для населения РФ. Убедительно показано состояние демографического неблагополучия в России и мире. Особое внимание уделено рассмотрению демографических рисков сокращения численности населения в рабочих возрастах, увеличению нагрузки на трудоспособное население. Доказана необходимость дальнейших исследований, посвященных использованию геропротекторов и современных геронтотехнологий в качестве средств и методов профилактики преждевременного снижения профессиональной работоспособности, замедления процессов старения организма работающих, снижения уровня смертности трудоспособного населения и увеличения профессионального долголетия.

Declines in body size can be an advantageous physiological response to warming temperatures, or a result of physiological and nutritional stress. Either way, studies often assume that these climate-induced trait changes have important implications for fitness and demography. We leveraged almost three decades of capture-mark-recapture data of 51 bird species in Panama to examine if body size has changed through time, how sensitive body size is to changes in weather, and if body size impacts population demography. We evaluated two metrics of body size, structural size (wing length), and body condition (residual body mass). Over the study, wing length changed in varying directions for 88% of species (23 decrease, 22 increase), but the effects were weak, and change was only significant for two species. Conversely, body condition declined for 88% of species (45), effects were stronger, and that change was significant for 22% of species (11). This suggests that nutritional stress is likely the cause of changes in body size, not an adaptive response to warming. Precipitation metrics impacted body condition across three of our four feeding guilds, while wing length was only impacted by weather metrics for two guilds. This suggests that body condition is more sensitive to change in weather metrics compared to wing length. Lastly, we found that the impact of changes in body size on survival and recruitment was variable across species, but these relationships were in the opposite direction, ultimately resulting in no change in population growth for all but one species. Thus, while different stages (adult survival and recruitment) of populations may be impacted by body size, populations appear to be buffered from changes. The lack of an effect on population growth rate suggests that populations may be more resilient to changes in body size, with implications for population persistence under expected climate change.

Understanding how life history shapes genetic diversity is a fundamental issue in evolutionary biology, with important consequences for conservation. However, we still have an incomplete picture of the impact of life history on genome-wide patterns of diversity, especially in long-lived semelparous plants. Puya raimondii is a high-altitude semelparous species from the Andes that flowers at 40-100 years of age. We sequenced the whole genome and estimated the nucleotide diversity of 200 individuals sampled from nine populations. Coalescent-based approaches were then used to infer past population dynamics. Finally, these results were compared with results obtained for the iteroparous species, Puya macrura. The nine populations of P. raimondii were highly divergent, highly inbred, and carried an exceptionally high genetic load. They are genetically depauperate, although, locally in the genome, balancing selection contributed to the maintenance of genetic polymorphism. While both P. raimondii and P. macrura went through a severe bottleneck during the Pleistocene, P. raimondii did not recover from it and continuously declined, while P. macrura managed to bounce back. Our results demonstrate the importance of life history, in particular generation time and reproductive strategy, in affecting population dynamics and genomic variation, and illustrate the genetic fragility of long-lived semelparous plants.

A secondary data analysis of the 2022 Philippine National Demographic and Health Survey (PNDHS) was conducted to explore the underlying structure of knowledge regarding communicable and noncommunicable diseases using multilevel confirmatory factor analysis (CFA). The PNDHS data consist of two levels: level-1 represents within-household data (household questionnaire), and level-2 represents between-household data (primary sampling unit (PSU)). Therefore, a two-level CFA and two-level variance CFA were performed. Furthermore, a multigroup analysis assessed the structural differences between males/females and urban/rural groups. In the PNDHS survey, 30,372 household interviews were completed. Knowledge levels for cancer, heart disease, diabetes, dengue fever, TB, and COVID-19 were 96.7%, 94.9%, 97.8%, 98.4%, 96.7%, and 92.8%, respectively. The two-level CFA indicated that the coefficient loadings of each item for both levels were statistically significant (Z-test, P < 0.001). Regarding two-level variance CFA, the variance at level-1 was higher than that at level-2 (13 and 6.7, respectively). The multigroup analysis revealed that the model was non-invariant (not equal) across gender and residence (likelihood ratio test; P < 0.001, P < 0.001, respectively). In conclusion, level-1 has greater effect than does level-2 because the variance in level-1 is greater than that in level-2, the knowledge of COVID-19 has the lowest loading compared to other items, and rural/urban areas and females/males exhibit different levels of health knowledge.

UNASSIGNED: The under-representativeness of participants in clinical trials limits the generalisability of results. This review evaluates the representative-ness within pharmaceutical randomised controlled trials (RCTs) in Singapore.
UNASSIGNED: Four bibliographic databases were searched for papers on pharmaceutical RCTs which included Singapore adults (≥18 years old), published between 2017 and 2022. The demographic characteristics of study participants were compared against the population in the 2020 Singapore census. Recruitment strategies and authors\' comments on the generalisa-bility of their findings were reviewed.
UNASSIGNED: Thirty-three publications were included (19 Singapore-only studies and 14 multiregional trials which included Singapore). Where data were available, we found that females and Indians were under-represented compared to the census (41.3% versus [vs] 51.1%, P<0.05; 7.3% vs 9.0%, P<0.05). Ethnic diversity varied between individual studies, and almost half (46.2%) of Singapore-only studies achieved census levels. However, more than one-third of the trials provided no data (31.6%) or partial data (5.3%) on ethnicity. Half of the multiregional publications stated the number of participants recruited from Singapore, but only 1 reported any detail beyond Asian participants. Recruitment strategies were mentioned in fewer than half (42.4%), and less than a quarter (24.2%) commented on sample representative-ness or the external validity of the evidence generated.
UNASSIGNED: There is room for improvement regarding the recruitment of RCT participants in Singapore, with particular attention to female gender and Indian ethnicity. Demographic data should also be presented in full. RCTs should be designed and reported such that clinicians can ascertain the generalisability to the Singapore population and the potential benefits from the studied interventions in clinical practice.

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Cats (Felidae) have become an integral part of many households. However, our understanding of the full spectrum of pathogens affecting cats (referred to as the infectome) is limited, mainly due to the inadequacy of commonly used diagnostic tools in capturing the complete diversity of potential pathogens and the prevalence of pathogen co-infections. In this study, we employed a meta-transcriptomic approach to simultaneously characterize the infectome contributing to different disease syndromes and to investigate spatial, demographic, and ecological factors influencing pathogen diversity and community composition in a cohort of 27 hospitalized cats and seven stray cats. We identified 15 species of pathogens, with Candidatus Rickettsia tarasevichiae and Tritrichomonas foetus representing potential spillover risks. Importantly, although most cases of ascites hyperplasia were explained by coinfection with multiple pathogens, we identified the potential novel clinical outcomes of M. aubagnense infection among cats. We demonstrated that the increase in infectome diversity can be explained by a variety of predictors including age growth, temperature increase, and a higher proportion of females, with age growth presenting the strongest effect. Fine-scale analysis indicated that a higher diversity of infectomes were harbored in young cats rather than adult ones. Our results demonstrated that most feline diseases are better explained by the presence of virus-bacteria or virus-virus coinfection. This study serves as a timely endorsement for clinical diagnosis by vets to consider the cause of a disease based on a panel of cryptical co-infecting pathogens rather than on individual infectious agents.
OBJECTIVE: Frequent studies reported the risks of cats as an intermediate host of zoonotic pathogens (e.g., SARS-CoV-2). Cats have a physically close interaction with their owners through activities like petting, kissing, and being licked on the cheek and hands. However, there are still limited studies that systematically investigate the infectome structure of cats. In this study, we employed a meta-transcriptomics approach to characterize 15 species of pathogens in cats, with Candidatus Rickettsia tarasevichiae first characterizing infection in diseased cats. Most feline diseases were better explained by the presence of virus-bacteria or virus-virus coinfection. The increase in infectome diversity could be influenced by a variety of predictors including age growth, temperature increase, and a higher proportion of females. A higher diversity of pathogens was harbored in young cats rather than adults. Importantly, we showed the value of linking the modern influx of meta-transcriptomics with comparative ecology and demography and of utilizing it to affirm that ecological and demographic variations impact the total infectome.

OBJECTIVE: Catatonia is a neuropsychiatric disorder that can occur in patients of any age, but it is uncertain whether patient demographics or underlying diagnoses differ between pediatric and adult patients. This study investigates patients of all ages diagnosed with catatonia during acute care hospitalizations in the United States over a 5-year period.
METHODS: The National Inpatient Sample, an all-payors database of acute care hospital discharges, was queried for patients with a discharge diagnosis of catatonia between 2016 and 2020 with patients stratified by age as pediatric (≤18 years) or adult (>18 years).
RESULTS: Among 174,776,205 hospitalizations recorded in the NIS from 2016 to 2020, 61,990 (95% CI: 60,257 to 63,723; 0.035%) involved a diagnosis of catatonia. Of these, 3255 were for pediatric patients and 58,735 were for adult patients. Compared with adult patients, pediatric catatonia patients were more likely to be male and non-White. Diagnostically, psychotic disorders, encephalitis, and neurodevelopmental disorders were more common primary discharge diagnoses in pediatric patients, while adult patients more frequently were diagnosed with mood disorders. Length of stay was not significantly different between pediatric and adult catatonia hospitalizations. Physical restraints were commonly applied for patients with catatonia.
CONCLUSIONS: Pediatric and adult catatonia patients differed in sex, race, and diagnosis, although hospital length of stay was not different between pediatric and adult catatonia hospitalizations. These results may inform catatonia diagnosis in the hospital setting and point to disparities that could be targets of quality improvement efforts.

The healthcare system in Germany is characterized by a comprehensive local patient care. Nevertheless, due to the increasing lack of medical personnel bottlenecks are impending, which are not only of a temporary nature. The increasing demography-related needs for care, insufficient healthcare competence of many people and the inadequate prevention will strengthen the demand for medical and nursing personnel. At the same time, physicians and nursing personnel from the high birth rate baby boomer years are leaving the healthcare system. This age cohort must now be replaced by a younger workforce; however, in Germany too few physicians are being trained when measured against the requirements. A marked increase in the number of university study places in medicine will not be able to alleviate the deficit in the short term but prospectively there is no way past an expansion of capacities. The decline in panel physicians, especially in general practitioner care, is accompanied by a clear increase of employees in the outpatient sector. The desire for reduced working hours is clearly recognizable throughout all age cohorts. The part-time quota is increasing. The discrepancy between desired and actual working times is largely underestimated. The increased part-time quota already shows that something must fundamentally change to be able to provide sufficient medical manpower and working hours for the treatment of patients. The association between increased part-time quota and dissatisfaction with the working situation in hospitals is obvious and has repercussions for the medical care. In a multifactorial process the causes and sequelae of bottlenecks in skilled personnel are mutually strengthened in a negative spiral. In the short term, the deficit in medical personnel can only be counteracted by a better cooperation between the outpatient and inpatient fields of care and by a massive reduction in bureaucracy. The digitalization can without doubt contribute to the relief of the healthcare system. Telemedical applications can improve the treatment in rural and structurally weak regions.
UNASSIGNED: Das Gesundheitswesen in Deutschland zeichnet sich durch eine flächendeckende, wohnortnahe Patientenversorgung aus. Gleichwohl drohen durch den zunehmenden Fachkräftemangel Engpässe, die nicht nur vorübergehender Natur sind. Der demografiebedingt zunehmende Versorgungsbedarf, unzureichende Gesundheitskompetenz vieler Menschen und die mangelnde Prävention werden die Nachfrage nach medizinischen und pflegerischen Fachkräften deutlich verstärken. Gleichzeitig verlassen Ärztinnen und Ärzte sowie Pflegepersonal aus den geburtenstarken Babyboomer-Jahrgängen das Gesundheitswesen. Diese Alterskohorte muss nunmehr durch jüngere Arbeitskräfte ersetzt werden. In Deutschland werden jedoch gemessen am Bedarf zu wenige Ärztinnen und Ärzte ausgebildet. Ein deutlicher Ausbau der Medizinstudienplätzen wird den Mangel kurzfristig nicht lindern können, perspektivisch führt aber kein Weg an einer Kapazitätsausweitung vorbei. Der Rückgang an Vertragsärztinnen und -ärzten, insbesondere in der hausärztlichen Versorgung, geht einher mit einem deutlichen Anstieg von Angestellten im ambulanten Bereich. Über alle Alterskohorten hinweg ist der Wunsch nach geringeren Arbeitszeiten erkennbar. Die Teilzeitquote steigt. Die Diskrepanz zwischen gewünschten und tatsächlichen Arbeitszeiten wird weithin unterschätzt. Dabei zeigt schon die gestiegene Teilzeitquote, dass sich etwas grundlegend ändern muss, um in den kommenden Jahren ausreichend ärztliche Arbeitskraft und Arbeitszeit für die Versorgung der Patientinnen und Patienten bereitstellen zu können. Der Zusammenhang zwischen gestiegener Teilzeitquote und Unzufriedenheit mit der Arbeitssituation in den Kliniken ist evident und hat Auswirkungen auf die ärztliche Versorgung. In einem multifaktoriellen Geschehen verstärken sich Ursachen und Folgen von Fachkräfteengpässen in einer Negativspirale. Kurzfristig wird dem Mangel an medizinischem Fachpersonal nur durch eine bessere Zusammenarbeit zwischen ambulantem und stationärem Versorgungsbereich und durch eine massive Entbürokratisierung begegnet werden können. Zweifellos kann die Digitalisierung des Gesundheitswesens zur Entlastung beitragen. Telemedizinische Anwendungen können die Versorgung in ländlichen und strukturschwachen Regionen verbessern.