Mediating role of multimorbidity in inequality in mortality: a register study on the Danish population

BackgroundThe social inequality in mortality is due to differential incidence of several disorders and injury types, as well as differential survival. The resulting clustering and possible interaction in disadvantaged groups of several disorders make multimorbidity a potentially important component in the health divide. This study decomposes the effect of education on mortality into a direct effect, a pure indirect effect mediated by multimorbidity and a mediated interaction between education and multimorbidity.MethodsThe study uses the Danish population registers on the total Danish population aged 45–69 years. A multimorbidity index based on all somatic and psychiatric hospital contacts as well as prescribed medicines includes 22 diagnostic groups weighted together by their 5 years mortality risk as weight. The Aalen additive hazard model is used to estimate and decompose the 5 years risk difference in absolute numbers of deaths according to educational status.ResultsMost (69%–79%) of the effect is direct not involving multimorbidity, and the mediated effect is for low educated women 155 per 100 000 of which 87 is an effect of mediated interaction. For low educated men, the mediated effect is 250 per 100 000 of which 93 is mediated interaction.ConclusionMultimorbidity plays an important role in the social inequality in mortality among middle aged in Denmark and mediated interaction represents 5%–17%. As multimorbidity is a growing challenge in specialised health systems, the mediated interaction might be a relevant indicator of inequities in care of multimorbid patients.

Risk factors at five-year survival in grade 3 breast cancer: a retrospective observational study of the New Zealand population

Background Breast cancer is the most common cancer in New Zealand, with approximately 3000 new registrations annually, affecting one in nine women and resulting in more than 600 deaths. This study analyzed data of patients with selected prognostic factors of Nottingham grade 3 tumors over a specified five-year period. The study aimed to identify factors that result in differential survival in the female, New Zealand population. Method This is an observational, retrospective cohort study of prospectively collected data from New Zealand Breast Cancer Register. The selected period of 1st January 2011 to 31st, December 2015 allowed a consistent overlap for a national five-year data of grade 3 breast cancer in New Zealand. Mortality was carried out using univariate Fine-Gray competing risk statistical models. Results This study showed that women in the older age group (> 70 years) had higher five-year mortality risk (HR: 1.7, 95% CI: 0.9–3.0, p = 0.053). Hormonal receptor analysis showed that ER positive, PR negative, and ER negative, PR negative subjects were at increased risk (HR = 3.5, 95% CI 2.3–5.4, p < 0.001) and (HR = 2.6, 95% CI, 1.8–3.9, p < 0.001) respectively. Molecular subtypes Triple Negative Breast Cancer and Luminal B subjects were at increased risk (HR = 3.0, 95% CI, 1.8–4.7, p < 0.001 and (HR = 3.3, 95% CI, 1.7–6.3, p < 0.001) respectively. HER2 enriched subjects were at a higher, but not significant, risk of five-year mortality compared to luminal A (HR = 1.6, 95% CI, 0.8–3.0, p = 0.10). NZ Europeans were at increased risk (HR = 1.7, 95% CI, 0.8–3.2, p = 0.11), with the highest Cumulative Incidence Function CIF, the largest proportion of HER2 enriched and TNBC across ethnicities.; however, Pacific Islanders experienced the highest HER2 CIF. Conclusion The survival rates for grade 3 breast cancer vary across the selected prognostic factors and ethnicity. The results of this study make an initial contribution to the understanding of grade 3 breast cancer in the New Zealand population.

From Molecular Recognition to the “Vehicles” of Evolutionary Complexity: An Informational Approach

Countless informational proposals and models have explored the singular characteristics of biological systems: from the initial choice of information terms in the early days of molecular biology to the current bioinformatic avalanche in this “omic” era. However, this was conducted, most often, within partial, specialized scopes or just metaphorically. In this paper, we attempt a consistent informational discourse, initially based on the molecular recognition paradigm, which addresses the main stages of biological organization in a new way. It considers the interconnection between signaling systems and information flows, between informational architectures and biomolecular codes, between controlled cell cycles and multicellular complexity. It also addresses, in a new way, a central issue: how new evolutionary paths are opened by the cumulated action of multiple variation engines or mutational ‘vehicles’ evolved for the genomic exploration of DNA sequence space. Rather than discussing the possible replacement, extension, or maintenance of traditional neo-Darwinian tenets, a genuine informational approach to evolutionary phenomena is advocated, in which systemic variation in the informational architectures may induce differential survival (self-construction, self-maintenance, and reproduction) of biological agents within their open ended environment.

Evaluation of population frequency for age-dependent multifactorial disorders

Aim. Description of the method to calculate the population incidence of age- and sex-dependent multifactorial diseases. Methods. For the analysis, we used statistical material of psychiatric hospitals in the Kharkiv region for 2016. Calculation of the population frequency was carrying out according to the methodology used in demographic studies. Results. In medical genetics, population frequency is mainly used for prognostic purposes to assess the genetic load of a population or to calculate the probability to inherit a disease. Evaluation of the population frequency of multifactorial disease is complicated by varying age of onset, differential survival, different thresholds of hereditary predisposition for men and women. Prevalence, which is often used instead population frequency, is not a gene pool characteristic and is not useful for genetic analysis and risk assessment. The population frequency, calculated for affective disorders by the proposed method (0.184%), is 1.33 times higher than the prevalence rate (0.138%), that is, a third of cases when using the prevalence turns out to be lost that distorts the derived genetic indicators. Conclusions. For the correct evaluation of the population frequency, the age-specific incidence for two sexes separately must be estimated, followed by the calculation of the cumulative frequencies. Keywords: multifactorial diseases, prevalence, morbidity, population frequency.

A New Look at Cultivar Preference in Hoplocampa testudinea (Hymenoptera: Tenthredinidae) on Apple in the Annapolis Valley of Nova Scotia, Canada

(1) Background: The European apple sawfly, Hoplocampa testudinea Klug (Hymenoptera: Tenthredinidae), can be an economically important pest in eastern Canada and shows preference for apple cultivars in Nova Scotia, Canada. We hypothesized that this preference could be due to oviposition by female H. testudinea (preference-performance hypothesis) during the bloom period or differential larval survival during development due to fruitlet physicochemical properties. (2) Methods: Fifteen commercial and experimental apple (Malusdomestica Borkh.; Rosaceae) cultivars located at the Kentville Research and Development Centre (Kentville, Nova Scotia) were chosen and examined for H. testudinea oviposition, larval performance during fruitlet development, fruitlet physicochemical properties and damage assessment at harvest from 2016–2019, inclusive. (3) Results: H. testudinea showed significant cultivar preference during oviposition, during development and at harvest, but the ranking of these cultivars was not the same throughout the season. Total impact by H. testudinea was consistent for most cultivars over multiple years of the study. (4) Conclusion: Correlation of oviposition with damage provided weak evidence for the preference-performance hypothesis. We propose that this relationship is weak due to differential survival of larvae during development.