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IntroductionThe prevalence of bronchiectasis in New Zealand (NZ) is higher than comparable countries (180/100,000 population)1; the burden and severity of disease are incompletely understood. Bronchiectasis registries such as EMBARC (>14,000 participants) and the Australian Bronchiectasis Registry (ABR, 1360 participants) have improved understanding of bronchiectasis and identified future research priorities. The aim of the NZ Bronchiectasis Registry (NZBR) is to contribute to the understanding of bronchiectasis aetiology and management, both in NZ and internationally. It is closely aligned with ABR and supported by Lung Foundation Australia.MethodsNZBR shares data fields with ABR and EMBARC, with additional fields to reflect unique socio-demographic characteristics of NZ participants. NZBR is a multi-centre, prospective, observational study enrolling consecutive patients in NZ. Participants are identified from existing clinical and research databases, and from inpatient and outpatient encounters. Eligible adult participants have a clinical diagnosis of bronchiectasis, excluding cystic fibrosis, confirmed on CT thorax. All participants are seen face-to-face and provide written consent.Demographics, clinical information, exacerbation history (including antibiotic prescription data) and health-related quality of life assessment are collected at enrolment and annual review. Data is entered into a secure online platform, which sits alongside ABR in REDCap.ResultsNational ethical approval is in place. Enrolment began at the primary site in June 2018, shortly followed by a second site. Two additional sites have local research governance approval. To date, 117 participants have been enrolled across 2 sites: 63/117 females (53.8%); mean age 62.4 (±15.6) years. 45/117 (38.4%) of participants are of M ori or Pacific Island origin; 41/117 (35.0%) participants live in the most deprived socioeconomic quintile.ConclusionThese early steps have paved the way for a national bronchiectasis registry and are an early indicator of health inequalities for bronchiectasis in NZ. NZBR will contribute to a regional Australasian Bronchiectasis Registry to create a comprehensive longitudinal dataset across Australia and NZ, to help establish the burden of disease, promote changes in clinical practice and improve clinical outcomes. Future plans include addition of paediatric sites and increased collaboration with international registries.ReferenceTelfar Barnard L, Zhang J. Asthmaand Respiratory Foundation New Zealand; 2017.

This article presents a narrative of the unfolding of the Second Demographic Transition (SDT) since the theory was first formulated in 1986. The first part recapitulates the foundations of the theory, and documents the spread of the SDT to the point that it now covers most European populations. Also for Europe, it focuses on the relationship between the SDT and the growing heterogeneity in period fertility levels. It is shown that the current positive relationship between SDT and TFR levels is not a violation of the SDT theory, but the outcome of a \"split correlation\" with different sub-narratives concerning the onset of fertility postponement and the degree of subsequent recuperation in two parts of Europe. The second part of the article addresses the issue of whether the SDT has spread or is currently spreading in industrialized Asian countries. Evidence gathered for Japan, South Korea, Hong Kong, Singapore, and Taiwan is presented. That evidence pertains to both the macro-level (national trends in postponement of marriage and parenthood, rise of cohabitation) and the micro-level (connections between individual values orientations and postponement of parenthood). Strong similarities are found with SDT patterns in Southern Europe, except for the fact that parenthood is still very rare among Asian cohabiting partners.

References to the second demographic transition (SDT) have increased dramatically in the past two decades. The SDT predicts unilinear change toward very low fertility and a diversity of union and family types. The primary driver of these changes is a powerful, inevitable, and irreversible shift in attitudes and norms in the direction of greater individual freedom and self-actualization. First, we describe the origin of this framework and its evolution over time. Second, we review the empirical fit of the framework to major changes in demographic and family behavior in the United States, the West, and beyond. As has been the case for other unilinear, developmental theories of demographic or family change, the SDT failed to predict many contemporary patterns of change and difference. Finally, we review previous critiques and identify fundamental weaknesses of this perspective, and we provide brief comparisons to selected alternative approaches.

BackgroundFunctional neurological disorder (FND) is the most common presentation in general neurology clinic after headache, accounting for approximately one-quarter of referrals. There is growing recognition of a need for tertiary FND services to support diagnosis and treatment of complex and disabling presentations, but as clinical coding seldom picks up on functional presentations, accurate data capturing the demographics and symptomology of patients referred to such clinics is not readily available. Analysis of these factors would inform and drive funding decisions relating to commissioning of relevant services.MethodsTertiary FND service clinic letters at a regional neuroscience centre were manually interrogated for patient demographics, symptomatology and diagnosis. New patients to the service between November 2020 and December 2022 were included in the analysis.Results207 patients were included, of which 194 (93.7%) had a new or re-confirmed diagnosis of FND at clinic. 149 (72.0%) were assigned female sex at birth and 192 (92.8%) were under 65 years of age at the time of review. A full spectrum of neurological symptoms was reported (mean of 5.9 per patient). Some of the most common symptoms reported were weakness (71.0%), sensory changes (69.0%), fatigue (65.4%), pain (61.3%), cognitive changes (55.7%), seizures (46.9%) and tremor (24.6%). 19 (9.2%) were given a new diagnosis of confirmed or probable migraine in addition to the 26 (13.4%) with an existing diagnosis of this disorder. Psychiatric co-morbidity in the FND cohort included anxiety (23.1%), depression (21.3%), post-traumatic stress disorder (12.9%) and personality disorder (6.2%). Other co-morbidities included: other functional disorder (29.9%); neurodevelopmental disorder (8.2%, including 5.7% with diagnosed autism spectrum disorder); and physical medical disorder (65.5%, comprising a broad range of body systems).ConclusionsThe majority of patients seen in this clinic were diagnosed with FND. The data corroborates many of the known risk factors, such as female sex, being of working age, and co-morbid psychiatric disorder. There is a particularly high prevalence of migraine, with over one-fifth of patients seen in clinic having a pre-existing or new diagnosis. There is a burden of physical medical health co-morbidity, emphasising that patients with FND often have potentially treatable symptoms that should not be discounted by assuming they are functional. The data may also reinforce growing evidence of an association with autism spectrum disorders.

Background and AimsComplex Regional Pain Syndrome (CRPS) is a rare, debilitating pain condition often attributed to distinct inciting events, long-term overuse, or no obvious cause. Variable presentation makes consistent assessment, diagnosis, and treatment of CRPS difficult. To understand how pain management providers diagnose and treat CRPS patients, we created an automated analytical electronic health record (Epic)-based registry to capture new patient encounters with qualifying diagnoses, including CRPS. A retrospective chart review was manually conducted to investigate demographics, clinical characteristics, and treatment regimens of CRPS patients.MethodsAfter IRB approval, patients diagnosed with neuropathic pain or CRPS between January 20th, 2022, and November 28th, 2023 were identified using CRPS ICD-10 codes from an institutional Epic-based registry. Data elements were manually extracted from Epic and collected in REDCap. Descriptive statistics were used to summarize data that includes patient demographics, co-morbidities, diagnostic details, and subsequent treatments.Results100 patients were reviewed at the time of abstract submission and their characteristics are summarized in table 1. Commonly reported symptoms at diagnosis were hyperalgesia/allodynia (64%), skin color asymmetry (63%), and asymmetric edema (67%) (table 2). Probable inciting events included lower extremity surgery (54%), fracture (12%), and trauma without fracture (33%) (table 3). The most commonly prescribed medication was gabapentin (34%), while the most frequently performed procedure was the lumbar sympathetic block (44%).Abstract OP15 Table 1Demographics and history of present illness of 100 registry patients qualifying with CRPSAbstract OP15 Table 2Budapest criteria patient-reported symptoms and observable signs during initial visit assessment for 100 registry patientsAbstract OP15 Table 3Probable inciting events preceding symptomatic CRPS onset, as reported by 100 registry patients during initial assessmentConclusionsContrary to existing literature, CRPS of the lower extremities was more common than that of the upper extremities in our registry patients. Pain was commonly managed using sympathetic blocks and anticonvulsant medications. Ongoing analyses include examination of CRPS subtype-specific treatments, trends in the use of off-label medications, and the effectiveness of various treatments.

Bronchiectasis is increasingly recognised but poorly described. There is variability in aetiology, management and outcomes. We have adapted the EMBARC platform and created a multisite UK based registry with affiliated biobank. The BronchUK partnership (www.bronch.ac.uk) aimed to recruit 1500 adult patients with annual follow up over 3–5 years. We report our demographic data.MethodsMulticentre recruitment (13 secondary care sites) with databasing of patient demographics. Data is quality assured on a routine basis. We followed the EMBARC protocol for data collection including Quality of Life Bronchiectasis (QOL-B) and SGRQ questionnaires.Results1403 patients have been recruited. We report data on the first 813 with complete core datasets; 504 were female (62%), 309 male (38%). The mean age 65 years SD 12.6 (median is 67 IQR 61–73). Patients were predominantly Caucasian (93%). The majority were never smokers 478 (58.8%) or ex-smokers 304 (37.4%) with only 31 (3.8%) self-reporting current smoking. Morbidity was high; Cardiovascular disease was present in 234 (28.8%). 147 (18.1%) were hospitalised in the last year due to respiratory disease, 666 (81.9%) were not. Exacerbations were common with one – 144 (17.7%), Two – 144 (17.7%) three or more- 319 (39.3%). Only 206 (25.3%) reported no exacerbations in prior 12 months. Haemophilus influenzae was the most frequent organism isolated (19.1% of all patients/29.3% of patients producing baseline sputum). Pseudomonas was cultured in most recent sputum in 98 (12.1%) rising to 223 (27.4%) isolating Pseudomonas in the last 2 years. The mean BMI was 26.5 (22.3–29.3) and median, FEV1% predicted median 76.9 (59.1–95.1). The Bronchiectasis severity index (BSI) was - mild= 233 (29%), moderate= 391 (48%), severe= 189 (23%). Common aetiologies were idiopathic (40%) and post infectious (34%). COPD and Asthma were either common comorbidities or suspected aetiologies (16–21% and 3–39%) respectively.ConclusionsThe BronchUK registry has a broadly representative cohort of patients in terms of simple demographics (female predominant, Haemophilus infections, idiopathic/post infectious aetiologies) but the morbidity levels and hospitalisation rates are noteworthy. Long term follow up will help us ascertain which patients are at highest risk of poor outcomes.AcknowledgementsMRC Funding grant MR/L011263/1, Recruiting sites and patients.

I argue here that in many ways demographic change can and should be seen as an essential factor of change. The demographic transition will be considered as a largely autonomous process that ended up having profound social, economic, and even psychological or ideational implications for social (Demeny 1972: 154). Demography will be seen as an independent variable. It is clear, or course, that history is never unilateral, and it is undeniable that this period of enormous change had many constituent causes. I will show that demographic change was one of them and by no means an insignificant one. This chapter seeks to contribute to a more balanced interpretation of the social and economic modernization that occurred in Europe and elsewhere between 1850 and 1975. Many of the arguments will refer to the transition among the forerunners of the process, the historic demographic transition. It will also evaluate the extent to which this same process in underway in the development world and how the way these societies undergo their own transition might condition the effects these processes have for development and social change. Adapted from the source document.