Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “UTAH”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources
PubMed2004

Associations between breast cancer risk factors and religious practices in Utah.

BACKGROUND: Utah has the lowest female malignant breast cancer incidence rates in the United States, due in part to low rates among women who are members of the Church of Jesus Christ of Latter-day Saints (LDS or Mormon). Several established reproductive and non-reproductive breast cancer risk factors may be lower among LDS women because of their religious doctrine related to marriage, family, and health. This paper investigates the association between selected breast cancer risk factors and religious preference and religiosity in Utah. METHODS: A 37-item anonymous cross-sectional telephone survey was developed and conducted during March and April 2002. Results are based on 848 non-Hispanic white female respondents. RESULTS: Number of births (parity), prevalence of breastfeeding, and lifetime total duration of breastfeeding were highest among LDS women who attended church weekly. Average months of breastfeeding per child were greatest among weekly church attendees, regardless of religious preference. Oral contraceptive use and total duration of hormone replacement therapy use were greatest for individuals of any religion attending church less than weekly and for individuals with no religious preference. Comparisons of divergent reproductive behaviors between LDS and non-LDS, and between weekly and less than weekly church goers, provide strong support for the relatively low breast cancer incidence rates previously identified among LDS and, therefore, in Utah. CONCLUSIONS: High parity and breastfeeding coincide with comparatively low breast cancer incidence rates among LDS and are consistent with recent findings of the Collaborative Group on Hormonal Factors in Breast Cancer, showing the primary role parity and breastfeeding play in reducing breast cancer.

Breast Feeding↗
PubMed2002

Evaluating the crash and citation rates of Utah drivers licensed with medical conditions, 1992-1996.

BACKGROUND: Medical problems may affect the ability to drive motor vehicles, and programs that control the issuing of driver licenses to individuals with medical conditions exist in most states. The main activity of these programs is the imposition of restrictions upon the driving privileges of individuals with medical conditions that are deemed to pose some risk to public safety. However, little is known about the effectiveness of these licensing programs. OBJECTIVE: The objective of this study was to compare the rates of adverse driving events (crash, at-fault crash and citations) experienced by drivers licensed with medical conditions to those of age-, sex- and location-matched controls. Separate comparisons were made for drivers reporting medical conditions licensed with full driving privileges, and those with restricted driving privileges (e.g. speed, area and time of day). DESIGN: Retrospective case-control. METHODS: The study population was all drivers licensed in the state of Utah who reported a medical condition on their driver license application, over the 5-year period 1992-1996. Drivers enter the program by self-reporting their medical problems. Control drivers were chosen from the entire population of drivers licensed in Utah for the same period. Information on driver license status, participation in the medical conditions program, citations, involvement in crashes, and death certificate data was obtained from the relevant state agencies. Probabilistic linkage methodology was used to link the records in these disparate databases for eventual analysis. Rates of citation, crashes and at-fault crashes, expressed as events per 10000 license days, were calculated separately for program drivers and their corresponding control groups for each medical condition category and restriction status. These data were used to determine an estimate of relative risk (RR) and 95% confidence intervals. RESULTS: As a group, medical conditions drivers had modestly elevated rates of adverse driving events compared with control drivers (RR 1.09-1.74). Rates in the largest medical category, 'cardiovascular conditions', were not higher than controls. Rates were higher than control for some conditions, such as 'alcohol' and 'learning and memory', for some adverse events (RR 2.2 -5.75). Drivers with more than one medical condition appeared comparable to the general group of medical conditions program drivers. CONCLUSIONS: Drivers in Utah medical conditions program had modestly elevated rates of adverse driving events compared to matched controls. Possible underreporting of medical conditions and accurate assessment of exposure rates are potential weaknesses in the program.

Accidents, Traffic↗
PubMed2004

Effect of repeal of the national maximum speed limit law on occurrence of crashes, injury crashes, and fatal crashes on Utah highways.

Speed limits were increased in Utah and other States after repeal of the national maximum speed limit law (NMSL) in 1995. This study analyzed effects of the increased speed limit on Utah highways on crash rates, fatality crash rates, and injury crash rates. Annual (1992-1999) rates of crashes, fatality crashes, and injury crashes for the following highway categories were calculated: urban Interstate segments (current speed limit 60-65 miles per hour (mph)); rural Interstate segments (current speed limit 70-75 mph); 55 mph rural non-Interstate highway segments; and high-speed non-Interstate highways (current speed limit 60-65 mph). Data were analyzed using autoregressive integrative moving average intervention time series analysis techniques. There were significant increases in total crash rates on urban (60-65 mph) Interstate segments (confounded by extensive ongoing highway construction on these highways), and in fatal crash rates on high-speed (60-65 mph) rural non-Interstate segments. The following variables were unaffected: total, fatality, and injury crash rates on rural Interstate segments; fatality and injury crash rates on urban Interstate segments; total and injury crash rates on high-speed non-Interstate segments. These results show an adverse effect on crash occurrence for subsets of crash types and highways, but do not show a major overall effect of NMSL repeal and increased speed limit on crash occurrence on Utah highways.

Accidents, Traffic↗
PubMed1996

Cancer pain management: pilot implementation of the AHCPR guideline in Utah.

BACKGROUND: Using the Agency for Health Care Policy and Research's (AHCPR's) 1994 Clinical Practice Guideline for Management of Cancer Pain, HealthInsight, the peer review organization for Utah and Nevada, organized a cooperative project with physicians and nurses from seven acute care hospitals in Utah. The project's purpose was to adapt the guideline into action plans for participating hospitals and provide the tools necessary to address six "core" guidelines-to assess and relieve pain, educate the patient/family and health care workers, measure patient satisfaction, and provide a continuum of care postdischarge. GUIDELINE DEVELOPMENT: The guidelines were further adapted to meet the needs of the individual hospitals and were implemented in January 1995. Baseline data was collected on 10 patient records per hospital. RESULTS: Survey results confirmed that although attitudes about cancer pain management were changing, more needed to be done to prevent patient suffering. Follow-up data after one year showed significantly more compliance on all six core guidelines. CASE STUDY: The oncology nurse manager and the hematology/oncology physician chief at one hospital joined the project team to support their own ongoing efforts to implement the guidelines. At that hospital, patient satisfaction with pain management has since increased from the 60%-80% level to at least 90%. STATEWIDE PROJECT EXPANSION: Statewide expansion was planned in fall 1995 to extend implementation to the remaining acute care hospitals and to other health care settings in Utah and to ease a patient's transition from one setting to another. CONCLUSION: The project team continues to monitor progress in guideline implementation. Surveys demonstrate that, at the time of diagnosis, up to 45% of cancer patients experience moderate to severe pain; 65%-90% experience severe pain when cancer reaches the advanced stages. Unrelieved cancer pain can cause intense suffering, diminished activity, loss of appetite, and loss of sleep.

Attitude↗
PubMed2006

Lack of association of glutamate decarboxylase 2 gene polymorphisms with severe obesity in utah.

Three polymorphisms of the glutamate decarboxylase 2 gene, which encodes the glutamic acid decarboxylase enzyme, have been associated with severe obesity in a large French cohort. One of these polymorphisms was shown to have functional consequences on promoter expression. Another polymorphism was associated with insulin levels and secretion. These associations were examined in 855 severely obese Utah subjects (mean BMI = 48 kg/m(2)) and a normal-weight and normoglycemic subset (N = 130, mean BMI = 22 kg/m(2)) of a random sample of the Utah population (N = 462). Comparisons of the normal-weight random group with the severely obese group did not result in significant genotype or allele frequency differences for any of the three polymorphisms, C61450A, T83897A, or A-243G (all p > or = 0.18). Haplotypes were also not related to severe obesity (p = 0.10). None of the polymorphisms was significantly related to fasting glucose, insulin levels, or homeostasis model assessment insulin resistance or secretion indices. This study of normal-weight and severely obese subjects from Utah does not provide evidence for involvement of the three genotyped polymorphisms in the glutamate decarboxylase 2 gene with obesity or with insulin- and glucose-related measures associated with obesity.

Adult↗
PubMed1999

The incidence and nature of surgical adverse events in Colorado and Utah in 1992.

BACKGROUND: Despite more than three decades of research on iatrogenesis, surgical adverse events have not been subjected to detailed study to identify their characteristics. This information could be invaluable, however, for guiding quality assurance and research efforts aimed at reducing the occurrence of surgical adverse events. Thus we conducted a retrospective chart review of 15,000 randomly selected admissions to Colorado and Utah hospitals during 1992 to identify and analyze these events. METHODS: We selected a representative sample of hospitals from Utah and Colorado and then randomly sampled 15,000 nonpsychiatric discharges from 1992. With use of a 2-stage record-review process modeled on previous adverse event studies, we estimated the incidence, morbidity, and preventability of surgical adverse events that caused death, disability at the time of discharge, or prolonged hospital stay. We characterized their distribution by type of injury and by physician specialty and determined incidence rates by procedure. RESULTS: Adverse events were no more likely in surgical care than in nonsurgical care. Nonetheless, 66% of all adverse events were surgical, and the annual incidence among hospitalized patients who underwent an operation or child delivery was 3.0% (confidence interval 2.7% to 3.4%). Among surgical adverse events 54% (confidence interval 48.9% to 58.9%) were preventable. We identified 12 common operations with significantly elevated adverse event incidence rates that ranged from 4.4% for hysterectomy (confidence interval 2.9% to 6.8%) to 18.9% for abdominal aortic aneurysm repair (confidence interval 8.3% to 37.5%). Eight operations also carried a significantly higher risk of a preventable adverse event: lower extremity bypass graft (11.0%), abdominal aortic aneurysm repair (8.1%), colon resection (5.9%), coronary artery bypass graft/cardiac valve surgery (4.7%), transurethral resection of the prostate or of a bladder tumor (3.9%), cholecystectomy (3.0%), hysterectomy (2.8%), and appendectomy (1.5%). Among all surgical adverse events, 5.6% (confidence interval 3.7% to 8.3%) resulted in death, accounting for 12.2% (confidence interval 6.9% to 21.4%) of all hospital deaths in Utah and Colorado. Technique-related complications, wound infections, and postoperative bleeding produced nearly half of all surgical adverse events. CONCLUSION: These findings provide direction for research to identify the causes of surgical adverse events and for targeted quality improvement efforts.

Adult↗
PubMed2004

Biological effects of Utah Valley ambient air particles in humans: a review.

The Utah Valley provided a unique opportunity to evaluate the health effects of particulate matter (PM) in humans. The area has had intermittently high particle levels with the principal point source being a steel mill. Due to a labor dispute, the mill was shut down. The closure and reopening of the steel mill allowed for an examination of potential correlates between epidemiological observations and measures of the biological effect of PM with experimental cell and human exposure. Epidemiologic investigation demonstrated an association of both the closure of the steel mill and the reduction in exposure to air pollution particles with changes in morbidity and mortality. Changes in these parameters were not fully accounted for by variation in the mass of PM. Metal content, in vitro oxidative stress, and release of pro-inflammatory mediators by cultured respiratory epithelial cells were all elevated in those aqueous extracts collected from the Utah Valley while the steel mill was open. Similarly, inflammatory injury in the lower respiratory tract of humans after instillation of aqueous extracts of filter PM was increased in those volunteers exposed to particles collected while the mill was open. These results indicate that equal masses of PM can induce disparate lung injuries suggesting that particle components may be relevant in assessing health effects after their exposure. Specifically, metals can participate in the biological effects of PM collected from the Utah Valley. In addition, correlates between findings of epidemiological studies and the biological effects of PM in cell and human investigation were demonstrated.

Air↗
PubMed1978

Cardiovascular mortality in Mormons and non-Mormons in Utah, 1969--1971.

Cardiovascular mortality in the State of Utah is among the lowest in the United States. The religion of 72% of the state residents (Mormon) proscribes the use of tobacco and alcohol; a large number of Mormons adhere to this proscription. This study analyzed the 6108 cardiovascular disease deaths between 1969--1971 in Utah of members in the Mormon Church. For both sexes, Mormons had 35% less mortality than expected from US rates for ischemic heart disease, while non-Mormons were not significantly different from US whites. These results support the relationship between cigarette smoking and mortality from cardiovascular disease. Mormon men also had lower mortality from hypertensive heart disease and Mormon women from rheumatic heart disease than non-Mormons in Utah.

Aged↗
PubMed1990

Individual external exposures from Nevada Test Site fallout for Utah leukemia cases and controls.

External gamma-ray exposures from fallout originating at the Nevada Test Site (NTS) have been assigned to 6,507 individual subjects (1,177 leukemia cases and 5,330 control subjects) who died as Utah residents between 1952 and 1981. Leukemia cases were identified, confirmed, and classified by cell type from the Utah Cancer Registry, Utah State vital records, and medical records. Residential histories were obtained from the Deceased Membership File (DMF) of the Church of Jesus Christ of Latter-day Saints (LDS), supplemented by information from the LDS Church Census Records that were taken in 1950, 1955, and 1960-62. Control subjects were selected randomly within age strata from the DMF and were frequency-matched to the cases by age at death and for sex. Individual radiation exposures were assigned as a function of residence location and time interval for each residence during the fallout period (1951-1958) using geographic exposure data taken from the literature. Temporal distribution of exposure for subjects who resided in more than one locality or who were born or died during the fallout period was determined from data of other investigators. Calculated gamma-ray exposures for each place of residence were summed for each subject to yield the exposure to fallout from the NTS.

Case-Control Studies↗
PubMed1995

The Utah Thyroid Cohort Study: analysis of the dosimetry results.

Above ground testing of nuclear weapons at the Nevada Test Site (NTS) during the 1950s created radioactive fallout that was dispersed into the atmosphere and deposited over a large geographical area of the U.S. One area believed to have received a considerable amount of exposure to radioiodines (131I and 133I) in the fallout was southwest Utah and southeast Nevada. This paper describes the estimates of doses to the thyroid for a cohort of 3,545 subjects who were children during the atmospheric testing period. This group of children was examined for thyroid disease during 1965-1970 and again in 1985-1986. The cohort was made up of children who lived in three counties in 1965: Washington County, Utah; Lincoln County, Nevada; and Graham County, Arizona (originally thought to be an unexposed group). Pathway analysis was used in the dosimetry, considering exposures through the ingestion of milk and vegetables, inhalation of iodine during the passage of the fallout cloud, and external exposure. Specific data were obtained on diet (including sources and levels of milk and vegetables consumed, residence history, and lifestyle) by interviewing the parents or nearest living relative of subjects. The final dosimetry file for each member of the cohort contained specific doses to the thyroid glands and uncertainties (reported as geometric standard deviations, GSD) related to each dose estimate. The mean absorbed dose to the thyroid for subjects living in Washington County, Utah, was 170 mGy; for Lincoln County, Nevada, 50 mGy; and for those living in Graham County, Arizona, 13 mGy. The maximum dose to any subject was 4,610 mGy. There were 10 subjects who had doses greater than 1 Gy. The majority of uncertainty values calculated in this study were GSD values between 2.0 and 4.0. The results of the dosimetry were combined with the results of clinical examinations of the cohort to determine if a causal relationship exists between dose to thyroid from NTS generated radioactive iodines and the incidence of thyroid disease.

Adult↗
PubMed2002

Utah youth suicide study, phase I: government agency contact before death.

OBJECTIVE: To delineate the probability of contact between government agencies and youths who complete suicide, to investigate the nature of those contacts, and to identify new risk factors for suicide. METHOD: A descriptive epidemiological analysis of data from multiple Utah government agencies on consecutive youth suicides (n = 151) between August 1, 1996, and June 6, 1999, aged 13-21 years. Data were collected from four government agencies: Office of the Medical Examiner, Juvenile Justice, Department of Human Services, and the Department of Education. RESULTS: Utah descriptive data were similar to national statistics, with the majority of completers being male (89%) and firearms the most common method of suicide (58%). The data demonstrated an association between youth suicide and contact with Juvenile Justice. Sixty-three percent of youths who completed suicide in Utah had contact with Juvenile Justice, and there was a direct correlation between number of referrals and increased suicide risk. Suicide completers had multiple minor offenses over many years. A significant minority of school-age subjects could not be located within the school system. Few suicide completers had evidence of active psychiatric treatment. CONCLUSIONS: Juvenile Justice is identified as a novel site for the screening and identification of youths at risk for suicide.

Adolescent↗
PubMed1988

An evaluation of Utah's primary care case management program for Medicaid recipients.

One of the first case management (CM) programs for limiting Medicaid enrollees' freedom of choice of provider was established by Utah. By assigning enrollees to specific providers responsible for arranging all nonemergency care, Utah intended both to improve access and to reduce program costs. State officials expected the program to increase recipients' use of primary-care providers, while reducing their use of specialists, prescription drugs, and hospital outpatient services. Savings from reductions in unnecessary use were expected to more than offset increases in outlays arising from access enhancements, resulting in lower program expenditures. This study investigated the extent to which the state Medicaid program achieved these goals. The analysis was based on a two-part multivariate model of usage, estimated from data created from claims-level information provided by Utah. The findings revealed that the use of primary-care physician services increased significantly. However, the program also raised the use of specialists' services and prescription drugs. In contrast, the use of hospital outpatient services was lowered. Overall, CM apparently achieved the objective of increased access, but failed to attain the cost-containment goal. The findings indicated that expected costs for ambulatory care rose by 25% in the early years as a result of case management.

Cost Control↗
PubMed1995

Surgical trends in the treatment of diseases of the lumbar spine in Utah's Medicare population, 1984 to 1990.

Chronic low back pain is a major source of disability in this country. The rate of surgical treatment for back disorders varies between small geographic areas in the northeastern United States. A statewide database was utilized to determine rate of surgery for mechanical low back problems in Utah's Medicare population from 1984 to 1990. The average surgery rate for Medicare enrollees was 274.7 per 100,000, and the Utah laminectomy and discectomy rates were at least 20% higher than the U.S. average. Back surgery rates rose by 55% over the study period, primarily because of increasing rates of surgery for spinal stenosis. There was statistically significant variation in surgery rates among regions in the state, with the highest region having a rate 50% greater than the lowest region. Rates of surgery for spinal stenosis had more variation than those for herniated disc surgery. There was no significant correlation between the number of surgeons performing back surgery and the rate of surgery. The variation and increase in back surgery rates in Utah's Medicare population are likely related to changes in the use of surgery for treatment of spinal stenosis and not to an increase in the number of back surgeons. Further investigation is needed to understand better the reasons for the observed increase in back surgery rates.

Diskectomy↗
PubMed2000

Negligent care and malpractice claiming behavior in Utah and Colorado.

BACKGROUND: Previous studies relating the incidence of negligent medical care to malpractice lawsuits in the United States may not be generalizable. These studies are based on data from 2 of the most populous states (California and New York), collected more than a decade ago, during volatile periods in the history of malpractice litigation. OBJECTIVES: The study objectives were (1) to calculate how frequently negligent and nonnegligent management of patients in Utah and Colorado in 1992 led to malpractice claims and (2) to understand the characteristics of victims of negligent care who do not or cannot obtain compensation for their injuries from the medical malpractice system. DESIGN: We linked medical malpractice claims data from Utah and Colorado with clinical data from a review of 14,700 medical records. We then analyzed characteristics of claimants and nonclaimants using evidence from their medical records about whether they had experienced a negligent adverse event. MEASURES: The study measures were negligent adverse events and medical malpractice claims. RESULTS: Eighteen patients from our study sample filed claims: 14 were made in the absence of discernible negligence and 10 were made in the absence of any adverse event. Of the patients who suffered negligent injury in our study sample, 97% did not sue. Compared with patients who did sue for negligence occurring in 1992, these nonclaimants were more likely to be Medicare recipients (odds ratio [OR], 3.5; 95% CI [CI], 1.3 to 9.6), Medicaid recipients (OR, 3.6; 95% CI, 1.4 to 9.0), > or =75 years of age (OR, 7.0; 95% CI, 1.7 to 29.6), and low income earners (OR, 1.9; 95% CI, 0.9 to 4.2) and to have suffered minor disability as a result of their injury (OR, 6.3; 95% CI, 2.7 to 14.9). CONCLUSIONS: The poor correlation between medical negligence and malpractice claims that was present in New York in 1984 is also present in Utah and Colorado in 1992. Paradoxically, the incidence of negligent adverse events exceeds the incidence of malpractice claims but when a physician is sued, there is a high probability that it will be for rendering nonnegligent care. The elderly and the poor are particularly likely to be among those who suffer negligence and do not sue, perhaps because their socioeconomic status inhibits opportunities to secure legal representation.

Adolescent↗
PubMed2001

Outcomes of posterolateral lumbar fusion in Utah patients receiving workers' compensation: a retrospective cohort study.

STUDY DESIGN: A retrospective cohort study consisting of a medical record review and a follow-up telephone survey of patients with lumbar fusion, at least 2 years after their surgery, was performed. OBJECTIVE: To identify presurgical correlates and long-term outcomes from posterolateral lumbar fusion in Utah patients receiving workers' compensation. SUMMARY OF BACKGROUND DATA: Lumbar fusion has been criticized for its highly variable outcomes, and compensated workers are at particular risk for poor outcomes. Evidence suggests that presurgical psychosocial factors may be important modifiers of back pain reporting and back surgery outcomes. METHODS: The patients in this study were 185 compensated workers in Utah who underwent posterolateral lumbar fusion. Patient medical records were independently reviewed, and medical and sociodemographic variables were coded. A telephone outcome survey was completed with 130 patients (70%) an average of 4.6 years after their surgery. RESULTS: Reported solid fusion, reoperation, and disability rates for the follow-up sample were 74%, 24%, and 25%, respectively. As reported by the patients, 41% experienced no change or a worsened quality of life. Mean scores from the Roland and Morris Back Pain Disability Questionnaire, the Stauffer-Coventry-Index, and the Short-Form 20 Multidimensional Health Survey indicate that many patients experienced postsurgical dysfunction. Presurgical predictors of outcomes were number of prior low back operations, income at time of injury, age, litigation, and depression. CONCLUSIONS: Outcomes of posterolateral lumbar fusion among compensated workers in Utah are inconsistent. Outcomes can be predicted by presurgical sociodemographic variables. Screening for such presurgical risk factors may be important for prudent surgical decisions and rehabilitation planning.

Adult↗
PubMed2002

Nurse practitioners' treatment of febrile infants in Utah: comparison to physician practice nationally.

PURPOSE: To determine nurse practitioners' (NPs') knowledge of published guidelines involving the treatment of infants with fever without a source and to compare the practice of NPs in Utah to physicians nationally. DATA SOURCES: Using a comparative descriptive design, a survey was sent to 450 NPs in Utah replicating the methodology of a 1998 survey of physicians. The NPs were asked about their evaluation decisions and management strategies for various ages of infants/toddlers with fever without a source. CONCLUSIONS: The practice decisions of NPs in Utah and physicians nationally were similar. Family NPs' clinical decisions aligned more closely with family practice medical doctors and pediatric NPs' with pediatricians. Overall, the younger the patient, the more likely were NPs to order labs and antibiotics or to hospitalize/refer to a physician. The fact that management decisions were not based upon existing protocols may account for the practice variation seen among NPs. IMPLICATIONS FOR PRACTICE: Management of a febrile infant is a common clinical scenario for the primary care provider. Although evidence-based protocols exist, the treatment of febrile infants remains controversial. Overall, NPs' evaluation and management of these infants were not shown to differ from physicians. Further studies are needed to determine why clinical guidelines are not being followed.

Age Factors↗
PubMed2002

Evaluation of the Utah student injury reporting system.

The Utah Student Injury Reporting System (SIRS), implemented in 1984 to monitor injuries to students in grades K-12 in Utah schools, has served as a model for surveillance systems created by other states and some European countries. This paper evaluates the Utah experience in developing and administering the SIRS. The evaluation identifies usefulness of the system, discusses the sensitivity of the system in detecting school injuries, estimates the system's costs, and provides suggestions to other states and districts interested in building a cost-effective and efficient surveillance instrument.

Adolescent↗
PubMed2001

Practitioner profiles and practice patterns for marriage and family therapists in Utah.

This report presents the results of a survey of practitioner profiles and practice patterns for marriage and family therapists (MFTs) in Utah. A sample of 77 clinical members of the Utah Association for Marriage and Family Therapy provided descriptive information on their demographics, training, years of experience, and specific information about their practice of MFT. The findings indicate that clinical members of the American Association for Marriage and Family Therapy in Utah are a mostly male, white, and highly educated group of practitioners who hold primary licensure in MFT and identify themselves primarily as MFTs. Similarities and differences with practice patterns research in Minnesota and 15 other states are discussed.

Demography↗