Census-based Study Research Articles

Leisure-time physical activity and cognitive function in the elderly community: population census

Adopting healthy habits, especially regular physical activity, is essential for healthy aging and cognitive health promotion. Objective: to describe the prevalence of leisure-time physical activity and its association with cognitive function in community-dwelling elderly. Methods: a cross-sectional, census-based study with individuals ≥ 60 years residing in Coxilha, Rio Grande do Sul in 2021. The level of physical activity, mental state, and sociodemographic characteristics were analyzed. Qualitative variables were presented in univariate frequency distributions and bivariate analysis through the chi-square test and Fisher's Exact Test. Results: Of the 519 elderly evaluated, only 11.4% were classified as physically active in their leisure time, being more common in elderly without cognitive decline (p=0.027). The other investigated variables did not show a significant association with the outcome (p>0.05). Conclusion: The prevalence of physically active elderly in leisure time is low, being more prevalent among those without cognitive decline.

Assessment of knowledge, attitudes, and practices of occupational risks and diseases among healthcare providers of the Regional Hospital Center of Dosso, Niger.

In Niger, a low-income country, occupational medicine is little known and practiced, particularly in the health sector, where healthcare workers are exposed to numerous occupational risks. This study aimed to assess knowledge, attitudes, and practices about occupational risks and diseases among healthcare providers working at the Hospital of Dosso (Niger) to determine their knowledge, attitudes, and practices level about occupational risks and diseases. A descriptive and quantitative census-based study was conducted among the 105 healthcare providers practicing at the hospital of Dosso between 1 April and 31 May 2023, using a self-administered questionnaire in the French language comprising a sociodemographic part and a knowledge, attitudes, and practices part about occupational risks and diseases. Knowledge, attitudes, and practices scores were calculated and Mann-Whitney U or Kruskal-Wallis tests were used to assess their association with sociodemographic characteristics. In total, 83 healthcare providers agreed to participate in the study, with a participation rate of 79%. A total of 28% of participants had received training on occupational risks and diseases. The knowledge score about occupational risks and diseases showed that 55.4% of participants had a knowledge level varying from medium to high. The score of attitudes and practices showed that 68.7% of responders had an attitudes and practices level varying from medium to high about occupational risks and diseases. According to the composite score of knowledge, attitudes, and practices, 53% of participants had a knowledge, attitudes, and practices level between medium and high. A significant association was found between the composite score of knowledge, attitudes, and practices and the workstation occupied, mainly medical imaging service (p = 0.006). The study showed that 53% of responders had an overall level of knowledge, attitudes, and practices about occupational risks and diseases between medium and high. Among their sociodemographic characteristics, only the workstation occupied (mainly medical imaging service) was statistically associated with the composite score of knowledge, attitudes, and practices. Considering these findings, the administrators of the Hospital of Dosso must recruit an occupational medicine specialist to provide information and prevention visits on occupational risks and diseases to healthcare providers working in this institution.

Impact of spirituality on elderly people's quality of life and life satisfaction after acute myocardial infarction: Iranian hospital-based study.

As people age, survival after a heart attack can affect their quality of life and lead to a decrease in life satisfaction. After a myocardial infarction, elderly patients may experience physical, psychological, emotional and social changes that affect their thoughts and behaviour in relation to spirituality. To investigate the relationship between spiritual well-being and other sociodemographic and medical history-related factors on quality of life and life satisfaction among elderly people after myocardial infarction. In a census-based cross-sectional study conducted at the Imam Reza Hospital in Amol, Iran, from May 2020 to May 2021, data on sociodemographics, medical history, subjective well-being, life satisfaction and quality of life were collected from 502 participants who were referred at the heart clinic. The findings showed that spiritual well-being dimensions (religious well-being, [self-assessment of one's relationship with God], and existential well-being, [self-assessment of one's sense of purpose in life and life satisfaction]) were not significantly associated with life satisfaction, but a high perception of both dimensions of spiritual well-being were associated with higher self-reported quality of life. A history of past-year hospital admission and cardiopulmonary resuscitation were significant predictors of life satisfaction, and educational level was a predictor of quality of life. The study found no significant association between spiritual well-being and life satisfaction among elderly people following myocardial infarction. This finding might have been influenced by the physical and emotional challenges experienced by the participants during the COVID-19 pandemic. Further studies are needed to confirm this relationship.

Predictors of referral behaviour and intention amongst physicians in a medical consortium based on the theory of planned behaviour: a cross-sectional study in China.

To promote patients' referral across healthcare institutions and integrated care delivery, we identified predictors of physicians' behaviour and intention to refer patients in a county medical consortium in China on the basis of the theory of planned behaviour (TPB). This census-based cross-sectional study was conducted in Yangxi Hospital Group (YHG). All physicians in county hospitals and township health centres were invited to participate. Structural equation modelling was employed to analyse the relationships between referral intention and behaviour and other TPB variables in the group of whole participants and in sub-groups. In total, 330 physicians participated in this study. One-third of participants were general practitioners, and half of them were from county hospitals. Referral behaviour of females (χ2 = 20.372, p < 0.001), who had lower education levels (χ2 = 17.859, p = 0.001), lower professional title (χ2 = 14.963, p = 0.005), and lower monthly salary (χ2 = 33.753, p < 0.001) were less frequent than the others. Among them, 116 (35.2%), 108 (32.7%), and 106 (32.1%) respondents reported that they had never referred patients, had referred patients 1-9 times, and had referred patients over 10 times during the past 3 months, respectively. The mean score of referral intention was 4.23/5 (SD = 0.71). In the model with all participants, a stronger referral intention (β = 0.218, 95% CI = 0.080-0.356) was associated with more frequent referral behaviour. The subjective norm (β = 0.703, 95% CI = 0.590-0.817) was the strongest predictor of physicians' referral intention, followed by perceived behavioural control (β = 0.234, 95% CI = 0.090-0.378). Mediated by referral intention, subjective norms (β = 0.153, p < 0.01) and perceived behavioural control (β = 0.190, p < 0.01) had significant indirect effects on physicians' referral behaviour. The model with participants in county hospitals showed similar results to the model with all participants. Meanwhile, in the model with participants in township health centres, there were no significant associations between referral behaviour and other TPB constructs. Physicians' referral behaviour was influenced by intention, subjective norms, and perceived behavioural control in Chinese county hospitals.

Tracking the settlement patterns of culturally and linguistically diverse (CALD) populations in Australia: A census-based study from 2001 to 2021

Tracking the settlement of culturally and linguistically diverse (CALD) populations serves as the foundation for population projection, urban planning, and policy making to achieve social justice, equity, and multicultural harmony. Drawing on census data in 2001, 2006, 2011, 2016 and 2021, our study contributes an Australian nationwide time-series study of the settlement of CALD populations at a fine neighbourhood level, enabling long-term tracking of changing settlement patterns and residential diversity and revealing potential drivers for such changes. Following segmented assimilation theory, we examine whether the CALD populations with higher education levels, higher socioeconomic status and better language skills may tend to partially move out and partially retain their ethnic concentrations, resulting in assimilation that occurs segmentally across urban fabrics. We find that both existing CALD communities and the formation of new CALD concentrations in peri-urban regions exhibit segmented assimilation over time. We also find the settlement patterns of CALD populations in urban areas are more diverse than in rural areas in most states/territories. Our study provides spatially explicit evidence with far-reaching policy implications for migration, place-based health, population and urban planning.

Are air quality perception and PM2.5 exposure differently associated with cardiovascular and respiratory disease mortality in Brussels? Findings from a census-based study

BackgroundThere is ample evidence that air pollution increases mortality risk, but most studies are based on modelled estimates of air pollution, while the subjective perception of air quality is scarcely assessed. We aimed to compare the effects of objective and subjective exposure to air pollution on cardiorespiratory mortality in Brussels, Belgium. MethodsData consisted of the 2001 Belgian census linked to registry-based mortality data for the follow-up period 2001–2014. We included individuals aged >30 years of age residing in Brussels at baseline (2001). Air pollution exposure was assessed with objective (modelled annual mean concentrations of PM2.5 in micrograms per cubic metre, μg/m3) and subjective indicators (poor self-reported air quality perception in the census). We used Cox Proportional Hazard models with age as the underlying time scale to evaluate associations with cardiovascular disease (CVD) and respiratory disease mortality, and separately, ischaemic heart disease (IHD), cerebrovascular disease, and COPD excluding asthma mortality. We specified single- and two-exposure models and evaluated effect modification by neighbourhood unemployment rate. Results437,340 individuals were included at baseline. During follow-up (2001–2014), 22,821 (5%) individuals had died from CVDs and 8572 (2%) from respiratory diseases. In single-exposure models, PM2.5 was significantly associated with an increased risk in CVD and IHD mortality (e.g. for IHD, per 5 μg/m3 increase: Hazard Ratio, HR:1.22, 95%CI:1.08–1.37), and poor air quality perception with COPD excluding asthma mortality (HR:1.23, 95%CI:1.15–1.33). Associations remained significant in the two-exposure models, and additionally, perception was associated with respiratory disease mortality. Associations became gradually stronger with increasing neighbourhood unemployment rate [e.g. in the highest, Q3: PM2.5 and cerebrovascular disease mortality (HR:1.53, 95%CI:1.04–2.24)]. ConclusionOur findings suggest that objective and subjective exposure to air pollution increased the risk of dying from cardiovascular and respiratory diseases respectively in Brussels. These results encourage policies reducing pollution load in Brussels whilst considering socio-economic inequalities.

Urban green spaces and suicide mortality in Belgium (2001–2011): A census-based longitudinal study

BackgroundExposure to green spaces is associated with improved mental health and may reduce risk of suicide. Here, we investigate the association between long-term exposure to residential surrounding greenness and suicide mortality. MethodsWe used data from the 2001 Belgian census linked to mortality register data (2001–2011). We included all registered individuals aged 18 years or older at baseline (2001) residing in the five largest urban areas in Belgium (n = 3,549,514). Suicide mortality was defined using the tenth revision of the World Health Organisation International Classification of Diseases (ICD-10) codes X60-X84, Y10–Y34, and Y870. Surrounding greenness was measured using the Normalized Difference Vegetation Index (NDVI) within a 300 m and 1,000 m buffer around the residential address at baseline. To assess the association between residential surrounding greenness and suicide mortality, we applied Cox proportional hazards models with age as the underlying time scale. Models were adjusted for age, sex, living arrangement, migrant background, educational attainment, neighbourhood socio-economic position. We additionally explored potential mediation by residential outdoor nitrogen dioxide (NO2) concentrations. Finally, we assessed potential effect modification by various socio-demographic characteristics of the population (sex, age, educational attainment, migrant background, and neighbourhood socio-economic position). Associations are expressed as hazard ratios and their 95% confidence intervals (CI) for an interquartile range (IQR) increase in residential surrounding greenness. ResultsWe observed a 7% (95%CI 0.89–0.97) and 6% (95%CI 0.90–0.98) risk reduction of suicide mortality for an IQR increase in residential surrounding greenness for buffers of 300 m and 1,000 m, respectively. Furthermore, this association was independent of exposure to NO2. After stratification, the inverse association was only apparent among women, and residents of Belgian origin, and that it was stronger among residents aged 36 or older, those with high level of education, and residents of most deprived neighbourhoods. ConclusionOur results suggest that urban green spaces may protect against suicide mortality, but this beneficial effect may not be equally distributed across all strata of the population.

Urban green spaces and suicide mortality in Belgium (2001-2011): a census-based longitudinal study

BACKGROUND Exposure to green spaces is associated with improved mental health and may reduce the risk of suicide. Here, we investigate the association between long-term exposure to residential surrounding greenness and suicide mortality. METHODS We used data from the 2001 Belgian census linked to mortality register data (2001-2011). We included individuals aged 18 years or older at baseline (2001) and residing in the five largest urban areas in Belgium (n=3,549,514). Suicide mortality was defined using ICD-10 codes X60-X84, Y10-Y34, and Y870. Surrounding greenness was measured using the Normalized Difference Vegetation Index (NDVI) within 300m and 1,000m buffers around the residential address at baseline. To assess the association between residential surrounding greenness and suicide mortality, we applied Cox proportional hazards models with age as the underlying time scale. Models were adjusted for age, sex, marital status, migrant background, educational attainment, neighbourhood socio-economic position. We additionally explored potential mediation with residential outdoor nitrogen dioxide (NO2) concentrations. Associations are expressed as hazard ratios (HR) and their 95% confidence intervals (CI) for an interquartile range (IQR) increase in residential surrounding greenness. RESULTS Between 2001 and 2011, 8,577 suicide deaths were registered. We observed a 7% (95%CI 0.89-0.97) and 6% (95%CI 0.90-0.98) risk reduction of suicide mortality for an IQR increase in residential surrounding greenness for buffers of 300m and 1,000m, respectively. Furthermore, this association was independent of exposure to NO2. After stratification, the inverse association was only apparent among females, and residents of Belgian origin, and that it was stronger among residents aged 36 or older, those with high level of education, and residents living in socio-economic deprived neighborhoods. CONCLUSION Our results suggest that urban green spaces may protect against suicide mortality, but this beneficial effect may not be equally distributed across all strata of the population. KEYWORDS Suicide mortality; surrounding greenness; longitudinal study

High-throughput low-cost nl-qPCR for enteropathogen detection: A proof-of-concept among hospitalized patients in Bangladesh.

BackgroundDiarrheal disease is a leading cause of morbidity and mortality globally, especially in low- and middle-income countries. High-throughput and low-cost approaches to identify etiologic agents are needed to guide public health mitigation. Nanoliter-qPCR (nl-qPCR) is an attractive alternative to more expensive methods yet is nascent in application and without a proof-of-concept among hospitalized patients.MethodsA census-based study was conducted among diarrheal patients admitted at two government hospitals in rural Bangladesh during a diarrheal outbreak period. DNA was extracted from stool samples and assayed by nl-qPCR for common bacterial, protozoan, and helminth enteropathogens as the primary outcome.ResultsA total of 961 patients were enrolled; stool samples were collected from 827 patients. Enteropathogens were detected in 69% of patient samples; More than one enteropathogen was detected in 32%. Enteropathogens most commonly detected were enteroaggregative Escherichia coli (26.0%), Shiga toxin-producing E.coli (18.3%), enterotoxigenic E. coli (15.5% heat stable toxin positive, 2.2% heat labile toxin positive), Shigella spp. (14.8%), and Vibrio cholerae (9.0%). Geospatial analysis revealed that the median number of pathogens per patient and the proportion of cases presenting with severe dehydration were greatest amongst patients residing closest to the study hospitals.”ConclusionsThis study demonstrates a proof-of-concept for nl-qPCR as a high-throughput low-cost method for enteropathogen detection among hospitalized patients.

Green spaces and risk of dementia-related mortality among the elderly in urban areas in Belgium: a 13-year follow-up census-based study

BACKGROUND AND AIM: Living in greener areas is associated with slower cognitive decline among the elderly, but few studies have explored the link with dementia-related mortality. This study examines the relationship between residential surrounding greenness and dementia-related mortality in the five largest urban areas in Belgium. METHODS: We used data from the 2001 Belgian census linked to mortality register data during 2001-2014. We included individuals aged 60 years or older and living in the agglomerations of Brussels, Antwerp, Ghent, Charleroi and Liege in 2001. Exposure to residential surrounding greenness was assessed using the Normalised Difference Vegetation Index (NDVI) within 500-m buffer from the residential address registered in 2001. We used ICD-10 codes to identify general dementia-related mortality including any neurodegenerative diseases (F00-F03, G12.2, G20-G22, G30-G31 and G35), and four types of dementia-related mortality: Alzheimer’s disease (G30); vascular dementia (F01); unspecified dementia (F03); and Parkinson’s disease (G20-G22). To define our cases, we considered any mention to dementia in the death certificate (i.e., as original, immediate, additional or intermediate cause of death). Cox proportional hazard models were conducted to obtain hazard ratios (HR) for dementia-related mortality for an IQR increase in surrounding greenness. Models were adjusted for age, gender, migrant background, education, housing tenure and PM2.5. RESULTS:In total, 1,089,215 individuals were included at baseline (2001). 6.1% died from neurodegenerative diseases during follow-up (1.9% Alzheimer’s disease, 0.5% vascular dementia, 0.4% Parkinson’s disease and 2.8% unspecified dementia). Surrounding greenness was inversely associated with all outcomes of dementia-related mortality, excepting Parkinson’s disease. These relationships remained significant after adjustment for all the covariates considered, but not with unspecified dementia after including PM2.5. The strongest beneficial association after complete adjustment was found for vascular dementia (HR 0.91, 95%CI: 0.86, 0.96). CONCLUSIONS:Our findings suggest that living close to green spaces in urban areas might reduce dementia-related mortality risk among the elderly. KEYWORDS: Green space, Neurodegenerative outcomes, Mortality

Is Mini-Plate Removal Necessary for Oral and Maxillofacial Surgery Patients? A Five-Year Case-Control Study.

Objectives:The purpose of this study was to determine the mini-plate and screw removal rate and reasons in maxillofacial surgery patients under previous semi-rigid fixation treatment in the past five years at the main trauma center of Mashhad.Materials and Methods:This was a census-based retrospective study. All the candidates who admitted to our department for maxillofacial plate removal due to symptomatic or infected mini-plates were included in this study. The patients’ age and gender, plate removal etiologies, and the time between plate insertion and removal were analyzed.Results:Mini-plates were inserted for 1026 patients. However, only 94 patients with a mean age of 29.4±11.1 years were candidates for plate removal. The plate removal rate was 9.16%. Infection and exposure were the most common causes of plate removal. The most prevalent removal site was the mandible (angle and body). The interval between mini-plate insertion and removal was an average of 12.9±5.6 months. It is noteworthy that the shortest lasting duration was when plate removal was secondary to pain (6.67 months) and infection (11.45 months).Conclusion:This research showed that the routine removal of plates does not appear to be generally indicated in healthy subjects unless there is an obvious and definitive clinical indication.

Nutritional status of children of Haitian descent and their demographic, socioeconomic and health characteristics in Cuiabá, State of Mato Grosso (MT), Brazil

The scope of this study was to analyze the distribution of anthropometric variables according to demographic, socioeconomic, and health characteristics among children of Haitian descent between 0 and 5 years of age living in Cuiabá-MT. It consists of a cross-sectional and census-based study with data collected between August 2016 and February 2017. The dependent variables were body mass index (BMI) and height-for-age z-score, using Student's t-Test and ANOVA in the statistical analysis. A total of 67 children, 73.2% to 24 months of age and 34.3% being male, were evaluated. There was a significant proportion of families with per capita income of less than 1/4 of the minimum wage (65.6%), with no home monitoring for the family health strategy (88.1%), and long working hours for mothers (43.3%). The onset of prenatal care until the third month of pregnancy and female sex were associated with higher BMI averages. For height-for-age, an association with lower mean values was found for households with more than one resident per room, higher age range of the child, and child-care in daycare centers. Thus, although few factors have an association with the anthropometric indications evaluated, it is necessary to consider the precarious socioeconomic conditions in which these children find themselves.

Targeted prevention of road traffic deaths in Greece: a multifactorial 5-year census-based study.

Between 2012 and 2016, Greece suffered yearly more than 800 deaths from road traffic incidents (RTIs), holding one of the worst performances in the European Union for RTI-related deaths per population. Our primary aim is to identify risk factors associated with mortality to set a targeted policy framework on road safety. This is a retrospective analysis of data collected prospectively from Traffic Police. A correlation of 29 factors with adult drivers' mortality was made, applying multivariate logistic regression models. At a second stage, a scoping literature review identified the best possible targeted prevention measures. A total of 93,019 drivers with a mean age of 42.2 ± 0.1years were recorded, of which 2772 (3%) died. Age above 65 (aOR 3.1, p < 0.001), non-use of seatbelt (aOR 8.2, p < 0.001) or helmet (aOR 2.85, p < 0.001) and alcohol consumption (aOR 3.3 for cars, 4 for motorbikes, p < 0.001) were the driver-related parameters with the strongest correlation with a fatal outcome. Drivers' behavior with specific high-risk maneuvers increased odds of death 2-4 times, depending on vehicle type. One-lane, rural road network was the environmental factor with the most significant impact. Based on the results of the analyses, our scoping review identified and suggested 23 specific measures for the Greek government and policymakers to examine. Human-related factors were the parameters with the strongest impact on mortality after an RTI in Greece. These findings demonstrate an educational gap that must be primarily addressed with the introduction of missing road safety education in schools and an intensified and innovative population awareness campaign.

Does physical ill-health increase the risk of suicide? A census-based follow-up study of over 1 million people.

Mental ill-health is a known risk factor for suicide mortality. However, the relationship between physical ill-health and suicide is less clear. This study examined the relationship between different aspects of physical ill-health and the risk of suicide death. Data for 1 196 364 adults (aged 18 years and over) were identified from the 2011 Northern Ireland Census and linked to death registrations until the end of 2015. Multivariate logistic regression was used to construct models to test associations with likelihood ratio tests for interactions. Over one in eight individuals (13.7%) reported multimorbidity (⩾2 physical health conditions) and one in four (25.4%) identified having limitation of daily activities. During follow-up, 51 672 individuals died; 877 due to suicide. The gradient in suicide risk by number of physical conditions disappeared following adjustment for activity limitation. Individuals with a lot of activity limitation were over three times more likely to die by suicide (OR = 3.13, 95% CI 2.50-3.93) compared to those with no limitations though this was reduced to OR = 1.72 (95% CI 1.35-2.20) with adjustment for poor mental health. The relationship between activity limitation and suicide was most pronounced at younger ages (18-34 years). This study suggests that it is the effect that physical illness has on a person's life, in terms of disruption to daily activity, rather than the number of conditions that predicts suicide risk, especially at younger ages. Improved awareness and better management of mental wellbeing of individuals with physical health conditions may help to reduce suicides, especially in younger people.

Sleep Quality and Fatigue among Breast Cancer Patients Undergoing Chemotherapy

Background: Breast cancer survivors make up a growing population facing treatment that poses long - standing adverse effects including chemotherapy- related sleep disorders and fatigue. There is limited knowledge of patients' lived experiences of chemotherapy- induced sleep disorders and fatigue. The aim of this study was to explore sleep quality and fatigue among breast cancer patients undergoing chemotherapy. Materials and Methods: One hundred fifteen patients were included in this census-based cross-sectional study. Data were collected through the Pittsburgh Sleep Quality Index and Brief Fatigue Inventory four days after the chemotherapy session. Statistical analysis was carried out using SPSS software version 13 and P<0.05 was considered statistically significant in all tests. Results: The mean hours of sleep were 5.6±1.83 in the range of 2 to 10 hours. The mean score of fatigue of participants was 5.59±1.67. Based on the cutting point, 57.4%, 20.9%, and 21.7% of participants had a moderate (4-6.9), mild (0.1-3.9), and severe (7-9.9) level of fatigue, respectively. The mean score of sleep quality among the participants was equal to 14.06±3.06, with a maximum and minimum of 7 and 21. The results of Spearman correlation coefficient showed that there is a significant relationship between fatigue and quality of sleep )0.210). Conclusion: Although the study findings revealed that patients with breast cancer undergoing chemotherapy experience different degrees of sleep disorders and fatigue, there is a need for more detailed studies to improve the quality of sleep and reduce fatigue in these patients due to the little attention paid to this issue in the medical field.

Does physical ill-health increase the risk of suicide? A Census-based follow-up study of over 1 million people

Background/Main Aim Prior poor mental ill-health is a recognised risk factor for suicide but the relationship between multiple physical health conditions and suicide risk is less clear.&#x0D; Methods Data of 1,196,364 adults (18-90years+) enumerated in Northern Ireland’s 2011 Census records were linked to death registrations until the end of 2015. Logistic regression models were generated to determine association between physical health status and both all-cause mortality and death from suicide, with adjustment for census-based attributes including the presence of mental health status. Physical health conditions severity was assessed using limiting long-term illness (LLTI: none, a little, a lot) and number of physical health conditions.&#x0D; Results About 14% of the cohort (n=164,473) had physical multimorbidity (two or more conditions) and 51,672 individuals died during follow-up; 877 due to suicide. A dose-response relationship was evident between number of physical conditions and all-cause death reaching an adjusted odds ratio (AOR) of 3.79 (95%CI: 3.65–3.94) in those with 4-or-more conditions (compared to those with no physical condition), but the association between number of physical conditions and suicide risk disappeared with adjustment for mental health. LLTI however, was an independent risk factor for suicide even after adjustment for mental health (AOR 1.52, 95%CI: 1.25–1.87 for those with daily activities limited a lot). The relationship between LLTI and suicide risk was only evident at younger ages (people aged less than 60).&#x0D; Conclusion This study demonstrates that the number of physical conditions is not an independent risk for suicide but that activity limitation is, though only at younger ages.

Are volunteering and caregiving associated with suicide risk? A Census-based longitudinal study

BackgroundOpposing risks have been identified between different prosocial activities, with volunteering having been linked to better mental health while caregiving has been associated with higher prevalence and incidence of depression. This study explored suicide risk of people engaged in prosocial activities of caregiving and/or volunteering.MethodsA Census-based record linkage study of 1,018,000 people aged 25–74 years (130,816 caregivers; 110,467 volunteers; and 42,099 engaged in both) was undertaken. Caregiving (light: 1–19; intense: ≥20 h/week), volunteering and mental health status were derived from 2011 Census records. Suicide risk (45 months follow-up) was assessed using Cox models adjusted for baseline mental health.ResultsIntense caregiving was associated with worse mental health (ORadj = 1.15: 95%CI = 1.12, 1.18) and volunteering with better mental health (OR = 0.87: 95%CI = 0.84, 0.89). For those engaged in both activities, likelihood of poor mental health was determined by caregiving level. There were 528 suicides during follow-up, with those engaged in both activities having the lowest risk of suicide (HR = 0.34: 95%CI = 0.14, 0.84). Engaging in either volunteering or caregiving was associated with lower suicide risk for those with good mental health at baseline (HR = 0.66: 95%CI = 0.49, 0.88) but not for their peers with baseline poor mental health (HR = 1.02: 95%CI = 0.69, 1.51).ConclusionsAlthough an increased risk of poor mental health was identified amongst caregivers, there was no evidence of an increased risk of suicide.

Spatial epidemiology of gestational age and birth weight in Switzerland: census-based linkage study

BackgroundGestational age and birth weight are strong predictors of infant morbidity and mortality. Understanding spatial variation can inform policies to reduce health inequalities. We examined small-area variation in gestational age...

Road traffic accident severity analysis: A census-based study in China

Background: In China, despite the decrease in average road traffic fatalities per capita, the fatality rate and injury rate have been increasing until 2015. Purpose: This study aims to analyze the road traffic accident severity in China from a macro viewpoint and various aspects and illuminate several key causal factors. From these analyses, we propose possible countermeasures to reduce accident severity. Method: The severity of traffic accidents is measured by human damage (HD) and case fatality rate (CFR). Different categorizations of national road traffic census data are analyzed to evaluate the severity of different types of accidents and further to demonstrate the key factors that contribute to the increase in accident severity. Regional data from selected major municipalities and provinces are also compared with national traffic census data to verify data consistency. Results: From 2000 to 2016, the overall CFR and HD of road accidents in China have increased by 19.0% and 63.7%, respectively. In 2016, CFR of freight vehicles is 33.5% higher than average; late-night accidents are more fatal than those that occur at other periods. The speeding issue is severely becoming worse. In 2000, its CFR is only 5.3% higher than average, while in 2016, the number is 42.0%. Conclusion and practical implementation: A growing trend of accident severity was found to be contrasting to the decline of road traffic accidents. From the analysis of casual factors, it was confirmed that the release way of the impact energy and the protection worn by the victims are key variables contributing to the severity of road traffic accidents.

Change in the number of PM2.5-attributed deaths in China from 2000 to 2010: Comparison between estimations from census-based epidemiology and pre-established exposure-response functions

Long-term exposure to ambient fine particulate matter (PM2.5) has been identified as a major contributor to disease burden in many countries, including China. The effects of long-term PM2.5 exposure have been evaluated by risk assessment studies, which are based on an exposure-response function (ERF) derived from a specific epidemiological study or multiple studies. To explore whether generalization from the pre-established ERFs (including the integrated exposure-response [IER] model and the global exposure mortality model [GEMM]) introduces biases into risk assessment of a specific local population, we conducted the first census-based epidemiological study of PM2.5, aimed at the entire population of mainland China. Using a difference-in-difference analysis at the county level, we associated mortality changes from 2000 to 2010 to corresponding PM2.5 changes, with adjustments made for multiple socioeconomic factors. Based on the epidemiological linkage between PM2.5 and total mortality, we calculated the change in PM2.5-attributed deaths and compared this value with the results derived from the pre-established models (IER and GEMM). According to the epidemiological model, a 10-μg/m3 increment in PM2.5 was associated with a 4.3% (95% confidence interval [CI]: 1.9%–6.7%) increment in total mortality, and the change in PM2.5-attributed deaths from 2000 to 2010 was estimated as 561,000 (95% CI: 539,000–581,000). The census-based estimation was in better agreement with the GEMM results (545,000–612,000) than was the IER result (354,000 [95% CI: 286,000–421,000]). In sensitivity analyses of the epidemiological model, the association between PM2.5 exposure and mortality was stronger among younger adults, consistent with the pre-established models. Due to the potential limitations of our findings, we cannot conclusively state that GEMM is more reliable than IER in China. Future studies are warranted to confirm or refute our findings.