External Causes Research Articles

Tendência temporal da incompletude do registro da raça/cor nos sistemas de informação em saúde do Brasil, 2009-2018

Abstract This ecological study of time trends and multiple groups evaluated incompleteness in the race/colour field of Brazilian health information system records and the related time trend, 2009-2018, for the diseases and disorders most prevalent in the black population. The Romero and Cunha (2006) classification was applied in order to examine incompleteness using secondary data from Brazil’s National Notifiable Diseases System, Hospital Information System and Mortality Information System, by administrative regions of Brazil, while percentage underreporting and time trend were calculated using simple linear regression models with Prais-Winsten correction (p-value<0.05). All records scored poorly except those for mortality from external causes (excellent), tuberculosis (good) and infant mortality (fair). An overall downward trend was observed in percentage incompleteness. Analysis by region found highest mean incompleteness in the North (30.5%), Northeast (33.3%) and Midwest (33.0%) regions. The Southeast and Northeast regions showed the strongest downward trends. The findings intended to increase visibility on the implications of the race/color field for health equity.

Causes of death among women of reproductive age during the war in Tigray, Ethiopia.

In resource-limited countries with weak healthcare systems, women of reproductive age are particularly vulnerable during times of conflict. In Tigray, Ethiopia, where a war broke out on 04 November 2020, there is a lack of information on causes of death (CoD) among women of reproductive age. This study aims to determine the underlying CoD among women of reproductive age during the armed conflict in Tigray. This community-based survey was carried out in six Tigray zones, excluding the western zone for security reasons. We used a multistage stratified cluster sampling method to select the smallest administrative unit known as Tabiya. Data were collected using a standardized 2022 WHO Verbal Autopsy (VA) tool. The collected data were analyzed using the InterVA model using R analytic software. The study reported both group-based and cause-specific mortality fractions. A total of 189,087 households were screened and 832 deaths were identified among women of reproductive age. The Global Burden of Disease classification showed that infectious and maternal disorders were the leading CoD, accounting for 42.9% of all deaths. External causes contributed to 26.4% of fatalities, where assault accounted for 13.2% of the deaths. Maternal deaths made up 30.0% of the overall mortality rate. HIV/AIDS was the primary CoD, responsible for 13.2% of all deaths and 54.0% of infectious causes. Other significant causes included obstetric hemorrhage (11.7%) and other and unspecified cardiac disease (6.6%). The high proportion of infectious diseases related CoD, including HIV/AIDS, as well as the occurrence of uncommon external CoD among women, such as assault, and a high proportion of maternal deaths are likely the result of the impact of war in the region. This highlights the urgent need for targeted interventions to address these issues and prioritize sexual and reproductive health as well as maternal health in Tigray.

A Review Of Certain Medical Plants With Antioxidant Qualities And In Vitro Approaches For Measuring Antioxidant Activity

Reactive oxygen species (ROS) are a type of extremely reactive molecule that results from oxygen metabolism. ROS, which include superoxide radicals, hydroxyl radicals, and hydrogen peroxide molecules, are frequently produced as byproducts of biological reactions or as a result of external causes. There is substantial evidence that ROS play a role in the development of degenerative illnesses. Evidence suggests that chemicals, particularly those derived from natural sources, can provide free radical protection. This has piqued the curiosity of researchers in natural antioxidants. Screening medicinal plants for antioxidant capacity is required. As a result, an attempt was undertaken to analyze various in vitro methods for assessing antioxidant activities of natural compounds derived from medicinal plants. All of the models are detailed, as well as the various estimation criteria. Finally, a great number of plants with antioxidant activity in vitro are described, although in vivo research is sparse.

Analysis of the trend of mortality from external causes in older adults in Brazil, 2000 to 2022

Resumo Objetivo analisar a tendência de mortalidade por causas externas em pessoas idosas no Brasil no intervalo temporal entre os anos 2000 e 2022 e identificar o perfil sociodemográfico de mortalidade. Método estudo ecológico de série temporal utilizando dados secundários, envolvendo a mortalidade em pessoas idosas por causas externas no Brasil, no período de 2000 a 2022. Os dados foram coletados a partir das bases de dados do Departamento de Informática do Sistema Único de Saúde, das estimativas da população residente e de dados populacionais censitários disponibilizados pelo Instituto Brasileiro de Geografia e Estatística. A frequência absoluta e relativa dos dados foi analisada a partir do software Excel 2010. As análises das tendências das taxas de mortalidade e regressão linear segmentada foram realizadas por meio do Joinpoint, com significância estatística avaliada por meio do teste de Monte Carl Resultados No período investigado, foram identificados 572.608 óbitos por causas externas em pessoas idosas com 60 anos ou mais. Em relação ao comportamento da mortalidade por causas externas em pessoas idosas, observou-se tendência de aumento nas taxas de mortalidade na maior parte do período estudado (2000 a 2013) com uma variação percentual anual (VPA: 1,86; IC95%: 1,5–2,2). Conclusão os resultados indicam uma tendência de crescimento da mortalidade de pessoas idosas por causas externas, refletindo a necessidade de priorização de políticas públicas que intervenham sobre esse evento.

СУТНІСТЬ РИЗИКІВ У ПІДПРИЄМНИЦЬКІЙ ДІЯЛЬНОСТІ

The article discusses the concept of risk, its types and classification, as well as methods of risk management. The concept of "risk management" as a relevant tool in decision-making is revealed. Modern approaches to risk management at various scales of business activity, from expert assessments to modern risk management systems, are analyzed. Classification of risks by management methods is defined. The importance of an automated approach to risk management is emphasized on the example of the COSO system, which allows implementing a systematic approach to risk management. The external and internal causes of risk as a result of actions in entrepreneurial activity have been established. The justified need to implement risk management in the modern world in business activity. The risks of business in the conditions of war in the country are outlined. Risks are systematized according to their nature of occurrence. The factors that negatively affect the company's reputation and can lead to the outflow of partners, investors and customers are identified. It has been proven that the control of business reputation will increase under the influence of the global trend on ESG (the company's compliance with sustainable development standards), as well as the growing discernment of the audience regarding the ethics of brands and their social responsibility. It was determined that for Ukrainian companies, the war made adjustments to contractual relations, and therefore it is necessary to carefully monitor risks, in particular in terms of rules of foreign jurisdictions, verification of companies and non-resident individuals, national requirements for companies that carry out activities or provide services abroad. It was concluded that in today's world, risk control is a global trend that allows companies not only to stay afloat, but also to turn adverse conditions to their advantage. Adaptability of business to risks and changes opens perspectives in many directions: for finding investors, building customer trust, entering international markets, positive image and reputation.

Long-term noise exposures and cardiovascular diseases mortality: A study in 5 U.S. states

BackgroundPrevious studies have linked noise exposure with adverse cardiovascular events. However, evidence remains inconsistent, and most previous studies only focused on traffic noise, excluding other anthropogenic sources like constructions, industrial process and commercial activities. Additionally, few studies have been conducted in the U.S. or evaluated the non-linear exposure-response relationships. MethodsWe conducted a relative incidence analysis study using all cardiovascular diseases mortality as cases (n = 936,019) and external causes mortality (n = 232,491) as contrast outcomes. Mortality records geocoded at residential addresses were obtained from five U.S. states (Indiana, 2007; Kansas, 2007–2009, Missouri, 2010–2019, Ohio, 2007–2013, Texas, 2007–2016). Time-invariant long-term noise exposure was obtained from a validated model developed based on acoustical measurements across 2000–2014. Noises from both natural sources (natural activities, including animals, insects, winds, water flows, thunder, etc.) and anthropogenic sources (human activities, including transportation, industrial activities, community facilities & infrastructures, commercial activities, entertainments, etc.) were included. We used daytime and nighttime total anthropogenic noise & day-night average sound pressure level combining natural and anthropogenic sources as exposures. Logistic regression models were fit controlling for Census tract-level & individual-level characteristics. We examined potential modification by sex by interaction terms and potential non-linear associations by thin plate spline terms. ResultsWe observed positive associations for daytime anthropogenic L50 (sound level exceeded 50% of time) noise (10-dBA OR = 1.047, 95%CI 1.025–1.069), nighttime anthropogenic L50 noise (10-dBA OR = 1.061, 95%CI 1.033–1.091) in a two-exposure-term model, and overall Ldn (day-night average) sound pressure level (10-dBA OR = 1.064, 95%CI 1.040–1.089) in single-exposure-term model. Females were more susceptible to all three exposures. All exposures showed monotonic positive associations with cardiovascular mortality up to certain thresholds around 45–55 dBA, with a generally flattened or decreasing trend beyond those thresholds. ConclusionsBoth daytime anthropogenic and nighttime anthropogenic noises were associated with cardiovascular disease mortality, and associations were stronger in females.

HEALTH AND DEMOGRAPHIC INDICATORS IN POPULATION OVER WORKING AGE

Highlights An analysis of the medical and demographic situation in the Russian Federation during the covid years (2020–2021) showed that the mortality rate in the studied population increased by 39.1%, the primary morbidity rate – by 26.3%, the incidence of COVID-19 increased by 135.6% and amounted to 10,304.1. The results of the study should be taken into account in the development of management decisions on the health of the elderly population at the federal, regional and municipal levels, as well as for planning dispensary work and preventive care for this population. Aim. To conduct an analysis of medical and demographic indicators and mortality rate in the population older than working age to develop management solutions regarding the health of older adults in the context of pension reforms.Methods. The study analyzed statistical data from the Federal State Statistics Service and the Central Scientific Research Institute of Public Health of the Russian Ministry of Health for period from 2012 to 2021.Results. The mortality rate in the population older than working age in the Russian Federation in 2021 amounted to 5 102.3‰oo. In the federal districts, the fluctuations in indicators were 1.3-fold: from 4 091.6‰oo in the North Caucasian Federal District to 5 374.6 in the Siberian Federal District. In the constituent entities of the Russian Federation, the difference between indicators was significant (2.9-fold): from 2 066.6‰oo in the Republic of Ingushetia to 5 974.6 in the Novgorod region. In 2021, the primary morbidity rate in the population older than working age in the Russian Federation was 66 183.5, in the Federal District the difference between indicators was 1.25-fold, the highest values ​​were noted in the Siberian Federal District – 73 257.0‰oo, the lowest in the Central Federal District – 58 462.2. In other constituent entities of the Russian Federation, the difference was significant as well (2.3-fold): the Oryol region showed 91 162.7‰oo, in the Kursk region - 39 282.9. In 2021, the following diseases had high morbidity rate in the Russian Federation: respiratory diseases – 21 391.3‰oo (32.3%), COVID-19 – 10 304.1 (15.6%), injury, poisoning and certain other consequences of external causes – 6 528.1‰oo (9.9%), and diseases of the circulatory system amounted to 6 191.7‰oo (9.4%). Regarding this class of diseases, the highest morbidity rates were associated with high blood pressure – 29.9%, cerebrovascular diseases – 28.4%, and hypertension– 25.4%. In federal subjects of the Russian Federation, the difference in the incidence of COVID-19 in the studied population was almost 6-fold in 2021: from 3463.4‰oo in the Chechen Republic to 20 481.6‰oo in the Altai Republic, indicating the ambiguity of COVID-19. During the year of the analysis (2020–2021), the mortality rates in the studied population increased from 4 408.1 to 5 102.9‰oo (by 39.1%), the primary incidence increased from 57 041.4 to 60 183.5‰oo (by 26. 3%), the incidence of COVID-19 increased from 4 373.9 to 10 304.1 COVID-19 (by 135.6%).Conclusion. The results of the study should be taken into account at the federal, regional and municipal levels during planning dispensary and preventive work for the health protection of the older generation.

Suicide victims and alcohol-related consumption in Brazil: An observational study and a narrative review of the literature.

Deaths due to external causes, mainly suicide, are a severe public health problem in Brazil. Evidence shows that the tendency to impulsive behavior is exacerbated after alcohol consumption. The relationship between alcohol and suicide is poorly described in the medical literature. The study aims to analyze the relationship between victims' blood alcohol levels and suicides in some municipalities in Greater São Paulo, Brazil. We reviewed the data from the medical records of 805 necropsies performed at the Medical Legal Institute of Sao Paulo in Franco da Rocha, Brazil, from 2001 to 2017. The manner of death was established based on the result of police inquiry. Deaths due to suicide (n=41) were selected for the study. Descriptive statistics and Student t-test was applied when appropriate. The variables studied were sex, age, suicide mechanism, and blood alcohol level (BAC). In all cases we could not determine how much time the deceased consumed alcohol before suicide. Of the individuals analyzed, 85.36% were male, and 14.64% were female. The most prevalent age range for males was between 18 and 23 (19.5%). For females, it was between 12 and 23 years (33.2%). Most suicides (48.78%) were due to hanging, followed by self-poisoning (22.08%) and firearms (17.1%). 38 victims (92.68%) presented a positive BAC, over 0.3 mg/dl. The higher levels were in the group of suicide by hanging (2.3 mg/ml). Thus, alcohol intoxication is common among suicide victims, and it can contribute to the fatal outcome as a risk factor. Further studies are necessary for a better comprehension of the effect of alcohol on suicide victims.

Coping with expectation violations in education: the role of optimism bias and need for cognitive closure

Although most individuals experience expectation violations in their educational years, individuals’ coping strategies differ depending on situational and dispositional characteristics with potentially decisive influence on educational outcomes. As a situational characteristic, optimism bias indicates that individuals tend to update their expectations after unexpected positive feedback and to maintain their expectations after unexpected negative feedback. As a dispositional characteristic, a higher need for cognitive closure (NCC) indicates that individuals tend to both update (accommodation) and try to confirm expectations (assimilation) after unexpected negative feedback. To better understand mechanisms behind optimism bias and context-dependent effects of NCC in an educational context, we included controllability (attribution of success/failure to internal or external causes) and self-enhancement (amplifying positive self-relevant aspects) in an experimental case vignettes study. Our sample of n = 249 students was divided into four experimental groups (high/low controllability × positive/negative valence) and read four different case vignettes referring to expectation violations in an educational context. MANCOVA revealed that individuals updated their expectations after unexpected positive feedback only with stronger (vs. weaker) self-enhancement and that individuals maintained their expectations after unexpected negative feedback in controllable (vs. uncontrollable) situations. Furthermore, interindividual differences in NCC interacted with controllability in predicting expectation update. We conclude that considering the influences of controllability and self-enhancement, we can better understand and evaluate the adaptivity of the optimism bias and context-dependent effects of NCC in an educational context.

Spatial patterns of mortality among the able-bodied population in the Republic of Bashkortostan

BACKGROUND: Regional differentiation adds complexity to the issue of high mortality among the working-age population. The identified regional patterns of mortality causes are typically not confined to specific areas, but rather influenced by spatial factors.
 AIM: To study temporal trends in spatial patterns of mortality of the working-age population mortality from the main causes of death in the Republic of Bashkortostan. In addition, we identified territorial factors associated with the mortality patterns and trends.
 METHODS: Mortality data on 6 main causes of death from 54 municipal districts, 20 urban districts and urban settlements were collected for the period from 2002 through 2020. The analysis included estimation of the Moran's index and the spatial panel data modeling.
 RESULTS: Spatial mortality patterns were evident for mortality from diseases of the circulatory system, infectious and parasitic diseases, and external causes. The impact of crime levels in a specific region (male: p=0.046; female: p=0.019) negatively affected mortality rates from circulatory diseases among working-age men and women. Additionally, for men, the volume of gross municipal product (GMP) had an additional effect (p=0.046). Factors that contribute to a decrease in mortality from external causes among able-bodied men and women included the growth of GMP (male: p=0.010; female: p=0.003 — for women), an increase in the number of doctors per 10,000 people in the population (male: p=0.001; female: p=0.037), and the availability of nursing staff (male: p=0.026; female: p=0.005). Furthermore, crime rates had a significant impact on mortality from external causes for men (p=0.028), while the availability of hospital beds played a crucial role for women (p=0.030).
 CONCLUSION: The study provides the evidence on the presence of spatial autocorrelation in the context of causes of death, as well as common and differing factors influencing male and female mortality in Bashkortostan. The findings provide a solid foundation for further analysis of spatially determined factors contributing to mortality among working-age population.

Inflation and finance

The study concentrates on the discussion in Hungary about the causes of contemporary inflation: what are the main causes of it and how to rank them. It tries to establish whether the simple methods of monetary policy are appropriate to stop inflation. The method of the study is an overview of recent professional articles and the analysis of the data of Central Statistical Office publications. It concludes that the Hungarian inflation has several internal and external causes: uncovered spending power especially in time of the COVID epidemic, the growing energy prices because of the Ukrainian war, money retention for Hungary in Brussels, the inadequatetiming of monetary policy actions, the role of imbalance of payments and exchange rates evolution – direct and indirect impulses-, the role of inherited state debts and the accumulated wage distortions which is now to correct, and the tax policy which relies mainly on VAT. The conclusion of the study is that only by autonomous monetary policy actions cannot deal with inflation, because the national policy cannot get rid of the international money markets. It is time to change the tax policy for a more structured one relying on the progressive income taxes.

THE “DOUBLE JEOPARDY” OF MIDLIFE AND OLD AGE MORTALITY TRENDS IN THE UNITED STATES

Abstract Since 2010, U.S. life expectancy growth has stagnated. Much research on U.S. mortality has focused on working age adults given adverse trends in drug overdose deaths, other external causes of death, and cardiometabolic deaths in midlife. We show that the adverse mortality trend at retirement ages (65+ years) has in fact been more consequential to the U.S. life expectancy stagnation since 2010, as well as excess deaths and years of life lost in 2019, than adverse mortality trends at working ages. These results reveal that the U.S. is experiencing a “double jeopardy” that is driven by both mid-life and older-age mortality trends, but more so by older-age mortality. Understanding and addressing the causes behind the worsening mortality trend in older ages will be essential to returning to the pace of life expectancy improvements that the U.S. had experienced for decades.

Review of ER stress and unfolded protein response

The cell is the fundamental unit of life, and all of the organelles within it perform essential tasks. Cells must meet their typical requirements for survival and development in order to contribute to the functioning of living things. Protein folding in the rough ER, the major organelle for the synthesis, folding, and modification of secreted and transmembrane proteins, is essential for their proper function in the cytoplasm. Endoplasmic reticulum stress (ERS) occurs when the protein-folding capacity of this organelle is disrupted due to various external causes or intracellular events, resulting to a buildup of misfolded or unfolded proteins. Concerns in this area are possible. Some illnesses, cell death, and metabolic abnormalities are examples. The cell's stress response mechanism is the unfolded protein response (UPR). Reduced translation, degradation of unfolded proteins to reduce damage, and increased production of cell-mate proteins all aid in the folding of nascent proteins. This research uses a literature review approach to learn about the ER, an experiment on ER Stress, the reaction mechanism of unfolded protein response (UPR), diseases induced by ER Stress, and the significance of UPR in these illnesses.

Reserves for Reducing Mortality in Russia in the Context of Its Age and Nosological Characteristics

The unattainability of increasing the life expectancy of the Russian population to 78 years within the announced time frame due to the epidemiological (COVID-19 pandemic) and subsequent geopolitical crisis has actualized the task of finding reserves for reducing mortality and concentrating efforts on priority areas. Based on official statistics, we analyzed the dynamics of mortality in the main (15-year, with age up to 1 year) age groups of the population from leading causes of death (causing 3/4 of mortality in the male population and 2/3 in the female population in each age group) for period 2000–2021. We calculated standardized mortality rates (European age structure standard). Mortality caused by alcohol and drugs was assessed collectively, taking into account external causes (poisoning with psychoactive substances, accidental and with uncertain intentions) and psychosomatic pathologies. When analyzing mortality from diseases of the circulatory system we distinguish acute and chronic forms of pathologies, since they are determined by various risk factors. There are reserves for increasing life expectancy at all ages due to a decrease in mortality from socially determined and preventable causes, but the main risk group is the most demographically and economically significant age stratum of 30–44-year-olds, the mortality rate in which (due to losses due to alcoholism and its consequences, HIV/AIDS, injuries of uncertain intent and ill-defined conditions) indicate persistent marginalization. In turn, this once again emphasizes that without the policy to reduce mortality going beyond healthcare, its effectiveness will be extremely low. A necessary condition for developing effective policies is the reliability and quality of information. Meanwhile, the general problem of accounting for the mortality of the Russian population, regardless of age, is the problem of diagnostic quality, as evidenced by the abnormally high level and contribution of losses from vague, uncertain and unidentified causes. The scope of application of the results obtained is their use to adjust the goals, priorities and system of measures in national projects aimed at increasing life expectancy. Directions for future research are related to the analysis of differentiation of mortality from the main causes from the social status of the deceased.

Assessment of maxillary sinus fluid volume for postmortem diagnosis of drowning

IntroductionDrowning is a comprehensive and exclusive diagnosis at autopsy. Autopsy findings such as pleural effusion and waterlogged lungs contribute to the diagnosis. Herein, we aim to reveal the practical usefulness and postmortem changes of the maxillary sinus fluid volume to diagnose drowning. MethodsWe evaluated 52 drowning and 59 nondrowning cases. The maxillary sinus fluid volume was measured using a computed tomography (CT) scan, and pleural effusion volume and lung weight were manually measured at autopsy. The utility of these three indices for diagnosing drowning and its postmortem changes was evaluated. ResultsThe maxillary sinus fluid volume was significantly higher in drowning cases than in other external causes and cardiovascular death cases. Receiver operating characteristic curve analysis revealed that a total maxillary sinus fluid volume >1.04 mL more usefully indicated drowning (odds ratio, 8.19) than a total pleural effusion volume >175 mL (odds ratio, 7.23) and a total lung weight >829 g (odds ratio, 2.29). The combination of maxillary sinus fluid volume and pleural effusion volume more effectively predicted drowning than one index alone. Moreover, the maxillary sinus fluid volume was less influenced by the postmortem interval than the other two indices up to a week after death. ConclusionMaxillary sinus fluid volume can be more useful than pleural effusion volume and lung weight with higher sensitivity and odds ratio for diagnosing drowning. Implications for practiceFluid accumulation in both the maxillary sinuses strongly predicts drowning in the postmortem imaging.

Short-term exposure to ambient air pollution and injuries due to external causes according to intentions and mechanisms

Although injuries are a leading cause of death and affect the life expectancy of individuals who live with disabilities globally, the potential role of air pollution exposure on injuries due to external causes has received little scientific attention, especially compared with that given to the association of air pollution and non-external causes of morbidity and mortality. We investigated the association between emergency department visits for externally caused injuries and short-term exposure to major ambient air pollutants, with focus on the intentions and mechanisms of injuries. We identified 2,049,855 injured patients in Seoul, South Korea between 2008 and 2016 using the National Emergency Database. Daily short-term exposure to air pollution including particles <10 μm (PM10) and <2.5 μm (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) was estimated based on hourly concentrations. We employed a time-stratified case-crossover study design using a conditional Poisson regression model adjusted for meteorological variables, influenza epidemics, and holidays. Immediate exposure (lag 0) to most pollutants significantly increased the risk of total injuries (PM2.5, 0.42 %; NO2, 0.68 %; SO2, 1.05 %; CO, 0.57 %; O3, 1.86 % per interquartile range increment), and the associations differed according to the intention and mechanism of injury. Unintentional and assault injuries were significantly associated with air pollution exposure, whereas self-harm injuries showed no association. In mechanism-specific analyses, injuries caused by falls, blunt objects, penetration, traffic accidents, machinery, and slips were associated with specific air pollutants, even in the co-pollutant models. The associations were stronger in injured patients aged <15 years, and in males than in their counterparts. Our results suggest that short-term air pollution exposure might play a role in the risk of externally caused injuries and the association may differ depending on the intention and mechanism of injury, which provide important evidence for injury prevention and air quality strategies.

Borderline personality disorder and the diagnostic co-occurrence of mental health disorders and somatic diseases: A controlled prospective national register-based study.

Information on borderline personality disorder (BPD) and its comorbidities is often limited to concentrate on a few diagnoses. The aim of the study was to use national register data to investigate all diagnostic co-occurring mental health disorders and somatic diseases 3 years before and after initial BPD diagnosis compared with a matched control group. The study was a register-based cohort of 2756 patients with incident BPD (ICD F60.3) and 11,024 matched controls, during 2002-2016. Comorbidity data were classified into main disease groups, in accordance with the World Health Organization ICD-10 criteria. Almost half the patients had been diagnosed with mental and behavioral disorders before the BPD diagnosis as compared to 3% in the control group. Further, the co-occurrence of diseases due to external causes of morbidity, including injury, self-harm, and poisoning were more represented in the BPD group before diagnosis as compared to the control group. In addition, co-occurring morbidity related to diseases in the circulatory, the respiratory, the digestive, the musculoskeletal, and the genitourinary system was more represented in the BPD group. After diagnosis, the proportion of patients with co-occurring morbidity increased further in all main disease groups in the BPD group. As many as 87% of patients had mental and behavioral co-occurring morbidity and 15% nervous diseases as compared with 3% and 4%, respectively, in the control group. Also, comorbidities related to external causes of morbidity, including for example, injury and self-harm were more represented in the BPD group. The BPD group had more somatic co-occurring morbidity, especially digestive, respiratory, circulatory, and endocrine diseases. Finally, the mortality over 12 years was statistically significantly higher in people with BPD than in the control group. Patients with BPD have higher odds for multiple physical health conditions and co-occurrence of mental health disorders.

External causes of death from death certificates in patients with dementia

AbstractBackgroundThe external causes of death, including unintentional injuries, falls, suicide, and complications of medical and surgical care, in dementia are not well‐established, particularly in rare dementias. We compared risk of death from specific external causes in patients with dementia and control participants.MethodThis was a nationwide population‐based cohort study in Sweden integrating 6 national registers from May 1, 2007, through December 31, 2018. We included all dementia patients aged 40 years or older identified from the Swedish Dementia Register‐SveDem and the national patient registry during the period and up to four control participants who were matched on the year of birth (± 3 years), sex and region of residence. Causes of death were obtained from death certificates compiled in the death registry. Hazard ratios (HRs) and 95% confidence intervals (CIs) of dementia on external cause‐specific mortality were calculated using Cox proportional models, adjusted for sociodemographic variables, comorbidity, and psychiatric disorders.ResultThe study cohort included 241 569 patients with dementia (99 380 men [41.1%]; mean [SD] age, 81.5 [8.5] years) and 794 562 control participants (352 295 men [44.3%]; mean [SD] age, 79.9 [8.6] years), over 3 871 433 person‐years. People with dementia presented higher incident rates for unintentional injuries and falls during old age, and suicide in middle aged dementia patients, while the reverse trend for suicide in dementia was observed after 75 years. The association varied according to time since diagnosis. Compared with control participants, people diagnosed with dementia had an adjusted HR of 2.66 (95% CI, 2.58‐2.74) for unintentional injuries, 2.10 (95% CI, 2.01‐2.20) for falls, 0.48 (95%CI, 0.40‐0.58) for suicide, 0.94 (95%CI, 0.89‐1.00) for complications of medical and surgical care, and 2.61 (95%CI, 2.04‐3.34) for other external causes. Compared with control participants, patients with frontotemporal dementia had the highest risk of unintentional injuries and falls, while participants with mixed dementia were less likely to die from suicide and complications of medical and surgical care.ConclusionSuicide risk screening in early‐onset dementia and early interventions for unintentional injuries and falls prevention in older patients with dementia should be provided.

Causes of fatal traumatic brain injury in Finland.

The phenotype of patients who suffer fatal traumatic brain injury (TBI) is poorly characterized. The authors examined the external causes, contributing diseases, and preinjury medication in adult patients with fatal TBI in a nationwide Finnish cohort. Deaths caused by TBIs in Finland were examined among decedents aged ≥ 16 years during 2005-2020 from the national Cause of Death Registry. Usage of prescription medications prior to TBI was studied using medication purchase data from the Social Insurance Institution of Finland. The cohort consisted of 71,488,347 person-years, 821,259 total deaths, and 14,630 TBI-related deaths during 2005-2020, of which 67% (n = 9792) occurred in men. Women were older than men among those who suffered TBI-related death (mean age 77.2 ± 17.1 vs 64.5 ± 19.5 years, p < 0.0001). The overall crude incidence rate of fatal TBIs was 20.5/100,000 person-years (28.1/100,000 in men and 13.2/100,000 in women). TBI was the cause of death in 1.8% of all deaths in the Finnish population during the study years, but in patients aged 16-19 years, TBIs caused more than 17% of all deaths. The most common external cause of fatal TBI was a fall (70%), followed by poisoning or toxic effects (20%) and violence or self-harm (15%) overall. In men, the order of the most common causes of fatal TBI was similar to overall results (64%, 25%, and 19%, respectively), while in women, the most common cause was a fall (82%), followed by complications in healthcare (10%) and poisoning or toxic effects (9%). Cardiovascular diseases, psychiatric diseases, and infections were the most common diseases contributing to death. Blood pressure (lowering) medications were the most common type of medications used before fatal TBI. CNS medications were the second most common medication group. In the context of fatal TBI in Europe, Finland remains at the upper end of fatal TBI incidence. TBI is a common cause of death in young adults, whereas the incidence of fatal TBI becomes increasingly higher with age in Finland. Cardiovascular diseases and psychiatric conditions were the most common diseases related to death, with opposite age trends. Healthcare facility complications were an alarmingly common cause of death in women with fatal TBI.

Состояние здоровья детей и подростков дальневосточного федерального округа

It is well-known that investigation of the features of incidence among children and adolescents in certain human environment aimed at identification of promising prevention vectors in the region is a priority in the development of healthcare system and the state’s social policy. The study was aimed to explore the regional features of the pediatric population health in the regions of the Far Eastern Federal District (FEFD). A retrospective analytical study was conducted; the values and structure of incidence in children and adolescents in 11 FEFD regions were assessed. It was found that classes X (Diseases of the respiratory system) and XIX (Injury, poisoning and certain other consequences of external causes) occupied the leading places in the structure of the long-term average annual incidence by disease classes in FEFD among children aged 0–14 and adolescents aged 15–17. The lowest incidence was reported for class III (Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism). Significant differences in the long-term average annual levels of the studied indicator between age groups in FEFD and significant differences from the all-Russian values were revealed. The findings can be used to predict the health status of the younger generation and determine the strategic direction of healthcare system in the macroregion.