Local Administrative Level Research Articles

Case-Time Series Study on the Short-term Impact of Meteorological Factors on West Nile Virus Incidence in Italy at the Local Administrative Unit Level, 2012 to 2021.

IntroductionWest Nile Virus (WNV) is a significant public health concern in southern Europe, with meteorological, climatic, and environmental factors playing a critical role in its transmission dynamics. This study aims to assess the short-term effects of meteorological variables on the incidence of WNV in five Italian regions in Northern Italy from 2012 to 2021. MethodsLinking epidemiological data from the national surveillance system and local meteorological data, we conducted a Case-Time Series analysis to examine the association between WNV incident cases and temperature, humidity, and precipitation recorded up to ten weeks before case occurrence at the local administrative unit level. We employed conditional quasi-Poisson regression and distributed lag non-linear models to explore delayed effects. ResultsOur study analyzed 1,110 autochthonous human cases of WNV. We found a positive association between WNV incidence and weekly mean temperature recorded between one to nine weeks before the diagnosis, with the highest effect at one week lag (IRR: 1.16; 95% CI 1.11-1.21). An increase in weekly precipitations between the sixth and ninth weeks before diagnosis was also positively associated with WNV incidence. Variations in minimum weekly humidity did not show a consistent impact. ConclusionsOur findings underscore the influence of temperature and, to a lesser extent, precipitation on WNV incidence in Northern Italy, highlighting the potential of climatic data in developing early warning systems for WNV surveillance and public health interventions.

A local perspective on the links between flora biodiversity and ecosystem services in the Northwest Highlands of Ethiopia

The main concern that this study attempts to address is the reason that the local people sustainably conserve church forests while aggressively exploiting biodiversity in common forests, shrublands, and grasslands. The study assesses the local perspective on the links between flora biodiversity and ecosystem services across a range of management options in the typical watershed of the Northwest highlands of Ethiopia. A mixed study design that included questionnaires, remote sensing, and hermeneutics was used because of the multidisciplinary character of the research. There has been a perceptible decline in flora biodiversity in the open-access shrublands, forests, and grasslands as a result of increased settlement encroachment, unchecked and continuous overgrazing, excessive firewood collection, and the cutting of living and dead tree and shrub biomass. Because of this, it was noticed that the availability of wild edible plants, medicinal plants, trees to produce tools, habitat for wild animals, and lumber production is drastically reduced. Alternatively, the church forests were preserved with responsive caring, which enables the outstanding performance of the majority of ecosystem services (except for collecting firewood and fibers) for the local community with the principles of equality and inclusiveness. Therefore, to restore open-access communal grazing ecosystems and the synergy of many ecosystem services in a given watershed, an effective institutional structure must be developed at the local administration level. To offer a range of ecosystem services and socioeconomic benefits, reforestation and planting of both exotic and native plants with enclosure management established on the values of justice, equality, inclusivity, and well-managed local governance with strict laws, sanctions, and enforcement must be the cornerstones of the management plan.

Assessing knowledge of dental house officers regarding dosage calculation and complications of local anaesthesia, in three tertiary care dental hospitals of DUHS, Karachi.

To assess the knowledge and awareness of dental house officers regarding calculation of local anaesthesia dosage, and to evaluate differences in practices at various tertiary care facilities. The cross-sectional study was conducted at three dental hospitals affiliated with Dow University of Health Sciences, Karachi from July to December 2022, and comprised house officers of either gender currently enrolled at the participating centres. Data was collected using a self-administered questionnaire to assess knowledge and awareness of local anaesthesia dosage calculation, administration methods, and common complications. Data was analysed using SPSS 26. Of the 200 subjects approached, 136(68%) responded, and 89(65.4%) of them were females. Knowledge regarding the meaning of 2% lidocaine solution was low 45(33%), and 68(50%) subjects were knowledgeable about the maximum dosage of lidocaine with epinephrine. In terms of practice, lidocaine was the most commonly administered local anaesthetic 115(85%), followed by bupivacaine 15(11%). The majority of subjects administered local anaesthesia with vasoconstrictor 127(94%), but only 36(27%) performed aspiration during administration. Syncope 71(52%) was the most commonly reported complication, followed by lip/cheek/tongue biting by 35(26%). House officers' knowledge level of local anaesthesia administration indicated the need for adequate training.

Spatial Analysis of Peri-Urban Areas of Bucharest in the Context of Big Data

Abstract The territorial expansion of the Bucharest-Ilfov region is a continuous process. This expansionist process is not always followed by an increase in the quality of life of the citizens, because in order to produce this effect, it is important that the territorial expansion is carried out in all branches (road infrastructure, residential buildings, access to medical services, access to education, access to shared public transport). As the specialized literature observes a chaotic development of this region, the research aims to analyze the peri-urban areas of the Municipality of Bucharest and the 6 sectors of the Municipality of Bucharest from the perspective of citizens' access from residential buildings to 3 basic services of society (transport, education and medicine), but also the identification of the spatial association relationship between the 6 sectors and peri-urban areas. In order to achieve these objectives, geospatial data of the big-data type were extracted, more precisely by extracting them with the help of artificial intelligence from satellites, and then processing these data. Also, the selected sample includes the 6 sectors of the Municipality of Bucharest, as well as the peri-urban areas. The main results indicate real development discrepancies both at the level of the 6 sectors of the Municipality of Bucharest, and at the level of the peri-urban areas, on all 3 dimensions analyzed. In addition, with the exception of two semi-significant local spatial autocorrelations, it cannot be stated that there is a spatial association relationship between the units in the sample, the development gaps being the result of the decision-making process at the local public administration level. Through the research results, development directions of the peri-urban areas and the 6 sectors can be identified to increase the quality of life of their citizens.

IJCM_296A: Assessment of burden of Long Covid, and it's determinants among patients with Long Covid in the rural community in Bengaluru Rural District – A community based cross sectional study.

Background: Longer-term consequences after SARS-CoV-2 infection are becoming an important burden to societies and healthcare systems. Long COVID-19 and post COVID-19 conditions are terms used clinically to describe ongoing or new symptoms that occur beyond 12 weeks of recovery from an acute infection, that cannot be explained by an alternative medical diagnosis. It is now understood that COVID-19 can impact on multiple organ systems, which can lead to a diverse range of persistent symptoms including fatigue, breathlessness, cough, loss of taste and/or smell, myalgia, memory issues and gastrointestinal problems. Very few studies have been conducted globally to assess the burden of Long Covid which are in hospital setting and none published in Karnataka state. This community based cross sectional study intends to bridge the gap in existing evidence pool and to influence evidence-based policy decisions at local administrative level. Objectives: To assess the prevalence of Long covid among people infected with COVID-19 in rural community Bengaluru rural district. Methodology: Community based cross sectional study was conducted between October 2023 to November 2023 in Orohalli & Jadigenahalli Panchayaths of Hoskote Taluk. After obtaining written and informed consent from the participants, all adults > 18years of age residing in identified villages, with COVID-19 RTPCR positive status, tested at least 12 weeks/ 3 months prior to the date of interviewed using a prevalidated questionare and Fatigue Assessment Scale. Data is analysed using SPSS trial version 21. Results: 420 participants were interviewed in 17 villages. Mean period between date of COVID positivity to date of interview was 490 days. 27 (6.4%) participants reported residual symptoms from COVID 19 infection suggestive of Long Covid. Majority of them complained of fatigue. Out 25 respondents with fatigue, 18 people had a score > 22 on FAS, indicative of clinical fatigue. Older age >60years, female gender, and ICU admission during infection, were associated with higher prevalence of long covid and are statistically significant (p value< 0.05) Conclusion: It is essential to determine the burden of longer-term consequences of SARS-CoV-2 infection and the needs of affected individuals, to successfully plan healthcare services and efficiently allocate public health resources.

Тенденції децентралізації публічного управління: сучасний стан та перспективи розвитку

The article deals with the current state and prospects for developing decentralization in public administration by transferring managerial functions and central authorities’ powers to the local administration level. The article emphasizes that despite being tested by war, Ukrainian decentralization received an impeccable assessment from the European Commission, which preceded granting our country the candidate status for the European Union membership. The history of decentralization is analyzed, and successive stages are singled out. The stages mainly relate to the normative and legal regulation of this process: the first stage (2014– 2019), the second stage (2020–2021), and the third stage (2022 – present). The third stage of the local self-government reform seems to be the most difficult since it occurred during the martial law period. The hostilities only emphasized the effectiveness of the decentralization reform: local self-government bodies responded promptly to the situation, resolving issues of settling internally displaced persons, repairing housing for them, providing facilities and premises for evacuated enterprises, and organizing humanitarian headquarters. An essential task of the third stage is adopting the Law on Amendments to the Constitution of Ukraine (regarding decentralization of power), a prerequisite for continuing decentralization reforms and their completion. The article examines the achievements that are positively reflected in the activities of the united territorial communities due to the decentralization process in the following areas: budget, healthcare, security, international cooperation, culture, education, and service provision. At the same time, the factors complicating the decentralization process and leading to problems in the practical and proper functioning of local authorities are considered. Attention is drawn to the need to adopt important laws, including the Laws “On the principles of the administrative and territorial structure of Ukraine”, “On service in local selfgovernment bodies” (revised version), “On state supervision over the legality of decisions of local self-government bodies”, “On local referendum”, as well as updating laws on local selfgovernment, on local state administrations, etc.

Studiu istoric al unei case urbane stil „Arta 1900”

This paper aims to answer a series of questions resulting from the presence of incomplete and superficial documentation gathered over time in the context of rehabilitation and restoration of historic houses in Turda, some of which are classified as monuments. Therefore, the following questions are considered: What is the value of a historical study in the context of an intervention? What is the structure of a historical study of a building? Who is in a position to carry out such a study and to impose permissions and restrictions? How can the research results be used? Does the history of one building illustrate wider policies of the Austro-Hungarian authorities to urbanise and modernise smaller towns in the realm? Although, this study is dedicated to a single building, located in the historical centre of the town, its detailed study and the reconstruction of its historical and architectural path can provide clues concerning the implementation of urban policies of the Austro-Hungarian Monarchy in provincial context. The building was classified as a historical monument, but its aspect today reflects its complicated history and the many unfortunate and misguided interventions it has undergone. It has also been neglected by existing research, and thus, its position within the „Art 1900” [Art Nouveau] has not been explored. Consequently, the present research attempts to make the most of the data recorded sporadically in various sources covering the history of Turda. On the other hand, the lack of conservation strategies for this type of heritage, reflected in a coherent legislative framework, has led until recently to a lax and confusing approach at the local administration level as well, as evidenced by the series of renovations and rehabilitation inappropriate to the original style, carried out by the local authority, owners or tenants over time. Good documentation forwarded to the authorities and current owners can, therefore, help these buildings and act as a method of educating the public, providing guidance concerning the value, functionality, and capacity of heritage to create more value for local communities.

Local Public Administration in the Process of Implementing Sustainable Development Goals

The concept of social responsibility and the United Nations’ (UN) Sustainable Development Goals (SDGs) share principles that focus on ensuring more empathetic, resilient, and just societies in which people can interrelate respectfully. The current tendency is to create innovative sustainable development strategies, focusing on local initiatives and demonstrating the role of local and regional governments as key change agents. This study focused on SD at the local public administration (LPA) level with the objective of determining how SDGs are implemented by LPAs, including examining administrative actors’ roles as coordinators of public goods and initiatives focused on convincing all stakeholders to participate actively in cocreating solutions to social, economic, and environmental problems. The relevant literature’s most prominent research topics and their evolution were explored using bibliometric techniques (i.e., evaluation, relational analysis, and the visualization of bibliometric elements using VOSviewer software (version 1.6.18)). The results suggest that the process of implementing SDGs presents LPAs with a set of challenges, concerns, and restrictions. The UN’s 2030 Agenda provides guidelines for how to meet its goals and targets, which helps LPAs set priorities and standards for development initiatives, but implementing them successfully is neither a quick nor an automatically successful process.

Understanding the spatial non-stationarity in the relationships between malaria incidence and environmental risk factors using Geographically Weighted Random Forest: A case study in Rwanda.

As found in the health studies literature, the levels of climate association between epidemiological diseases have been found to vary across regions. Therefore, it seems reasonable to allow for the possibility that relationships might vary spatially within regions. We implemented the geographically weighted random forest (GWRF) machine learning method to analyze ecological disease patterns caused by spatially non-stationary processes using a malaria incidence dataset for Rwanda. We first compared the geographically weighted regression (WGR), the global random forest (GRF), and the geographically weighted random forest (GWRF) to examine the spatial non-stationarity in the non-linear relationships between malaria incidence and their risk factors. We used the Gaussian areal kriging model to disaggregate the malaria incidence at the local administrative cell level to understand the relationships at a fine scale since the model goodness of fit was not satisfactory to explain malaria incidence due to the limited number of sample values. Our results show that in terms of the coefficients of determination and prediction accuracy, the geographical random forest model performs better than the GWR and the global random forest model. The coefficients of determination of the geographically weighted regression (R2), the global RF (R2), and the GWRF (R2) were 4.74, 0.76, and 0.79, respectively. The GWRF algorithm achieves the best result and reveals that risk factors (rainfall, land surface temperature, elevation, and air temperature) have a strong non-linear relationship with the spatial distribution of malaria incidence rates, which could have implications for supporting local initiatives for malaria elimination in Rwanda.

Is it possible to create a unified urban greenery management system (UGMS) on a national scale? The concept for EU Member State of Poland

MotivesCurrently developed urban greenery management systems (UGMS) are limited in scope and profiled towards solving particular issues. Moreover, due to the lack of common standards and solutions, UGMS implementation requires considerable financial effort, which is only feasible for wealthy urban centres. There is a need for universal, cost-effective technological solutions which could constitute a common urban green infrastructure at all country administrative levels. AimThis research aims to present a technological architecture of a universal UGMS capable of data integration and analysis at both local and central administrative levels, and present its prospective data management functionality through a proof-of-concept implementation by the example of Olsztyn city, located in the EU Member State of Poland. MethodsEmpirical study has been conducted by means of qualitative assessment through state-of-the-art analysis of green information systems, national spatial data infrastructure (NSDI) including land administration system (called Integrated Real Estate Information System) and Geoportal, development and testing of a proof-of-concept solution through management, analysis and visualizations of green areas, objects and related phenomena; quantitative assessment has been performed through in-situ inventory of urban greenery in the City of Olsztyn, Poland. ResultsThe presented study resulted in a concept UGMS architecture based on existing NSDI. The projected functionality of the designed UGMS has been implemented and tested on a real-world urban greenery database. The research thesis, that open databases integrated with national SDI data are sufficient to create a uniform and complete nationwide UGMS was confirmed.

Food insecurity in the Eastern Indo-Gangetic plain: Taking a closer look.

Food security is an important policy issue in India. As India recently ranked 107th out of 121 countries in the 2022 Global Hunger Index, there is an urgent need to dissect, and gain insights into, such a major decline at the national level. However, the existing surveys, due to small sample sizes, cannot be used directly to produce reliable estimates at local administrative levels such as districts. The latest round of available data from the Household Consumer Expenditure Survey (HCES 2011-12) done by the National Sample Survey Office of India used stratified multi-stage random sampling with districts as strata, villages as first stage and households as second stage units. Our Small Area Estimation approach estimated food insecurity prevalence, gap, and severity of each rural district of the Eastern Indo-Gangetic Plain (EIGP) region by modeling the HCES data, guided by local covariates from the 2011 Indian Population Census. In HCES, 5915 (34429), 3310 (17534) and 3566 (15223) households (persons) were surveyed from the 71, 38 and 18 districts of the EIGP states of Uttar Pradesh, Bihar and West Bengal respectively. We estimated the district-specific food insecurity indicators, and mapped their local disparities over the EIGP region. By comparing food insecurity with indicators of climate vulnerability, poverty and crop diversity, we shortlisted the vulnerable districts in EIGP. Our district-level estimates and maps can be effective for informed policy-making to build local resiliency and address systemic vulnerabilities where they matter most in the post-pandemic era. Our study computed, for the Indian states in the EIGP region, the first area-level small area estimates of food insecurity as well as poverty over the past decade, and generated a ranked list of districts upon combining these data with measures of crop diversity and climatic vulnerability.

The implementation of sufficiency economy in local development: A case study of administrative areas of Takuk Nuea Subdistrict Administrative Organization, Vibhavadi District, Surat Thani Province, Thailand

This research aims to (1) evaluate the implementation of sufficiency economy philosophy for local development in Tambon Takoek Nuea, Amphoe Wipawadee, Surat Thani province, (2) study the attitudes of the community towards the role of Tambon Takoek Nuea in driving the sufficiency economy philosophy for local development, and (3) examine the relationship between perception factors and participation factors with the attitudes of the community towards the role of Tambon Takoek Nuea in driving the sufficiency economy philosophy for local development. The research utilized a quantitative research method. The researchers used criteria for assessing the understanding, perception, and access to the sufficiency economy philosophy at the local administrative organization level as a framework for evaluation. An online questionnaire was used to collect data to study the community's attitudes in Tambon Takoek Nuea, with a sample size of 400 people. The data were analyzed using the SPSS software to calculate percentages, means, standard deviations, and to compare differences using t-tests and one-way ANOVA tests at a 95% confidence level. The Pearson correlation coefficient was used to test the relationships between variables. The study found that (1) Tambon Takoek Nuea had an evaluation result of sufficiency economy understanding at the level of "understanding" (253 points) according to the Happiness Organization framework. (2) The community had attitudes towards the role of Tambon Takoek Nuea in driving the sufficiency economy philosophy for local development at an overall moderate level (mean of 3.22), and factors such as age, education level, and occupation showed significant differences in attitudes at a statistical significance level of 0.05. (3) Perception factors were correlated with the community's attitudes towards the role of Tambon Takoek Nuea in driving the sufficiency economy philosophy for local development in all three aspects, namely management, participatory community development planning, and community resources. This abstract summarizes the objectives, methodology, and key findings of the research, highlighting the importance of driving the sufficiency economy philosophy for local development in the context of Tambon Takoek Nuea's local administrative organization.

Exploring knowledge creation, capabilities, and relations in a distributed policy foresight system: Case Finland

In an uncertain and increasingly interdependent world, cross-sectoral policy foresight is needed to tackle complex phenomena. However, most existing foresight studies have focused on a single sector or domain. This article adopts a systems perspective and explores knowledge creation, capabilities, and relations in a distributed policy foresight system cutting across government sectors and national, regional, and local administrative levels. The article is based on empirical material collected in Finland in 2019, describing the Finnish policy foresight system's existing organizational and systemic foresight capacities. Our results indicate that policy foresight considers relatively narrow future horizons relying heavily on futures knowledge that is accessible in the immediate operating environment. The full potential of foresight is not utilized. Distributed foresight collaboration at the systems level is hindered by lack of coherence, coordination, and collaboration structures. We propose ways to improve the foresight system's performance and point to ecosystem literature as a productive direction for foresight research to further the paradigm of distributed foresight systems.

Spatial dimensions of illiteracy in Romania, 1992-2011.

Starting with the chapter approaching the educational characteristics of the three census databases carried out in post-communist Romania (1992, 2002, and 2011), broken down at the local administrative unit level, the article aims to analyze from a geographical perspective the phenomenon of illiteracy. In the collective mindset, this notion is primarily associated with poverty, lack of accessibility to education, and/or lack of interest in school. During the three decades covered by this study, influenced by the change of the communist political regime and the economic instability, the complexity of the spatial dimensions of illiteracy is defined by particular demographic, confessional, and ethnic connections which have experienced various dynamics, but following the general tendency of the peripheralization of the phenomenon. Although the Romanian education system adopted certain Western reforms and implemented certain modern strategies, its quasi-obsolete strategies have persisted or have been aggravated in certain well-defined communities, which have been evolving against the downward trend, betraying a severe educational failure, especially in the south of the Romanian Plain, the south of Dobrogea Region, and in Transylvanian Depression. Therefore, in pursuing the implications of the ethnic and religious heritage, as well as the residential area factor, this research is devoted to the study of the main geographical areas where illiteracy is still present and to its relations with the social and economic environment.

Environmental taxation and a reflection of its main elements in the accounting system

The subject of research is the procedure for taxation and reflection of environmental tax in the accounting system. The purpose of the article is to disclose a methodological approach to environmental taxation in Ukraine, which will make it possible to develop proposals for improving the information base formed by the accounting system and its further use in order to form various types of reporting, as well as planning actions to reduce the amount of pollution by business entities. The methodological basis of the study is the general scientific and special methods of scientific knowledge, applied at the empirical and theoretical levels of research: comparative, analytical, selective, dialectical, systematic approach, induction and deduction, generalization. Results of work. The article carried out studies of the current state of taxation in the context of components of environmental taxes, analyzed the volume of such taxes in the budget by types of environmental pollution. National, regional and local administrative levels of influence have been identified that allow the implementation of environmental plans and measures in the legal field. Taking into account the current requirements of users of accounting information, the documentary reflection of the economic activity of the calculation of environmental tax obligations has been improved. A complex of analytical accounting system for settlement operations with the environmental tax budget was developed and its practical application is presented. Field of application of results in the activities of economic entities in certain sectors of the economy. Conclusions. The proposed procedure for reflecting transactions under accrued budgetary obligations is the result of compliance with environmental tax requirements. Environmental accounting, in turn, is the basis for obtaining this information on costs, analyzing and monitoring rational environmental activities. Therefore, the main objective of environmental accounting is to develop expense items to account for general operating expenses (or to form a separate sub-account to account for environmental expenses under the items) and accounting for 92 Administrative expenses. At the same time, аpplication of accounting standart 16 "Expenses" facilitates the provision of a list of items of expenses related to their accounting.

High Level of Unwarranted Clinical Variation in the Use of Lower Extremity Revascularisation Procedures in Hungary (2013–2017)

Assessment of variations in the use of lower extremity open vascular surgical procedures (LEOPEN) and lower extremity endovascular procedures (LEENDO) across small geographic areas in Hungary from 2013 to 2017. Introduction of a new metric giving a rough estimate of unwarranted clinical variation in revascularisation practice. Spatial variation (at local administrative unit level) of referral for LEOPEN and LEENDO was evaluated through a retrospective analysis using healthcare administrative data of all beneficiaries in Hungary. The same assessment was performed for percutaneous coronary intervention in acute myocardial infarction (PCIAMI). The latter was considered a reasonable comparator (similar at risk population, well organised, guideline driven patient pathways, small room for referral discretion). Consequently, the ratio of spatial variations of LEOPEN and LEENDO to PCIAMI (as a reference) are thought to reflect unwarranted clinical variation. A total of 109 882 procedures were identified in the database (LEOPEN, LEENDO, PCIAMI) affecting 85 083 patients. While estimates of spatial variations for LEOPEN and LEENDO turned out to be high (systematic component of variation [SCV] 0.09 and 0.21, respectively), PCIAMI showed a low SCV value of 0.02. Consequently, the ratios of SCVs were SCV/SCVref = 4.67 (LEOPEN) and SCV/SCVref = 10.3 (LEENDO), indicating high levels of unwarranted clinical variation. The analysis showed that patients living in different locations of Hungary face very different odds of having lower extremity revascularisation procedures (open or endovascular). This spatial variation is thought to be related mainly to the failure in vascular service organisation. The newly introduced numerical estimate of unwarranted clinical variation may support within, and also between, system comparisons.

Local Government Administration and Grassroots Development in Imo State: A Case Study of Owerri Municipal Council

This study is an assessment of local government administration as an instrument of grassroots development in Nigeria, using Owerri Municipal Council as a case study. With a well-structured questionnaire supported with oral interviews, data were generated from one hundred and seventy municipal council staff stratified into three categories of top management, middle and low cadres. Employing the Spearman‟s Rank Coefficient as the main statistical tool of analysis, the study revealed among others that a significant relationship exists between the state of infrastructure and grassroots development in Nigeria and between the level of ineffective local government administration and the extent of job creation among the local populace. Further findings showed that a significant relationship exists between insufficient skilled manpower and the level of grassroots rural-urban migration as well as between ineffective local government administration and the level of grassroots participation in democratic activities. Following these findings, the study therefore, concluded thus: that the state of infrastructure is poor, resulting in low grassroots development in Nigeria. Similarly, the study inferred that ineffective local government administration led to poor resource management, which in turn impeded grassroots job creation, and that lack of skilled manpower fuelled rural-urban migration in Nigeria, while ineffective local government administration was a significant determinant factor to poor grassroots participation in democratic processes in Nigeria. Therefore, prominent among others, the study advocated for an upward review of the revenue sharing formula in favour of the local governments being a grassroots government closest to the populace, while sanctioning erring personnel who may be tempted to engage in funds misappropriation.

VULNERABILITY GRADIENTS AND SPATIAL PATTERNS IN THE GREEK RURAL SPACE: DETECTING REQUIRING SMART SERVICES

In Greece, rural depopulation is observed over time, reflecting a particularly unbalanced population distribution. In recent years, however, the economic crisis is leading to rapidly decreasing rates of urbanization, and relative revitalization of some rural areas. Considering the above, there is therefore the question of the resilience and attractiveness of rural areas, especially marginalized ones. The fundamental objective for ensuring their sustainability is the possibility of addressing the key social and economic needs of the local population, thus contributing to a minimum level of social integration and improvement of living standards. The main purpose of the present study is to introduce a typology for the marginalized rural areas in Greece, applied to the local administrative spatial level and more specifically to detect among those, the most vulnerable requiring the implementation of smart services. Based on the acknowledgment of territorial heterogeneity, the analysis is defined by a multidimensional data warehouse. In particular, spatial, societal, environmental, and cultural marginalities define the corresponding data collected. Multicriteria Analysis (Explanatory Factor analysis, Hierarchical analysis and Discriminant analysis) and spatial tools (GIS) identified the main types (spatial patterns) of Greek marginalized local administrative units. The implementation of this methodological tool aims at the evaluation and classification of the needs of local societies. The proposed research is an innovative approach to Greek data, in terms of scientific contribution to the identification of rural areas with new criteria and the emergence of smart services as rural resilience tools.

Trading off fiscal budget adherence and child protection.

Many countries delegate a substantial part of social service decisions to local administrative levels, while federal laws provide the overall framework for service levels. Strict regulations to reduce budget overruns may however leave local governments with a potential trade-off between adhering to fiscal budgets and supplying critical welfare services as e.g. programs to protect vulnerable children. We investigate if budgetary constraints influence child protection decisions using high-quality register data. We show that the introduction of fiscal sanctions to improve budget adherence contributed to a sharp decline in budget overruns on child protective services by reducing the number of children in out-of-home care. Our results further show that monthly variation in budget adherence within a fiscal year affects the probability of a placement in out-of-home care for children in need of help towards the end of a fiscal year. We estimate that a budget overrun of 10 percentage points by mid-year leads to a 1.2 percent reduction in the number of children in care over the remaining part of the fiscal year. Municipalities reduced child protection expenditure by choosing cheaper types of care and ending placement for children in out-of-home care, particularly for children turning 18. Our paper contributes to the literature on fiscal federalism by documenting the trade-off between managing public expenditure and providing safety and equal opportunity for vulnerable children. We thus highlight that enforcing strict budget adherence may be in conflict with social policy goals. Our results raise an important discussion about centralization versus delegation of critical public services.

Spatial analysis of factors impacting lower limb major amputation rates in Hungary: Is geography partially destiny?

Background: Lower limb major amputations represent a substantial public health burden in Hungary, where previous research revealed markedly high rates with significant spatial variations. Therefore, we aimed to assess to what extent healthcare and socio-economic factors in the local environment explain the regional disparity. Patients and methods: In a retrospective cohort analysis, based on the healthcare administrative data of the Hungarian population, lower limb major amputations were identified from 1st of January 2017 to 31st of December 2019. The permanent residence of the amputees on the local administrative level (197 geographic units) was used to identify potential healthcare (outpatient care, revascularisation activity) and socio-economic (educational attainment, local infrastructure and services, income and employment) determinants of amputations. Spatial effects were modelled using the spatial Durbin error regression model. Results: 10,209 patients underwent 11,649 lower limb major amputations in the observational period. In our spatial analysis, outpatient care was not associated with local amputation rates. However, revascularisation activity in a geographic unit entailed an increased rate of amputations, while revascularisations in the neighbouring areas were associated with a lower rate of amputations, resulting in an overall neutral effect (β=-0.002, 95% CI: -0.05 - 0.04, p=0.96). The local socio-economic environment had a significant direct inverse association with amputations (β=-7.45, 95% CI: -10.50 - -4.42, p<0.0001) . Our spatial model showed better performance than the traditional statistical modelling (ordinary least squares regression), explaining 37% of the variation in amputations rates. Conclusions: Regional environmental factors explain a substantial portion of spatial disparities in amputation practice. While the socio-economic environment shows a significant inverse relationship with the regional amputation rates, the impact of the local healthcare-related factors (outpatient care, revascularisation activity) is not straightforward. Unravelling the impact of the location on amputation practice requires complex spatial modelling, which may guide efficient healthcare policy decisions.