Municipal Register Research Articles

Actividad turística y su relación con la gentrificación en el centro histórico de Quito

El Municipio del Distrito Metropolitano de Quito creó dos Zonas Especiales para el Turismo (ZET), a través de la ordenanza municipal Nº 236 del 2012, estableciéndolas en los espacios con mayor concentración de oferta turística: el Centro Histórico y el barrio de La Mariscal, con el fin de fomentar y promocionar la actividad turística de estas zonas, mediante un plan de gestión que regule las actividades en el territorio. En este marco, se realiza una investigación sobre gentrificación y turismo en el Centro Histórico de Quito, cuyo análisis se realiza a través de la revisión bibliográfica de distintas políticas de fomento de la actividad turística y del catastro de emprendimientos de servicios turísticos que son parte del sector, y su relación con la ocupación del suelo urbano en esta zona de la ciudad. Las razones para dicho análisis, residen en el hecho de que las políticas implementadas por el gobierno local, no parecen haber podido impedir los cambios significativos que trae consigo la actividad turística, sin afectar la calidad de vida de los habitantes tradicionales del Centro Histórico. Combinando información de tipo cualitativo y cuantitativo, se identificaron los planes y programas efectuados para dinamizar la actividad turística, y la evolución de emprendimientos relacionados con la prestación de servicios turísticos. A través de este estudio, se puede dimensionar de qué manera la actividad turística ha generado políticas y emprendimientos de alto nivel en la ZET Centro Histórico de Quito, y cómo estos han afectado a su población a través del desplazamiento.

Taking Advantage of Voluntary Associations of Municipalities for Financing Public Investment Project

Due to the settlement structure of the Czech Republic which is quite extensive, there is a large number of small municipalities on its territory, which do not have the possibility to finance larger investment projects aiming at the development of their area. Therefore, it is important, if not essential, for such municipalities to join into associations with other municipalities. The article deals with the characteristics of possible forms of inter-municipal cooperation with a more detailed focus on taking advantage of voluntary associations of municipalities. The data from the municipal association register shows that a substantial part of municipal associations was created for the purpose of building drinking water supply, sewerage systems or waste water treatment plants. Although this purpose is still up-to-date, the aim of this article is to show how to take advantage of the associations of municipalities also for other investment projects and to propose an optimal way of financing. The main aim of this article is to find out if it is possible to take advantage of the associations of municipalities for financing investment activities of municipalities. Furthermore, based on the analysis of the current state of the register of associations municipalities in the Czech Republic, it tries to propose optimal ways of financing such activities. Based on the analysis of several investment projects financing in municipalities, the research evaluates whether joining of municipalities into voluntary associations and the implementation of construction works via these associations is generally beneficial for them. The resulting proposal described in the article can serve municipalities as a well-arranged guide to the organization and financing of their investment plans.

Real estate dispossession, income and immigration in Las Palmas de Gran Canaria (Spain)

The legal proceedings of real estate dispossession are essential elements in understanding the impact of the economic crisis on Spanish cities. Those that took place between 2009 and 2017 in Las Palmas de Gran Canaria, their quantitative dimension and their intra-urban distribution are analysed in this study. This perspective allows an appreciation of their relationship with the unequal distribution of income and alien status, factors leading the investigations on the loss of property. In order to achieve this objective, the records of the Common Service of Notifications and Seizures have been used together with data of the Inland Revenue Ministry and Municipal Register, combining statistical and cartographical analysis with the purpose of finding associations and predictive factors. The study reveals that there is a great concentration of real estate deprivation in the central areas of the city and that the standards of distribution of dispossession are inversely related to the level of income of the urban districts and directly related to the foreign population. This tends to confirm that dispossession must be interpreted as the result of mechanisms of capitalist accumulation, which reinforce socio-urban inequalities.

Abstract 220: Public Defibrillator Accessibility and Mobility Trends During the Covid-19 Pandemic in Canada

Introduction: The COVID-19 pandemic has led to widespread closures of non-essential businesses and buildings. The impact of such closures on public automated external defibrillator (AED) accessibility compared to mobility trends is unknown. Methods: We identified all publicly available online AED registries in Canada last updated May 1, 2019 or later. AEDs were classified by location type using addresses and registry notes, and deemed completely inaccessible, partially inaccessible, or unaffected using government-issued closure orders as of May 1, 2020. We mapped AED location types to categories used by Google’s COVID-19 Community Mobility Reports and calculated the median percent change in daily traffic between Feb. 15 - May 1, 2020 (excluding Apr. 10-12). We compared the percent of completely inaccessible AEDs to the median percent change in traffic for each category. Results: We identified three provincial (British Columbia, Alberta, Nova Scotia) and two municipal (Mississauga and Toronto in Ontario) online AED registries, collectively covering 13.1 million people. Of the 5,845 AEDs identified, 69.9% were completely inaccessible, 18.8% were partially inaccessible, and 11.3% were unaffected. AEDs in parks (n=141), almost all retail and recreational locations (n=1,539), and two-thirds of workplaces (n=3,633) were completely inaccessible, grocery and pharmacy-based (n=173) AEDs were partially inaccessible, and transit station (n=277) and residential (n=85) AEDs were unaffected. The largest discrepancies between AED accessibility and mobility occurred in parks (100% completely inaccessible vs. 10.5% traffic decrease), retail and recreation (99.0% completely inaccessible vs. 48.0% traffic decrease), and transit stations (100% unaffected vs. 63.0% traffic decrease). Conclusion: Government-mandated closures due to the COVID-19 pandemic have led to a greater reduction in AED accessibility than mobility in many locations across Canada.

Brief alcohol intervention at a municipal registry office: reach and retention.

The aim was to investigate the suitability of a municipal registry office for alcohol screening and brief intervention. We analyzed whether trial participation and retention differ by alcohol- and health-related, demographic and socio-economic participant characteristics. Over 3 months, all 18- to 64-year-old visitors of a registry office were systematically screened. Persons with alcohol consumption in the past 12 months (N = 1646) were randomized to brief alcohol intervention (BAI) or assessment only. BAI was delivered by computer-generated individualized feedback letters at baseline, 3 and 6 months. Logistic and ordered logistic regression models were used to investigate whether the odds of trial participation and retention depended on participant characteristics. Models were rerun separately for low-risk and at-risk drinkers with Alcohol Use Disorder Identification Test-Consumption scores ≥4/≥5 for women/men indicating at-risk drinking. The trial participation rate was 67% with higher odds of participation in younger adults (P < 0.001). Retention rates at 3 and 6 months were 85% and 81%, respectively. Higher retention was associated with older age, higher level of school education and non-smoking (all p-values ≤0.05). Low-risk drinkers were more likely to participate in the trial (P < 0.01) and in post-baseline assessments (P < 0.05) than at-risk drinkers. Our data suggest that registry offices could be a suitable setting to reach people from the general population for BAI. Especially the understudied group of low-risk drinkers was well reached through BAI and showed high adherence. BAI that addresses alcohol consumers beyond those at risk may be well accepted in proactively recruited people from the general population.

Low mortality rate after atrial fibrillation ablation: results from the Netherlands Heart Registration

Abstract Background Ablation therapy is widely used as a treatment of atrial fibrillation (AF) and is associated with 3.6% minor and major complications in the Netherlands. Mortality following AF ablation is rare, but has been reported 0.46% in the United States in recent literature. We hypothesize that in the Netherlands, where AF ablation is performed in high volume centres only, 30-day mortality rate is low. Purpose To describe 30-day mortality in the Netherlands after AF ablation. Methods In the Netherlands Heart Registration, all 16 Dutch ablation centres participate and 14 out of 16 centres reported AF ablation outcomes using predefined variables for quality purposes. The number of reported procedures per centre was on average 236/year [range, 33–593], where 87.5% of the centres perform &amp;gt;150 AF ablations per year. All patients who underwent AF ablation were eligible for this analysis irrespective of ablation method used, or whether it was the first or a redo AF ablation. 30-day mortality was derived from, the municipal death registration, and individually checked by each participating ablation centre. No further analysis was available on the cause of death. Results In total, 20,230 patients who underwent AF ablation between 01-01-2013 and 31-12-2018 were included. The majority of patients were male (68%), mean age was 60.9±9.8 years, mean body mass index was 27.3±4.2kg/m2, and the average CHA2DS2VASc score was 1.6±1.3. Reduced left ventricular (LV) ejection fraction (&amp;lt;50%) was present in 13.2% of the patients. Paroxysmal AF was present in 72.7% of patients, persistent AF in 24.9% and longstanding persistent in 2.3%. The index procedure was a redo-ablation in 22.7%. Mortality outcomes were available for 18,413 (91.0%) procedures, as some centres had a backlog of patients that needed death certificate checking [range, 0% - 19.4%], this factor was considered random. In total 12 patients (0.07%) died within 30-days after an AF ablation procedure. These patients were 68.5 years old [range, 55–76 years], 91.7% had a history of paroxysmal AF and 8.3% persistent AF, LV ejection fraction was &amp;lt;50% in 8.3% and 25% of the patients had a previous AF ablation (p=0.02 for age, others p=NS). Conclusion Patients undergoing AF ablation in the Netherlands mainly presented with paroxysmal AF. In a setting where AF ablation is performed in high volume centres only, such as the Netherlands, 30-day mortality is very low after AF ablation. Funding Acknowledgement Type of funding source: None

Mortality in patients with systemic lupus erythematosus and neuropsychiatric involvement: A retrospective analysis from a tertiary referral center in the Netherlands.

ObjectiveWe aimed to evaluate all-cause and cause-specific mortality in patients with systemic lupus erythematosus (SLE) and neuropsychiatric (NP) symptoms in the Netherlands between 2007–2018.MethodsPatients visiting the tertiary referral NPSLE clinic of the Leiden University Medical Center were included. NP symptoms were attributed to SLE requiring treatment (major NPSLE) or to other and mild causes (minor/non-NPSLE). Municipal registries were checked for current status (alive/deceased). Standardized mortality ratios (SMRs) and 95% confidence intervals (CI) were calculated using data from the Dutch population. Rate ratio (RR) and 95% CI were calculated using direct standardization to compare mortality between major NPSLE and minor/non-NPSLE.Results351 patients were included and 149 patients were classified as major NPSLE (42.5%). Compared with the general population, mortality was increased in major NPSLE (SMR 5.0 (95% CI: 2.6–8.5)) and minor/non-NPSLE patients (SMR 3.7 (95% CI: 2.2–6.0)). Compared with minor/non-NPSLE, mortality was similar in major NPSLE patients (RR: 1.0 (95% CI: 0.5–2.0)). Cause-specific mortality rates demonstrated an increased risk of death due to infections in both groups, whereas death due to cardiovascular disease was only increased in minor/non-NPSLE patients.ConclusionMortality was increased in both major NPSLE and minor/non-NPSLE patients in comparison with the general population. There was no difference in mortality between major NPSLE and minor/non-NPSLE patients.

Disparities in emergency department use between Italians and migrants residing in Rome, Italy: the Rome Dynamic Longitudinal Study from 2005 to 2015

BackgroundThe Emergency Department (ED) can be considered an indicator of accessibility and quality and can be influenced in period of economic downturns. In the last fifteen years, the number of migrants in Italy has doubled (from 2.4 million in 2005 to 5.2 in 2019, 4.1 and 8.7% of the total population, respectively). However, evidence about migrants’ healthcare use is poor, and no studies focused on the ED utilisation rate during the Great Recession are available. This study aims to analyse trends in all-cause and cause-specific ED utilisation among migrants and Italians residing in Rome, Italy, before and after 2008.MethodsLongitudinal study based on data from the Municipal Register of Rome linked to the Emergency Department Register from 2005 to 2015. We analysed 2,184,467 individuals, aged 25–64 in each year. We applied a Hurdle model to estimate the propensity to use the ED and to model how often individuals accessed the ED.ResultsMigrants were less likely to be ED users than Italians, except for Africans (RR = 1.46, 95%CI 1.40–1.52) and Latin Americans (RR = 1.04, 95%CI 1.00–1.08) who had higher all-cause utilisation rates than non-migrants. Compared to the pre-2008 period, in the post-2008 we found an increase in the likelihood of being an ED user (OR = 1.34, 95%CI 1.34–1.35), and a decrease in ED utilisation rates (RR = 0.96, 95%CI 0.96–0.97) for the whole population, with differences among migrant subgroups, regardless of cause.ConclusionsThis study shows differences in the ED utilisation between migrants and Italians, and within the migrant population, during the Great Recession. The findings may reflect differentials in the health status, and barriers to access primary and secondary care among migrants. In this regard, health policies and cuts in health spending measures may have played a key role, and interventions to tackle health and access disparities should include policy measures addressing the underlying factors, adopting a Health in All Policies perspective. Further researches focusing on specific groups of migrants, and on the causes and diagnoses related to the ED utilisation, may help to explain the differences observed.

On the move again? Residential trajectories of refugees after obtaining asylum in the Netherlands

AbstractEfforts by European countries to disperse refugees across the country often implicitly presuppose permanent settlement in dispersal locations. Migrant (re)settlement theories, however, suggest that onward mobility after (social) housing allocation is a more likely outcome. This paper explores refugees' onward residential trajectories after dispersal in the Netherlands, including possible onward international mobility. We follow refugees who entered the municipal registers in 1998 and 1999 (N = 13,490) over a ten‐year period after taking up residence in the first private dwelling. We find that residential trajectories are related to the household situation and vary considerably across origin groups. In general, ‘stable trajectories’, with a continuation of the type of initial location after dispersal (rural, suburban or urban), are most common. About half of the refugees who stayed in the Netherlands did not leave the municipality of allocation during their a private housing trajectory. Yet, those who were allocated to rural municipalities have in the majority of the cases relocated over time. We find some evidence that social networks and transitions to home ownership are associated with rural to urban movement. Recent policy changes that allow for more participation in the housing allocation procedures of the refugees themselves may reduce resettlement needs and costs for refugees.

Cambios sociodemográficos durante la Guerra Civil española en el municipio de Benagalbón. Un análisis de fuentes primarias

La Guerra Civil tuvo un intenso impacto sobre el conjunto de la sociedad española y afectó a aspectos profundos de la vida cotidiana de la población general. En el presente artículo se describen los cambios socio demográficos que se produjeron durante el transcurso de la Guerra Civil en el municipio de Benagalbón (Málaga), mediante triangulación y comparación de los datos de los padrones municipales de los años 1935 y 1940 con análisis de contenido de fuentes orales locales. &#x0D; Los resultados muestran que en un municipio de 5.555 habitantes en 1935 se había producido en 1940 un incremento demográfico del 2,9 % con aumento del analfabetismo y del empleo precario y cambios en la estructura de propiedad, acompañado de pérdida del 32,7 % de la población que las fuentes orales relacionan con la huida masiva hacia Almería en 1937, ante el avance de las tropas rebeldes.

Residential Mobility, Gentrification and Neighborhood Change in Spanish Cities: A Post-Crisis Perspective

Urban neighborhoods in Barcelona and Madrid are currently experiencing intense social transformations, with exclusive (and excluding) areas expanding (more or less rapidly) in resurgent central spaces. Recent literature suggests that, in parallel with urban expansion and latent re-urbanization, the most vulnerable population segments are being displaced and concentrated in suburban areas with worse access to all types of services. By proposing a comprehensive analysis of annual data on migration and residential mobility based on municipal population registers, the present study outlines the role of an increasing participation of highly qualified individuals in migratory and residential flows to explain changes in social composition at the intra-urban spatial scale. For the first time in Spain, we have been able to consider the impact of an individual variable assessing ‘education level’ on migration and residential mobility patterns, allowing a better characterization of interconnected processes of population substitution, polarization and segregation.

Ultra-Long-term Follow-up of Interferon Alfa Treatment for HBeAg-Positive Chronic Hepatitis B Virus Infection

Interferon-alpha (IFN-α) treatment for chronic hepatitis B (CHB) virus infection is finite and leads to relatively higher functional cure rates (HBsAg loss) than nucleo(s)tide analogue (NA) therapy. Effects of pegylated (PEG)/conventional IFN-α treatment on clinical outcomes were evaluated in an ultra-long-term follow-up of CHB patients. HBeAg-positive patients treated with (PEG)IFN-α at a tertiary referral centre between 1977-2014 were included. We reviewed medical charts and consulted the municipal registry for patient information. Patients were invited for a single visit at the outpatient clinic in the case of missing follow-up data. The endpoints included serum HBeAg/HBsAg loss and incidence of clinical events, using life table methods and person-years to analyze the incidence of events. Patients were censored upon retreatment. The study cohort included 267 patients, 67% male, 58% Caucasian, with a median age of 32 years. The median follow-up duration was 11.5 years. The 5 and 10-year cumulative incidence of HBsAg loss were 14% and 32%, respectively. Baseline factors associated with a higher rate of HBsAg loss were male sex, Caucasian race, genotype A, age ≥40 years, and cirrhosis. HBsAg loss rates did not differ significantly between those who received short-term (≤24 weeks) vs long-term (>24 weeks) therapy. Both HBeAg and HBsAg loss were significantly associated with improved clinical outcomes. Early response (HBeAg loss) was associated with more HBsAg loss and better patient outcomes. During long-term follow-up, high rates of HBsAg loss were observed from a single (PEG)IFN-α course. Its persistent effects suggest that a role for IFN-α remains, potentially in novel combination therapies in search of a functional cure.

Lonely last days? Social networks and formal care at the deathbed of urban elderly in Antwerp, Brussels and Ghent, 1797

ABSTRACT This article examines the locus of care of the elderly in the cities of Antwerp, Brussels and Ghent at the end of the eighteenth century by investigating the circumstances of their decease. The article uses a cross-sectional analysis of the municipal death registers of 1797 to shed light on the informal networks and formal provisions that surrounded the urban elderly (aged 60 years and older) during their last days and shortly after their death. By evaluating the roles of hospitals and private houses as places of death and the presence of family and neighbours as witnesses, the article assesses both formal and informal channels of support. In addition, the article examines how the locus of care correlated with marital status, socio-economic position and migration background.

Individuals' Preferences for Esophageal Cancer Screening: A Discrete Choice Experiment.

The increasing incidence of esophageal adenocarcinoma (EAC) and the dismal prognosis has stimulated interest in the early detection of EAC. Our objective was to determine individuals' preferences for EAC screening and to assess to what extent procedural characteristics of EAC screening tests predict willingness for screening participation. A discrete choice experiment questionnaire was sent by postal mail to 1000 subjects aged 50 to 75 years who were randomly selected from the municipal registry in the Netherlands. Each subject answered 12 discrete choice questions of 2 hypothetical screening tests comprising 5 attributes: EAC-related mortality risk reduction, procedure-related pain and discomfort, screening location, test specificity, and costs. A multinomial logit model was used to estimate individuals' preferences for each attribute level and to calculate expected rates of uptake. In total, 375 individuals (37.5%) completed the questionnaire. Test specificity, pain and discomfort, mortality reduction, and out-of-pocket costs all had a significant impact on respondents' preferences. The average expected uptake of EAC screening was 62.8% (95% confidence interval [CI] 61.1-64.5). Severe pain and discomfort had the largest impact on screening uptake (-22.8%; 95% CI -26.8 to -18.7). Male gender (β 2.81; P < .001), cancer worries (β 1.96; P = .01), endoscopy experience (β 1.46; P = .05), and upper gastrointestinal symptoms (β 1.50; P = .05) were significantly associated with screening participation. EAC screening implementation should consider patient preferences to maximize screening attendance uptake. Based on our results, an optimal screening test should have high specificity, cause no or mild to moderate pain or discomfort, and result in a decrease in EAC-related mortality.

Progress towards eliminating tuberculosis in Ga West Municipality, Ghana: analysis of tuberculosis surveillance data, 2017.

To assess the progress made towards the actualization of the 80% reduction in incident cases, monitor trends and to assess the quality of GWM TB surveillance data from 2012 to 2016. The study was descriptive secondary data analysis. Tuberculosis cases recorded in the District Health Information Management Systems (DHIMS) and municipal TB registers. The Municipal TB Coordinator was interviewed for clarification on the data. A TB patient was defined as one who coughed persistently for two weeks or more. Trend of TB cases in Ga West Municipality. A total of 441 TB cases were registered of which 68.9% were smear positive. Males were (67%). Age group 35-44 years were the most affected (28.6%). The incidence rose from 21.5 (2012) to 41.6 (2015). The 2016 incidence was 40.7 (± 5.63) per 100,000 population. This is significantly different from the current national incidence of 156 (p < 0.05). Data was 95% complete. Discrepancies existed between data in registers compared to the DHIMS but were not statistically significant. The 80% reduction in incident cases target may not be attained by the GWM due to the rising number of incident cases. However, data quality is good. The study was funded by the authors.

Strategies for the Improvement of Pet Health and Welfare in Portugal Based on a Pilot Survey on Husbandry, Opinion, and Information Needs.

Simple SummaryThis study examined husbandry practices in companion animals being conducted in Portugal in order to understand the health and welfare issues which can be improved. One of the more important findings is that, despite adopting most pets, pet owners do not adopt from animal shelters, possibly due to the large bureaucratic process. Veterinary practice is viewed as expensive and identification of animals with microchip is frequently disregarded. These issues may result in important threats to animal welfare and health and should be addressed at societal level. Several strategies based on results are proposed to improve pet health and welfare in Portugal, focusing on showcasing the importance of veterinary care, reducing the number of lost or abandoned animals, and improving awareness and education.Pets are present in half of the homes across Portugal. However, little is known about the husbandry, opinion, and information needs of Portuguese pet owners. Thus, the objective of this work was to clarify this information providing the basis for suggesting potential improvements. Responses were collected through an online survey, including inhabitants from different regions of Portugal (n = 111). Cats and dogs are the most popular pets and the majority are adopted, fed commercial diets, live indoors, are vaccinated, dewormed, and treated for external parasites, and occasionally visit the veterinary practice. Portuguese owners are interested in improving their pet’s health, and would like to learn more about welfare, health assessment, and diet from veterinarians. However, microchip and municipal registration are often overlooked. Lack of adoption from animal shelters as well as expectations over the cost of veterinary practice were other difficulties identified in this study. Strategies for the improvement of pet health and welfare in Portugal were proposed as improving the perception of the value and importance of veterinary care, reducing the number of lost and abandoned pets, and improving awareness and education. Thus, Portuguese stakeholders and authorities must take the required measures to improve these issues.

Associations of Diet Quality and All-Cause Mortality Across Levels of Cardiometabolic Health and Disease: A 7.6-Year Prospective Analysis From the Dutch Lifelines Cohort.

To simultaneously investigate the association of diet quality and all-cause mortality in groups with varying cardiometabolic diseases (CMDs) at baseline. From the population-based Lifelines cohort, 40,892 non-underweight participants aged ≥50 years with data on diet quality and confounding factors were included (enrollment 2006-2013). From food-frequency questionnaire data, tertiles of the Lifelines Diet Score were calculated (T1 = poorest, T3 = best diet quality). Four CMD categories were defined: 1) CMD free, 2) type 2 diabetes, 3) one cardiovascular disease (CVD), 4) two or more CMDs. Months when deaths occurred were obtained from municipal registries up until November 2019. Multivariable Cox proportional hazards models were applied for the total population and stratified by CMD categories. After a median follow-up of 7.6 years, 1,438 participants died. Diet quality and CMD categories were independently associated with all-cause mortality in crude and adjusted models (P < 0.001). A dose-response relationship of diet quality with all-cause mortality was observed in the total population (P trend < 0.001, T2 vs. T3 = 1.22 [1.07-1.41], T1 vs. T3 = 1.57 [1.37-1.80]). In stratified analyses, the association was significant for CMD-free individuals (T1 vs. T3 = 1.63 [1.38-1.93]) and for patients with type 2 diabetes (1.87 [1.17-3.00]) but not for patients with one CVD (1.39 [0.93-2.08]) or multiple CMDs (1.19 [0.80-1.76]). A high-quality diet can potentially lower all-cause mortality risk in the majority of the aging population. Its effect may be greatest for CMD-free individuals and patients with type 2 diabetes. Tailored dietary guidelines may be required for patients with extensive histories of CMDs.

Survive and Thrive in Brazil: The Boa Vista Early Childhood Program: study protocol of a stepped-wedge, randomized controlled trial

BackgroundA growing body of evidence suggests that early life health and developmental outcomes can be improved through parental support programs. The objective of this project was to test the feasibility, impact, and relative cost-effectiveness of an adapted “Reach Up and Learn” program delivered through home-visiting programs as well as through center-based parenting groups on child health and development in the municipality of Boa Vista, Brazil.MethodsA randomized, stepped-wedge design was used to roll out and evaluate the two parenting platforms in Boa Vista municipality. A total of 39 neighborhoods with a high Neighborhood Vulnerability Index were selected for the study. For the first phase of the program, nine neighborhoods were randomly selected for home visits, and two were randomly selected for the center-based parenting groups. In the second phase of the program, 10 neighborhoods were added to the home-visiting program, and eight were added to the center-based program. In the final phase of the program, the remaining 10 control areas will also be assigned to treatment. Study eligibility will be assessed through a baseline survey completed by all pregnant women in the 39 study areas. Pregnant women will be eligible to participate in the study if they are either classified as poor, were under age 20 years when they became pregnant, or if they indicate to have been exposed to domestic or sexual violence. To assess program impact, an endline survey will be conducted when children reach age 2 years. The primary study outcome is child development at age 2 years as measured by the PRIDI instrument. Secondary outcome will be infant mortality, which will be assessed linking municipal vital registration systems to the program rollout.DiscussionThis trial will assess the feasibility and impact of parenting programs rolled out at medium scale. The results from the trial should create evidence urgently needed for guiding Brazil’s national Criança Feliz program as well as similar efforts in other countries.Trial registrationClinicalTrials.gov, ID: NCT03386747. Registered on 13 December 2017. All items of the World Health Organization Trial Registration Data Set are available in this record.

An Italian Network of Population-Based Birth Cohorts to Evaluate Social and Environmental Risk Factors on Pregnancy Outcomes: The LEAP Study.

In Italy, few multicentre population-based studies on pregnancy outcomes are available. Therefore, we established a network of population-based birth cohorts in the cities of Turin, Reggio Emilia, Modena, Bologna, and Rome (northern and central Italy), to study the role of socioeconomic factors and air pollution exposure on term low birthweight, preterm births and the prevalence of small for gestational age. In this article, we will report the full methodology of the study and the first descriptive results. We linked 2007–2013 delivery certificates with municipal registry data and hospital records, and selected singleton livebirths from women who lived in the cities for the entire pregnancy, resulting in 211,853 births (63% from Rome, 21% from Turin and the remaining 16% from the three cities in Emilia-Romagna Region). We have observed that the association between socioeconomic characteristics and air pollution exposure varies by city and pollutant, suggesting a possible effect modification of both the city and the socioeconomic position on the impact of air pollution on pregnancy outcomes. This is the largest Italian population-based birth cohort, not distorted by selection mechanisms, which has also the advantage of being sustainable over time and easily transferable to other areas. Results from the ongoing multivariable analyses will provide more insight on the relative impact of different strands of risk factors and on their interaction, as well as on the modifying effect of the contextual characteristics. Useful recommendations for strategies to prevent adverse pregnancy outcomes may eventually derive from this study.

Population and Economic Cycles in the Main Spanish Urban Areas: The Migratory Component

The paper aims to analyse how the different economic phases that Spain has experienced in the first two decades of the 21st century (expansion, recession, and recovery) have influenced population stocks and migratory flows in the five largest metropolitan areas defined as Functional Urban Areas (FUAs) in Spain: Barcelona, Bilbao, Madrid, Seville and Valencia. Using Padrón Continuo (municipal registers) and Estadística de Variaciones Residenciales (residential change statistics) as data sources, both native and immigrant – i.e. born abroad – stocks, and internal and international migration flows are analysed. We study differences between (a) diverse groups of foreigners (by continental origin), also comparing them to natives; and (b) different types of residential mobility by migrants’ previous place of residence: “intrametropolitan” movements (between urban cores and peripheries), migration flows between the five urban areas and the rest of Spain, and international migration.&#x0D; Results show that intrametropolitan migration flows between the five urban cores and their peripheries were characterised by suburbanisation during the expansion phase. These flows were particularly relevant for Spanish-born persons and, among foreign-born migrants, for people born in the Americas (mainly Latin Americans). These flows to the suburban periphery decreased during the economic crisis, and in 2013 and 2014 net intrametropolitan migration of most foreign groups was characterised by recentralisation. Spaniards’ intrametropolitan movements almost reached equilibrium during the recession years: Natives decreased their moves from cores to rings, while they were increasingly attracted to urban centres. Owing to the incipient economic recovery, suburbanisation is progressively recovering its previous strength. As for other types of residential moves, foreign-born migrants moving from abroad and the rest of Spain to the five FUAs during the economic expansion phase reversed the direction of their flows in the economic crisis years, migrating abroad or dispersing throughout Spain in search of jobs. Consequently, their stocks declined in some years. Currently, due to the incipient economic recovery, the five FUAs are attracting internal and international foreign-born immigrants once again, so their foreign-born population stocks are increasing in both cores and peripheries. Spaniards show the opposite behaviour regarding flows to and from the five areas analysed – they tended to disperse throughout the rest of Spain during the economic expansion phase. This trend continued during the crisis years, but at a slower pace, as natives became increasingly attracted to urban cores. Furthermore, this latter trend has strengthened during the post-crisis years. Finally, considering foreign-born and Spanish populations together, large urban areas are increasingly attractive. This global tendency is to the detriment of rural areas and of non-metropolitan small and medium size towns, which lose population due to negative net migration.&#x0D; * This article belongs to a special issue on “Internal Migration as a Driver of Regional Population Change in Europe: Updating Ravenstein”.