National Statistics Institute Research Articles

A Yaounde – Kigali Experience Sharing for Harmonious City Biking Culture in Sub-Saharan Africa

Salvaging motorbike calamities and urban chaos would not only safeguard lives but achieve urban tranquility in Yaounde and Cameroon. The disorder in this transport sector observed in Yaounde can be uncurled and riders called to order as solution to the chaos accrued. This article exposes the shortcomings of biking transport as inadequate training and reckless riding have led to the urban chaos and calamities observed. If it does not occur from high speed, perhaps it would be a mentality problem. Some 140 questionnaires were administered to motor bike riders, clients, and transport authorities in Yaounde. Field observation and interview sessions were organized to have first-hand information on calamities in the city. Hotbed neighbourhoods of accidents were captured through a GPS and transformed into maps and tables. An in-depth documentary research at the Ministry of Transport and its delegations as well as the national institute of statistics was done to have data for analysis. Findings adhere to the fact that total identification of riders, mandatory use of helmets for rider and passenger as well as stringent speed limits with unadorned sanctions can be used to address the situation. This paper advocates that the Kigali experience in the management and control of motor bike transport be shared in Yaounde so as to reduce, if not curb urban mayhem and wanton accidents.

Measuring the Accuracy of Aggregates Computed from a Statistical Register

AbstractThe Italian National Statistical Institute (Istat) is currently engaged in a modernization programme that foresees a significant revision of the methods traditionally used for the production of official statistics. The main concept behind this transformation is the use of the Integrated System Statistical Registers, created by a massive integration of administrative archives and survey data. In this article, we focus on how to measure the accuracy of register estimates of a population total from measurements calculated at the unit level. We propose the global mean squared error (GMSE) as a statistical quantity suitable for measuring accuracy in the context of the production of official statistics. It can be defined to explicitly consider the main sources of uncertainty that may affect registers. The article suggests a feasible calculation strategy for the GMSE that allows National Statistical Institutes to build algorithms that can promptly be applied for each user request, thus improving the relevance, transparency and confidence of official statistics. Through a simulation study, we verified the efficacy of the proposed strategy.

The effect of education on fruit and vegetable purchase disparities in Chile

PurposeThe objective of this article is to analyze fruit and vegetable (FV) purchasing decisions between 2011–12 and 2016–17 in Chile, and FV purchases by level of education in this period as determinant to explain dietary disparities across population groups.Design/methodology/approachUsing Oaxaca-Blinder decomposition, the authors analyze FV purchases over time. Taking into consideration censoring, this study uses two waves of the Family Budget Survey (national representative) by the National Statistics Institute of Chile.FindingsThe authors find that when comparing income quintiles 1–4, between 2011–12 and 2016–17, the years of education of the household head cannot explain FV purchases disparities. In contrast, in income quintile 5, between 2011–12 and 2016–17, the marginal effect of education of the household head has significantly decreased FV purchases. When analyzing social determinants, gender and income quintiles in 2016–17, they do not have a significant effect on FV purchase disparities. However, the zone of the household, metropolitan zone vs other urban zones in the country has a significant effect on FV purchase disparities.Research limitations/implicationsThe datasets cover food home purchases.Practical implicationsThe authors can conclude the relevance of implementing policies and programs to lead for healthier food environments such as offer more FVs in the school feeding program and social protection nutrition sensitive measures.Originality/valueUsing two waves of a nationally representative dataset, this article decomposes the effect of education of the household head to explain FV purchase disparities.

DOP41 Temporal Trends in the epidemiology of Inflammatory Bowel Diseases in the public healthcare system in Brazil: A large population-based study

Abstract Background Background: Population-based data on incidence and prevalence of Inflammatory Bowel Diseases (IBD) in newly industrialized countries such as Brazil are scarce. This study aims to define temporal trends of estimated incidence and prevalence rates of Crohn’s disease (CD) and ulcerative colitis (UC) in Brazil using unique public healthcare datasets. Methods Methods: All IBD patients (UC and CD) from the unique public healthcare national system (DATASUS) were included from January 2012 to December 2020 and identified according to ICD codes, medication use or IBD-relates procedures. Data extraction was performed with the platform “TT Disease Explorer” (Techtrials Healthcare Data Science, Brazil) and checked by 2 independent reviewers. The platform collects publicly available data from the ministry of health via electronic algorithms (ETLs and Webcrawlers) with automatic updates. The population of Brazil was calculated according to the national Brazilian Geographics and Statistics Institute (IBGE). Average Annual Percent Change (AAPC) and 95% confidence intervals (CI) were calculated using poisson (or negative binomial) regression for incidence and log binomial regression for prevalence. Results Results: A total of 212,026 IBD patients (UC: n=140,705; CD: n=92,326) were included, There was a higher proportion of females as opposed to males, and age at health system entry was similar to developed countries (figure 1). Estimated incidence rates of IBD were 9.41 per 100,000 in 2012 and 9.57 per 100,000 in 2020 (AAPC=0.80%; CI -0.37–1.99; p=0.18); for UC, incidence increased from 5.69 per 100,000 to 6.89 per 100,000 (AAPC=3.04; CI 1.51–4.58; p<0.001) and for CD incidence dropped from 3.71 per 100,000 to 2.68 per 100,000 (AAPC=-3.24%; CI -4.45- -2.02; p<0.001) in the same time period (figure 2). Estimated prevalence rates of IBD increased significantly from 30.01 per 100,000 in 2012 to 100.13 per 100,000 in 2020 (AAPC=14.87%; CI 14.78–14.95; p<0.001); For UC, from 17.4 per 100,000 to 66.45 per 100,000 (AAPC=16.51%; CI 16.41–16.62; p<0.001) and for CD from 14.24 per 100,000 to 43.6 per 100,000 (AAPC=13.49%; CI13.37-13.61; p<0.001) in the same time period (figure 3). Conclusion Conclusions: Estimated incidence rates of IBD have remained stable from 2012–2020. Incidence of CD is significantly decreasing whereas of UC is significantly increasing. There was a significant increase in estimated prevalence rates of CD and UC. This massive rise in prevalence can support planning for future strategies for public healthcare providers in our country towards better IBD care. This is the largest IBD epidemiological study from newly industrialized countries to date.

Lung cancer mortality attributable to residential radon exposure in Spain and its regions

Lung cancer has the highest cancer mortality rate in developed countries. The principal risk factor for lung cancer is tobacco use, with residential radon being the leading risk factor among never smokers and the second among ever smokers. We sought to estimate mortality attributable to residential radon exposure in Spain and its Autonomous Regions, with correction for dwelling height and differentiation by tobacco use. We applied a prevalence-based method for estimating attributable mortality. For estimations, we considered exposure to radon in the different Autonomous Regions corrected for dwelling height, using the National Statistics Institute Housing Census and prevalence of tobacco use (never smokers, smokers and ex-smokers). The results showed that 3.8% (838 deaths) of lung cancer mortality was attributable to radon exposure of over 100 Bq/m3, a figure that rises to 6.9% (1,533 deaths) when correction for dwelling height is not performed. By Autonomous Region, the highest population attributable fractions, corrected for dwelling height, were obtained for Galicia, Extremadura, and the Canary Islands, where 7.0, 6.9, and 5.5% of lung cancer mortality was respectively attributable to radon exposure. The greatest part of the attributable mortality occurred in men and among smokers and ex-smokers. Residential radon exposure is a major contributor to lung cancer mortality, though this contribution is highly variable among the different territories, indicating the need for targeted prevention policies. Correction of estimates for dwelling height is fundamental for providing reliable estimates of radon-attributable mortality.

Does the elimination of work flexibility contribute to reducing wage inequality? Empirical evidence from Ecuador

From the empirical point of view, measures that promote work flexibility increase income inequalities and unemployment rates in the long-term, as well as promoting employment precariousness and the informality of the labor sector. The objective of the present work is to investigate the effect on wage inequality of eliminating work flexibility, which was undertaken in Ecuador in 2008. A two-way effect econometric model was applied with panel data. Data from the 21 provinces of Ecuador covering the period of 2007-2018 were obtained from the National Employment, Unemployment and Under-Employment Survey (ENEMDU) of the National Statistical and Census Institute (INEC). The results suggest that the elimination of work flexibility had a significant and negative effect on inequality; the policy was effective in reducing inequality. This result is significant for all the years subsequent to the introduction of these measures, although with variations according to regional and economic characteristics. Policies aimed at reducing inequality should focus on improving workers' bargaining power and on generating an environment that favors increasing levels of formality.

Volcanic Ash as a Precursor for SARS-CoV-2 Infection Among Susceptible Populations in Ecuador: A Satellite Imaging and Excess Mortality-Based Analysis.

The global coronavirus disease 2019 (COVID-19) pandemic has altered entire nations and their health systems. The greatest impact of the pandemic has been seen among vulnerable populations, such as those with comorbidities like heart diseases, kidney failure, obesity, or those with worse health determinants such as unemployment and poverty. In the current study, we are proposing previous exposure to fine-grained volcanic ashes as a risk factor for developing COVID-19. Based on several previous studies it has been known since the mid 1980s of the past century that volcanic ash is most likely an accelerating factor to suffer from different types of cancer, including lung or thyroid cancer. Our study postulates, that people who are most likely to be infected during a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) widespread wave will be those with comorbidities that are related to previous exposure to volcanic ashes. We have explored 8703 satellite images from the past 21 y of available data from the National Oceanic and Atmospheric Administration (NOAA) database and correlated them with the data from the national institute of health statistics in Ecuador. Additionally, we provide more realistic numbers of fatalities due to the virus based on excess mortality data of 2020-2021, when compared with previous years. This study would be a very first of its kind combining social and spatial distribution of COVID-19 infections and volcanic ash distribution. The results and implications of our study will also help countries to identify such aforementioned vulnerable parts of the society, if the given geodynamic and volcanic settings are similar.

Extended Exergy Analysis (EEA) of Italy, 2013–2017

In recent years, many studies have been published on the applications of exergy analyses to complex systems, including entire countries. Oddly, the results, although consistent, appear to lead to divergent conclusions. The underlying problem is that in a “pure” thermodynamic analysis, the so-called “externalities”, i.e., labor, capital, and environmental costs, are often neglected or only approximately included in the picture. In 1998, an extension of the theory that included the exergy content of the externalities was introduced, called “extended exergy accounting” (EEA). Its novelty consisted of the explicit inclusion of the exergy embodied in the externalities. The aim of this work is to use the results of the extended exergy accounting to obtain an indicator that can be used to assess the sustainable development of a country. First, a novel methodological approach to the theory is presented, based on the exploitation of a very large dataset obtained from several national and European statistical institutions. After a brief discussion of the theory, an application to the case of Italy is developed over a 5 years time window (2013–2017). The paper includes a comparison with the concurrent evolution of other sustainability indicators and of the gross domestic product (GDP) indicator. The results show a consistent trend for EE as compared with those of other indicators, and also convincingly proves that this trend is incompatible with that of the GDP. The EE indicator is called the exergy footprint, which also displays a remarkable sensitivity to both environmental and economic factors.

Analysis of the gap in enterprise access to renewable energy between rural and urban areas in Cameroon

Permanent access to energy is an essential pillar of economic development. However, there is a growing evidence that contemporary energy systems are not able to provide energy to the entire population on a sustainable basis and at affordable prices. In the face of these challenges, renewable energy can play an important role, especially in rural areas where access to centralized electricity grids is difficult. This paper aims to examine the access gaps of enterprises to renewable energy between rural and urban areas in Cameroon. The analysis is based on a sample of 209,482 enterprises, taken from the Second General Census of Enterprises in Cameroon (RGE-2) carried out by the National Institute of Statistics (NIS). The econometric estimations, obtained using the Blinder-Oaxaca decomposition, reveal that access rate to renewable energy for firms in rural areas is lower than that of firms located in urban areas. An increase in the level of education of the promoter of an enterprise, obtaining credit from banks, microfinance and savings, and the formalization of enterprises in rural areas can also contribute to reducing the gap in rural areas in terms of accessing to renewable energy. The discrimination suffered by rural enterprises related to the gender of entrepreneurs, the sector of activity, the business environment and professional experience tend to increase this gap. To reduce this gap, there is a need to promote access to finance for rural enterprises and their migration from the informal to the formal sector.

Pulmonary Embolism Mortality Associated with the Necessity of Being Hospitalized Outside the Canton of Residence in Ecuador

Introduction: Pulmonary embolism (PE) is a common cause of cardiovascular death, with hospital mortality rates in South America around 14%. However, there is limited information regarding Ecuador. Objectives: To present a survival analysis of Ecuadorian patients affected by PE. Methods: We performed a survival analysis study based on the retrospective review of the hospital discharges by PE in Ecuador from 2011 to 2018 through the Ecuadorian National Statistics and Census Institute databases. Results: We found 2974 cases of PE. From them, 505 (16.98%) patients deceased, 59.72% were females, 64.79% had an age ≥60 years with an average of 65.04 years, 19.80% were treated outside their canton of residence, and 7.57% were associated to acute cor pulmonale (ACP). Using the Cox regression model, being treated outside the canton of residence (HR 1.40, p<0.05) and age ≥60 years (HR 1.64, p<0.05) reduced the overall survival. Contrasting, the absence of ACP improved the OS (HR 0.68, p<0.05). Excluding patients aged ≥60 years, and with ACP, being treated outside the canton of residence increased the risk of death by PE (HR 1.77, p<0.05). However, this effect was non significative in patients ≥60 years of age and with ACP (p>0.05). Conclusion: Patients treated by PE outside their canton of residence had an increased risk of mortality during the in-hospital stay, especially those younger than 60 years without ACP.

Influence of Computer Knowledge and Level of Education on Spanish Citizens’ Propensity to Use E-Commerce

This article analyzes the influence of Spanish citizens’ computer knowledge and level of education on their tolerance of, or aversion to, risk in the online purchase of goods and services. To this end, annual survey data from Spain’s National Statistics Institute were used to know the incidence in e-commerce of the following variables: “computer knowledge,” “electronic commerce,” and “socioeconomic characteristics.” A method based on the design of a computer knowledge indicator was used, followed by a bivariate logistic regression to determine computer knowledge and level of education. The results show that the higher the level of computer knowledge, the greater the impulse to buy online and the higher the tolerance of risk. There was also a positive relation between level of education and propensity to buy; the higher the level of education, the greater the propensity.

Can patients suffering an ST elevation myocardial infarction enjoy a similar life expectancy to that of the general population?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction and objectives There has been a continuous process of improvement after (ST-segment elevation myocardial infarction) STEMI. Our aim was to know whether patients &amp;lt; and ≥ 65 years suffering a STEMI can recover a life expectancy similar to that of the general population of the same age, sex and geographical region. Methods We included all patients who suffered a STEMI from January 2014 until January 2020 and compared them to a reference population provided by the National statistics Institute from Spain. For those patients surviving the acute event as well as the first 30 days, we calculated their observed survival, expected survival and the excess of mortality calculated with the Ederer II method. If the expected survival was inside the 95% confidence interval(CI) of the observed survival there was not a significant excess of mortality. We repeated all analyses for survivors stratifying by 65 years. Results We included 1722 patients, 899 patients were &amp;lt;65 years. For patients &amp;lt; 65 years who survived a STEMI, observed survival at 3 and 5 years of follow-up was 97.68%(95%CI, 96.05%-98.64%) and 94.14%(95%CI, 90.89%-96.25%), respectively. Expected survival for 3 and 5 years was 98.12% and 96.61%. For patients ≥ 65 years who survived the STEMI, observed survival at 3 and 5 years was 85.52%(95%CI, 82.23%-88.24%) and 75.43%(95%CI, 70.26%-79.83%), respectively. Expected survival for 3 and 5 years was 86.48% and 76.56%. Conclusions For survivors of the acute event, life expectancy is similar to that of the general population of the same age, sex and geographical region. Table 1Year of Follow UpObserved Survival (95% CI)Expected SurvivalAnual Excess of Mortality (95% CI)&amp;lt;65 yearsFirst Year99.23%(98.29%-99.65%)99.43%0.19%(-0.23%-1.14%)Second Year98.76%(97.61%-99.36%)98.79%-0.16%(-0.48%-0.84%)Third Year97.68%(96.05%-98.64%)98.12%0.36%(-0.25%-1.82%)Fourth Year95.82%(93.55%-97.31%)97.39%1.37%(0.27%-3.65%)Fifth Year94.14%(90.89%-96.25%)96.61%0.73%(-0.31%-3.88%))≥65 yearsFirst Year93.69%(91.59%-95.29%)95.64%2.15%(0.45%-4.39%)Second Year90.22%(87.61%-92.31%)91.09%-1.05%(-2.46%-1.12%)third Year85.52%(82.23%-88.24%)86.48%0.21%(-1.69%-3.06%)Fourth Year81.32%(77.38%-84.65%)81.80%-0.54%(-2.69%-3.06%)Fifth Year75.43%(70.26%-79.83%)76.56%1.20%(-2.17%6.98%)Abstract Figure 1

Dental education and proportion of inhabitants by Dentist in Angola

The objective was to verify the proportion of dentists in relation to the Angolan population, to undergraduate and graduate courses in dentistry, and to analyze the pedagogical projects of the existing courses. This is a descriptive, exploratory and documentary study that analyzed data on the population and the number of dentists in Angola, obtained through information from the National Statistics Institute and the Order of Doctors of Angola. An application for cell phones called “Qualificar”, made available by the Angolan government, was used to collect information about the existing courses. The websites of the Ministry of Higher Education, Science, Technology and Innovation; National Institute for Evaluation, Accreditation and Recognition of Higher Education Studies in Angola; and the National Press were consulted to collect data related to higher education in Angola. Information on pedagogical projects was obtained directly from Higher Education Institutions (HEIs). Angola has 701 dentists registered for a population of 30,175,553 inhabitants, that is, a proportion of 1/43,460. Among the eighty existing HEIs, only ten were authorized by the government to offer undergraduate courses in dentistry: six were located in the country's capital and four were distributed in other provinces, with workload varying from 4,688 to 5,536 hours. It was concluded that of the seven academic regions in the country, 4 do not have courses in dentistry; the number of dentists is not compatible with the population of Angola; no HEI offered postgraduate courses in dentistry and there is no standardization of pedagogical projects among the existing undergraduate courses.

Natural Disasters in Bulgaria – Crises Events for the Period 2010–2018

The paper presents an overview of the occurrence of crisis events from natural processes and phenomena in our country. Official data from the National Statistical Institute covering the period 2010–2018 were researched. The results show that natural disasters are among the most common causes of crises. Over half of the reported crises of a natural origin are the result of floods.

Attribute dependency data analysis for massive datasets by fuzzy transforms

We present a numerical attribute dependency method for massive datasets based on the concepts of direct and inverse fuzzy transform. In a previous work, we used these concepts for numerical attribute dependency in data analysis: Therein, the multi-dimensional inverse fuzzy transform was useful for approximating a regression function. Here we give an extension of this method in massive datasets because the previous method could not be applied due to the high memory size. Our method is proved on a large dataset formed from 402,678 census sections of the Italian regions provided by the Italian National Statistical Institute (ISTAT) in 2011. The results of comparative tests with the well-known methods of regression, called support vector regression and multilayer perceptron, show that the proposed algorithm has comparable performance with those obtained using these two methods. Moreover, the number of parameters requested in our method is minor with respect to those of the cited in the above two algorithms.

High-Resolution Estimates and the Burden of Undetected and Untreated Chagas Disease Cases in Spain

Introduction: Spain is the non-endemic country with the highest burden of Chagas disease outside the Americas, and it represents a model for non-endemic countries concerning health policies to control the disease. This study generates high-resolution estimates of the burden of undetected and untreated T.cruzi infection cases in Spain and compare them with the actual number of cases reported by official sources. Methods: A study using aggregate data collected from the literature and official sources (Spanish National Statistics Institute; Spanish Agency of Medicines and Medical Devices) was undertaken, from 2010 to 2018, to estimate the number of Chagas disease cases and the underdiagnosis and undertreatment rates. Results: We estimated a total of 55,367 migrants living with Chagas disease in Spain in 2018, out of them 613 (1%) were children under 15 years of age. Bolivian migrants represented 54% of the total estimated cases. Underdiagnosis and undertreatment rates were heterogeneous among the different Spanish autonomous regions, being the estimated global underdiagnosis rate of around 71%. The global rate of undertreatment in Spain was estimated to be 82·5% among patients older than 14 years. Conclusion: The burden of Chagas disease in Spain remains high, with both considerable underdiagnosis and undertreatment rates, particularly notorious in childbearing age women despite being a priority group; but much improved in children, suggesting the efficacy of antenatal screening programmes implemented in the country. Funding: None to declare Declaration of Interest: All authors declare not competing interest

Trends in mortality due to pressure ulcers in Spain, over the period 1999–2016

Aimto analyse trends in mortality by Pressure Ulcers (PU) in Spain, between 1999 and 2016. MethodsMortality due to PU in residents in Spain over 65, where a PU was underlying/basic cause of death, was analysed. Data for populations and deaths were gathered from the Spanish National Statistics Institute. Variables were age, sex, year of death and underlying/basic cause of death. Age-adjusted mortality rates were calculated (direct method), with 2013 European standard population. To analyse temporal trends and to detect significant changes, joinpoint regression models were adjusted to estimate average annual percentage change of Age-Adjusted mortality Rates for each segment detected. An analysis was performed for those over 65, and by the age groups 65–84, and over 84 years. ResultsA total of 11,238 deaths due to PU in people over 65, between 1999 and 2016, were analysed. There was a general decrease for both, women and men, over the period. From the Joinpoint analysis, for men, two changes were detected in those over 65, with a significant decrease observed until 2008. For those over 84, was a significant decrease of 4.4% on average per year. For women, a significant decrease is observed in all age groups, with a change of trend in 2007. ConclusionThis study provides a general overview of the epidemiology of PU mortality in Spain. It may serve as a confirmation of the good health policies carried out in the past on PU, given that we observe a generalised decrease in mortality from PUs over the period. Mortality was higher in women at the beginning of the period but without differences at the end, compared with men. Changes occurred over time could be explained by implementation of patient safety policies.

TRENDS IN THE DIETARY HABITS OF THE BULGARIAN POPULATION DURING A NINE YEARS PERIOD-2010-2018

Objective: Bulgaria is one of the European countries with highest rate of cardiovascular morbidity and -mortality. In attempt to find out the reasons for this negative fact, we tried to analyze the changes in the typical Bulgarian diet during the last decade. Design and method: We used the household consumption data from National Statistical Institute of Bulgaria for the mean consumption of the main food products per person per year. The available information included period of 9 years-2010-2018. Results: There is a decrease of the consumption of sugar from 8.5 kg/person/year to 6.9 kg/person/year, but there is increase of the consumption of sugary (from 1.4 to 1.7 kg/person/year) and chocolate products (from 1.1 to 1.5 kg/person/year). There is also significant increase of the intake of soft drinks (known to be the most powerful source of hidden sugar) - from 50.9 to 66.5 l/person/year. The salt consumption slightly decreased (2.0 to 1.8 kg/person/year) but the intake of dried and processed (and very salty) meat products increased from 3.2 to 4.0 kg/person/year. The intake of the traditional Bulgarian sunflower oil decreased from 14.1 to 12 l/person/year, but the consumption of butter increased from 0.2 to 1.0 kg/person/year. The consumption of red meat increased and that was mainly due to increased intake of pork-from 6.9 to 10.5 kg/person/year. On the opposite- the trend of increased consumption of fish until year 2013 was negatively reversed in the following years, reaching the lowest point of 5.2 kg/person/year in 2018. The consumption of fruits and vegetables remained relatively stable, but there is a negative trend of decreased intake of local products (rich of antioxidants) such as apples, pepper and cabbage. Alcohol consumption increased significantly (23.6–31 l/person/year), mainly due to increased beer intake. And finally, despite of law restrictions- the intake of cigarettes increased from 591 to 674 person/year. Conclusions: Our conclusion is that the trends in the dietary habits of the Bulgarian population during a nine years period-2010–2018 are generally negative. We must improve the level of dietary education from early age and involve the whole society in this process.

Economic Crisis in Portugal: Trajectory of the Incidence of Depression and Correlation With Unemployment

Previous studies have found an increase in the incidence rate of depression between 2007 - 2013 in Portugal, with a positive correlation with the unemployment rate, namely, in men. So, it was hypothesized that this increase is related with the situation of economic crisis. This study aimed to investigate if the correlation between unemployment rates and the incidence of depression is maintained in the post-crisis period of economic recovery in Portugal (2016 - 2018). An ecological study was carried out, using data from the General Practitioners Sentinel Network concerning depression incidence (first episodes and relapses) and data from the National Statistics Institute on unemployment rates in the Portuguese population. The correlation coefficient was estimated using linear regression and the results were disaggregated by sex. Between 2016 and 2018, there was a consistent decrease in the incidence of depression in both sexes. During the 1995 - 2018 period, a positive correlation was observed between unemployment and depression, with a coefficient of 0.833 (p = 0.005) in males and of 0.742 (p = 0.022) in females. The reduction in the incidence of depression in both sexes observed between 2016 - 2018 corroborates a positive correlation between unemployment and depression in the Portuguese population, previously observed between 2007 - 2013. This study highlights the need to monitor the occurrence of mental illness in the Portuguese population, especially in moments of greatest social vulnerability in order to establish preventive measures, as a way to mitigate the impact of future economic crises.

Development of the Madrid Stroke Programme: Milestones and Changes in Stroke Trends and Mortality from 1997 to 2017

Introduction: Stroke is a serious health problem, given it is the second leading cause of death and a major cause of disability in the European Union. Our study aimed to assess the impact of stroke care organization measures (such as the development of stroke units, implementation of a regional stroke code, and treatment with intravenous thrombolysis and mechanical thrombectomy) implemented from 1997 to 2017 on hospital admissions due to stroke and mortality attributed to stroke in the Madrid health region. Methods: Epidemiological data were obtained from the National Statistics Institute public website. We collected data on the number of patients discharged with a diagnosis of stroke, in-hospital mortality due to stroke and the number of inhabitants in the Madrid health region each year. We calculated rates of discharges and mortality due to stroke and the number of inhabitants per SU bed, and we analysed temporal trends in in-hospital mortality due to stroke using the Daniels test in 2 separate time periods (before and after 2011). Figures representing annual changes in these data from 1997 to 2017 were elaborated, marking stroke care organizational measures in the year they were implemented to visualize their temporal relation with changes in stroke statistics. Results: Hospital discharges with a diagnosis of stroke have increased from 170.3/100,000 inhabitants in 1997 to 230.23/100,000 inhabitants in 2017. However, the in-hospital mortality rate due to stroke has decreased (from 33.3 to 15.2%). A statistically significant temporal trend towards a decrease in the mortality percentage and rate was found from 1997 to 2011. Conclusions: Our study illustrates how measures such as the development of stroke units, implementation of a regional stroke code and treatment with intravenous thrombolysis coincide in time with a reduction in in-hospital mortality due to stroke.