Municipality Of Residence Research Articles

Suicides in Belgrade, Serbia in the period 2009-2018

Abstract Background Suicides fall in violent deaths and more recently have shown an increasing trend in developed and developing countries. This is a major public health problem that could and should be prevented. Unfortunately, it is among the top twenty leading causes of death worldwide. This public health problem exists in Belgrade and Serbia, as well. Methods An analysis of death certificates shows an insight into the causes of death of inhabitants of Belgrade. The paper presents data from the Database of deceased persons in Belgrade, for the period 2009- 2018. Data are analyzed using frequencies and incidence rates by sex, age groups, month of death, day of death, and municipality of residence of deceased. Results In Belgrade, from 2009 to 2018 the incidence rate of suicides is decreasing. The standardized suicide rate was highest in 2009 (12/100.000). Men often committed suicides at all observed years, and the rates are usually higher as in women. The highest number of suicides occur in April, July and June and observing days within a week Wednesday and Tuesday lead. The average age of men who committed suicide was 57 years and women 59.5 years. The most common method of carrying out the suicide was 'by hanging, strangulation and suffocation' (X70 according to ICD-10) and frequency was 45.2%. Conclusions The incidence rate of suicides at Belgrade territory shows the trend of decline in the observed period, between 2009 and 2018. Besides that, other attributes indicate that age-sex-manner of suicides could be changed, as for being targeted for prevention. Preventing suicides is a new challenge for public health and all public sectors have to be involved in prevention. Considering ageing of a population, migration and other negative demographic trends in Belgrade and Serbia, it is necessary to raise our competencies in inhibition of these unfortunate events. Key messages Preventing suicides is a challenge for public health. It is necessary to raise competencies in order to prevent suicides.

Integrating environmental, entomological, animal, and human data to model the Leishmania infantum transmission risk in a newly endemic area in Northern Italy

Integrating environmental, entomological, animal, and human data to model the Leishmania infantum transmission risk in a newly endemic area in Northern Italy

Lower Limb Revascularization for Peripheral Arterial Disease in 10,951 Procedures over 11 years in a Public Health System: A Descriptive Analysis of the Largest Brazilian City

Lower Limb Revascularization for Peripheral Arterial Disease in 10,951 Procedures over 11 years in a Public Health System: A Descriptive Analysis of the Largest Brazilian City

Place of death among older people in Finland and Norway

Aims: This study aimed to find out how place of death varied between countries with different health and social service systems. This was done by investigating typical groups (concerning age, sex and end-of-life trajectory) of older people dying in different places in Finland and Norway. Methods: The data were derived from national registers. All those who died in Finland or Norway at the age of ⩾70 years in 2011 were included. Place of death was analysed by age, sex, end-of-life trajectory and degree of urbanisation of the municipality of residence. Two-proportion z-tests were performed to test the differences between the countries. Multinomial logistic regression analyses were performed separately for both countries to find the factors associated with place of death. Results: The data consisted of 68,433 individuals. Deaths occurred most commonly in health centres in Finland and in nursing homes in Norway. Deaths in hospital were more common in Norway than they were in Finland. In both countries, deaths in hospital were more common among younger people and men. Deaths in nursing homes were commonest among frail older people, while most of those who had a terminal illness died in health centres in Finland and in nursing homes in Norway. Conclusions: Both Finland and Norway have a relatively low share of hospital deaths among older people. Both countries have developed alternatives to end-of-life care in hospital, allowing for spending the last days or weeks of life closer to home. In Finland, health centres play a key role in end-of-life care, while in Norway nursing homes serve this role.

Estadio clínico tardío de cáncer de mama en el estado de Jalisco: magnitud y variaciones espaciotemporales

Los registros oficiales indican que, en Jalisco, México, el diagnóstico de cáncer de mama (Cama) en mujeres generalmente se realiza en fases avanzadas. Mediante datos georreferenciados de pacientes atendidas en un hospital de tercer nivel, se identificó la magnitud y variación espaciotemporal asociada a estadio clínico tardío (IIb, IIIa, IIIb, IIIc, IV) por municipio de residencia en el trienio 2013-2015. Los municipios Acatic, Atoyac y Zapotlanejo mostraron un incremento en la tasa estimada para este periodo, cuyo valor fue 44.6, 17.7 y 19.2 por cada cien mil mujeres mayores de 20 años, respectivamente. Además, el riesgo de estadio tardío se incrementó hasta cuatro veces según el municipio de residencia. Los resultados sugieren cuáles son los municipios donde se requiere mejorar la detección y diagnóstico de Cama, pero sobre todo garantizar un tratamiento oportuno para las mujeres que residen en los lugares de mayor riesgo, en apego a lineamientos establecidos en la NOM 041-SSA2-2011.

Trends in Consumption of Sweet, Unsweetened and Alcoholic Beverages in Mexican Adults: 2006 to 2016

Trends in Consumption of Sweet, Unsweetened and Alcoholic Beverages in Mexican Adults: 2006 to 2016

Renin–Angiotensin–Aldosterone System Blockers and the Risk of Covid-19

BackgroundA potential association between the use of angiotensin-receptor blockers (ARBs) and angiotensin-converting–enzyme (ACE) inhibitors and the risk of coronavirus disease 2019 (Covid-19) has not been well studied.MethodsWe carried out a population-based case–control study in the Lombardy region of Italy. A total of 6272 case patients in whom infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed between February 21 and March 11, 2020, were matched to 30,759 beneficiaries of the Regional Health Service (controls) according to sex, age, and municipality of residence. Information about the use of selected drugs and patients’ clinical profiles was obtained from regional databases of health care use. Odds ratios and 95% confidence intervals for associations between drugs and infection, with adjustment for confounders, were estimated by means of logistic regression.ResultsAmong both case patients and controls, the mean (±SD) age was 68±13 years, and 37% were women. The use of ACE inhibitors and ARBs was more common among case patients than among controls, as was the use of other antihypertensive and non-antihypertensive drugs, and case patients had a worse clinical profile. Use of ARBs or ACE inhibitors did not show any association with Covid-19 among case patients overall (adjusted odds ratio, 0.95 [95% confidence interval {CI}, 0.86 to 1.05] for ARBs and 0.96 [95% CI, 0.87 to 1.07] for ACE inhibitors) or among patients who had a severe or fatal course of the disease (adjusted odds ratio, 0.83 [95% CI, 0.63 to 1.10] for ARBs and 0.91 [95% CI, 0.69 to 1.21] for ACE inhibitors), and no association between these variables was found according to sex.ConclusionsIn this large, population-based study, the use of ACE inhibitors and ARBs was more frequent among patients with Covid-19 than among controls because of their higher prevalence of cardiovascular disease. However, there was no evidence that ACE inhibitors or ARBs affected the risk of COVID-19.

Mortality among male forensic and non-forensic psychiatric patients: matched cohort study of rates, predictors and causes-of-death

Background: The mortality of forensic psychiatric (FP) patients compared to non-forensic psychiatric (non-FP) patients has been sparsely examined. Methods: We conducted a matched cohort study and compared Danish male FP patients (n = 490) who underwent pre-trial forensic psychiatric assessment (FPA) 1980–1992 and were subsequently sentenced to psychiatric treatment with matched (on year of birth, marital status, and municipality of residence) male non-FP patients (n = 490) and male general population controls (n = 1716). FP and non-FP patients were also matched on major psychiatric diagnostic categories. To determine mortality and identify potential predictors of mortality, we linked nationwide register data (demographics, education, employment, psychiatric admission pattern and diagnoses, cause of death) to study cohorts. Average follow-up time was 19 years from FPA assessment/sampling until death/censoring or 31 December 2010 and risk factors were studied/controlled with Cox proportional hazard analysis. Results: Overall, psychiatric patients had significantly higher mortality compared to matched general population controls (medium to large effects). Among patients, 44% (213) of FP vs. 36% (178) of matched non-FP patients died during follow-up (p = 0.02). When we used Cox regression modeling to control for potential risk factors; age, education, immigrant background, employed/studying at index, length of psychiatric inpatient stay/year, and ever being diagnosed with substance use disorder (SUD), FP patient status was no longer significantly associated with increased mortality, whereas SUD and longer inpatient time per year were independently associated with increased mortality. Discussion: This study suggests that SUD and longer inpatient time per year are independent risk factors for increased mortality in psychiatric patients.

Party leaders and voter responses to political terrorism

In this article, we study the political implications of terrorism rooted in extremist political ideologies. Our data uniquely allow studying the potential role of party leader evaluations on political outcomes, including voter turnout and vote choice. To strengthen causal identification, we combine an event-study framework with the fact that Norwegians were affected personally to differing degrees by the 22 July 2011 terror attack because of variation in the victims’ municipalities of residence. Our main findings suggest that extreme right-wing terrorism influences party vote intentions and evaluations of political leaders strongly in the short run, as well as party choice in actual elections in the longer run. We document shifts within Norway’s left-right political blocs rather than shifts between those blocs frequently observed following religious/separatist violence.

Social inequality and pneumonia hospitalization in children under five years of age in Maranhão, Brazil

Abstract Objectives: to describe the characteristics of pneumonia hospitalizations in children under five years of age across the State of Maranhão, Brazil, and explore patterns of spatial distribution of admissions. Methods: ecological study using data on occurrences (age, gender, skin color/race, month of occurrence, and municipality of residence) between 2012 and 2017 taken from the Unified Health System’s Hospital Information System and municipal level socioeconomic indicators for 2010. Each respiratory disease, including pneumonia, was presented as a percentage of overall admissions for respiratory tract diseases, together with the monthly distribution of admissions as a percentage of total annual cases, and annual rate of admissions by gender. The General G* statistic was calculated to identify significant clustering of municipalities with similar proportions of hospital admissions for pneumonia relative to overall hospital admissions. Results: pneumonia was the leading cause of admissions for respiratory disease, accounting for 57% of all cases and occurring with greater frequency in the rainy season (February to June) and in cities with lower socioeconomic indicator values. The rate of admissions decreased over the study period. Significant clusters (p<0.05) of municipalities with high proportions of hospital admissions for pneumonia relative to overall hospital admissions occurred predominantly in the south of the state, while clusters with low propor-tions were located mainly in and around the metropolitan region of the state capital São Luís. Conclusions: pneumonia was shown to be a key cause of hospitalization in children and its distribution was associated with contextual socioeconomic factors, reflecting the quality of life and health status of children in Maranhão.

Environmental disasters and birth outcomes: Impact of a tailings dam breakage in Brazil.

Environmental disasters and birth outcomes: Impact of a tailings dam breakage in Brazil.

Paediatric ambulatory care sensitive hospitalisation and Italian deprivation index: retrospective multilevel analysis of administrative data from 2008 to 2018 in the Abruzzo Region (Southern Italy).

to estimate and analyse the trend of paediatric hospitalisations for Ambulatory Care Sensitive Conditions (ACSCs) from 2008 to 2018 in a region of southern Italy and to assess the association with the socio-economic deprivation index (DI). retrospective observational study. ACSC hospitalisations in children (<=18 years) were identified. Discharges for ACSC of the Abruzzo Region from 2008 to 2018 were selected and the deprivation index of the municipality of residence was assigned to the hospital discharge record where the patient's residence was reported. the rate of paediatric preventable admissions (PPHs) related to ACSC, standardized by age and gender with the direct method, was calculated for the years of observation. The average annual percentage change (AAPC) was calculated with a trend analysis. In addition, the odds ratios (ORs) of hospitalisation for ACSC were calculated using a hierarchical logistic regression model. 252,513 hospitalisations were examined, of which 16,264 (6.4%) attributable to ACSC. During the study period, the hospitalisation rate decreased from 8.59 per 1,000 to 6.12 per 1,000 residents, with an AAPC of -3.7, which was statistically significant (p<0.05). Furthermore, an association was highlighted between hospitalisations related to ACSC and the deprivation of the municipality of residence. Using as a comparison people residing in the municipalities belonging to the first quintile, the least deprived, the strength of the association between PPHs and DI increased from the third quintile (OR 1.13; CI95% 1.02-1.24) up to the fifth quintile, most deprived (OR 1.14; CI95% 1.01-1.30). paediatric patients residing in Abruzzo have a risk of undergoing a preventable hospitalisation associated with an ACSC which depends on the deprivation index of the municipality of residence. Although it is difficult to evaluate the mechanisms involved in the relationship between economic deprivation and hospitalisation, DI can be useful to identify the areas which are most at risk on which to prioritize public health interventions.

Tabacco, alcohol and pemba consumption during pregnancy in French Guyana

The risks to the unborn child from maternal consumption of alcohol, tobacco and substances during pregnancy are well documented in the medical literature. Data on such consumption in Frensh Guyana are scattered and scarce, which prevents prevention policies from being adapted to the local context. To compensate for the inadequacy of the data, a questionnaire survey was conducted in 2017-2018 in Guyana's three maternity units with 789 mothers. Among other things, this survey aimed at gathering data about consumption, about information received on substance consumption during pregnancy, and about the interest of professionals met by the women in these matters. Tobacco and alcohol consumption at the end of pregnancy were respectively 2% and 17%. Two profiles of alcohol consumers emerged: in Cayenne, French women with a high school level of education or more consuming on occasion wine and in Saint-Laurent-du-Maroni, regular beer consumers among women speaking a language of the river, born in Guyana. Finally, Pemba (clay) was used by 15% of the pregnant women. Although the percentage of smokers is much lower than that of metropolitan France, the percentage of alcohol consumers is significantly higher in Guyana. Women speaking in Creole and French or/and those with a high school level education and more would be less asked about their alcohol consumption. Finally, these women with a high school degree or more believe that they have had information about alcohol risk during school or through prevention campaigns, while those with a primary education level would have been better informed by health professionals. The low tobacco consumption of women in Guyana is in line with that of all the FODs. Alcohol consumption during pregnancy seems slightly higher than in metropolitan France. Alcohol users have specific profiles, linked to the isolation of the municipality of residence, a low level of education, traditional consumption of Pemba and previous experience of miscarriage. The prevalence of Pemba use is a source of concern for professionals, especially when associated with beer consumption. Mobilization of local teams on the issue of alcohol during pregnancy is strong. However, professionals tend to interview women in lower Professions and Socioprofessional Categories, or PCS, more often, as in metropolitan France, with a level of education below the high school degree or whose mother tongue differs from French or French Creole.

Socioeconomic status of patients in a Swedish national self-management program for osteoarthritis compared with the general population\u2014a descriptive observational study

BackgroundFirst-line treatment for hip and knee osteoarthritis (OA) including education and supervised exercises, delivered as a self-management program, is considered one of the mainstays in OA treatment. However, the socioeconomic profile of the population that utilizes first-line treatment for hip and knee OA is unclear. The aim of this study was to describe the socioeconomic status (SES) of a population referred to a self-management program for OA, in comparison with that of the general Swedish population.MethodsThis is a cross-sectional study including 72,069 patients with hip or knee OA enrolled in the National Quality Register for Better management of patients with Osteoarthritis (BOA) between 2008 and 2016, and registered before participation in a structured OA self-management program. A reference cohort (n = 216,207) was selected from the general Swedish population by one-to-three matching by year of birth, sex and residence. Residential municipality, country of birth, marital status, family type, educational level, employment, occupation, disposable income and sick leave were analyzed.ResultsThe BOA population had higher educational level than the reference group, both regarding patients with hip OA (77.5% vs 70% with ≥10 years of education), and with knee OA (77% vs 72% with ≥10 years of education). Their average disposable income was higher (median [IQR] in Euro (€), for hip €17,442 [10,478] vs €15,998 [10,659], for knee €17,794 [10,574] vs €16,578 [11,221]). Of those who worked, 46% of patients with hip OA and 45% of the reference group had a blue-collar occupation. The corresponding numbers for knee OA were 51 and 44% respectively. Sick leave was higher among those with hip and knee OA (26%) than those in the reference groups (13% vs 12%).ConclusionsThe consistently higher SES in the BOA population compared with the general population indicates that this self-management program for OA may not reach the more socioeconomically disadvantaged groups, who are often those with a higher disease burden.

Intermunicipal healthcare flows and perinatal births and deaths in Greater Metropolitan Rio de Janeiro, Brazil, in 2011 and 2014

The regionalization of perinatal care should consider existing healthcare structures for facilitating access. This spatial-temporal ecological study identified intermunicipal flows of perinatal births and deaths in Greater Metropolitan Rio de Janeiro, Brazil, in 2011 and 2014, defined parameters, and systematized proposals for organizing the regionalization of perinatal care. The data sources were the Brazilian Information System on Live Births, Mortality Information System, National Registry of Healthcare Establishments, and 2010 Population Census. The study identified existing relations between the mothers' municipalities of residence and the occurrence of perinatal births and deaths. Each municipality was analyzed singly and pairwise (residence/occurrence) according to the vital event, healthcare resources, and pragmatic criteria of life-threatening conditions at birth. We conducted descriptive analyses of dominant flows, exploratory principal components analysis, and cluster analysis. The existing healthcare networks were identified, and 47 variables were summarized in three factors (analytical dimensions) - availability of beds, risk of life-threatening conditions, and socioeconomic status - accounting for 60%/80%, 20%/30%, 13%/22%, respectively, of the variance pertaining to each year analyzed. The factors were used to form clusters, classified in 3 to 5 strata. Three proposals were drafted for perinatal health regions. The study's principal contribution was having presented parameters for monitoring the regionalization and systematic reevaluation of this process based on administrative records.

Drug Utilization Pattern of Antibiotics: The Role of Age, Sex and Municipalities in Determining Variation.

PurposeThe purpose was to analyze drug prescription and antibiotic use by age and sex in Italy’s Campania Region, and to estimate the distribution of prescription rates in children (≤14 years old), adults (between 15 and 65 years old), and older adults (≥65 years old) at a municipality level.MethodsThis was a retrospective analysis of pharmacy records in Campania (Southern Italy), in 2016. Difference in antibiotic prescriptions in different age groups was assessed by prevalence rates. Age-adjusted prevalence rates were categorized into quintiles and mapped by the patient’s municipality of residence. Relationship between prevalence rates for the different age groups was estimated using the non-parametric Spearman rank correlation test.ResultsThere were 2,738,118 were patients with at least one antibiotic prescription. Antibiotics prescription was higher in children aged <5 years and in the older adults aged >70 years. Prevalence rate distribution was different among municipalities in all age groups. A positive correlation between the rank distribution of prevalence rates at municipality level was identified for children and adults (rs=0.56; P<0.01), adults and the older adults (rs=0.79; P<0.01), and children and the older adults (rs=0.46; P<0.01). Among the studied age groups, the most prescribed antibiotic class was penicillin (except the older adults aged ≥85 years) ranging from 45% in children to 27.2% in the older adults. Fluoroquinolones were the least prescribed antibiotic class, ranging from 0.2% in children to 30.2% in the older adults.ConclusionA considerably high use of antibiotic drugs has been detected in Campania Region, with values exceeding the regional and national average. Prescriptions at municipal level differ from one age group to another. Antibiotic use is often unjustified, and to decrease the number of prescriptions and improve their appropriateness, several measures at territorial level are recommended.

COMPRIME - COnhecer Mais PaRa Intervir MElhor: Preliminary Mapping of Municipal Level Determinants of COVID-19 Transmission in Portugal at Different Moments of the 1st Epidemic Wave

COMPRIME - COnhecer Mais PaRa Intervir MElhor: Preliminary Mapping of Municipal Level Determinants of COVID-19 Transmission in Portugal at Different Moments of the 1st Epidemic Wave

Application of a geographic information system in the study of spatial aspects of cervical cancer incidence in Belgrade

Background/Aim. Cervical cancer is still an important public health problem in Belgrade. The aim of this study was to explore spatial patterns of cervical cancer, provision and accessibility of women?s health service on the primary health care level in Belgrade, as well as the needs for improving cancer surveillance and preventive programs. Methods. This study applied a descriptive epidemiological method and a geographic information system based on data on cervical cancer diagnosed among female residents of Belgrade in 2006 and 2011. A map of the density of cases, with precise and complete data on the address of residence at the time of diagnosis, and a map of the distribution of gynecological practices in the primary health care in Belgrade, were generated through the process of georeferencing. Results. A total of 569 cases of cervical cancer were registered in 2006 and 2011, without significant differences. Significant associations were noticed for municipality of residence and year of diagnosis (?2= 42.99, df = 16, p = 0.000), and year of diagnosis and age groups 30?34 (? = 0.038, f = 3.998, df = 11, ANOVA), 40?44 (? = 0.001, f = 7.545 df = 13, ANOVA) and 45?49 (? = 0.046, f = 2.679, df = 15, ANOVA). The process of georeferencing covered a total of 466 (81.8%) cases with 97.4% of all cases diagnosed in 2006 and 68.6% in 2011. The generated maps showed similar spatial patterns of cases for both years: a higher density of cases with addresses in central parts of urban and suburban municipalities, as well as in parts of densely populated areas of urban municipalities. There was no regularity of grouping found for the cases in relation to the provision of women?s health service, or of distance from the place of residence of cases to gynecological practices. Conclusion. Our results indicate possibilities for the perception of the spatial distribution of cervical cancer and needs for improving cancer surveillance and preventive programs on small geographical areas.

Neighborhoods, Networks, and Delivery Methods

We investigate potential mechanisms of information transmission among patients when explaining territorial variations in the use of cesarean sections. Defining networks as mothers living in the same Italian municipality (average size approximately 10,000 residents), we show that a one standard deviation increase of the incidence of cesarean sections for the 12 months before the delivery date in the future mother’s municipality of residence increases the probability of her receiving the treatment by 3%. This result captures mainly network effects for Italian mothers, while it captures both network and neighborhood effects for foreign mothers. Both groups adjust for the transmission of complementary information, such as the incidence of complications due to cesarean sections. The selection of mothers across hospitals does not uniquely explain our results, which are robust to alternative sample selections.

Movilidad residencial en la Región Metropolitana de Córdoba, 2005-2010

El objetivo de este trabajo es analizar la movilidad residencial dentro de la Región Metropolitana de Córdoba, particularmente los cambios de municipio de residencia en el período 2005-2010. Los datos provienen del Censo Nacional de Población, Hogares y Vivienda 2010 y se utiliza la información sobre el municipio de residencia habitual y en una fecha fija anterior y se calculan tasas de ingresos y egresos a los diferentes municipios que componen la región, como así también tasas netas de movilidad residencial, según el tamaño de población y la distancia respecto del centro metropolitano. También se estima la intensidad de la movilidad residencial de acuerdo a las características de los individuos y hogares que protagonizaron dichos desplazamientos. Los municipios de menor tamaño y ubicados a una distancia intermedia exhiben las mayores tasas netas de movilidad residencial, y la mayor intensidad se registra entre los adultos de entre 30 y 39 años con mayores niveles educativos y en los niños de 5 a 9 años, que residen en hogares que se encuentran en la etapa inicial de la conformación del nuevo hogar familiar. Los resultados obtenidos dan cuenta del importante papel que tiene la movilidad residencial en la configuración de la nueva dinámica socio-territorial de la región.