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For more than 20 years, the American College of Physicians (ACP) has advocated for the need to address firearm-related injuries and deaths in the United States. Yet, firearm violence continues to be a public health crisis that requires the nation's immediate attention. The policy recommendations in this paper build on, strengthen, and expand current ACP policies approved by the Board of Regents in April 2014, based on analysis of approaches that the evidence suggests will be effective in reducing deaths and injuries from firearm-related violence. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has been a global public health concern since March 11, 2020. Healthcare systems struggled to meet patients' growing needs for diagnosis, treatment, and care. As healthcare industries struggled to cope with the overwhelming demands, advanced intelligence and computing technologies have become essential. Artificial intelligence techniques have become essential for identifying and triaging patients, predicting disease severity, and detecting outcomes. The aim of the paper is to propose a gradient boosting-based model to predict the mortality of COVID-19 patients and to improve the prediction accuracy by incorporating resampling strategies. A real COVID-19 data that includes patients' travel, health, geographical, and demographic information is obtained from a public repository. The dataset used in the study has the class imbalance problem, and several approaches are applied to solve the problem. In this study, a gradient boosting-based model for predicting the mortality of COVID-19 patients is proposed. This approach incorporates resampling strategies, such as synthetic minority oversampling technique (SMOTE), random under-sampling, and clustering-based under-sampling, to address the imbalanced class distribution problem in the dataset. Then, gradient boosting machines (GBM) such as extreme gradient boosting (XGBoost), light gradient boosting machine (LightGBM), and categorical boosting (CatBoost) are analyzed in terms of accuracy and computational time. Random search method is used to find the optimal hyper-parameters for the algorithms. A stacking-based hybrid model that combines the XGBoost, LightGBM, and CatBoost algorithms was used for comparison in the experiments. In the experiments, the factors that can influence the mortality of COVID-19 patients are investigated. And, it is found that the age of the patient, whether the patient belonged to Wuhan, the difference between when they first noticed symptoms and when they visited the hospital (in days) affect the mortality. By utilizing over/under-sampling approaches, we ameliorated the concern of class imbalance. XGBoost, LightGBM, and CatBoost are effectively analyzed in terms of various performance metrics to determine the suitable GBM for the proposed system. The experimental results revealed that the stacking-based hybrid model performs well with the balanced dataset provided by SMOTE. CatBoost produces superior results for a balanced dataset with random under-sampling and clustering-based under-sampling. The main focus of the study is to propose a gradient boosting-based model for predicting the mortality of COVID-19 patients. This study also emphasizes the importance of addressing the imbalanced class distribution problem in the dataset and incorporates resampling strategies to improve the prediction accuracy. Our promising result confirms the success of the proposed system in predicting mortality of COVID-19 disease. [ABSTRACT FROM AUTHOR]

Researchers are often faced with evaluating the effect of a policy or program that was simultaneously initiated across an entire population of units at a single point in time, and its effects over the targeted population can manifest at any time period afterwards. In the presence of data measured over time, Bayesian time series models have been used to impute what would have happened after the policy was initiated, had the policy not taken place, in order to estimate causal effects. However, the considerations regarding the definition of the target estimands, the underlying assumptions, the plausibility of such assumptions, and the choice of an appropriate model have not been thoroughly investigated. In this paper, we establish useful estimands for the evaluation of large-scale policies. We discuss that imputation of missing potential outcomes relies on an assumption which, even though untestable, can be partially evaluated using observed data. We illustrate an approach to evaluate this key causal assumption and facilitate model elicitation based on data from the time interval before policy initiation and using classic statistical techniques. As an illustration, we study the Hospital Readmissions Reduction Program (HRRP), a US federal intervention aiming to improve health outcomes for patients with pneumonia, acute myocardial infraction, or congestive failure admitted to a hospital. We evaluate the effect of the HRRP on population mortality among the elderly across the US and in four geographic subregions, and at different time windows. We find that the HRRP increased mortality from pneumonia and acute myocardial infraction across at least one geographical region and time horizon, and is likely to have had a detrimental effect on public health. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic caused an unusual population mortality rate. This paper aims to determine a causal relationship and its incidence between the Technical Efficiency (TE) of health systems and the Covid-19 mortality rate. Using the Data Envelopment Analysis (DEA) methodology and the OLS, GLS and 2SLS adjustment methods, in 108 countries grouped according to per capita health expenditure, it was found that a 1% increase in the TE of the health systems of the analyzed countries reduces the number of deaths from Covid-19 by between 61 and 127 per hundred thousand inhabitants, concluding that the efficiency of expenditure was transcendental in the prevention of mortality caused by the pandemic. [ABSTRACT FROM AUTHOR]

Public health officials promoted COVID-19 vaccines to limit burdens placed on the U.S. healthcare system and end the pandemic. People in some closed religious communities refused to vaccinate and likely acquired temporary immunity through infection. This paper compares the death rates in Amish, Old Order Mennonites, and conservative Mennonite groups to a rate estimated for the U.S. population. Approximately two-thirds of the U.S. population was immunized against COVID-19, while few in the Amish/Mennonite community were. We find divergent patterns. Once vaccines became available, excess deaths declined in the general population and remained elevated among Amish and Mennonites. Vaccination campaigns must consider and value the cultural beliefs of closed religious communities to be effective. [ABSTRACT FROM AUTHOR]

This paper argues that we ought to rethink the harm-reduction prioritization strategy that has shaped early responses to acute resource scarcity (particularly of intensive care unit beds) during the COVID-19 pandemic. Although some authors have claimed that "[t]here are no egalitarians in a pandemic," it is noted here that many observers and commentators have been deeply concerned about how prioritization policies that proceed on the basis of survival probability may unjustly distribute the burden of mortality and morbidity, even while reducing overall deaths. The paper further argues that there is a general case in favor of an egalitarian approach to medical rationing that has been missed in the ethical commentary so far; egalitarian approaches to resource rationing minimize wrongful harm. This claim is defended against some objections and the paper concludes by explaining why we should consider the possibility that avoiding wrongful harm is more important than avoiding harm simpliciter. [ABSTRACT FROM AUTHOR]

Purpose: The USA has a rapidly aging prison population that, combined with their poorer health and living conditions, is at extreme risk for COVID-19. The purpose of this paper is to compare COVID-19 mortality trends in the US prison population and the general population to see how mortality risk changed over the course of the pandemic. The authors first provide a national overview of trends in COVID-19 mortality; then, the authors assess COVID-19 deaths among older populations using more detailed data from one US state. Design/methodology/approach: The authors used multiple publicly available data sets (e.g. Centers for Disease Control and prevention, COVID Prison Project) and indirect and direct standardization to estimate standardized mortality rates covering the period from April 2020 to June 2021 for the US and for the State of Texas. Findings: While 921 COVID-19-related deaths among people in US prisons were expected as of June 5, 2021, 2,664 were observed, corresponding to a standardized mortality ratio of 2.89 (95%CI 2.78, 3.00). The observed number of COVID-19-related deaths exceeded the expected number of COVID-19-related deaths among people in prison for most of the pandemic, with a substantially widening gap leading to a plateau about four weeks after the COVID-19 vaccine was introduced in the USA. In the state population, the older population in prison is dying at younger ages compared with the general population, with the highest percentage of deaths among people aged 50–64 years. Research limitations/implications: People who are incarcerated are dying of COVID-19 at a rate that far outpaces the general population and are dying at younger ages. Originality/value: This descriptive analysis serves as a first step in understanding the dynamic trends in COVID-19 mortality and the association between age and COVID-19 death in US prisons. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality in the United States is a public health crisis and national emergency. Missed or delayed recognition of preventable life-threatening symptoms and untimely treatment of preventable high-risk medical conditions have been cited as key contributors to the nation's worsening mortality rates. Effective strategies are urgently needed to address this maternal health crisis, particularly for Black birthing populations. Morbidity and Mortality Assessment: Lifting Outcomes Via Education (MAMA LOVE) is a web-based platform that focuses on the identification of maternal morbidity and mortality risk factors. Objective: The purpose of this paper is to present the conceptualization, development, heuristics, and utility evaluation of the web-based maternal mortality risk assessment and educational tool MAMA LOVE. Methods: A user-centered design approach was used to gain feedback from clinical experts and potential end users to ensure that the tool would be effective among groups most at risk for maternal morbidity and mortality. A heuristic evaluation was conducted to evaluate usability and need within the current market. Algorithms describing key clinical, mental health, and social conditions were designed using digital canvas software (Miro) and incorporated into the final wireframes of the revised prototype. The completed version of MAMA LOVE was designed in Figma and built with the SurveyJS platform. Results: The creation of the MAMA LOVE tool followed three distinct phases: (1) the content development and creation of an initial prototype; (2) the feedback gathering and usability assessment of the prototype; and (3) the design, development, and testing of the final tool. The tool determines the corresponding course of action using the algorithm developed by the authors. A total of 38 issues were found in the heuristic evaluation of the web tool's initial prototype. Conclusions: Maternal morbidity and mortality is a public health crisis needing immediate effective interventions. In the current market, there are few digital resources available that focus specifically on the identification of dangerous symptoms and risk factors. MAMA LOVE is a tool that can address that need by increasing knowledge and providing resources and information that can be shared with health care professionals. [ABSTRACT FROM AUTHOR]

High urbanization and a consequent change in land cover can lead to a deterioration in air quality and generate impacts on public health. The objective of this paper is to provide a multitemporal analysis of the influence of particulate matter ≤ 10 μm (PM10) on human mortality from the land cover variation in a Latin American megacity. Six monitoring stations (monitoring daily PM10 concentration, increases in daily mortality (IDM), and land cover) were established throughout the megacity. The results suggest that for every 10% increase in vegetation cover, the daily PM10 concentration and IDM decreases by 7.5 μg/m3 and 0.34%, respectively. Moreover, it is evident that the monitoring station with the lowest vegetation cover (8.96 times) shows an increase of 1.56 times and 4.8 times in the daily PM10 concentration and IDM, respectively, compared with the monitoring station with the highest vegetation cover (46.7%). It is also suggested that for each increase of 100 inhabitants/hectare in population density, the daily PM10 concentration and IDM increases by 9.99 µg/m3 and 0.45%, respectively. Finally, the population densification of the megacity possibly implies a loss of vegetation cover and contributes to the increase in PM10 and IDM. [ABSTRACT FROM AUTHOR]

This study examines whether individualism weakens the effectiveness of the COVID-19 vaccine eligibility expansions in the United States in 2021, and assesses the associated social benefits or costs associated with individualism. We construct a county-level composite individualism index as a proxy of culture and the fraction of vaccine eligible population as a proxy of vaccination campaign (mean: 41.34%). We estimate whether the COVID-19 vaccine eligibility policy is less effective in promoting vaccine coverage, reducing in COVID-19 related hospitalization and death using a linear two-way fixed effect model in a sample of 2866 counties for the period between early December 2020 and July 1, 2021. We also test whether individualism shapes people's attitudes towards vaccine using a linear probability model in a sample of 625,308 individuals aged 18–65 (mean age: 43.3; 49% male; 59.1% non-Hispanic white, 19.1% Hispanic, 12% African American; 5.9% Asian) from the Household Pulse Survey. The effects of expanded vaccine eligibility are diminished in counties with greater individualism, as evidenced by lower effectiveness in increasing vaccination rates and reducing outpatient doctor visits primarily for COVID-related symptoms and COVID deaths. Moreover, our results show that this cultural influence on attitudes towards vaccine is more pronounced among the less educated, but unrelated to race. Assuming an average level of vaccine eligibility policies and an average intensity of individualism across the nation, we calculate that the average social cost associated with an individualistic culture amid the pandemic is approximately $50.044 billion, equivalent to 1.32% of the total U.S. health care spending in 2019. Our paper suggests that strategies to promote public policy compliance should be tailored to accommodate cultural and social contexts. • We examine whether individualism weakens effectiveness of COVID-19 vaccine policies. • The effects of vaccine policy are diminished in counties with greater individualism. • Individuals have less trust in COVID-19 vaccine in a more individualistic culture. • Strategies to promote policy compliance should be tailored to accommodate cultural contexts. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) has been causing negative impacts on various sectors in Sri Lanka, as a result of the public health interventions that the government had to implement in order to reduce the spread of the disease. Equivalent work carried out in this context is outdated and close to ideal models. This paper presents a mathematical epidemiological model, called SEQIJRDS, having additional compartments for quarantine and infected people divided into two compartments as diagnosed and non diagnosed, compared to the SEIR model. We have presented the rate equations for the model and the basic reproduction number is derived. This model considers the effect of vaccination, the viral load of the variants, mask use, mobility, contact tracing and quarantine, natural immunity development of the infected people, and immunity waning of the recovered group as key developments of the model. The model has been validated for the COVID-19 pandemic in Sri Lanka by parameter derivation using mathematical formulations with the help of the existing data, the literature, and by model fitting for historical data. We present a comparison of the model projections for hospitalized infected people, the cumulative death count, and the daily death count against the ground truth values and projections of the SEIR and SIR models during the model validation. The validation results show that the proposed SEQIJRDS model's 12-week projection performance is significantly better than both the SEIR and SIR models; the 2-, 6-, 8-, and 10-week projection performance is always better, and the 4-week projection performance is only slightly inferior to other models. Using the proposed SEQIJRDS model, we project mortality under different lockdown procedures, vaccination procedures, quarantine practices, and different mask-use cases. We further project hospital resource usage to understand the best intervention that does not exhaust hospital resources. At the end, based on an understanding of the effect of individual interventions, this work recommends combined public health interventions based on the projections of the proposed model. Specifically, three recommendations—called minimum, sub-optimum, and optimum recommendations—are provided for public health interventions. [ABSTRACT FROM AUTHOR]

This paper introduces a special issue of The History of the Family on sanitation and urban mortality. The special issue contains papers which focus on the impact of sanitary reforms on mortality change in Australia, Switzerland, Finland, Sweden, and England and Wales. The current paper outlines the main features of the debate over the causes of mortality change and the role played by sanitary reforms in this. It then highlights some of the methodological and other challenges posed by the definition of 'urban' areas, the identification of relevant sanitary reforms, and the choice of dependent variables. The paper then proceeds to summarise the main features of the individual papers before drawing some conclusions for future research. [ABSTRACT FROM AUTHOR]

Background: This paper describes a model for estimating COVID-19 related excess deaths that are a direct consequence of insufficient hospital ward bed and intensive care unit (ICU) capacity.Methods: Compartmental models were used to estimate deaths under different combinations of ICU and ward care required and received in England up to late April 2021. Model parameters were sourced from publicly available government information and organisations collating COVID-19 data. A sub-model was used to estimate the mortality scalars that represent increased mortality due to insufficient ICU or general ward bed capacity. Three illustrative scenarios for admissions numbers, 'Optimistic', 'Middling' and 'Pessimistic', were modelled and compared with the subsequent observations to the 3rd February.Results: The key output was the demand and capacity model described. There were no excess deaths from a lack of capacity in the 'Optimistic' scenario. Several of the 'Middling' scenario applications resulted in excess deaths-up to 597 deaths (0.6% increase) with a 20% reduction compared to best estimate ICU capacity. All the 'Pessimistic' scenario applications resulted in excess deaths, ranging from 49,178 (17.0% increase) for a 20% increase in ward bed availability, to 103,735 (35.8% increase) for a 20% shortfall in ward bed availability. These scenarios took no account of the emergence of the new, more transmissible, variant of concern (b.1.1.7).Conclusions: Mortality is increased when hospital demand exceeds available capacity. No excess deaths from breaching capacity would be expected under the 'Optimistic' scenario. The 'Middling' scenario could result in some excess deaths-up to a 0.7% increase relative to the total number of deaths. The 'Pessimistic' scenario would have resulted in significant excess deaths. Our sensitivity analysis indicated a range between 49,178 (17% increase) and 103,735 (35.8% increase). Given the new variant, the pessimistic scenario appeared increasingly likely and could have resulted in a substantial increase in the number of COVID-19 deaths. In the event, it would appear that capacity was not breached at any stage at a national level with no excess deaths. it will remain unclear if minor local capacity breaches resulted in any small number of excess deaths. [ABSTRACT FROM AUTHOR]

Background: Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2) has challenged public health agencies globally. In order to effectively target government responses, it is critical to identify the individuals most at risk of coronavirus disease-19 (COVID-19), developing severe clinical signs, and mortality. We undertook a systematic review of the literature to present the current status of scientific knowledge in these areas and describe the need for unified global approaches, moving forwards, as well as lessons learnt for future pandemics.Methods: Medline, Embase and Global Health were searched to the end of April 2020, as well as the Web of Science. Search terms were specific to the SARS-CoV-2 virus and COVID-19. Comparative studies of risk factors from any setting, population group and in any language were included. Titles, abstracts and full texts were screened by two reviewers and extracted in duplicate into a standardised form. Data were extracted on risk factors for COVID-19 disease, severe disease, or death and were narratively and descriptively synthesised.Results: One thousand two hundred and thirty-eight papers were identified post-deduplication. Thirty-three met our inclusion criteria, of which 26 were from China. Six assessed the risk of contracting the disease, 20 the risk of having severe disease and ten the risk of dying. Age, gender and co-morbidities were commonly assessed as risk factors. The weight of evidence showed increasing age to be associated with severe disease and mortality, and general comorbidities with mortality. Only seven studies presented multivariable analyses and power was generally limited. A wide range of definitions were used for disease severity.Conclusions: The volume of literature generated in the short time since the appearance of SARS-CoV-2 has been considerable. Many studies have sought to document the risk factors for COVID-19 disease, disease severity and mortality; age was the only risk factor based on robust studies and with a consistent body of evidence. Mechanistic studies are required to understand why age is such an important risk factor. At the start of pandemics, large, standardised, studies that use multivariable analyses are urgently needed so that the populations most at risk can be rapidly protected.Registration: This review was registered on PROSPERO as CRD42020177714 . [ABSTRACT FROM AUTHOR]

Background: Despite mortality from breast cancer in Africa being higher than in high income countries, breast cancer has not been extensively studied in the region. The aim of this paper was to highlight the rising burden of breast cancer with an emphasis on sub-Saharan Africa as well as trends, characteristics, controversies and their implications for regional development. Methodology: A review of published studies and documents was conducted in Medline, Scopus, Pubmed and Google using combinations of key words-breast neoplasm, breast cancer, cancer, incidence, mortality, Africa, Nigeria. Graphical and frequency analyses were carried out on some of the incidence and mortality figures retrieved from published papers and the GLOBOCAN website. Findings: Globally, about 25% and 15% of all new cancer cases and cancer deaths respectively among females were due to breast cancer. Africa currently had the highest age-standardized breast cancer mortality rate globally, with the highest incidence rates being recorded within the sub-Saharan African sub-region. Incidence trends such as inherently aggressive tumour and younger age profile had been subject to controversies. Certain factors such as westernized diet, urbanization and possibly increasing awareness had been implicated, though their specific contributions were yet to be fully established. Conclusion: Unless urgent action is taken, breast cancer will compound sub-Saharan Africa's disease burden, increase poverty and gender inequality as well as reverse the current global gains against maternal and neonatal mortality. [ABSTRACT FROM AUTHOR]

Valid and timely information about various domains of public health underpins the effectiveness of humanitarian public health interventions in crises. However, obstacles including insecurity, insufficient resources and skills for data collection and analysis, and absence of validated methods combine to hamper the quantity and quality of public health information available to humanitarian responders. This paper, the second in a Series of four papers, reviews available methods to collect public health data pertaining to different domains of health and health services in crisis settings, including population size and composition, exposure to armed attacks, sexual and gender-based violence, food security and feeding practices, nutritional status, physical and mental health outcomes, public health service availability, coverage and effectiveness, and mortality. The paper also quantifies the availability of a minimal essential set of information in large armed conflict and natural disaster crises since 2010: we show that information was available and timely only in a small minority of cases. On the basis of this observation, we propose an agenda for methodological research and steps required to improve on the current use of available methods. This proposition includes setting up a dedicated interagency service for public health information and epidemiology in crises. [ABSTRACT FROM AUTHOR]

Epidemic diseases are defined by excess. They are dramatic and they attract attention. Endemic diseases, on the other hand, are regarded as "normal" and tend to be neglected. Yet it is clear that this contrast can entail inaccurate impressions of risk, as well as disparities in the imperative to action. This paper looks at two examples, one from the early modern period and the other from the 19th century. The earliest attempts in England to define excess mortality, primarily from plague, came in the form of parish registration, which led, in London, to the publication of Bills of Mortality. The first to analyse the Bills in order to define risk was the London tradesman John Graunt. The causes of death recorded in the Bills were a reflection of popular opinion, but Graunt used the process of aggregation to reveal mistaken ideas about the most notorious diseases, some of which were endemic rather than epidemic. He also regarded "chronical" diseases as the best measure of the healthiness of a city. In the 19th century, the centrality of plague was replaced by that of cholera, which has attracted much attention from social historians. Yet the case for public health reform was founded not on the random and comparatively isolated epidemics of cholera, but on the constant mortality caused by what were called the continued fevers, notably typhus and typhoid. The Benthamite sanitarians adopted an increasingly simplified, localist approach, which was at odds with professional opinion but was adjusted to the need both to increase popular understanding and to promote official action where it was most likely to be effective. When cholera receded, major endemic causes of death remained in the form of respiratory disease and infant mortality. Uncertainties and problems of identification and comparability persisted into the 20th century and beyond. [ABSTRACT FROM AUTHOR]

While there has been extensive attention to the 'demand side' - or use and adverse consequences, including mortality - of the 'opioid crisis' presently unfolding across North America, few considerations have focused on the supply side. This paper examines the supply side dynamics of this unprecedented public health phenomenon. We provide evidence for several interrelated supply-side elements that have contributed to the present public health crisis. We observe that initially, persistently high levels of prescription opioid availability and use exposed large proportions of the North American population to opioids, resulting in correspondingly high levels of medical and non-medical use (e.g., involving diversion). While various intervention measures to control prescription opioid availability and use have been implemented in recent years, leading to eventual reductions in opioid dispensing levels, these occurred late in the crisis's evolution. Moreover, these supply reductions have not been met by corresponding reductions in opioid use or demand levels. These growing discrepancies between opioid demand and prescription-based sources have left major gaps in opioid supplies. In response to such supply gaps, highly potent and toxic illicit opioid products have rapidly proliferated across North America, and become a core driver of the dramatic spikes in opioid overdose fatality levels in recent years. These supply-related interrelations are corroborated by a corresponding increase in illicit opioid-related fatalities, which arose just as medical opioid supplies began to decrease in many jurisdictions. Improved analyses and understanding of the supply-side dynamics of the opioid crisis are urgently needed in order to inform future intervention and policy development. Meanwhile, the high mortality toll related to illicit, highly toxic opioid exposure requires sustained solutions, including supply-oriented measures (e.g., safer opioid distribution for at-risk users) towards improved public health protection. [ABSTRACT FROM AUTHOR]

How are health inequalities articulated across urban and rural spaces in Tanzania? This research paper explores the variations, differences, and inequalities, in Tanzania's health outcomes-to question both the idea of an urban advantage in health and the extent of urban-rural inequalities in health. The three research objectives aim to understand: what are the health differences (morbidity and mortality) between Tanzania's urban and rural areas; how are health inequalities articulated within Tanzania's urban and rural areas; and how are health inequalities articulated across age groups for rural-urban Tanzania? By analyzing four national datasets of Tanzania (National Census, Household Budget Survey, Demographic Health Survey, and Health Demographic Surveillance System), this paper reflects on the outcomes of key health indicators across these spaces. The datasets include national surveys conducted from 2009 to 2012. The results presented showcase health outcomes in rural and urban areas vary, and are unequal. The risk of disease, life expectancy, and unhealthy behaviors are not the same for urban and rural areas, and across income groups. Urban areas show a disadvantage in life expectancy, HIV prevalence, maternal mortality, children's morbidity, and women's BMI. Although a greater level of access to health facilities and medicine is reported, we raise a general concern of quality and availability in health services; what data sources are being used to make decisions on urban-rural services, and the wider determinants of urban health outcomes. The results call for a better understanding of the sociopolitical and economic factors contributing to these inequalities. The urban, and rural, populations are diverse; therefore, we need to look at service quality, and use, in light of inequality: what services are being accessed; by whom; for what reasons? [ABSTRACT FROM AUTHOR]

Previous authors have drawn attention to the role played by loan-financed public works in reducing mortality in England and Wales during the latter part of the nineteenth century. These arguments have often been based on an analysis of the loans sanctioned by the Government's central health departments following the creation of the first General Board of Health in 1848, but little attempt has been made to disaggregate the loans either by function or geographical area. Moreover, as the Local Government Board itself acknowledged, it is also important to take account of the large number of loans which were approved by other means. This paper offers the first large-scale chronological account of the full range of loans which were either approved by Local Act of Parliament or sanctioned by a central department throughout the whole of the period from the end of the Napoleonic Wars to the start of the First World War. Although it largely supports the outline provided by previous research, it draws new attention to the importance of the loans which were authorised in the wake of the US Civil War in the 1860s. It also explores the relationship between these loans and the decline of mortality in areas which have previously been identified as 'high-performing and high-contributing areas' to Britain's late nineteenth-century mortality decline, and makes an initial attempt to link these loans to the improvements which occurred. [ABSTRACT FROM AUTHOR]

Injuries continue to be a public health concern in Canada. National injury death data are essential for understanding the magnitude and pattern of injuries. This paper used the Vital Statistics - Death database to examine deaths associated with injuries in 2015. Injuries were ranked against causes of death, and more in-depth analysis of injury categories was conducted by sex and age. Unintentional injuries were the 6th leading causes of death overall, with different ranking by sex. Among unintentional injury deaths, leading causes included falls, poisonings, motor vehicle traffic collisions, and suffocation, which varied by age group. [ABSTRACT FROM AUTHOR]

In this paper age-space-time models based on one and two-dimensional P-splines with B-spline bases are proposed for smoothing mortality rates, where both fixed relative scale and scale invariant two-dimensional penalties are examined. Model fitting and inference are carried out using integrated nested Laplace approximations, a recent Bayesian technique that speeds up computations compared to McMC methods. The models will be illustrated with Spanish breast cancer mortality data during the period 1985-2010, where a general decline in breast cancer mortality has been observed in Spanish provinces in the last decades. The results reveal that mortality rates for the oldest age groups do not decrease in all provinces. [ABSTRACT FROM AUTHOR]

In the present paper, an epidemic model with Z-type control mechanism has been proposed and analyzed to explore the disease control strategy on an infectious disease outbreak. The uncontrolled model can have a disease-free equilibrium and an endemic equilibrium. The expression of the basic reproduction number and the conditions for the stability of the equilibria are derived. It is also observed that the disease-free equilibrium is globally asymptotically stable if R 0 < 1 , whereas the endemic equilibrium is globally asymptotically stable if R 0 > 1. The model is further improved by considering Z-control mechanism and investigated. Disease can be controlled by using Z-control while the basic reproduction of the uncontrolled system is greater than unity. The positivity conditions of the solutions are derived and the basin of attraction for successful implementation of Z-control mechanism is also investigated. To verify the analytical findings, extensive numerical simulations on the model are carried out. [ABSTRACT FROM AUTHOR]

Chile suffers significant pollution from large industrial emitters associated with the mining, metal processing, paper production, and energy industries. The aim of this research was to determine whether the presence of large industrial facilities ( i.e. coal- and oil-fired power plants, pulp and paper mills, mining facilities, and smelters) affects mortality and morbidity rates in Chile. For this, we conducted an ecological study that used Chilean communes as small-area observation units to assess mortality and morbidity. Public databases provided information on large pollution sources relevant to Chile. The large sources studied were oil- and coal-fired power plants, copper smelters, pulp and paper mills, and large mining facilities. Large sources were filtered by first year of production, type of process, and size. Mortality and morbidity data were acquired from public national databases, with morbidity being estimated from hospitalization records. Cause-specific rates were calculated for the main outcomes: cardiovascular, respiratory, cancer; and other more specific health outcomes. The impact of the large pollution sources was estimated using Bayesian models that included spatial correlation, overdispersion, and other covariates. Large and significant increases in health risks (around 20%–100%) were found for communes with power plants and smelters for total, cardiovascular, respiratory, all-cancer, and lung cancer mortality. Higher hospitalization rates for cardiovascular disease, respiratory disease, cancer, and pneumonia (20–100%) were also found for communes with power plants and smelters. The impacts were larger for men than women in terms of both mortality and hospitalizations. The impacts were also larger when the sources were analyzed as continuous (production volume) rather than dichotomous (presence/absence) variables. In conclusion, significantly higher rates of total cardiovascular, respiratory, all-cancer and lung cancer mortality and cardiovascular, respiratory, cancer and pneumonia hospitalizations were observed in communes with power plants and smelters. [ABSTRACT FROM AUTHOR]

Ecological public health has been proposed as an approach appropriate for addressing the multiple transitions that currently affect human health and sustainability. The paper draws on the author's experience in public health in Glasgow to analyse the health challenges faced by this postindustrial Scottish city. Like other such cities, it not only faces multiple health challenges but also demonstrates a currently unexplained excess mortality that has been dubbed the 'Glasgow Effect'. To explore this troubled mixture, the paper outlines four historical waves of public health challenge and response in Glasgow over the last century, and proposes that a fifth is emerging. The challenge now is how to negotiate environmental sustainability with social, political and economic sustainability to enhance health for all. The paper suggests that gains made by past approaches still need to be protected and can be included within ecological public health, but they lack the wider vision, coherence and capacity required if cities are to address the scale and range of contemporary conditions. A number of lessons are offered for the ecological public health perspective. [ABSTRACT FROM AUTHOR]

The provinces of China have suffered from severe PM2.5 pollution in recent years, presenting a significant threat to human health. Identifying associations between mortality rate and PM2.5 level is extremely useful for a range of purposes, such as the development of preventive measures, increasing health awareness, and establishing disaster warning systems. Based on remote sensing data, station monitoring data, and statistical data, this paper uses the exposure response function, regression analysis, and kriging to evaluate the number of deaths in China’s 31 provinces caused by PM2.5 pollution in 2015. Variations in the number of deaths and mortality rates in China under different PM2.5 concentration control standards have been simulated by a range of countries and organizations helping to develop optimal control standards for each province individually according to actual PM2.5 concentration. These results show that: 1) PM2.5 pollution has an important effect on the mortality rate in China. The rate caused by PM2.5 pollution in 2015 accounted for 1.75‰, or approximately 2.62 million people and 31.14% of all deaths in China. 2) Strict control standards for PM2.5 concentration can bring significant health benefits, with projections that if PM2.5 concentration in China's provinces were controlled to the level set by China, the EU, Japan, USA, and Australia, the number of deaths caused by PM2.5 pollution would be reduced by approximately 0.95, 1.52, 2.02, 2.26, and 2.49 million people, respectively, or 36.24%, 58.08%, 79.91%, 86.47%, and 95.20% compared with baseline year data. 3) Choosing appropriate control targets for limiting PM2.5 concentrations in different provinces in China is an effective way to obtain optimal health benefits. Beijing, Tianjin, Hebei, Shandong, and Henan should adopt a 35 μg/m3 standard with a 25 μg/m3 standard appropriate for Shanxi, Liaoning, Jilin, Shanghai, Jiangsu, Zhejiang, Anhui, Hubei, Hunan, Chongqing, Shanxi, and Xinjiang; 13 provinces, including Inner Mongolia, Heilongjiang, Fujian, Jiangxi, Guangdong, Guangxi, Sichuan, Guizhou, Yunnan, Tibet, Gansu, Qinghai, and Ningxia, should adopt the 15 μg/m3 standard; and Hainan should consider choosing a 12 μg/m3 standard. [ABSTRACT FROM AUTHOR]

Life expectancy has increased in the United States over many decades. The difference in life expectancy between black and white Americans has also decreased, but some states have made much more progress towards racial equality than others. This paper describes the pattern of contributions of six major causes of death to the black-white life expectancy gap within US states and the District of Columbia between 1969 and 2013, and identifies states diverging from the overall pattern. Across multiple causes, the District of Columbia, Illinois, Wisconsin, and Michigan had the highest contributions to black-white inequality, while New York, Massachusetts, and Rhode Island had the lowest contributions and have either achieved or are the closest to achieving black-white equality in life expectancy. [ABSTRACT FROM AUTHOR]

This paper investigates age variations in foreign-born vs. native-born mortality ratios in an international comparative perspective, with the purpose of gaining insight into the mechanisms underlying the so-called migrant mortality advantage. We examine the four main explanations that have been proposed in the literature for the migrant mortality advantage (i.e., in-migration selection effects, out-migration selection effects, cultural effects, and data artifacts), and formulate expectations as to whether they should generate an increase, a decrease, or no change in relative mortality over the life course. Using data from France, the US and the UK for periods around 2010, we then examine typical age patterns of foreign-born vs. native-born mortality ratios in light of this theoretical framework. We find that these mortality ratios vary greatly by age, with important similarities across migrant groups and host countries. The most systematic age pattern we find is a U-shape pattern: at the aggregate level, migrants often experience excess mortality at young ages, then exhibit a large advantage at adult ages (with the largest advantage around age 45), and finally experience mortality convergence with natives at older ages. The explanation most consistent with this pattern is the “in-migration selection effects” explanation. By contrast, the “out-migration selection effects” explanation is poorly supported by the observed patterns. Our age disaggregation also shows that migrants at mid-adult ages experience mortality advantages that are often far greater than typically documented in this literature. Overall, these results reinforce the notion that migrants are a highly-selected population exhibiting mortality patterns that poorly reflect their living conditions in host countries. [ABSTRACT FROM AUTHOR]

Background: Pancreatic cancer is the fourth-leading cause of cancer deaths in the United States. The silent nature of the disease and its poor prognosis, the need for further research, along with the need to assess the outcomes of current approaches necessitate an ongoing evaluation of the epidemiology and mortality-trends of this malignancy. Continuous monitoring of disease-patterns, on population-levels, may help scientists assess the quality of healthcare delivery, boost their understanding of diseases' characteristics and risk factors, and detect gaps whereby further research is needed. None of the previous reports shed light on pancreatic adenocarcinomas (PAC), the most common type of Pancreatic Cancer, as the primary outcome. In this study we aim to investigate PAC's incidence and mortality trends over the last four decades in the United States.Methods: We used SEER 9 database to study PAC cases during 1974-2014. Incidence and mortality rates were calculated by sex, age, race, state and stage of PAC. Annual percent change (APC) was calculated using joinpoint regression software.Results: We reviewed 67,878 PAC cases; most of these cases were in the head of pancreas. Overall PAC incidence rates increased 1.03% (95% CI, 0.86-1.21, p <.001) per year over the study period. Rates of adenocarcinoma of the head of pancreas increased 0.87% (95% CI, 0.68-1.07, p <.001), and rates of adenocarcinoma of the body and tail of pancreas increased 3.42% (95% CI, 3.06-3.79, p <.001) per year during 1973-2014. PAC incidence-based mortality increased 2.22% (95% CI, 1.93-2.51, p <.001) per year. However, during 2012-2014 there was a statistically significant decrease in PAC incidence-based mortality; APC, -24.70% (95% CI, -31.78 - -16.88, p <.001).Conclusion: PAC's incidence and mortality rates have been increasing for decades. However, the last few years have shown a promising decrease in mortality. We believe that further advances in healthcare delivery and research can lead to a further mortality decrease. Future studies can use this paper as a baseline to keep monitoring the outcomes of PAC's therapy. [ABSTRACT FROM AUTHOR]

Background A heatwave can be a devastating natural disaster to human health, and elderly people are particularly vulnerable. With the continuing rise in earth's surface temperature alongside the world's aging population, research on the mortality burden of heatwave for the older population remains relatively sparse. The potential magnitude of benefits of averting such deaths may be considerable. Objectives This paper examined the short-term mortality displacement (or “harvesting”) of heatwave, characterized the heatwave-mortality relationship, and estimated death burden and health costs attributable to heatwave among the elderly in Australia. Methods We collected daily data on the temperature and deaths of people aged ≥75 years in the five largest cities of Australia (Sydney, Melbourne, Brisbane, Perth and Adelaide), totaling 368,767 deaths in different periods between 1988 and 2011. A total of 15-tiered heatwave definitions, based on intensity (95th to 99th percentiles of temperature distribution) and duration (two or more consecutive days), were used to quantify heatwave effects, using time-series regression and random-effects meta-analysis. We calculated attributable deaths for each city and by different types of heatwave. Potential economic benefits in monetary terms were also estimated, considering that heat-related deaths are avoidable. Results Among the Australian elderly population, we found significant associations between heatwave and deaths, with raised mortality immediately in the first few days followed by lower-than-expected mortality. In general, heatwave was associated with an average death increase of 28% (95% confidence interval: 15% to 42%), and greater increases were mostly observed for more intense heatwaves across multiple megacities. During the study period, there were dozens to hundreds of deaths attributable to heatwave for each city, equating to an economic loss of several million Australian dollars every year. Although the estimated attributable deaths varied by heatwave intensity and duration, the pattern was not consistent across cities. Conclusions Heatwave caused harvesting effects on mortality in the elderly population of Australia, and contributed to a substantial amount of death burden and indirect financial costs. To lessen the health impacts of heatwave in the affected regions, effective heatwave early warning systems and interventions targeted at the elderly population could be beneficial, both now and in the future. [ABSTRACT FROM AUTHOR]

Introduction: Many national and subnational governments need to routinely measure the completeness of death registration for monitoring and statistical purposes. Existing methods, such as death distribution and capture-recapture methods, have a number of limitations such as inaccuracy and complexity that prevent widespread application. This paper presents a novel empirical method to estimate completeness of death registration at the national and subnational level. Methods: Random-effects models to predict the logit of death registration completeness were developed from 2,451 country-years in 110 countries from 1970–2015 using the Global Burden of Disease 2015 database. Predictors include the registered crude death rate, under-five mortality rate, population age structure and under-five death registration completeness. Models were developed separately for males, females and both sexes. Findings: All variables are highly significant and reliably predict completeness of registration across a wide range of registered crude death rates (R-squared 0.85). Mean error is highest at medium levels of observed completeness. The models show quite close agreement between predicted and observed completeness for populations outside the dataset. There is high concordance with the Hybrid death distribution method in Brazilian states. Uncertainty in the under-five mortality rate, assessed using the dataset and in Colombian departmentos, has minimal impact on national level predicted completeness, but a larger effect at the subnational level. Conclusions: The method demonstrates sufficient flexibility to predict a wide range of completeness levels at a given registered crude death rate. The method can be applied utilising data readily available at the subnational level, and can be used to assess completeness of deaths reported from health facilities, censuses and surveys. Its utility is diminished where the adult mortality rate is unusually high for a given under-five mortality rate. The method overcomes the considerable limitations of existing methods and has considerable potential for widespread application by national and subnational governments. [ABSTRACT FROM AUTHOR]

In this paper, it is argued that the fact that, so far, even the worst and most far-reaching epidemics—from the Plague of Athens in 430 BC and the Plague of Justinian in 541/542 AD to the Hong Kong Flu from 1968/69—always finally petered out can be explained using Manfred Eigen’s quasispecies concept: Indeed, as the infectious agents, while duplicating themselves in the infected organisms, mutate all the time, these infected organisms carry along quite a multitude of mutational variants or—in Manfred Eigen’s terms—a whole quasispecies of infectious agents implying that, within that quasispecies, those variants that differ from the wild type may actually serve as some kind of vaccination program when infecting some previously uninfected persons. In this context, some data regarding various recent epidemics will also be illustrated, using Daniel Huson’s SplitsTree software tool. [ABSTRACT FROM AUTHOR]

Trickle-down has been addressed, so far, using income-based measures of inequality and poverty. However concerns over the inequality in access to other dimensions important for quality of life remains. I revisit trickle-down using the Alkire and Foster (J Public Econ 95(7-8), 2011) class of measures to estimate multidimensional poverty in India. Using NSS data estimates are presented for the 16 major states and are compared to income-based measures. Adding dimensions in poverty measurement results in the reversal of several income-based conclusions about poverty across regions. The paper also finds that contrary to income-based findings, Muslims are less poor than Hindus under the multidimensional criteria. [ABSTRACT FROM AUTHOR]

Heat stress is one of the environmental factors influencing the health of individuals and the wider population. There is a large body of research to document significant increases in mortality and morbidity during heat waves all over the world. This paper presents key results of research dealing with heat-related mortality (HRM) in various cities in Poland which cover about 25% of the country’s population. Daily mortality and weather data reports for the years 1991-2000 were used. The intensity of heat stress was assessed by the universal thermal climate index (UTCI). The research considers also the projections of future bioclimate to the end of twenty-first century. Brain storming discussions were applied to find necessary adaptation strategies of healthcare system (HCS) in Poland, to minimise negative effects of heat stress. In general, in days with strong and very strong heat stress, ones must expect increase in mortality (in relation to no thermal stress days) of 12 and 47%, respectively. Because of projected rise in global temperature and heat stress frequency, we must expect significant increase in HRM to the end of twenty-first century of even 165% in comparison to present days. The results of research show necessity of urgent implementation of adaptation strategies to heat in HCS. [ABSTRACT FROM AUTHOR]

Recent studies have described a reduction in the rate of improvement in American mortality. The pace of improvement is also slow by international standards. This paper attempts to identify the extent to which rising body mass index (BMI) is responsible for reductions in the rate of mortality improvement in the United States. The data for this study were obtained from subsequent cohorts of the National Health and Nutrition Examination Survey (NHANES III, 1988-1994; NHANES continuous, 1999-2010) and from the NHANES linked mortality files, which include follow-up into death records through December 2011. The role of BMI was estimated using Cox models comparing mortality trends in the presence and absence of adjustment for maximum lifetime BMI (Max BMI). Introducing Max BMI into a Cox model controlling for age and sex raised the annual rate of mortality decline by 0.54% (95% confidence interval 0.45-0.64%). Results were robust to the inclusion of other variables in the model, to differences in how Max BMI was measured, and to how trends were evaluated. The effect of rising Max BMI is large relative to international mortality trends and to alternative mortality futures simulated by the Social Security Administration. The increase in Max BMI over the period 1988- 2011 is estimated to have reduced life expectancy at age 40 by 0.9 years in 2011 (95% confidence interval 0.7-1.1 years) and accounted for 186,000 excess deaths that year. Rising levels of BMI have prevented the United States from enjoying the full benefits of factors working to improve mortality. [ABSTRACT FROM AUTHOR]

It is widely acknowledged that the climate is warming globally and within the UK. In this paper, studies which assess the direct impact of current increased temperatures and heat-waves on health and those which project future health impacts of heat under different climate change scenarios in the UK are reviewed.This review finds that all UK studies demonstrate an increase in heat-related mortality occurring at temperatures above threshold values, with respiratory deaths being more sensitive to heat than deaths from cardiovascular disease (although the burden from cardiovascular deaths is greater in absolute terms). The relationship between heat and other health outcomes such as hospital admissions, myocardial infarctions and birth outcomes is less consistent. We highlight the main populations who are vulnerable to heat. Within the UK, these are older populations, those with certain co-morbidities and those living in Greater London, the South East and Eastern regions.In all assessments of heat-related impacts using different climate change scenarios, deaths are expected to increase due to hotter temperatures, with some studies demonstrating that an increase in the elderly population will also amplify burdens. However, key gaps in knowledge are found in relation to how urbanisation and population adaptation to heat will affect health impacts, and in relation to current and future strategies for effective, sustainable and equitable adaptation to heat. These and other key gaps in knowledge, both in terms of research needs and knowledge required to make sound public- health policy, are discussed. [ABSTRACT FROM AUTHOR]

In this paper, I estimate the impact of city-level public health regulations in the market for cow's milk on the mortality of infants and young children between 1900 and 1920. I find that the introduction of city-level dairy farm inspections reduced mortality from Diarrhea & Enteritis for one-year-old children by 1.3 annual deaths per thousand, a 14 percent effect relative to the baseline rate for this cause and a 3 percent effect relative to the baseline rate for all causes for this age group. Back-of-the-envelope calculations reveal that the benefits from these regulations exceeded costs by at least a factor of two. [ABSTRACT FROM AUTHOR]

Heart rate variability (HRV) indexes functioning of the vagus nerve, arguably the most important nerve in the human body. The Neurovisceral Integration Model has provided a structural framework for understanding brain-body integration, highlighting the role of the vagus in adaptation to the environment. In the present paper, we emphasise a temporal framework in which HRV may be considered a missing, structural link between psychological moments and mortality, a proposal we label as Neurovisceral Integration Across a Continuum of Time (or NIACT). This new framework places neurovisceral integration on a dimension of time, highlighting implications for lifespan development and healthy aging, and helping to bridge the gap between clearly demarcated disciplines such as psychology and epidemiology. The NIACT provides a novel framework, which conceptualizes how everyday psychological moments both affect and are affected by the vagus in ways that have long-term effects on mortality risk. We further emphasize that a longitudinal approach to understanding change in vagal function over time may yield novel scientific insights and important public health outcomes. [ABSTRACT FROM AUTHOR]

Objectives: High levels of excess mortality (i.e. that not explained by deprivation) have been observed for Scotland compared with England & Wales, and especially for Glasgow in comparison with similar post-industrial cities such as Liverpool and Manchester. Many potential explanations have been suggested. Based on an assessment of these, the aim was to develop an understanding of the most likely underlying causes. Note that this paper distils a larger research report, with the aim of reaching wider audiences beyond Scotland, as the important lessons learnt are relevant to other populations. Study design: Review and dialectical synthesis of evidence. Methods: Forty hypotheses were examined, including those identified from a systematic review. The relevance of each was assessed by means of Bradford Hill's criteria for causality alongside--for hypotheses deemed causally linked to mortality--comparisons of exposures between Glasgow and Liverpool/Manchester, and between Scotland and the rest of Great Britain. Where gaps in the evidence base were identified, new research was undertaken. Causal chains of relevant hypotheses were created, each tested in terms of its ability to explain the many different aspects of excess mortality. The models were further tested with key informants from public health and other disciplines. Results: In Glasgow's case, the city was made more vulnerable to important socioeconomic (deprivation, deindustrialisation) and political (detrimental economic and social policies) exposures, resulting in worse outcomes. This vulnerability was generated by a series of historical factors, processes and decisions: the lagged effects of historical overcrowding; post-war regional policy including the socially selective relocation of population to outside the city; more detrimental processes of urban change which impacted on living conditions; and differences in local government responses to UK government policy in the 1980s which both impacted in negative terms in Glasgow and also conferred protective effects on comparator cities. Further resulting protective factors were identified (e.g. greater 'social capital' in Liverpool) which placed Glasgow at a further relative disadvantage. Other contributory factors were highlighted, including the inadequate measurement of deprivation. A similar 'explanatory model' resulted for Scotland as a whole. This included: the components of the Glasgow model, given their impact on nationally measured outcomes; inadequate measurement of deprivation; the lagged effects of deprivation (in particular higher levels of overcrowding historically); and additional key vulnerabilities. Conclusions: The work has helped to further understanding of the underlying causes of Glasgow's and Scotland's high levels of excess mortality. The implications for policy include the need to address three issues simultaneously: to protect against key exposures (e.g. poverty) which impact detrimentally across all parts of the UK; to address the existing consequences of Glasgow's and Scotland's vulnerability; and to mitigate against the effects of future vulnerabilities which are likely to emerge from policy responses to contemporary problems which fail sufficiently to consider and to prevent long-term, unintended social consequences. [ABSTRACT FROM AUTHOR]

The persistence of socioeconomic inequalities in health, despite all that has been done to reduce social and economic inequalities in many European countries, is one of the great disappointments of public health. In this paper, I summarize the results of a series of studies into the explanation of variations and trends in inequalities in mortality in three European regions: the Nordic countries with their puzzlingly large inequalities in mortality, Southern European countries with their miraculously small inequalities in mortality and Central & Eastern European countries in which inequalities in mortality have disastrously exploded since the early 1990 s. The results of these studies show that inequalities in mortality are remarkably variable and dynamic, which suggests that it may be possible to reduce them if we exploit the entry-points for policy that these studies have also identified, such as poverty, smoking, excessive alcohol consumption and lack of access to health care. At the same time, another lesson is that health inequalities are influenced in sometimes unexpected ways by factors that are not under our control, and that we cannot expect to eliminate these health inequalities soon. [ABSTRACT FROM AUTHOR]

The United States is in the midst of a drug crisis of unprecedented magnitude. It developed slowly at first, but has exploded across the country in recent years. It is exacting a huge human and financial cost. As the crisis continues to accelerate, it is beginning to decimate some areas, particularly small rural communities, including many in Central Appalachia. While the medical field and some other disciplines seem to have gone all in with regards to research on the crisis, regional science has pretty much been invisible. This paper lays out some facts regarding the crisis and makes a case for regional science to step up and be part of the discussion. [ABSTRACT FROM AUTHOR]

Background: It is now widely accepted that social and physical environment participate in shaping health. While mortality is used to guide public health policies and is considered as a synthetic measure of population health, few studies deals with the contextual features potentially associated with mortality in a representative sample of an entire country. This paper investigates the possible role of area deprivation (FDep99) and travel time to health care on French cause-specific mortality in a proper multilevel setting.Methods: The study population was a 1% sample representative of the French population aged from 30 to 79 years in 1990 and followed up until 2007. A frailty Cox model was used to measure individual, contextual effects and spatial variances for several causes of death. The chosen contextual scale was the Zone d'Emploi of 1994 (348 units) which delimits the daily commute of people. The geographical accessibility to health care score was constructed with principal component analysis, using 40 variables of hospital specialties and health practitioners' travel time.Results: The outcomes highlight a positive and significant association between area deprivation and mortality for all causes (HR = 1.24), cancers, cerebrovascular diseases, ischemic heart diseases, and preventable and amenable diseases (HR from 1.14 to 1.29). These contextual associations exhibit no substantial differences by sex except for premature ischemic heart diseases mortality which was much greater in women. Unexpectedly, mortality decreased as the time to reach health care resources increased. Only geographical disparities in cerebrovascular and ischemic heart diseases mortality were explained by compositional and contextual effects.Discussion: The findings suggest the presence of confounding factors in the association between mortality and travel time to health care, possibly owing to population density and health-selected migration. Although the spatial scale considered to define the context of residence was relatively large, the associations with area deprivation were strong in comparison to the existing literature and significant for almost all the causes of deaths investigated.Conclusion: The broad spectrum of diseases associated with area deprivation and individual education support the idea of a need for a global health policy targeting both individual and territories to reduce social and socio-spatial inequalities. [ABSTRACT FROM AUTHOR]

According to mortality statistics, in Mexico, during the period 2002-2010, 393 people died by excessive natural heat, mostly in the northwest of the country. Information about these cases is valuable for understanding the social determinants of health associated with this cause of death, so in this paper we analyze the characteristics of dead people that reveal their social situation. The statistics, for example, show that most of the victims were men, most of whom had a low socioeconomic status. This paper explores and opens several lines of research on the impact of high temperatures on the population. [ABSTRACT FROM AUTHOR]

Diabetes is one of the leading causes of morbidity and mortality and it can result in several complications such as kidney failure, heart failure, stroke, and blindness making it a major medical and public health concern in the United States. Statistical methods are important to detect risk factors and identify the best sampling plan to determine predictive bounds for diabetic patients' data. The main objective of this paper is to identify the best fit bootstrapping sampling method and to draw the predictive bound considering diabetes patient data. A random sample was used from the National Health and Nutritional Examination Survey (NHANES) for this study. We found that there were significant relationships between age, marital status, and race/ethnicity with diabetes status (p < 0.001) and no relationship was observed between gender and diabetes status. We ran the logistic regression to identify the risk factors from the data. We identified that the significant risk factors are age (p < 0.001), total protein (p < 0.001), fast food (p < 0.0339), and direct HDL (p < 0.001). This study provides evidence that the parametric bootstrapping method is the best fit method compared with other methods to estimate the predictive error bounds. These findings will be of great significance for identifying the best sampling methods, which can increase the statistical accuracy of laboratory clinical research of diabetes. This will also allow for the determination of precise risk factors that will best represent the data by detecting mild and extreme outliers from disease observations. Therefore, these results will be useful for researchers and clinicians to select the best sampling methods to study diabetes and other diseases in order to maximize the accuracy of their results. This article is part of a Special Issue entitled: Oxidative Stress and Mitochondrial Quality in Diabetes/Obesity and Critical Illness Spectrum of Diseases - edited by P. Hemachandra Reddy. [ABSTRACT FROM AUTHOR]

Introduction Prescription opioid pain reliever overdose is a major public health issue in the United States. To characterize the location of drug-related deaths, we examined fatal prescription opioid and illicit drug-related deaths reported in 12 states. Methods Data are from the Substance Abuse and Mental Health Services Administration's Drug Abuse Warning Network (DAWN). Medical examiners or coroners in 12 states (MA, MD, ME, NH, NM, OK, OR, RI, UT, VA, VT, WV) reported details of state-wide drug-related mortality during 2008–2010. DAWN data included location and manner of death, age, race, and drugs involved. Deaths were coded into three categories: prescription opioid-related, illicit drug-related, and cases that involved both a prescription opioid and an illicit drug. Results During a 3-year period, there were 14,091 opioid or illicit drug-related deaths in 12 states. More than half of the prescription opioid-related deaths in all states, except Maryland, occurred at home, rather than in public or in a health care facility. Although it was still the predominant category, lower percentages of illicit drug-related deaths occurred at home. Conclusion Prescription opioid overdoses have increased substantially, and the location of the person at the time of death can have important public health implications for interventions. Practical applications This paper highlights that bystander support can be a critical lifesaving factor in drug related deaths but may be more likely for illicit drug-related deaths than for prescription opioid-related deaths. [ABSTRACT FROM AUTHOR]

Over 90% of deaths attributable to malaria are in African children under 5 years old. Yet, new treatments are often tested primarily in adult patients and extrapolations have proven to be sometimes invalid, especially in dosing regimens. For studies in severe malaria an additional complication is that the decline in severe malaria in adult patients precludes sufficiently powered trials in adults, before the intervention can be tested in the ultimate target group, paediatric severe malaria. In this paper we propose an alternative pathway to the development of drugs for use in paediatric severe malaria. We argue that following the classical phase I and II studies, small safety and efficacy studies using well-chosen surrogate endpoints in adult severe malaria be conducted, instead of larger mortality endpoint trials. If the drug appears safe and promising small pilot studies in paediatric severe malaria using the same endpoints can follow. Finally, with carefully observed safeguards in place to ensure high ethical standards, promising candidate interventions can be taken forward into mortality endpoint, well-powered, large paediatric studies in African children with severe malaria. Given the available research capacity, limited numbers of prudently selected interventions can be studied in phase III trials, and adaptive designs should be considered. [ABSTRACT FROM AUTHOR]

Migration has been hypothesised to be selective on health but this healthy migrant hypothesis has generally been tested at destinations, and for only one type of flow, from deprived to better-off areas. The circulatory nature of migration is rarely accounted for. This study examines the relationship between different types of internal migration and adult mortality in Health and Demographic Surveillance System (HDSS) populations in West, East, and Southern Africa, and asks how the processes of selection, adaptation and propagation explain the migration-mortality relationship experienced in these contexts. The paper uses longitudinal data representing approximately 900 000 adults living in nine sub-Saharan African HDSS sites of the INDEPTH Network. Event History Analysis techniques are employed to examine the relationship between all-cause mortality and migration status, over periods ranging from 3 to 14 years for a total of nearly 4.5 million person-years. The study confirms the importance of migration in explaining variation in mortality, and the diversity of the migration-mortality relationship over a range of rural and urban local areas in the three African regions. The results confirm that the pattern of migration-mortality relationship is not exclusively explained by selection but also by propagation and adaptation. Consequences for public health policy are drawn. [ABSTRACT FROM AUTHOR]

Background: Scotland has a persistently high mortality rate that is not solely due to the effects of socio-economic deprivation. This "excess" mortality is observed across the entire country, but is greatest in and around the post-industrial conurbation of West Central Scotland. Despite systematic investigation, the causes of the excess mortality remain the subject of ongoing debate.Discussion: Attachment processes are a fundamental part of human development, and have a profound influence on adult personality and behaviour, especially in response to stressors. Many studies have also shown that childhood adversity is correlated with adult morbidity and mortality. The interplay between childhood adversity and attachment is complex and not fully elucidated, but will include socio-economic, intergenerational and psychological factors. Importantly, some adverse health outcomes for parents (such as problem substance use or suicide) will simultaneously act as risk factors for their children. Data show that some forms of "household dysfunction" relating to childhood adversity are more prevalent in Scotland: such problems include parental problem substance use, rates of imprisonment, rates of suicide and rates of children being taken into care. However other measures of childhood or family wellbeing have not been found to be substantially different in Scotland compared to England. We suggest in this paper that the role of childhood adversity and attachment experience merits further investigation as a plausible mechanism influencing health in Scotland. A model is proposed which sets out some of the interactions between the factors of interest, and we propose parameters for the types of study which would be required to evaluate the validity of the model. [ABSTRACT FROM AUTHOR]

The entirety in health care has as one of its dimensions the access to the several levels of technological density of the system, which includes basic units and specialty hospitals and clinics. The Intensive Care Unit is the hospital sector for people at risk of worsening of conditions that could not be avoided or controlled whatsoever. This paper aims at describing the profile of hospitalizations in adult intensive care units in the city of Anápolis, Goiás, in 2012. It is a descriptive, documental and retrospective research with a quantitative approach to information. The data show that hospitalization average was lower than a thousand cases per year, mostly males; and the prevalent age groups corresponded to more advanced adulthood and elders; from the three analyzed units, two had a permanence average lower than other studies, except an emergency hospital; the main reasons for hospitalization were acute myocardial infarction, stroke and Congestive Heart Failure. The mortality rate was higher than the average found in most studies. The results point out the impact of demographic and epidemiological transition in demand and the use of health services. [ABSTRACT FROM AUTHOR]