Many studies have identified urban-rural differences in schizophrenia risk. Hypothetical underlying cause(s) may include toxic exposures, diet, infections, and selective migration. The authors investigated whether the underlying cause(s) responsible for the urban-rural differences were rooted in families or in individuals. Linking data from the Danish Civil Registration System and the Danish Psychiatric Central Register, a population-based cohort of 711,897 people aged 15 years or more was established. Overall, 2,720 persons developed schizophrenia during the period 1970-2001. The authors evaluated whether the nearest older sibling's place of birth had an independent effect on schizophrenia risk. If the cause(s) responsible for the urban-rural differences are rooted in individuals only, the nearest older sibling's place of birth should have no independent effect. In this analysis, the nearest older sibling's place of birth had an independent effect; among persons who lived in a rural area during their first 15 years of life, the relative risk was 1.59 (95% confidence interval: 1.10, 2.30) if their nearest older sibling had been born in the capital area as compared with a rural area. Some of the cause(s) responsible for the urban-rural differences in schizophrenia risk are rooted in families, but some might also be rooted in individuals.
Comment In: Am J Epidemiol. 2006 Jun 1;163(11):979-8116675534
To describe differences in treatment and delay times in acute chest pain at the three hospitals in Göteborg, Sweden.
All patients admitted to the three hospitals within Sahlgrenska University (SU) (Sahlgrenska: SU/S, Östra: SU/Ö and Mölndal: SU/M) with acute chest pain during 3 months in 2008 were evaluated for diagnosis, early treatment and outcome.
In all, 2588 visits by 2393 patients were included (visits n=1253 SU/S; n=853 SU/Ö; n=482 SU/M) of which 50%, 63% and 51% were hospitalised (p
To examine, on empirical data, whether drinking patterns, in addition to overall alcohol consumption, contribute to differences in rates of alcohol related problems between populations.
Cross sectional survey.
One Russian, one Polish, and one Czech city.
1118 men and 1125 women randomly selected from population registers.
Problem drinking; negative social consequences of drinking; alcohol consumption and drinking pattern.
Rates of problem drinking and of negative consequences of drinking were much higher in Russian men (35% and 18%, respectively) than in Czechs (19% and 10%) or Poles (14% and 8%). This contrasts with substantially lower mean annual intake of alcohol reported by Russian men (4.6 litres) than by Czech men (8.5 litres), and with low mean drinking frequency in Russia (67 drinking sessions per year, compared with 179 sessions among Czech men). However, Russians consumed the highest dose of alcohol per drinking session (means 71 g in Russians, 46 g in Czechs, and 45 g in Poles), and had the highest prevalence of binge drinking. In women, the levels of alcohol related problems and of drinking were low in all countries. In ecological and individual level analyses, indicators of binge drinking explained a substantial part of differences in rates of problem drinking and negative consequences of drinking between the three countries.
These empirical data confirm high levels of alcohol related problems in Russia despite low volume of drinking. The binge drinking pattern partly explains this paradoxical finding. Overall alcohol consumption does not suffice as an estimate of alcohol related problems at the population level.
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Injecting opioid users are at elevated risk of death. Although liver disease (especially hepatitis C) is common, its impact on mortality is low in active injectors. Because opioid substitution therapy (OST) reduces the risk of death from directly drug related causes, we hypothesised that the proportion of liver-related deaths would increase in subjects receiving OST. We investigated liver-related mortality in a cohort of injecting opioid users attending a needle exchange program (NEP) in a Swedish city in relation to OST exposure.
Participants enrolled in the NEP between 1987 and 2011 with available national identity numbers, and registered use of opioids, were included. Linkage based on national identity numbers was performed with national registers for death, emigration and prescription of OST. Participants were categorised as non-OST recipients until the registered date of first OST prescription, and hence as OST recipients. Hazard ratios were calculated by Cox regression for overall and liver-related mortality in relation to OST, with OST as a time-dependent variable.
Among 4494 NEP participants, 1488 opioid users were identified; 711/1488 had been prescribed OST. During a follow-up period of 15?546 person-years 368 deaths occurred. Sixteen deaths were caused by liver disease; 10 of these occurred in OST recipients. The risk of liver-related death was significantly increased in OST receiving participants (hazard ratio 3.08, 95% confidence interval [1.09, 8.68], P?=?0.03).
Liver related mortality among opioid users was significantly elevated in OST recipients, showing the long-term importance of chronic liver disease in this population. [Jerkeman A, Håkansson A, Rylance R, Wagner P, Alanko Blomé M, Björkman P. Death from liver disease in a cohort of injecting opioid users in a Swedish city in relation to registration for opioid substitution therapy. Drug Alcohol Rev 2017;36:424-431].
A prospective study of an unselected group of patients admitted in a Medical Department in 1978 (n = 257) and 1987 (n = 361) after deliberate self-poisoning is presented. The rate increased significantly over the period of the study (P less than 0.05). Family problems, unemployment, poor social conditions and alcohol and drug abuse had increased. The main psychiatric diagnosis was neurosis. From 1978 to 1987 "abuse" had increased substantially. The 10-year mortality rate was 4.5 and 4.1 times the expected value for female and male patients, respectively. We conclude that social and psychiatric problems are increasing and that the treatment of these patients today is far from satisfactory.
Previous studies have shown an inconsistent time trend on the prevalence of anotia and microtia. Little has been reported on the epidemiologic characteristics of anotia and microtia in the Chinese population.
Data from 1996-2007 were obtained from the Chinese Birth Defects Monitoring Network in China. Birth prevalence of anotia and microtia were assessed according to demographic characteristics and annual time trend. Poisson regression was used to calculate crude and adjusted prevalence ratios (APRs) and 95% confidence intervals (CIs) for selected demographic characteristics and subgroups of anotia and microtia.
A total of 1933 cases with anotia/microtia were identified among 6,308,594 live births, stillbirths, and terminations of pregnancy, yielding a rate of 3.06 per 10,000 births. Isolated anotia/microtia had a prevalence of 2.25 per 10,000 births, whereas among nonisolated cases, the prevalence was 0.81 per 10,000 births. The prevalence rates of anotia/microtia increased significantly during 1996-2007 (p?
Older adults living in rural and urban areas have shown to distinguish themselves in technology adoption; a clearer profile of their Internet use is important in order to provide better technological and health-care solutions. Older adults' Internet use was investigated across large to midsize cities and rural Sweden. The sample consisted of 7181 older adults ranging from 59 to 100 years old. Internet use was investigated with age, education, gender, household economy, cognition, living alone/or with someone and rural/urban living. Logistic regression was used. Those living in rural areas used the Internet less than their urban counterparts. Being younger and higher educated influenced Internet use; for older urban adults, these factors as well as living with someone and having good cognitive functioning were influential. Solutions are needed to avoid the exclusion of some older adults by a society that is today being shaped by the Internet.
Higher levels of morbidity among older adults result in greater need for pharmaceutical products and pharmacy services compared with the need in the general population. Rural residents reportedly have reduced access to healthcare services secondary to transportation difficulties, a limited supply of healthcare workers and facilities, and financial constraints.
To examine differences in the prevalence and intensity of prescription pharmaceutical use among urban and rural older adults in Manitoba, Canada.
Participant data from the 1996/1997 Manitoba Study of Health and Aging were linked to pharmaceutical claims data recorded in Manitoba Health's Drug Program Information Network. The effect of residence on the prevalence and intensity of drug use was determined, in addition to the effects of other sociodemographic characteristics, measures of health, and health service utilization.
The prevalence of prescription pharmaceutical use did not differ between urban and rural residents (90.6% vs 89.5%, respectively; p = 0.60). Users of home-care services (OR 1.93; 95% CI 1.09 to 3.39), those who perceived their income as adequate (2.38; 95% CI 1.09 to 5.17), and those with a higher number of chronic health problems (1.42; 95% CI 1.26 to 1.62) were significantly more likely to access prescription medications. Rural and urban residents were equally likely to be high users of prescription drugs (21.3% vs 20.0%, respectively; p = 0.64).
Poor health status is associated with a higher prevalence and intensity of use of prescription drugs among older Manitobans. Rural residence is not a barrier to receipt of prescription pharmaceuticals.
In recent years, epidemiologists have established major variations in the incidence of schizophrenia and have begun to investigate the causes of these variations. The report by Pedersen and Mortensen (Am J Epidemiol 2006;163:971-8) in this issue of the Journal examines the contribution of family-level factors to the urban-rural difference in the incidence of schizophrenia. Their results suggest that familial life in urban environments confers some effect that persists after families move to rural settings. Taking these findings together with those of previous studies, it appears that factors operating at the level of the social context, the family, and the individual may all contribute to the urban-rural difference in schizophrenia incidence. This work exemplifies an integrative, multilevel approach to epidemiologic research that employs principles central to eco-epidemiology and other, similar frameworks.
Comment On: Am J Epidemiol. 2006 Jun 1;163(11):971-816675535
This paper examined whether or not closer proximity to local services and amenities was associated with maintenance of more frequent walking over time among urban-dwelling seniors over and above individual-level characteristics.
A sample of 521 adults who were part of the VoisiNuAge study and who resided in a large North American urban area reported on the frequency of walking outside the home over a 3-year period and on their health, sociodemographic characteristics, social support and resources, and perceptions of different features of their residential environment. Information about the distance between their home and 16 services and amenities was obtained from a geographic information system. Seniors were then classified into quartiles of proximity (Q1, Q2, Q3, Q4).
Unadjusted and adjusted ordinal growth curve models showed that closer proximity to services and amenities was associated with greater likelihood of frequent walking at all times throughout the 3-year period.
Findings are consistent with the notion that environments may act as buoys for the maintenance of important health behaviors. Future experimental and quasi-experimental research is required to explore whether or not the environment can play a causal role in influencing patterns of walking over time.