Temporal changes of heat-attributable mortality in Prague, Czech Republic, over 1982–2019

While previous research on historical changes in heat-related mortality observed decreasing trends over the recent decades, future projections suggest increasing impact of heat on mortality in most regions of the world. This study aimed to analyse temporal changes in temperature-mortality relationships in Prague, Czech Republic in the warm season (May–September), using a daily mortality time series from 1982 to 2019. To investigate possible effect of adaptation to increasing temperature, we divided the study period into four decades (1980s–2010s). We used conditional Poisson regression models to identify decade-specific relative risk of heat-related mortality and to calculate the annual number of heat-attributable deaths and the heat-attributable fraction of total warm season deaths. We estimated their trends over the whole study period by a generalized additive model with non-parametric smoothing spline. Our results showed that the unprecedentedly hot 2010s was associated with approximately twice as large relative risk of heat-related mortality than in previous decades. This resulted in the reversal of the trend in heat-attributable mortality in the 1990s and its increase during the last two decades. Our findings highlight the importance of further improvement of adaptation measures such as heat-and-health warning systems to protect the heat-susceptible population

Seroprevalencia y factores asociados a la brucelosis bovina en la provincia de Pinar del Río, Cuba

The objective of this study was to determine the seroprevalence of bovine brucellosis and identify risk factors for brucellosis in Pinar del Río province, Cuba. A cross-sectional study was performed based on the results of the epidemiological surveillance programme. Geospatial distribution was analyzed by calculating the standardized incidence ratio (SIR) at the municipality level. In addition, the association between diagnostic results and factors such as the productive system, sex and age groups (<12, 12-24, 24-36, >36 months) was assessed. A total of 12 760 blood samples were processed and 113 were positive; thus, the estimated seroprevalence in the province was 0.89% (95 % CI 0.74-1.06). The disease was present in three out of eight municipalities in the province (Los Palacios, Consolación del Sur and Pinar del Río), although only in Los Palacios the prevalence was significantly higher than that expected: 2.40 (1.30-3.28). Furthermore, the prevalence ratio in animals younger than 12 months was 8.33 (1.41-49.42) times higher than in animals between 12 and 24 months of age. In conclusion, the municipality of origin and age category are relevant factors that should be considered by the health authorities to design disease control strategies in the province.El objetivo del estudio fue determinar la seroprevalencia de brucelosis bovina e identificar factores de riesgo para brucelosis en la provincia de Pinar del Río, Cuba. Se realizó un estudio transversal basado en los resultados del programa de vigilancia epidemiológica. La distribución geoespacial se analizó mediante el cálculo de la razón de incidencia estandarizada (SIR) a nivel de municipio. Además, se evaluó la asociación entre los resultados del diagnóstico y factores como el sistema productivo, el sexo y los grupos de edad (<12, 12-24, 24-36, >36 meses). Se procesaron 12 760 muestras de sangre y 113 resultaron positivas; así, la seroprevalencia estimada en la provincia fue de 0.89% (IC 95 % 0.74-1.06). La enfermedad estuvo presente en tres de los ocho municipios de la provincia (Los Palacios, Consolación del Sur y Pinar del Río), aunque solo en Los Palacios la prevalencia fue significativamente superior a la esperada: 2.40 (1.30-3.28). Además, la razón de prevalencia en animales menores de 12 meses fue 8.33 (1.41-49.42) veces mayor que en animales entre 12 y 24 meses. En conclusión, el municipio de procedencia y la categoría de edad son factores relevantes que deben ser considerados por las autoridades de salud para diseñar estrategias de control de enfermedades en la provincia

Prevalencia de brucelosis en bovinos y búfalos en las regiones de Centroamérica y el Caribe y Sudamérica. Revisión Sistemática y Metaanálisis

Background: Brucellosis produces losses in livestock raising in the Americas. This region reports prevalence variations associated with the implementation of control programs, thus requiring an analysis that permits the combination of results to reach conclusions, which may be conducted through meta-analysis. Aim. To estimate the combined prevalence of Brucellosis in Cattle and Buffaloes in Central America and the Caribbean, and South America in the 2010-2021 period, and to analyze the different time performances in all the regions and the species. Materials and methods: Several papers published in electronic databases, such as PubMed / PubMed Central, Science Direct, Scielo, Ebsco, and Google Scholar were selected. Original papers and postgraduate theses available were included, provided they offered information about cattle and buffaloes, using the serological techniques recommended by the World Animal Health Organization, and which provided the sample size and the number of positives. A meta-analysis was done to estimate the combined prevalence of the disease, and the effect on the subgroups was evaluated by meta-regression. Results: Overall, 65 that met the selection criteria were included, 56 related to cattle, and 11 to buffaloes. The combined prevalence was 3.0%; differences between cattle (2.7%) and buffaloes (5.2%) were observed. The differences between the periods studied accounted for 4.3% (2011-2016) and 2.0% (2017-2021), respectively. Conclusions: The combined prevalence of the disease was 3.0%, which was higher in buffaloes, which dropped in the last five years. No differences were observed between the two regions studied. Keywords: The Americas, bovids, Brucella, disease prevalence (Source AGROVOC)Antecedentes: La brucelosis provoca pérdidas en la ganadería en los países de América. En esta región se reportan variaciones en su prevalencia asociadas a la implementación de los programas de control, por lo que se requiere un análisis que permita la combinación de los resultados y llegar a conclusiones, proceso que se puede realizar a partir de un metaanálisis. Objetivo. Estimar la prevalencia combinada de brucelosis para los bovinos y búfalos de las regiones de Centroamérica y el Caribe y Sudamérica en el periodo 2010-2021 y analizar diferencias en su comportamiento en el tiempo, entre ambas regiones y especies. Materiales y Métodos: Se seleccionaron artículos publicados en las bases de datos electrónicas PubMed / PubMed Central, Science Direct, Scielo, Ebsco y Google Scholar. Se incluyeron los trabajos originales y tesis de posgrado disponibles, que incluyeran información sobre bovinos y búfalos, utilizaran técnicas serológicas recomendadas por la Organización Mundial de Sanidad Animal y proporcionaran el tamaño de muestra y número de positivos. Se realizó un metaanálisis para estimar la prevalencia combinada de la enfermedad y se evaluó el efecto de los subgrupos mediante un análisis de metarregresión. Resultados: Se identificaron 65 artículos que cumplimentaban los criterios de selección, 56 en bovinos y 11 en búfalos. La prevalencia combinada fue del 3,0% y se presentaron diferencias entre bovinos (2,7%) y búfalos (5,2%), así como entre los períodos estudiados, 4,3% en el período 2011-2016 y 2,0% en el período 2017-2021. Conclusiones: La prevalencia combinada de la enfermedad fue del 3,0%, la misma fue mayor en búfalos, disminuye en los últimos cinco años y no se presentaron diferencias entre las dos regiones estudiadas. Palabras clave: Américas, bóvidos, Brucella, prevalencia de una enfermedad (Fuente: AGROVOC

Spatial clustering and contextual factors associated with hospitalisation and deaths due to COVID-19 in Sweden : A geospatial nationwide ecological study

Introduction: In Sweden, thousands of hospitalisations and deaths due to COVID-19 were reported since the pandemic started. Considering the uneven spatial distribution of those severe outcomes at the municipality level, the objective of this study was, first, to identify high-risk areas for COVID-19 hospitalisations and deaths, and second, to determine the associated contextual factors with the uneven spatial distribution of both study outcomes in Sweden. Methods: The existences of spatial autocorrelation of the standardised incidence (hospitalisations) ratio and standardised mortality ratio were investigated using Global Moran's I test. Furthermore, we applied the retrospective Poisson spatial scan statistics to identify high-risk spatial clusters. The association between the contextual demographic and socioeconomic factors and the number of hospitalisations and deaths was estimated using a quasi-Poisson generalised additive regression model. Results: Ten high-risk spatial clusters of hospitalisations and six high-risk clusters of mortality were identified in Sweden from February 2020 to October 2020. The hospitalisations and deaths were associated with three contextual variables in a multivariate model: population density (inhabitants/km 2) and the proportion of immigrants (%) showed a positive association with both outcomes, while the proportion of the population aged 65+ years (%) showed a negative association. Conclusions: Our study identified high-risk spatial clusters for hospitalisations and deaths due to COVID-19 and the association of population density, the proportion of immigrants and the proportion of people aged 65+ years with those severe outcomes. Results indicate where public health measures must be reinforced to improve sustained and future disease control and optimise the distribution of resources

Risk of acute myocardial infarction and ischaemic stroke following COVID-19 in Sweden: a self-controlled case series and matched cohort study

Background COVID-19 is a complex disease targeting many organs. Previous studies highlight COVID-19 as a probable risk factor for acute cardiovascular complications. We aimed to quantify the risk of acute myocardial infarction and ischaemic stroke associated with COVID-19 by analysing all COVID-19 cases in Sweden. Methods This self-controlled case series (SCCS) and matched cohort study was done in Sweden. The personal identification numbers of all patients with COVID-19 in Sweden from Feb 1 to Sept 14, 2020, were identified and cross-linked with national inpatient, outpatient, cancer, and cause of death registers. The controls were matched on age, sex, and county of residence in Sweden. International Classification of Diseases codes for acute myocardial infarction or ischaemic stroke were identified in causes of hospital admission for all patients with COVID-19 in the SCCS and all patients with COVID-19 and the matched control individuals in the matched cohort study. The SCCS method was used to calculate the incidence rate ratio (IRR) for first acute myocardial infarction or ischaemic stroke following COVID-19 compared with a control period. The matched cohort study was used to determine the increased risk that COVID-19 confers compared with the background population of increased acute myocardial infarction or ischaemic stroke in the first 2 weeks following COVID-19. Findings 86 742 patients with COVID-19 were included in the SCCS study, and 348 481 matched control individuals were also included in the matched cohort study. When day of exposure was excluded from the risk period in the SCCS, the IRR for acute myocardial infarction was 2·89 (95% CI 1·51–5·55) for the first week, 2·53 (1·29–4·94) for the second week, and 1·60 (0·84–3·04) in weeks 3 and 4 following COVID-19. When day of exposure was included in the risk period, IRR was 8·44 (5·45–13·08) for the first week, 2·56 (1·31–5·01) for the second week, and 1·62 (0·85–3·09) for weeks 3 and 4 following COVID-19. The corresponding IRRs for ischaemic stroke when day of exposure was excluded from the risk period were 2·97 (1·71–5·15) in the first week, 2·80 (1·60–4·88) in the second week, and 2·10 (1·33–3·32) in weeks 3 and 4 following COVID-19; when day of exposure was included in the risk period, the IRRs were 6·18 (4·06–9·42) for the first week, 2·85 (1·64–4·97) for the second week, and 2·14 (1·36–3·38) for weeks 3 and 4 following COVID-19. In the matched cohort analysis excluding day 0, the odds ratio (OR) for acute myocardial infarction was 3·41 (1·58–7·36) and for stroke was 3·63 (1·69–7·80) in the 2 weeks following COVID-19. When day 0 was included in the matched cohort study, the OR for acute myocardial infarction was 6·61 (3·56–12·20) and for ischaemic stroke was 6·74 (3·71–12·20) in the 2 weeks following COVID-19. Interpretation Our findings suggest that COVID-19 is a risk factor for acute myocardial infarction and ischaemic stroke. This indicates that acute myocardial infarction and ischaemic stroke represent a part of the clinical picture of COVID-19, and highlights the need for vaccination against COVID-19

Avoiding bias in self‐controlled case series studies of coronavirus disease 2019

Many studies, including self-controlled case series (SCCS) studies, are being undertaken to quantify the risks of complications following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). One such SCCS study, based on all COVID-19 cases arising in Sweden over an 8-month period, has shown that SARS-CoV-2 infection increases the risks of AMI and ischemic stroke. Some features of SARS-CoV-2 infection and COVID-19, present in this study and likely in others, complicate the analysis and may introduce bias. In the present paper we describe these features, and explore the biases they may generate. Motivated by data-based simulations, we propose methods to reduce or remove these biases

Geospatial Distribution of Family Planning Services in Kira Municipality, Wakiso District, Uganda

Introduction: Access to family planning (FP) services remains a challenge, particularly in informal urban settlements. The unmet need for FP in these settings is high, with a correspondingly high prevalence of unintended pregnancies that may lead to unsafe abortions. However, there is a paucity of quality data on the distribution of FP services in such settings in Uganda. This paper described the geospatial distribution of FP services in Kira Municipality, Wakiso District, Uganda. Methods: This was a cross-sectional study in which we determined the availability and distribution of FP services in Kira Municipality. Community mapping and analysis were conducted using ArcGIS (version 10.1) and ArcGIS Online. Stata version 13.1 was used for data analysis. Chi-square test was used to compare the contraceptive provision and availability among facilities from informal and formal settlements. Results: Of the 176 healthcare facilities surveyed, only 42% (n = 74) offered contraceptives in informal settlements. The majority of the facilities were privately owned small clinics (95%). At least 80% of the facilities provided three or more modern contraceptive methods, with no difference (p = 0.107) between facilities in informal and formal settlements. Only 30.7% (p = 0.001) of the facilities provided at least one long-acting contraceptive. Similarly, 20 and 12% (p = 0.001) of the facilities had implants and intrauterine devices (IUDs) on the day of the survey. Almost 25% of the facilities did not offer contraceptive services (counseling and commodities) to unmarried adolescents. Conclusions: Most facilities were small privately-owned clinics, offering at least three modern contraceptive methods. The unavailability of long-acting reversible methods in the informal settings may affect the quality of FP services due to limited choice. The inequity in service provision that disfavors the unmarried adolescent may increase unwanted/unintended pregnancies. We recommend that local governments and partners work toward filling the existing commodities gap and addressing the discrimination against unmarried adolescents in such settings