Suchergebnisse

Why should legislative proceedings in the grand duchy of Luxemburg be given consideration? It is a country with an area less than that of Rhode Island and with a population (260,000) which would barely fill a second class city—a mere atom in the world's history. Nor has it played an heroic part in the great crisis. Here is the excuse. The discussions in the chamber of deputies have reflected, not in their depths but in their shallows, nearly all the phases of the seething unrest which agitates larger nations, and therein lies the reason for offering a few pictures drawn from the official records of the grand ducal chamber— the German reports as they are sent out daily, translated from the proceedings in French, and the final French comptes-rendus. They are miniatures of the processes of readjustment in progress across the Atlantic.The Luxemburg chamber of deputies is a legislative body that has been evolved by a series of still visible leaps and jumps from the simplest feudal conditions to the assembly recently elected by universal adult suffrage on a basis of proportional party representation according to the system of the scrutin de liste. Its modernity is so complete that a Socialist woman has obtained a seat, yet the conservative character of the forbears of the body is not entirely lost to view in the mists of the past.The old duchy of Luxemburg—a countship until raised to higher dignity by an imperial brother of its count (1354)—lost its early independence in the fifteenth century (1441), and thenceforth shared the political lot of the Belgic provinces under Burgundian, Spanish and Austrian rule.

BackgroundExisting association between mental disorders and suicidality is mostly based on cross- sectional studies, using clinical samples.
Objective and methodsWe examined the patterns of association between mental disorders and subsequent suicide in a representative sample of the Canadian household population. This is a retrospective cohort study that used data from the Canadian Community Health Survey 2002 linked to the Death Database 2000-2011 and the Hospitalization Database 1999/2000-2012/2013) (N=27,000). Mental disorders (past-year major depressive episodes (MDE), bipolar disorders (BPD), anxiety disorders (AD), and substance-dependent (SD)) were diagnosed in the survey data using the Composite International Diagnostic Interview. Subsequent suicide events (deaths/hospitalizations for suicide attempts) were identified using ICD-10-CA codes. Time-to-event data were analyzed using competing-risk regression models, adjusting for age, sex, marital status, and educational attainment. Due to the violation of the proportional hazard assumption, the models were stratified into two strata. Sampling weights were used to ensure representation of the target population.
ResultsOf 27,000 respondents, mental disorders were diagnosed in 15.0% respondents and 0.4% had suicide events. Each mental disorder was significantly associated with an increased risk of suicide. The strength of association between mental disorder and suicide weakened over-time for MDE, SD, but not for BPD and AD. For example, using the time-to-event cut-off 4-year, the hazard ratio (HR) for MDE was 6.02 (95% CI=2.65,13.68) in the first 4-year, whereas, it was 2.03 (95% CI=0.91,4.53) after 4-year. The HRs of suicide for BPD were 16.95 (95% CI=6.88,41.75) and 15.81 (95% CI=5.89,42.45) before and after 4-year.
Conclusions/ImplicationsFindings reflect improvement of suicide-risk over-time for people with MDE and SA and the persisting risk for people with BPD and AD. Our findings underscore the importance of early management of mental disorders for effective suicide prevention, and requirement of longer-term follow-up for people with BPD and AD.

IntroductionAgeing populations place considerable burden on healthcare systems. Innovative methods to implement and evaluate new care models to reduce unwarranted hospital presentations, are needed.
Objectives and ApproachTo use linked Electronic Medical Record (EMR) data to evaluate a pilot community-based model of care to reduce hospital presentations in a cohort of patients at-risk of hospital representations following an acute admission. Patients admitted to a metropolitan hospital with a non-surgical condition andidentified as being at-risk of readmission using a state-wide risk algorithm, were eligible to receive a 30-day care navigation model of care. The intervention group were matched to similar eligible patients, who received usual care using propensity score matching. Linked data were obtained from the EMR based Data Warehouse to provide information on subsequent readmissions and community-based health service contacts. Readmission rates were compared at 30, 60, and 90-days post-discharge using Cox Proportional Hazards Regression, adjusted for confounders and weighted by the propensity score. Descriptive analyses were used to compare demographics and healthcare utilisations.
ResultsData from 412,971 potentially eligible patients were extracted. Sixty-five received the intervention of which 63 were matched to 280 controls (aged 51-91 years, 54% female, 63% lived alone). At 30-days post-discharge (during intervention delivery) an 80% reduction in readmission rate in the intervention group was observed (Hazard Ratio [HR] 0.20; 95%Confidence Interval (CI) [0.01, 4.20]). At 60-days (HR 0.48; 95%CI [0.03, 8.05]) and 90-days (HR 0.83; 95%CI [0.06, 11.36]), readmission rate reductions decreased to 52% and 17% respectively. In the intervention group, 68.9% received an out-patient appointment compared to 40% of controls (P<0.001) and 7.7% received allied health compared to none of the controls (p=0.003) within 90-days post-discharge.
Conclusion/ImplicationsResults have informed hospital-wide service implementation thereby demonstrating the value of linked EMR data and advanced statistical methods in the evaluation of real-world healthcare.

Abstract. The Tsunami Alert Centre of the National Institute of Geophysics and Volcanology (CAT-INGV) has been promoting, since 2018, the study of tsunami risk perception in Italy. Between 2018 and 2021 a semi-structured questionnaire on the perception of tsunami risk was administered to a sample of 5842 citizens residing in 450 Italian coastal municipalities, representative of more than 12 million people. The survey was conducted with
the computer-assisted telephone interviewing (CATI) methodology, described in
Cerase et al. (2019), who published the results of the first pilot survey
(about 1000 interviews). The large sample and the socio-demographic
stratification give an excellent representation of the resident population
in the surveyed Italian coastal municipalities. Moreover, in 2021 an
optimized version of the questionnaire was also administered via Telepanel
(a tool for collecting proportional and representative opinions of citizens) that was representative of the Italian population and included 1500 people distributed throughout the country. In this work we present the main results of the three survey phases, with a
comparison among the eight surveyed regions and between the coastal regions and some coastal metropolitan cities involved in the investigations (Rome, Naples, Bari, Reggio Calabria, and Catania). Data analysis reveals heterogeneous and generally low tsunami risk
perception. Some seaside populations, in fact, show a good perception of tsunami risk,
while others, such as in Apulia and Molise, reveal a lower perception, most
likely due to the long time elapsed since the last event and lack of
memory. We do not find relevant differences related to the socio-demographic
characteristics (age, gender) of the sample, whereas the education degree
appears to affect people's perception. The survey shows that the
respondents' predominant source of information on tsunamis is the television and other media sources (such as newspapers, books, films, internet), while the official sources (e.g., civil protection, local authorities, universities and research institutes) do not contribute significantly. Also,
we find an interesting difference in people's understanding of the words
tsunami and maremoto, the local term commonly used in Italy until the 2004
Sumatra–Andaman event, which should be taken into account in scientific and risk
communication. The Telepanel survey, based on a nationwide sample,
highlights a lower level of tsunami risk perception in comparison to average risk perception levels found in the coastal-municipality sample. Our results are being used to drive our communication strategy aimed at
reducing tsunami risk in Italy, to activate dissemination and educational
programs (data driven), to fill the data gap on tsunami risk perception in
the North-Eastern Atlantic, Mediterranean and connected seas (NEAM) area, and to implement multilevel civil protection actions
(national and local, top-down and bottom-up). Not least, outputs can address a better development of the UNESCO Tsunami Ready program in Italy.