The impact of eliminating a child benefit on birth timing and infant health

We study the effects of the cancellation of a sizeable child benefit in Spainon birth timing and neonatal health. In May 2010, the government announced that a2,500-euro universal "baby bonus" would stop being paid to babies born startingJanuary 1, 2011. We use detailed micro data from birth certificates from 2000 to 2011,and find that more than 2,000 families were able to anticipate the date of birth of theirbabies from (early) January 2011 to (late) December 2010 (for a total of about 10,000births a week nationally). This shifting took place in part via an increase as well as ananticipation of pre-programmed c-sections, seemingly mostly in private clinics. We findthat this shifting of birthdates resulted in a significant increase in the number ofborderline low birth weight babies, as well as a peak in neonatal mortality. The resultssuggest that announcement effects are important, and that families and healthprofessionals may face effective trade-offs when deciding on the timing (and method) ofbirth.

Minimal data requirements for a continuous monitoring of the quality of care using the DRG classification.

The DRG classification provides a useful tool for the evaluation of hospital care. Indicators such as readmissions and mortality rates adjusted for the hospital Casemix could be adopted in Switzerland at the price of minor additions to the hospital discharge record. The additional information required to build patients histories and to identify the deaths occurring after hospital discharge is detailed.

Mortality associated with diabetes mellitus in comparison with history of cardiovascular disease in older women.

BACKGROUND: Women with diabetes mellitus have an increased risk of cardiovascular disease (CVD) mortality and current treatment guidelines consider diabetes to be equivalent to existing CVD, but few data exist about the relative importance of these risk factors for total and cause-specific mortality in older women. METHODS: We studied 9704 women aged ≥65 years enrolled in a prospective cohort study (Study of Osteoporotic Fractures) during a mean follow-up of 13 years and compared all-cause, CVD and coronary heart disease (CHD) mortality among non-diabetic women without and with a prior history of CVD at baseline and diabetic women without and with a prior history of CVD. Diabetes mellitus and prior CVD (history of angina, myocardial infarction or stroke) were defined as self-report of physician diagnoses. Cause of death was adjudicated from death certificates and medical records when available (>95% deaths confirmed). Ascertainment of vital status was 99% complete. Log-rank tests for the rates of death and multivariate Cox hazard models adjusted for age, smoking, physical activity, systolic blood pressure, waist girth and education were used to compare mortality among the four groups with non-diabetic women without CVD as the referent group. Results are reported as adjusted hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: At baseline mean age was 71.7±5.3 years, 7.0% reported diabetes mellitus and 14.5% reported prior CVD. 4257 women died during follow-up, 36.6% were attributed to CVD. The incidence of CVD death per 1000 person-years was 9.9 and 21.6 among non-diabetic women without and with CVD, respectively, and 23.8 and 33.3 among diabetic women without and with CVD, respectively. Compared to nondiabetic women without prior CVD, the risk of CVD mortality was elevated among both non-diabetic women with CVD (HR=1.82, CI: 1.60-2.07, P<0.001) and diabetic women without prior CVD (HR=2.24, CI: 1.87-2.69, P<0.001). CVD mortality was highest among diabetic women with CVD (HR=3.41, CI: 2.61-4.45, P<0.001). Compared to non-diabetic women with CVD, diabetic women without prior CVD had a significantly higher adjusted HR for total and CVD mortality (P<0.001 and P<0.05 respectively). CHD mortality did not differ significantly between non-diabetic women with CVD and diabetic women without prior CVD. CONCLUSION: Older diabetic women without prior CVD have a higher risk of all-cause and CVD mortality and a similar risk of CHD mortality compared to non-diabetic women with pre-existing CVD. For older women, these data support the equivalence of prior CVD and diabetes mellitus in current guidelines for the prevention of CVD.

The application of trend surface models to the analysis of time factors in Swiss cancer mortality.

To study different temporal components on cancer mortality (age, period and cohort) methods of graphic representation were applied to Swiss mortality data from 1950 to 1984. Maps using continuous slopes ("contour maps") and based on eight tones of grey according to the absolute distribution of rates were used to represent the surfaces defined by the matrix of various age-specific rates. Further, progressively more complex regression surface equations were defined, on the basis of two independent variables (age/cohort) and a dependent one (each age-specific mortality rate). General patterns of trends in cancer mortality were thus identified, permitting definition of important cohort (e.g., upwards for lung and other tobacco-related neoplasms, or downwards for stomach) or period (e.g., downwards for intestines or thyroid cancers) effects, besides the major underlying age component. For most cancer sites, even the lower order (1st to 3rd) models utilised provided excellent fitting, allowing immediate identification of the residuals (e.g., high or low mortality points) as well as estimates of first-order interactions between the three factors, although the parameters of the main effects remained still undetermined. Thus, the method should be essentially used as summary guide to illustrate and understand the general patterns of age, period and cohort effects in (cancer) mortality, although they cannot conceptually solve the inherent problem of identifiability of the three components.

Risk factors of stroke mortality in the African region: a cohort study

Background: Population-based cohort studies of risk factors of stroke are scarce in developing countries and none has been done in the African region. We conducted a longitudinal study in the Seychelles (Indian Ocean, east of Kenya), a middle-income island state where the majority of the population is of African descent. Such data in Africa are important for international comparison and for advocacy in the region. Methods: Three examination surveys of cardiovascular risk factors were performed in independent samples representative of the general population aged 25-64 in 1989, 1994 and 2004 (n=1081, 1067, and 1255, respectively). Baseline risk factors data were linked with cause-specific mortality from vital statistics up to May 2007 (all deaths are medically certified in the Seychelles and kept in an electronic database). We considered stroke (any type) as a cause of death if the diagnosis was reported in any of the 4 fields in the death certificates for underlying and concomitant causes of death. Results. Among the 2479 persons aged 35-64 at baseline, 280 died including 56 with stroke during follow up (maximum: 18.2 years; mean: 10.2 years). In this age range, age-adjusted mortality rates (/100'000/year) were 969 for all cause and 187 for stroke; age-adjusted prevalence of high blood pressure (≥140/90 mmHg) was 48%. In multivariate Cox survival time regression, stroke mortality was increased by 18% and 35% for a 10-mmHg increase in systolic, respectively diastolic BP (p<0.001). Stroke mortality was also associated with age, smoking ≥5 cigarettes vs. no smoking (HR: 2.4; 95% CI: 1.2-4.8) and diabetes (HR: 1.9; 1.02-3.6) but not with sex, LDL-cholesterol intake, alcohol intake and professional occupation. Conclusion. This first population-based cohort study in the African region demonstrates high mortality rates from stroke in middle-aged adults and confirms associations with high BP and other risk factors. This emphasizes the importance of reducing BP and other modifiable risk factors in high risk individuals and in the general population as a main strategy to reduce the burden of stroke.

Trends in mortality from coronary heart and cerebrovascular disease in Switzerland, 1969-87.

Trends in age-specific and age-standardized death certification rates from all ischaemic heart disease and cerebrovascular disease in Switzerland have been analysed for the period 1969-87, i.e. since the introduction of the Eighth Revision of the International Classification of Diseases for coding causes of death. For coronary heart disease, overall age-standardized rates of males in the mid-late 1980's were similar to those in the late 1960's, although some upward trend was evident up to the mid 1970's (with a peak rate of 120.4/100,000, World standard, in 1978) followed by steady declines in more recent years (103.8/100,000 in 1987). These falls were larger in truncated (35 to 64 years) rates. For females, overall age-standardized rates were stable around a value of 40/100,000, while truncated rates tended to decrease, particularly over most recent years, with an overall decline of over 25%. Examination of age-specific trends showed that in both sexes declines at younger ages were already evident in the earlier calendar period, while above age 50 some fall became evident only in most recent years. Thus, in a formal log-linear age/period/cohort model, both a period and a cohort component emerged. In relation to cerebrovascular diseases, the overall declines were around 40% in males (from 67.4 to 41.2/100,000, World standard) and 45% for females (from 56.6 to 31.7/100,000), and were proportionally comparable across subsequent age groups above age 45. The estimates for the age/period/cohort model were thus downwards both for the period and the cohort component although, in such a situation, it is difficult to disentangle the major underlying component.(ABSTRACT TRUNCATED AT 250 WORDS)

Lack of seasonal variation in cardiovascular mortality in a country near the equator

Introduction: Mortality from cardiovascular disease (CVD) varies according to seasons in countries that are located far away from the equator, likely linked to concomitant seasonal variation in underlying CVD risk factors. We assessed temporal variation in CVD mortality in the Seychelles, a small island state situated near the equator and where the climate is virtually constant throughout the year. Seychelles is one of the few countries located near the equator where all deaths are registered. Methods: We recoded all deaths along broad causes, including CVD (n=5643), stroke (2112) and myocardial infarction (MI, 804). Stroke and MI were considered as the cause of death if the diagnosis appeared in any of the four fields for underlying causes of death in the death certificates. In view of the small size of the population, we pooled all deaths (n=13'163) between 1989 and 2010. Results: Mortality for all CVD, stroke and MI did not systematically vary according to month or season (chi square >0.05). A lack of variation was also observed within sex and age categories. Conclusion: The lack of seasonal variation in CVD mortality in a country located near the equator is consistent with the hypothesis that seasonal variation in CVD decreases along decreasing a country's latitude.

Traumatic Brain Injury in Iowa Inpatient Hospital Data, 2003-2005

According to the Centers for Disease Control and Prevention, unintentional injury is the fifth leading cause of death for all age groups and the first leading cause of death for people from 1 to 44 years of age in the United States, while homicide remains the 2nd leading cause of death for 15 to 24 years old (CDC, 2006). In 2004, there were approximately 144,000 deaths due to unintentional injuries in the US; 53% of which represent people over 45 years of age (CDC, 2004). With 20,322 suicidal deaths and 13,170 homicidal deaths, intentional injury deaths affect mostly people under 45 years old. On average, there are 1,150 unintentional deaths per year in Iowa. In 2004, 37% of unintentional deaths were due to motor vehicle accidents (MTVCC) occurring across all age ranges and 30% were due to falls involving persons over 65 years of age 82% of the time (IDPH Health Stat Div., 2004). The most debilitating outcome of injury is traumatic brain injury, which is characterized by the irreversibility of its damages, long-term effects on quality of life, and healthcare costs. The latest data available from the CDC estimated that, nationally, 50,000 traumatic brain injured (TBI) people die each year; three times as many are hospitalized and more than twenty times as many are released from emergency room (ER) departments (CDC, 2006). Besides the TBI registry, brain injury data is also captured through three other data sources: 1) death certificates; 2) hospital inpatient data; and, 3) hospital outpatient data. The inpatient and outpatient hospital data are managed by the Iowa Hospital Association, which provides to Iowa Department of Public Health the hospital data without personal identifiers. (The hospitals send reports to the Agency of Health Care Research and Quality, which developed the Health Care Utilization Project and its product, the National Inpatient Sample).

Propuesta de ecoetiqueta para espacios de interés natural. Prueba piloto en la Vall d'Alinyà

Este artículo, presenta una propuesta de ecoetiqueta que evalúa la calidad de los espacios de interés natural. Debido a la inexistencia de una ecoetiqueta de servicios de estas características, se han estudiado antecedentes de certificados ecológicos de servicios y sistemas de evaluación de espacios naturales y urbanos. A partir de este estudio, se han evaluado 110 indicadores preexistentes, de los cuales se han adaptado 59 indicadores, 29 de cumplimiento obligatorio y 30 recomendables, divididos en tres flujos: Flujo Humano, Flujo Natural y Flujo de Gestión, y 17 vectores; con los cuales se ha elaborado un sistema de evaluación adaptado a esta ecoetiqueta. Con la determinación del reglamento y las condiciones generales para la concesión de la propuesta de ecoetiqueta, se ha realizado una Prueba Piloto en la Vall d’Alinyà (Provincia de Lérida) centrada en el Flujo Humano, verificando de forma positiva la aplicación de la certificación en este espacio. Los resultados indican una adecuación de más del 90% de los indicadores seleccionados, mientras que se ha observado, principalmente, deficiencias en los sistemas hídricos y energéticos de la Vall d’Alinyà. Por ello, se han elaborado una serie de propuestas de mejora.

Gestión de confianza en redes ad hoc

El despliegue de un esquema de confianza es fundamental para poder desarrollar servicios de seguridad que permitan administrar y operar una red. Sin embargo, las soluciones empleadas en las redes tradicionales no se adaptan a un entorno ad hoc debido a la naturaleza dinámica y sin infraestructura de estas redes. En el presente trabajo se propone un esquema de confianza práctico y eficiente basado en una infraestructura de clave pública distribuida, umbral y jerárquica, que no requiere sincronización temporal entre todos los nodos de la red. La autorización de usuarios en el sistema se hace a través de certificados de corta duración que eliminan la necesidad de mantener la publicación y diseminación de unas listas de revocación. Por otro lado, una entidad externa de confianza permite alargar la reputación de un usuario de la red más allá de la existencia de la propia red.

Mortality associated with diabetes mellitus in comparison with history of cardiovascular disease in older women.

Current treatment guidelines consider diabetes to be equivalent to existing cardiovascular disease (CVD), but few data exist about the relative importance of these risk factors for total and CVD mortality in older women.We studied 9704 women aged >= 65 years enrolled in a prospective cohort study (Study of Osteoporotic Fracture) during a mean follow-up of 13 years and compared all-cause and CVD mortality among non-diabetic women without and with history of CVD at baseline and diabetic women without and with history of CVD. Diabetes mellitus and CVD were defined as self-report of physician diagnoses. Cause of death was adjudicated from death certificates and medical records when available. Ascertainment of vital status was 99% complete. Multivariate Cox hazard models adjusted for age, smoking, physical activity, systolic blood pressure, waist girth and education were used to compare mortality among the four groups with non-diabetic women without CVD as the referent group. At baseline mean age was 71.7 } 5.3 years, 7.0% reported diabetes mellitus and 14.5% reported prior CVD. 4257 women died during follow-up, 36.6% were attributed to CVD. Compared to non-diabetic women without prior CVD, the risk of CVD mortality was elevated among both non-diabetic women with CVD (HR = 1.82, 95% CI: 1.60-2.07, P <0.001) and diabetic women without prior CVD (HR = 2.24, CI: 1.87-2.69, P <0.001). CVD mortality was highest among diabetic women with CVD (HR = 3.41, CI: 2.61-4.45, P <0.001). Compared to non-diabetic women with CVD, diabetic women without prior CVD had a significantly higher adjusted HR for total and CVD mortality (P < 0.001 and P <0.05 respectively). Older diabetic women without prior CVD have a higher risk of all-cause and CVD mortality compared to nondiabetic women with pre-existing CVD. For older women, these data support the equivalence of prior CVD and diabetes mellitus in current guidelines for the prevention of CVD in primary care.

Vahva todennus julkisen avaimen järjestelmässä

Arvokasta tai luottamuksellista tietoa käsittelevien palveluiden, kuten pankki- ja kauppa-palveluiden, tarjoaminen julkisessa Internet-verkossa on synnyttänyt tarpeen vahvalle todennukselle, eli käyttäjien tunnistuksen varmistamiselle. Vahvassa todennuksessa käytetään salaus-menetelmien tarjoamia keinoja todennus-tapahtuman tieto-turvan parantamiseen heikkoihin todennusmenetelmiin nähden. Todennusta käyttäjätunnus-salasana-yhdistelmällä voidaan pitää heikkona menetelmänä. Julkisen avaimen järjestelmän varmenteita voidaan käyttää WWW-ympäristössä toimivissa palveluissa yhteyden osapuolten todentamiseen. Tässä työssä suunniteltiin vahva käyttäjän todennus julkisen avaimen järjestelmällä WWW-ympäristössä tarjottavalle palvelulle ja toteutettiin palvelun tarjoavan sovelluksen komponentiksi soveltuva yksinkertainen varmentaja OpenSSL-salaustyökalupaketin avulla. Työssä käydään läpi myös salauksen perusteet, julkisen avaimen järjestelmä ja esitellään olemassaolevia varmentajatoteutuksia ja mahdollisia tieto-turva-uhkia Vahva todennus tulee suunnitella siten, että palvelun käyttäjä ymmärtää, mikä tarkoitus hänen toimillaan on ja miten ne edistävät tietoturvaa. Internet-palveluissa käyttäjän vahva todennus ei ole yleistynyt huonon käytettävyyden vuoksi.

Wireless Authentication and Authorization, case Wireless Access Control System

Lyhyen kantaman radiotekniikoiden hyödyntäminen mahdollistaa uudenlaisten paikallisten palveluiden käytön ja vanhojen palveluiden kehittämisen. Kulunvalvonta on päivittäisenä palveluna valittu työn esimerkkisovellukseksi. Useita tunnistus- ja valtuutustapoja tutkitaan, ja julkisen avaimen infrastruktuuri on esitellään tarkemmin. Langattomat tekniikat Bluetooth, Zigbee, RFID ja IrDA esitellän yleisellä tasolla langattomat tekniikat –luvussa. Bluetooth-tekniikan rakennetta, mukaan lukien sen tietoturva-arkkitehtuuria, tutkitaan tarkemmin. Bluetooth-tekniikkaa käytetään työssä suunnitellun langattoman kulunvalvontajärjestelmän tietojen siirtoon. Kannettava päätelaite toimii käyttäjän henkilökohtaisena luotettuna laitteena, jota voi käyttää avaimena. Käyttäjän tunnistaminen ja valtuuttaminen perustuu julkisen avaimen infrastruktuuriin. Ylläpidon allekirjoittamat varmenteet sisältävät käyttäjän julkisen avaimen lisäksi tietoa hänestä ja hänen oikeuksistaan. Käyttäjän tunnistaminen kulunvalvontapisteissä tehdään julkisen ja salaisen avaimen käyttöön perustuvalla haaste-vastaus-menetelmällä. Lyhyesti, järjestelmässä käytetään Bluetooth-päätelaitteita langattomina avaimina.

Henkilökohtaisen päätelaitteen käyttö lähimaksujärjestelmässä

Henkilökohtaista luotettavaa päätelaitetta voidaan käyttää maksuvälineenä langattomissa maksujärjestelmissä. Päätelaitteen luotettavuus saadaan aikaan sen sisältämien tietojen salauksen ja käyttäjän tunnistuksen avulla. Kaupankäynnin tietoturvan kannalta järjestelmien tärkeimpiä tehtäviä ovat osapuolten tunnistaminen ja tietoyhteyden suojaaminen. Tässä työssä esitellään automaatti- ja ruokalamaksamisen järjestelmä, jossa käytetään maksuvälineenä Bluetooth-ominaisuudella varustettua kämmentietokonetta. Henkilökohtaisen luotettavan päätelaitteen vaatimuksia ja uhkia käydään läpi. Samoin erilaisia menetelmiä käyttäjän ja laitteiden tunnistukseen sekä tietoyhteyden suojaamiseen. Käyttäjän tunnistus perustuu julkisten avainten varmenteisiin, joihin on sisällytetty tietoa niin asiakkaasta, maksuvälineestä kuin maksumenetelmästäkin. Maksumenetelmäksi on valittu tilien käyttö. Tietoyhteyden suojaamiseen käytetään epäsymmetristä salausta.

Päästökaupan ja vihreiden sertifikaattien vaikutus sähkön ja kaukolämmön toimittajaan

Kasvihuonekaasujen päästökauppa ja vihreät sertifikaatit liittyvät kehitysvaiheessa olevaan ilmastopoliittiseen kokonaisuuteen, jonka tarkoitus on rajoittaa ihmisen toiminnasta aiheutuvaa kasvihuoneilmiön voimistumista. Työssä tutkittiin Euroopan Unionin sisäisen päästökaupan ja vihreiden sertifikaattien vaikutusta energian toimittajaan. Tarkastelu tehtiin kohdeyrityksinä toimineiden yritysten näkökulmasta keskittyen energianhankintatapojen kilpailukykyyn ja kustannusmuutoksiin sekä niiden vaikutusten selvittämiseen. Päästökauppa tulee toteutuessaan heikentämään energiantuotannossa käytettyjen fossiilisten polttoaineiden ja turpeen kilpailukykyä hiilidioksidipäästöttömiin tuotantomuotoihin nähden ja aiheuttamaan lisäkustannuksia hiilidioksidia aiheuttavien tuotantomuotojen käytölle. Vihreät sertifikaatit ovat tapa tukea uusiutuvista energianlähteistä tuotettua sähköä. Niistä on kehittymässä Euroopassa erilaisia järjestelmiä eikä yhtenäisten eurooppalaisten markkinoiden toteutumisesta ole varmuutta. Suomalaisiin sähköntoimittajiin vihreät sertifikaatit voivat vaikuttaa myös, mikäli Suomeen perustetaan kansallinen sertifikaattijärjestelmä tai sähköntuottajat pystyvät hyödyntämään muiden maiden järjestelmiä.