The role of professional associations in reducing maternal mortality worldwide.

The death of hundreds of thousands of women due to pregnancy-related complications casts a shadow over the modern obstetrical world. This paper examines the potential roles and responsibilities of professional obstetrical and midwifery associations in addressing this tolerated tragedy of maternal deaths. We examine the successes and challenges of obstetrical and midwifery associations and encourage the growth and development of active associations to address maternal mortality within their own borders. Professional associations can play a vital role in the reduction of maternal mortality worldwide. Their roles include lobbying for women's health and rights, setting standards of practice, raising awareness and team building. Associations from developed countries can influence and strengthen their colleagues within developing countries; for example, the FIGO Save the Mothers initiative. Professional associations should be encouraged to play an active role in reducing maternal mortality within their own country and abroad.     

Do patient characteristics,disease, or treatment explain social inequality in survival from colorectal cancer?

This paper investigates the association between individually measured socioeconomic status (SES) and all-cause survival in colorectal cancer patients, and explores whether factors related to the patient, the disease, or the surgical treatment mediate the observed social gradient.     

The treatment of hypertension

1 A 'retrospective' of the development of the drug treatment of hypertension is presented from the early days of ganglion blockers to the present time together with a review of the evidence of benefit from treatment.
2 Current issues and debates are summarised including shortfalls in the control of hypertension in populations, difficulties surrounding the measurement of blood pressure, disagreement on the levels of blood pressure to treat, the goal blood pressures to aim at, issues surrounding lifestyle measures such as the low salt diet and low intensity exercise, and treatment with diuretics and with calcium antagonists.
3 A 'perspective' is presented on some avenues for progress in the years ahead. These will include the identification of genetic markers to determine the hypertensive individuals with the greatest risk of death and of cardiovascular complications.     

Mortality among female registered nurses and school teachers in British Columbia

The mortality profile of female nurses and teachers in British Columbia (BC) was examined using age-standardized proportional mortality ratios (PMRs) calculated for the period 1950–1984. Lowered overall mortality among nurses was seen for degenerative heart disease and for cerebrovascular accidents. Significantly elevated PMR values were observed for cancer of the breast and ovary in nurses of age 20–65 years. PMRs were significantly elevated for cancer of the pancreas and leukemia among those age 20 years and older. Elevated values were also observed for motor vehicle accidents and suicide among nurses in both age groups. Lower than expected mortality from degenerative heart disease and cerebrovascular accidents was seen in working age teachers (age 20–65 years). However, elevated PMRs were detected for carcinoma of the colon, breast, endometrium, brain, and melanoma. Among those 20 years and over, significantly elevated PMRs were also observed for cancers of the ovary and other digestive organs. Elevated PMRs were found for motor vehicle and aircraft accidents. Mortality from cirrhosis of the liver was lower than anticipated in both teachers and nurses. A number of significant PMRs declined when deaths of “homemakers” were withdrawn from the comparison group used to generate PMR values, suggesting that risk of death from various causes among women working outside the home differ from those seen in women who are predominantly in the home.     

Minor,moderate and severe head injury

Summary The future role of the neurosurgeon in the management of head injury is reviewed in terms of the care of patients with minor, moderate and severe head injuries. In minor head injury it is predicted that there will be increasing pressure on the neurosurgeon to undertake the management and follow-up of all patients who have sustained head injury, and this will place a considerable additional load on each neurosurgical unit. This is based on a survey of 1919 head injuries admitted in one calendar year (1981), consisting of 93 severe injuries (GCS < 8), 210 moderate injuries (GCS 8–12), and 1616 minor injuries (GCS 13/14). In moderate injuries CT will assume a major role in detecting hematoma early and identifying contusions. There may yet be a role for steroids in these cases and there should be a greater use of neurorehabilitation, instead of the current overemphasis on the severely injured. In severe injury future efforts will be to prevent early secondary insults and to find better methods of controlling raised intracranial pressure.     

A method for partitioning cancer mortality trends by factors associated with diagnosis: An application to female breat cancer

U.S. cancer mortality data derived from information recorded on death certificates are frequently relied upon as an indicator of progress against cancer. A limitation of this measure is the lack of information pertaining to the onset of disease, such as year-of-diagnosis, age-at-diagnosis, stage of disease at diagnosis and histology of lesions. However, population-based cancer registries collect these types of data and allow the calculation of an incidence-file based mortality rate. This incidence-based mortality rate allows a partitioning of mortality by variables associated with the cancer onset. Breast cancer incidence-based mortality measures are created and compared to mortality rates based on death certificates over a comparable time period. Novel mortality measures, such as mortality rates by stage-at-diagnosis, age-at-diagnosis and year-of-diagnosis, are used to illustrate the value of this approach.     

Monitoring maternity mortality in Botswana

This paper describes the maternity monitoring system in Botswana, developed in 1998, and the main methods used: maternal death and morbidity reviews at service delivery level, analysis by the National Maternal Mortality Audit Committee of data from the reviews as reported on two forms, perinatal reviews and surveys using process indicators. We carried out a study of these findings to examine whether the system was working well. Surveys using process indicators in 2001 and 2006 were analysed. Other data examined were from 2004-2006 and early 2007. The Maternal Death Notification Form was found to be comprehensive but not all health facilities were submitting them and some gave incomplete information. In 2001, 70% of pregnant women attended antenatal care but access to emergency obstetric care was uneven. In 2006, 28 facilities with maternity services surveyed were providing 24-hour delivery care, but laboratory, theatre and blood supplies were more limited, and only 50% of doctors and 67% of midwives had life-saving skills. Antibiotics were widely available, but there were shortages of magnesium sulphate, diazepam, oxytocics and manual vacuum aspiration kits. Recommendations for improvements have been made, training for skilled attendants is ongoing and a medical school has just opened at the University of Botswana.     

Elevated body mass index and mortality risk in the elderly

The purpose of this report was to perform a systematic review and meta-analysis of the studies examining the impact of an elevated body mass index (BMI) on mortality risk in elderly (> or =65 years) men and women. A variance-based method of meta-analysis was used to summarize the relationships from available studies. The summary relative risk of all-cause mortality from the 26 analyses that included a risk estimate for a BMI within the overweight range was 1.00 (95% confidence intervals, 0.97-1.03). The summary relative risk of all-cause mortality for the 28 analyses that included a risk estimate for a BMI within the obese range was 1.10 (1.06-1.13). These calculations indicate that a BMI in the overweight range is not associated with a significantly increased risk of mortality in the elderly, while a BMI in the moderately obese range is only associated with a modest increase in mortality risk.     

Trends of incidence and mortality rates of stroke from 1983 to 2000 in Hanzhong rural population

Objective: To explore the trends of incidence and mortality rates of stroke in Hanzhong rural population. Methods: Acting as the WHO MONICA project. Results: The incidence rate of stroke was 152. 9/100 000. There was decline trend in male(P <0. 05). The mortality rate of stroke was 115.9/100 000. There was no significant decline trend during 18-year period (P < 0. 05). The incidence and mortality rates of stroke of male were higher than those of female(P<0. 05). The incidence and mortality rates were all increased with age(P <0. 01 ). Conclusion: It must stick to the long- term prevention measures to decrease incidence rate, and improve the condition of medical treatment to reduce the mortality rate in rural population.