Generational and regional differences in trends of mortality from ischemic heart disease in Japan from 1969 to 1992.

The authors compared generational and regional trends of premature mortality from ischemic heart disease (IHD) from 1969 to 1992 for persons aged 30-69 years. They selected Tokyo and Osaka prefectures as the most urbanized and compared them with the rest of Japan. The data were divided into two periods: period I (1969-1978, International Classification of Diseases, Eight Revision) and period II (1979-1992, International Classification of Diseases, Ninth Revision). In both populations, IHD mortality decreased for both sexes, but mortality from nonspecific heart disease remained constant in men and decreased in women. In Tokyo and Osaka prefectures, the percentage decline per year in IHD mortality for both sexes was significantly smaller in period II than in period I. However, in the rest of Japan, it did not decrease for either sex. Age-specific analysis showed that the percentage decline per year in period II was smallest for the group aged 30-49 years (men, 0.05%; women, 0.76%) in Tokyo and Osaka prefectures, while it was similar for all age groups in the rest of Japan. For men, the IHD mortality rate in 1991-1992 for those aged 30-49 years was higher in Tokyo and Osaka prefectures (9.4/100,000) than in the rest of Japan (5.4/100,000).     

The Seattle virus watch. V. Epidemiologic observations of rhinovirus infections, 1965-1969, in families with young children.

Rhinovirus (RV) infections in Seattle Virus Watch (VW) families (1965-1969) were monitored by screening respiratory specimens in WI-38 cell cultures and by homotypic neutralization tests on sera related to family episodes revealed by RV isolation. Temporally related illness in members not proven infected was also taken to indicate infection. RV isolates (including those from the New York VW, 1961-1965) were typed within the official 90-serotype frame. Typed isolates from New York (165 with 39 serotypes) and Seattle (456 with 59 serotypes) were compared with the Tecumseh Study to test the hypothesis that some serotypes are "common," persisting because of greater infectivity. Of 32 serotypes qualifying as "common" in at least 1 study, 4 were "common" in all 3 studies and 8 in 2 studies. The 23 "common" Seattle serotypes differed from the remaining 36 serotypes in being more infective and in their more frequent association with prolonged shedding. The New York and Seattle isolates together revealed an increase over time in the proportion not typable or of of higher numbered types, consistent with progressive shift in RV antigenic character. WI-38 isolates indicated spring peaks of RV all 4 years but a fall peak only in 1967. An even larger fall peak was seen when all specimens from September-November 1968 were re-examined in fetal tonsil diploid cells. Thus, both spring and fall peaks appear to describe RV seasonality. RV infections explained 16% of all reported respiratory illness (20% of upper respiratory), but RV-associated illness in young children, especially under 2 years, was more severe and almost twice as frequent as in adults. The age of introducers and the direct relation of family size to frequency of episodes indicate that community spread depends largely on preschool children, including infants. Within families, the secondary attack rate (SAR) was highest following paternal introduction and, for all introducers, the SAR varied inversely with age (mother excepted). RV shedding was observed most often (85% of specimens) from the day before to 6 days after illness onset but prolonged shedding was common (to 21 days in 20% and 28 days in 1.4% of infections). RV infectivity, reflected by SAR among nonimmunes, was highest for infants (78%) and, for all ages, was greater with ill than with well introducers (71% versus 27%). Immunogenicity of RV was poor (Seroresponse: 48% of shedders, 32% of nonshedding contacts) but varied greatly with serotype. Illness frequencies among non-immunes were 59% for all proven infections and 35% when infection was not shown..     

Examining the evidence of under-five mortality reduction in a community-based programme in Gaza, Mozambique

Effective implementation of programmes with the community Integrated Management of Childhood Illness model has demonstrated improvements in care-seeking behaviours and utilisation of health services. The child survival programme implemented in Chokwe district of Gaza province, Mozambique, achieved high coverage for bed net use (80%), oral rehydration therapy for children with diarrhoea (94%) and prompt care-seeking from trained providers for children with danger signs. The project also instituted a community-based vital registration and health information system for routine surveillance of births, deaths and childhood illnesses using an extensive network of 2300 volunteers. Evidence from this system indicated a 66% reduction in infant mortality and a 62% reduction in under-five mortality. To check the reliability of the findings, an independent mortality assessment was carried out using a pregnancy history questionnaire with a sample population of 998 women using standard methodologies applied in the Demographic and Health Surveys. The mortality survey showed reductions of 49% and 42% in infant and under-five mortality, respectively. The leading causes of death identified by verbal autopsies were malaria (30%), neonatal causes (17%) and pneumonia (21.3%). These findings suggest that effective community-based partnerships that support the delivery of health services can contribute to mortality reductions.     

Regional differences in decline of mortality from selected conditions: The Netherlands, 1969-1984

In The Netherlands, as in many other industrialized countries, recent mortality developments have been characterized by rapid declines for a number of important causes of death. The results of an analysis of regional variation in mortality decline within The Netherlands are reported, covering the period 1969-1984. The causes of death included in this analysis are Perinatal mortality, Cerebrovascular disease, a more global 'Amenable' selection (formed by aggregating a number of causes of death considered to be amenable to medical intervention), Cancer of the stomach, Ischaemic heart disease and Traffic accidents. For Perinatal mortality, Cerebrovascular disease, the 'Amenable' selection, and Ischaemic heart disease, as well as for Total mortality, declines have not been geographically homogeneous. Perinatal mortality had a tendency to decline faster in regions where starting levels were higher, suggesting a certain convergence. For Cerebrovascular disease and the 'Amenable' selection, but especially for Ischaemic heart disease, the reverse was true. A simple correlation analysis shows that for Perinatal mortality, as well as for the 'Amenable' selection, mortality declined faster in less urbanized, more peripherally located, lower income areas. There is no association with the presence of a university hospital. This pattern suggests that faster mortality decline for these conditions is due to factors other than faster diffusion of new medical technologies. For Ischaemic heart disease, mortality declined faster in more urbanized, more centrally located, higher income areas. Although this pattern is what one would expect as a result of regional differences in the diffusion of new medical technologies, it may also be due to differences in the diffusion of new lifestyles.(ABSTRACT TRUNCATED AT 250 WORDS)     

Impact of a clinic-based growth monitoring programme on maternal nutrition knowledge in Lesotho.

An evaluation of the impact of a nationwide clinic-based growth monitoring (GM) programme was done in Lesotho to determine if clinic attendance was associated with improved maternal knowledge of weaning practices and diarrhoea. A total of 907 mothers from eight clinics were included in the study. Our results showed that mothers who had attended the clinics knew more about the appropriate timing for introducing animal protein-rich foods in the child's diet and about the use of oral rehydration salts for diarrhoea, than those who had not. The difference in knowledge between previous clinic attendants and new attendants was particularly marked among mothers with less than secondary schooling and mothers with young babies (less than 6 months). From observation in the clinics, we believe that group nutrition education, although it was not integrated with growth monitoring, was probably responsible for the positive association between clinic attendance and maternal knowledge. Prior clinic attendance was not specifically associated with improved knowledge about feeding during diarrhoea or the need to stop breastfeeding gradually. These need to be better incorporated into present clinic nutrition education. Whether improvements in growth monitoring would further significantly improve nutrition education remains to be seen.     

National trends in the mortality of children with sickle cell disease, 1968 through 1992.

OBJECTIVES: This paper describes national trends in mortality of children with sickle cell disease and the settings in which death occurred. METHODS: United States death certificate data from 1968 through 1992 were used to calculate mortality rates of Black children with sickle cell disease 1 to 14 years old. Deaths from trauma, congenital anomalies, and perinatal conditions were excluded. RESULTS: Between 1968 and 1992, mortality rates of Black children with sickle cell disease decreased 41% for 1- to 4-year-olds, 47% for 5- to 9-year-olds, and 53% for 10- to 14-year-olds. During 1986 through 1992, children who died before hospital admission accounted for 41% of deaths among 1- to 4-year-olds, 27% among 5- to 9-year-olds, and 12% among 10- to 14-year-olds. CONCLUSIONS: Survival of Black children with sickle cell disease has improved markedly since 1968. A substantial proportion of deaths continue to occur prior to hospital admission. Trends in sickle cell mortality can be monitored inexpensively with death-certificate data.     

The mortality of Swedish and U.S. white males: a comparison of experience, 1969-1971.

The life expectancy of males in the United States is lower than that of males in most of the developed countries and in some of the not-so-developed ones. U.S. females, by contrast, do much better in international ranking. This study compares the mortality of U.S. white males with that of Swedish males who have had the highest reported male life expectancies in the world since the early 1960s. Life expectancy at birth in 1969-71 was 67.9 for U.S. white males compared with 71.9 for Swedish males. Greater U.S. white male mortality is found at all ages from birth through ages 75-79. At the upper ages there is a reversal of the differential with U.S. white males having lower mortality than their Swedish counterparts. The greatest relative differentials between the two male populations is found at ages under 1, ages 20-24, and ages 50-59. At ages under 1 the greater U.S. white male mortality is accounted for mainly by higher death rates from infectious diseases, at ages 20-24 by higher rates from the external causes of death (specifically accidents and homicide), and at ages 50-59 from most of the major organic causes of death.     

Colorectal cancer incidence and mortality in Texas 1990-1992: a comparison of rural classifications.

Although cancer incidence and mortality rates are known to be higher in urban populations, more unstaged tumors and later staged cancer are diagnosed in rural populations. Most investigators have used a dichotomous definition of urban and rural in studying these populations, and they have not considered whether a more detailed categorization of rural areas could influence their findings. The objective of this study was to evaluate colorectal cancer incidence and mortality rates in Texas from 1990 to 1992 by using a dichotomous definition (Metropolitan Area vs. Nonmetropolitan Area [MA/non-MA]) and two more detailed rural classifications (the Rural-Urban Continuum Code [RUCC] and the Urban Influence Code [UIC]). Cancer data were obtained from the Texas Cancer Registry for 1990 to 1992 and supplemented with data from the Texas State Department of Vital Statistics (mortality), the US Census Bureau (age, gender, race) and the Area Resource File (rural and urban definitions). Incidence and mortality rates, age-adjusted to the 1970 US standard population, were calculated for non-Hispanic White, African American, and Hispanic males and females. Results revealed a nonlinear relationship between rural category and colorectal cancer incidence or mortality for all races. Applying the MA definition yielded rates in the middle of the ranges obtained with using RUCC or UIC classifications and most closely reflected the result for non-Hispanic Whites using the more detailed scales. Our results suggest that a dichotomous definition of rural and urban may mask important variation in colorectal cancer incidence and mortality rates within rural areas.     

Explaining differential rates of mortality decline for Swedish men and women: a time-series analysis, 1945-1992.

The aim of this study is to identify social factors that could be related to differential rates of mortality decline for men and women in Sweden. The annual changes in fifteen indicators and their relationship with changes in absolute excess male mortality were analyzed by means of time series analysis for the period 1945-1992. Economic growth seems to have been more beneficial for women's survival than for that of men. A few labor market indicators (unemployment rate and the wage ratio men/women) may have had some influence on changes in excess male mortality as well. Consumption factors, such as alcohol consumption and cigarette consumption, have been important for changes in excess male mortality. Changes in excess male mortality have been particularly pronounced among 65-74 year olds, due to rapidly improved female survival in these age groups. I discuss the finding that there seem to be connections between, on the one hand, changes in general social factors such as economic growth and labor market factors, and perhaps urbanization and alcohol and cigarette consumption on the other. I therefore suggest that gender-specific consumer behavior, seen as an outcome of gender-specific norm systems, is one mechanism which links changes in general social factors to changes in excess male mortality.     

西安市南院门社区2004—2006年婴幼儿生长发育纵向监测

【目的】了解西安市南院门社区儿童生长发育的现状和影响生长发育的主要细节,找出今后儿童保健的工作重点。【方法】对现有南院门社区2004—2006年486例0~3岁婴幼儿进行生长发育纵向监测。【结果】得到南院门社区0~3岁各年龄组男女体重身长的均值标准差,及体重与身长的增长与出生时的倍数关系,与世界卫生组织(WHO)(1995)资料比较基本一致,3岁内赶上并超过WHO标准。【结论】西安市南院门社区0~3岁婴幼儿生长发育良好,体格发育在生后第一年增长速度最快。     

Morbidity and growth of infants and young children in a rural Mexican village.

The relationship between childhood illnesses and growth increments in length and weight was investigated in a 13-month birth cohort of rural Mexican children. Increments in length and weight for each year from birth to three years were related to high and low frequencies of reported time ill during the same period. Seventy-two of the 276 children had already been characterized as exhibiting "growth failure" relative to other members of the cohorts, and this was considered as a separate factor in the study. We found that upper and lower respiratory infection did not affect incremental gain in height or weight. A high frequency of diarrheal infection was found to reduce weight gain, although gain in height was not affected. Relative to the total sample, the average child with a high frequency of diarrhea achieved only 95 per cent of expected body weight age three; a chidl with both growth failure and high diarrheal frequency reached only 90 per cent of expected body weight at age three.     

沈阳市2008-2012年5岁以下儿童死亡监测结果分析

目的 获得沈阳市2008-2012年5岁以下儿童死亡情况及主要死亡原因, 探讨干预措施。方法 对沈阳市2008-2012年5岁以下儿童死亡监测资料进行统计分析。结果 2008-2012年沈阳市5岁以下儿童死亡率、婴儿死亡率和新生儿死亡率呈下降趋势。5岁以下儿童死亡率城乡差距缩小。早产低出生体重、先天性心脏病、其它先天异常、窒息、肺炎是5岁以下儿童死亡的主要原因。结论 加强健康教育、预防早产低出生体重和出生缺陷发生、提高农村医疗保健水平、降低婴儿特别是新生儿死亡率, 是降低5岁以下儿童死亡率的关键。     

Widening social inequalities in mortality: the case of Barcelona, a southern European city.

OBJECTIVE: To analyse trends in mortality inequalities in Barcelona between 1983 and 1994 by comparing rates in those electoral wards with a low socioeconomic level and rates in the remaining wards. DESIGN: Mortality trends study. SETTING: The city of Barcelona (Spain). SUBJECTS: The study included all deaths among residents of the two groups of city wards. Details were obtained from death certificates. MAIN OUTCOME MEASURES: Age standardised mortality rates, age standardised rates of years of potential life lost, and age specific mortality rates in relation to cause of death, sex, and year were computed as well as the comparative mortality figure and the ratio of standardised rates of years of potential life lost. RESULTS: Rates of premature mortality increased from 5691.2 years of potential life lost per 100,000 inhabitants aged 1 to 70 years in 1983 to 7606.2 in 1994 in the low socioeconomic level wards, and from 3731.2 to 4236.9 in the other wards, showing an increase in inequalities over the 12 years, mostly due to AIDS and drug overdose as causes of death. Conversely, cerebrovascular disease showed a reduction in inequality over the same period. Overall mortality in the 15-44 age group widened the gap between both groups of wards. CONCLUSION: AIDS and drug overdose are emerging as the causes of death that are contributing to a substantial increase in social inequality in terms of premature mortality, an unreported observation in European urban areas.