Some international comparisons of mortality amenable to medical intervention

A series of outcome indicators was proposed for assessing the curative aspects of health care using several diseases for which evidence suggested that death was largely avoidable provided that appropriate medical treatment could be given in time. International data were examined for those causes for which data were readily available. Time trends in mortality were compared for each of these conditions for six countries that had experienced appreciable growth in health services during 1950-80. Mortality from the heterogeneous "avoidable" causes had declined faster than mortality from all other causes in each of the six countries. Despite problems of diagnosis, reporting, and classification of diseases that may have existed among countries, making international comparisons of absolute mortality difficult, the trends of declining mortality were similar, lending credibility to the use of these causes of mortality as indices of health care within countries. Changes within countries may also have been attributable to changes in social, environmental, genetic, and diagnostic factors, which were not examined. Nevertheless, the consistency in mortality trends for this group of "amenable" diseases suggested that improvements in medical care were a factor in their rapid decline.     

心理护理对产妇在分娩过程中的影响

目的分析心理护理对产妇产妇在分娩过程中的影响。产妇在分娩过程中处于一种矛盾的心理状态,一方面对即将出生的小生命抱着期待、喜悦的心情;另一方面对即将来临的分娩感到忧虑和紧张[1]。因此妇女临产前多会出现各种不同的心理变化。作为一个助产士应该知道分娩虽然是一个正常的生理过程,但是心理因素的影响也很大,不良的情绪可以导致神经系统紊乱,使顺产转化成难产。产科护士应当了解产妇的心理活动,给予适当的心理护理,使产妇在整个分娩过程中保持良好的状态。     

Maternal mortality

Maternal mortality in Chittaranjan Seva Sadan, Calcutta, in 1983, 1985 and 1986 was 2.45, 3.01 and 2.8 per thousand respectively. Abortion contributed a little in 1983 and 1985, whereas it was 15.7% in 1986. Haemorrhage was the commonest single cause of death in 1983 (28%) and 1985 (21.4%) as opposed to eclampsia in 1986 (28.9%). Infective hepatitis during pregnancy and labour was the commonest indirect cause of maternal mortality followed by anaemia. Usual difficulties like lack of antenatal care, multiparity, low socio-economical status, illiteracy, etc, in populated developing countries are responsible for this sad state of affairs in this country as well.     

Maternal deaths from suicide in Singapore

INTRODUCTION: Maternal mortality in Singapore, as in other developed countries, has remained low in the past decade. In the United Kingdom and Australia, maternal deaths from suicide and psychiatric causes have been the leading cause of maternal mortality, and there have therefore been comprehensive healthcare programmes to address the mental health needs of mothers. METHODS: In this study, we looked at maternal deaths from 2000 to 2004, by linking coronial cases of female suicide in the reproductive age group 15-45 years, with the birth registration database, to identify both early and late maternal deaths. RESULTS: There was only one identified maternal death among 589 female suicides aged 15-45 years, occurring in a teenager within the first month postpartum. There was likely also another case that was unconfirmed and unreported. CONCLUSION: From this preliminary study, suicide and psychiatric causes are not significant causes of maternal mortality in Singapore. However, given that the epidemiology of postnatal depression statistics mirror that of the other countries, it is possible that maternal suicides have been underreported, and the load may well be higher. There is a need for a similar confidential enquiry into maternal deaths to be set up here, as is already in place in various countries, notably the United Kingdom and Australia, for the past decade.     

Global trends in adolescent health

Increasingly, morbidity and mortality trends for young people in developing nations are paralleling those in the industrialized world. As infectious causes of mortality diminish, unintentional injuries, suicide, homicide, war, and maternal mortality represent the primary causes of death in the second decade of life for most nations where data are maintained. As developing nations increasingly place priority on the education of their youth, early marriage and precocious child rearing are discouraged, and other problems, such as out-of-wedlock childbirth and illicit abortions, emerge. Problems such as substance abuse and suicide arise with the urban migration, increased unemployment, and disruption of traditional social structures that are experienced as developing countries industrialize.     

The importance of "throwing money at" the problem of global health

More funding from wealthy countries is required to improve health care and the infectious disease situation in developing countries. Although progress has been made, funds for fighting AIDS, tuberculosis, and malaria remain inadequate. These treatable and preventable diseases together kill over 6 million people every year. Funds are needed to improve access to existing medicines as well as to increase research and development of drugs. The idea that "throwing money at the problem is not going to solve it" rightly holds that increased funding is not sufficient for solving the health care problems of developing countries. In order to work, funds must be spent wisely. This does not mean that increased funding is unnecessary.     

Perinatal mortality--an analysis of causes and strategies

Perinatal mortality is the most sensitive index while imparting healthcare to mother during pregnancy and delivery and also to the baby in perinatal period. Perinatal mortality is higher in rural areas than in urban areas. Worldover perinatal or infant mortality rate is on decline. Developed countries are ahead of developing nations in giving good antenatal, intrapartal as well as neonatal care. Factors responsible for perinatal mortality in Indian context lie in sociodemographic, maternal and foetal aspects. Regional differences also are there in India while assessing perinatal mortality and delivery practices. The lacunae are to be identified while recommending strategies to be taken to lower the perinatal mortality. A community based data system should be developed so that the information should flow from down to above, from village to subcentre to primary health centre and further from district to state. Some newborns need special care. Since newborns need early recognition of danger signs and prompt treatment measures.     

Policy and management constraints on access to and use of life-saving emergency obstetric care in India

Maternal mortality is still very high in India and the developing world. India's maternal mortality ratio is about 540 deaths per 100,000 live births. Poverty and lack of resources contribute to this, but the main reasons for such high maternal mortality are policy barriers and management problems that impede access to good-quality emergency obstetric care in rural areas. The government policy does not encourage training general practitioners to provide cesarean sections, even when there are very few specialists available in rural and remote areas. Nurses are also prohibited from providing such basic emergency care procedures as intravenous oxytocics, antibiotics, and anticonvulsants. The doctors, nurses, and other hospital staff in managerial positions are not trained in modern management skills, which contributes to poor-quality services. The situation can be improved by training existing medical staff to provide emergency obstetric services in rural areas and training hospital managers in management skills. International aid organizations and women doctors should lobby for such policy changes, which will help increase access and quality of emergency obstetric care.     

公立医院改革与社会责任的履行

本文针对公立医院改革如何推进、从何处着手等重要问题,从妇幼保健院的工作实践出发,阐述了公立医院改革与社会责任履行之间的关系:①对公立医院社会责任的认识。②对妇幼保健院社会责任的认识,包括着力"品牌建设"、在"两个数据"上下功夫、不断满足新需求。③介绍了妇幼保健院社会责任体现的创新性实践。④对如何更好地履行妇幼保健院的社会责任提出了重点建设好区县级妇幼保健机构、纠正妇幼保健机构发展过程中出现的偏差、必须坚持保健与临床相结合的妇幼卫生工作方针等建议。     

Breast feeding as a family planning method

Prompted by declines in average durations and proportions of women breast feeding in several developing countries, international organizations have placed breast feeding promotion high on their health policy agendas. Breast feeding can prolong the length of the birth interval directly through its ability to cause lactational amenorrhea and anovulation. Maintenance of lactational amenorrhea depends, however, on frequent intervals (at least 6 feeds/day) of high intensity (15 minutes on each breast). Breast feeding also enhances child survival through good nutrition and protection from infection. Urban residence, maternal education, and use of modern contraceptives have been associated, in developing countries, with lower levels of breast feeding initiation and duration. Changes in maternity services, including helping mothers to initiate breast feeding within 30 minutes of delivery, 24-hour rooming-in, and encouraging breast feeding on demand, are recommended to promote child survival. Also essential, to encourage breast feeding among working mothers, are policies to provide women with paid maternity leave and workplace-based child care.     

Prevention of excess mortality in refugee and displaced populations in developing countries

More than 30 million refugees and internally displaced persons in developing countries are currently dependent on international relief assistance for their survival. Most of this assistance is provided by Western nations such as the United States. Mortality rates in these populations during the acute phase of displacement have been extremely high, up to 60 times the expected rates. Displaced populations in northern Ethiopia (1985) and southern Sudan (1988) have suffered the highest crude mortality rates. Although mortality rates have risen in all age groups, excess mortality has been the greatest in 1- through 14-year-old children. The major causes of death have been measles, diarrheal diseases, acute respiratory tract infections, and malaria. Case-fatality ratios for these diseases have risen due to the prevalence of both protein-energy malnutrition and certain micronutrient deficiencies. Despite current technical knowledge and resources, several recent relief programs have failed to promptly implement essential public health programs such as provision of adequate food rations, clean water and sanitation, measles immunization, and control of communicable diseases. Basic structural changes in the way international agencies implement and coordinate assistance to displaced populations are urgently needed.     

Evolution of emergency cardiac care in Canada.

Acute myocardial infarction is the most common cause of death in Canada. Most deaths occur within the first 2 hours of the onset of symptoms, before the person seeks or is able to obtain medical aid, and are due to arrhythmias rather than massive myocardial damage. Effective electrical and drug treatment of arrhythmias has reduced the hospital mortality but not the community mortality. If mortality from acute myocardial infarction and other causes of sudden unexpected death is to be reduced substantially a major reorganization of emergency medical services is needed so that the benefits of the modern coronary care unit can be provided to the patient as rapidly as possible. Public education in basic life support procedures to sustain life until advanced life support aid arrives is the first step towards the development of a more effective system of emergency cardiac care.     

Diarrheal diseases in the history of public health

While the public health threat of HIV/AIDS in developing countries has drawn increasing attention from the international community for more than two decades, other health problems such as diarrheal diseases continue to contribute to higher morbidity and mortality rates in much of the developing world. This literature review is an account of both the history and current risks associated with diarrheal diseases.     

1994-2013年我国孕产妇死亡率及其与孕产保健服务利用的关系

目的:了解我国孕产妇死亡率(MMR)、孕产保健利用率变化趋势,探究两者关系,为进一步降低我国MMR提供参考。方法:挖掘《中国卫生统计年鉴》及中国妇幼卫生相关监测数据,采用灰色关联分析探讨孕产妇死亡水平与孕产保健利用率关联性。结果:1994-2013年全国MMR由64.8/10万降至23.2/10万(下降64.2%),降幅农村高于城市;死因产科出血仍居第1位,羊水栓塞上升至第2位。孕产保健利用率上升,升幅农村高于城市,其中住院分娩率上升最快。关联分析显示全国和农村MMR与六项孕产保健利用率均呈明显负相关关系(P<0.01),城市MMR仅与住院分娩率呈显著负相关关系(P<0.01)。存在问题:MMR地区差异仍然存在;流动人口成为孕产保健重点人群。结论:二十年来我国MMR下降明显,但随着孕产保健利用效应最大化,未来仅依靠提高住院分娩率等措施来降低MMR的作用已非常有限,需思考新的策略与措施。     

Safe motherhood--a long way to achieve

Maternal mortality ratio (MMR) is the most important index for monitoring the progress of safe motherhood programmes. A retrospective analysis of all maternal deaths at RG Kar Medical College and Hospital, Calcutta from 1st January, 1995 to 31st December, 1997 was carried out. There were 29,563 live births and 203 maternal deaths giving cumulative MMR of 686.67 per 100,000 live births. Among the victims 25.6% were < or = 20 years of age, majority (73.4%) were unbooked, mostly from rural (59.6%) or urban slum (20.2%) and from low socio-economic status (59.6%). Most (60.10%) were multiparous and 50.74% patients died within 24 hours of hospital admission. Direct causes were responsible for 83.25%, indirect causes for 14.78% and unrelated causes for 1.97% of maternal deaths. Toxaemia was the leading cause (53.20%) of maternal mortality. Other important causes were haemorrhage (16.75%), sepsis (12.31%), severe anaemia (6.4%), infective hepatitis (1.47%) and heart disease (3.44%). In comparison to previous years no significant changes in MMR had been found though there were temporary decline in some years. The contribution of toxaemia in maternal deaths is significantly high and is on the rise. The other national and global pictures were reviewed. India is among the countries of high MMR and far away from achieving safe motherhood. Majority of deaths are preventable. The medical causes of maternal deaths are in fact, the end point of a longer chain of many underlying factors like low socio-economic status, poverty, illiteracy, high parity and inadequate or no health care. An active community-based health care system accessible to every mother with strong referral system is the most effective approach to achieve safe motherhood.     

On the state of the public ill health: premature mortality in the United Kingdom and Europe

Recently published data on mortality in the European Economic Community and Scandinavia convincingly showed that mortality among men and women aged 45-64 was considerably higher in the United Kingdom than elsewhere. This applied to deaths due to circulatory and respiratory disease, cancer, and all causes. For example, in 1980 in Scotland twice as many, or more, women aged 55-64 per 100 000 died of heart disease than in Belgium, Denmark, France, Greece, West Germany, the Netherlands, Norway, and Sweden. Reductions in mortality from all causes during 1950-80 in the United Kingdom did not match those in other countries, such as Finland and France. Whether the public in the United Kingdom knows about its relatively poor mortality state is doubtful. To secure improved funding of appropriate preventive and treatment services directed at reducing premature mortality, public awareness should be raised urgently so that politicians and political parties will respond quickly in a way that the problem demands.     

“Avoidable mortality” as an index of health care outcome: Results from the european community atlas of “Avoidable death”

The history of the European Community Atlas of “Avoidable Death” is given. Data from the second Atlas are presented. For all causes of death except asthma there was a decrease in mortality in the period 1980–1984 with respect to 1974–1978. Taking the EC as a whole as the standard (100) population the standardised mortality ratio (SMR) in Ireland in the period 1980-1984 for tuberculosis was 160, for asthma 180 and maternal mortality 58. Ireland had the highest mortality for tuberculosis in both time periods. Asthma mortality increased in all countries except Scotland between 1974–1978 and 1980–1984. Ireland had one of the highest declines in maternal mortality over the two time periods. Within Ireland tuberculosis mortality was highest in the Mid-Western Health Board and lowest in the North-Western Health Board. Asthma mortality was highest in the Western Health Board and lowest in the Mid-Western Health Board. Maternal mortality was highest in the Midland Health board and lowest in the Southern Health Board.     

An audit of perinatal mortality

Perinatal mortality rates are considered in the western world to be a quantitative barometer of maternity care. This 6-year prospective perinatal audit was conducted at a tertiary hospital in order to determine foetal outcome, and the common causes of foetal and early neonatal deaths. Of a total of 30,987 births, there were 469 stillbirths and 391 early neonatal deaths, giving a perinatal mortality rate of 27.7 per 1000 total births. The leading causes of stillbirths were the hypertensive disorders of pregnancy, abruptio placentae, diabetes mellitus, intrapartum foetal distress and lethal congenital anomalies. Neonatal deaths were mainly due to the respiratory distress syndrome (57.8%), birth asphyxia (22.2%) and sepsis (13.5%). A dedicated medical team, including a neonatologist, to manage pre-eclampsia, and more senior obstetric involvement in the labour ward are recommended.     

Maternal death in Papua New Guinea, 1984-1986

The life-time risk of maternal death in the developing world is about 500 times that for women in developed countries. This disparity is wider than for any other public health statistic. The causes of 304 maternal deaths occurring in the period 1984-1986 are reported; this most likely represents only 10% of the total occurring in Papua New Guinea. The maternal mortality rate is estimated at 7/1000 for the period. Figures for Simbu Province are given in more detail than are available for other parts of Papua New Guinea.     

母婴床旁护理在产科病房的应用及效果观察

目的：探讨母婴床旁护理在产科病房的应用及效果。方法我院在2011年1月至2012年1月所收治的240例母婴患者为试验对象,随机分为试验组和对照组,试验组母婴实施母婴床旁护理,对照组母婴接受常规的临床护理,对比分析两组母婴的临床护理效果。结果试验组母婴在新生儿护理机能掌握效果、健康育儿知识的正确率以及产妇及其家属的满意率等方面都显著优于对照组产妇,两组母婴的试验数据对比差异有统计学意义（ P〈0．01）。结论母婴床旁护理能提高产妇满意度,促进产妇掌握母婴保健知识和育儿技能,值得临床推广。