Perinatal mortality in twins and factors influencing mortality in Japan, 1980--98

The perinatal mortality rate (PMR) in twins was analysed using Japanese vital statistics during the period 1980-98. There was a total of 1992 twin perinatal deaths. The PMR in twins significantly decreased from 91 per 1000 births in 1980 to 31 per 1000 in 1998. The PMR was higher in males than females, but the differences between the sexes decreased over time. It was significantly higher in the second-born than the first-born of the twins. The fetal death rate was 2.8 times higher in monozygotic than dizygotic twins. The PMR decreased to one-sixth for the maternal age group > or =40 years, one-fifth for <20 years, and between one-third and a half for 20--39 years during the period 1980--98. It was lowest for birthweights (BW) between 2500 g and 2999 g during the entire period; the PMR decreased with gestational age (GA) up to 38--39 weeks and increased thereafter. The effect of BW on the PMR was greater than that of GA except in the shorter GA group. The proportion of twin perinatal deaths with extremely low BW (<1000 g) increased from 50% in 1980 to 68% in 1998. Thus, the declining PMR was unlikely to be due to the improvement in BW in twins. It is likely that it is related to the improved medical management of twins during the perinatal period and the first week of life.     

Risk factors for early infant mortality in Sarlahi district, Nepal

OBJECTIVES: Early infant mortality has not declined as rapidly as child mortality in many countries. Identification of risk factors for early infant mortality may help inform the design of intervention strategies. METHODS: Over the period 1994-97, 15,469 live-born, singleton infants in rural Nepal were followed to 24 weeks of age to identify risk factors for mortality within 0-7 days, 8-28 days, and 4-24 weeks after the birth. FINDINGS: In multivariate models, maternal and paternal education reduced mortality between 4 and 24 weeks only: odds ratios (OR) 0.28 (95% confidence interval (CI) = 0.12-0.66) and 0.63 (95% CI = 0.44-0.88), respectively. Miscarriage in the previous pregnancy predicted mortality in the first week of life (OR = 1.98, 95% CI = 1.37-2.87), whereas prior child deaths increased the risk of post-neonatal death (OR = 1.85, 95% CI 1.24-2.75). A larger maternal mid-upper arm circumference reduced the risk of infant death during the first week of life (OR = 0.88, 95% CI = 0.81-0.95). Infants of women who did not receive any tetanus vaccinations during pregnancy or who had severe illness during the third trimester were more likely to die in the neonatal period. Maternal mortality was strongly associated with infant mortality (OR = 6.43, 95% CI = 2.35-17.56 at 0-7 days; OR = 11.73, 95% CI = 3.82-36.00 at 8-28 days; and OR = 51.68, 95% CI = 20.26-131.80 at 4-24 weeks). CONCLUSION: Risk factors for early infant mortality varied with the age of the infant. Factors amenable to intervention included efforts aimed at maternal morbidity and mortality and increased arm circumference during pregnancy.     

Infant mortality rates in single, twin and triplet births, and influencing factors in Japan, 1995–98

The infant mortality rate (IMR) was analysed among single, twin and triplet births during the period from 1995 to 1998 using Japanese Vital Statistics. This study also investigated the effects of order of multiple births and of birthweight on the IMR. Proportions of neonatal deaths among total infant deaths were about 1/2 for singletons and 3/4 for both twins and triplets. Thus, to reduce the IMR, intensive care of multiple births is likely to be very important during the first month of life. The IMR was higher in males than females for both singletons and twins, but not in triplets. Relative risks of the IMR in multiples relative to singletons were 5-fold in twins and 12-fold in triplets. The IMR was higher in the second-born (18 per 1000 live births) than the first-born (16) twin and higher in the third-born (51) than the first-born (31) and the second-born (34) triplet. The higher risk in the second-born than the first-born twin may be related to delivery complications. The IMR decreased rapidly as birthweight increased in singletons, twins, and triplets. IMRs for < or =1500 g were 2.4 per 1000 live births in singletons, 5.9 in twins and 6.1 in triplets. The corresponding proportions of infant deaths were 75%, 33% and 10% respectively. The higher relative risks of multiple births are almost entirely the result of the lower birthweight distribution among twins and triplets. To reduce the IMR, birthweight is an important factor in twins, triplets and singletons. The overall early neonatal death rate decreased as gestational age rose in singletons, twins and triplets. For birthweights <1000 g, higher IMRs were related to gestational ages of <28 weeks.     

Trends in mortality from intractable diseases in Japan, 1972-2004

PURPOSE: In 1972, the Ministry of Health, Labour and Welfare of Japan defined intractable diseases as those with unknown etiology, no established treatment regimens, and severe sequelae of physical, mental and social difficulties. Since then, the Ministry has promoted scientific research on these diseases and offered financial support to those suffering from their effects. The purpose of the present study was to analyze trends in deaths from the diseases in Japan over the period from 1972-2004. METHODS: For the selected intractable diseases with 100 deaths or more per year, crude (CDR) and direct age-standardized death rates (ADR) were computed using the national underlying-cause-of-death mortality database of Japan based on International Classification of Diseases. Joinpoint regression analysis was applied to identify significant changes in the trends. RESULTS: The CDRs in the latest observed year per 1 million persons/year) for males and females were 25.55 and 25.93, respectively, for Parkinson's disease, 5.41 and 6.92 for aplastic anemia, 0.87 and 3.50 for systemic lupus erythematosus, 2.93 and 2.36 for amyloidosis, 1.40 and 1.54 for polyarteritis nodosa, 1.34 and 1.61 for idiopathic thrombocytopenic purpura, and 1.02 and 0.74 for ulcerative colitis. The respective annual percentage changes (APCs) for males and females during the overall period decreased for ulcerative colitis (-5.2% and -7.5%), aplastic anemia (-3.6% and -3.7%), idiopathic thrombocytopenic purpura (-2.1% and -3.0%), and systemic lupus erythematosus (-0.9% and -2.6%), while the APCs increased for amyloidosis (+3.3% and +3.5%), polyarteritis nodosa (+3.2% and +4.0%), and Parkinson's disease (+0.7% in males alone). With the APCs in the latest trend phase, polyarteritis nodosa and Parkinson's disease in females showed appreciable declines; on the other hand, amyloidosis in males demonstrated the significant increase, and ulcerative colitis in males exhibited an apparent leveling off of the decline. CONCLUSION: The ADRs for most of the intractable diseases have declined significantly in Japan over the last 3 decades. The decline might be attributed in large part to improved diagnosis and treatment because of the lack of effective primary prevention measures. Support for the affected patients and further research on etiology and radical cure of the diseases must be considered necessary.     

Trends in infant mortality inequalities in the Americas: 1955-1995

STUDY OBJECTIVE:s: To describe overall and income related trends in infant mortality inequalities in the Region of the Americas from 1955 to 1995. DESIGN: Infant mortality rates (IMRs) were computed and their trends assessed by ordinary least squares. Overall trends in IMR inequalities among countries were analysed by comparing 10 year period IMRs, Gini coefficients, and Lorenz curves. Income related trends in IMR inequalities were assessed using 10 year period IMR ratios between the highest and the lowest quintiles of the per capita gross national product (GNP) distributions (adjusted for purchasing power). SETTING: Aggregated country data were used for all countries with over 200 thousand inhabitants (33 geopolitical units). The 10 year period midpoint IMR estimates used for the 1955-1995 time series were those published by the United Nations in 1997. MAIN RESULTS: IMRs decreased from 90.34 to 31.31 per 1000 live births between 1955 and 1995 at an average of 15.3 every 10 years. In contrast, Lorenz curves and Gini coefficients were similar for the five 10 year periods. After grouping by adjusted GNP distribution, a similar decreasing trend of IMR was observed in all groups. The rate ratio between the group at the lowest quintile and that at the highest quintile ranged from 4 to 5. The analysis of variance for repeated observations showed that there is a significant reduction in the IMR (F=130.18; p<0.01), that trends did not differ significantly among groups (F=1.16; p=0.32), and that they were approximately linear (F=155.83; p<0.01). CONCLUSIONS: Despite a sizable reduction in the infant mortality, whether or not income related, levels of IMR inequality among countries have remained almost constant between 1955 and 1995 in the Region of the Americas. Further analysis and focused interventions are needed to tackle the challenges of reducing these persistent mortality inequalities.     

Risk factors for infant mortality in Down's syndrome: a nationwide study

The aim of this study was to assess risk factors for the excessive infant mortality rates (IMR) of infants with Down's syndrome (DS). The study population included all 847 Jewish DS births in Israel during 1979-83 and 1987-91. Cases were identified through the National DS Registry. Data were abstracted from hospitalisation records. Ninety-one per cent of the DS diagnoses were confirmed by a cytogenetic analysis. The DS IMR were 24.3 times higher than in the general population. Major risk factors affecting DS IMRs were health status, time period of birth and residential arrangement of the infant. Other known risk factors for infant mortality, such as young maternal age, high birth order and low birthweight, had a weaker impact on IMR in the DS population. Our results imply that the current better survival of infants with DS is a function of the changing attitude towards this population. The study identifies a potential for further reduction in the mortality rates of DS infants, provided there is willingness to adopt a more active and supportive treatment and further changes in ethical codes of the public.     

Risk factors and measures of prevention of infant mortality

The authors analyze endo- and exogenous factors responsible for infant death during the first year of life. Biological anamnesis, conditions and life style were studied in 102 families which had infants dead during the first year of life. The data were collected by interviewing mothers and analyzing primary case histories of infants. Statistical processing of the results of social hygienic study distinguished 33 significant risk factors promoting infant death. Children born from mothers at a high risk of perinatal disease and in socially defective families are at a highest risk of neonatal death. Experience gained at pediatric health center No. 39 in Nizhnii Novgorod is described as the optimal structure of a territorial pediatric health center maximally realizing the measures aimed at prevention of neonatal mortality. This health center has a special department for infants, primary prevention center, and social public health service.     

Age-period-cohort analysis of lung cancer mortality in Japan, 1960-1995

The mortality data on lung cancer in Japan from 1960 to 1995 was analysed based on an age-period-cohort (APC) model. Though the APC model has an 'identifiable problem' caused by the relationship of age, period and cohort parameters, non-linear components of them revealed their original (separated) effects. They were: (1) non-linear age effects had a peak in 55-59 and 60-64 years old in males and 50-54 in females, (2) non-linear period effects were very small in both genders, (3) non-linear age and period effects were small enough to neglect compared with their linear effects, and (4) there were five parts of trends in Japanese lung cancer mortality in both genders in the non-linear birth cohort effects. The 1961-65 birth cohort effect seemed to increase differently from previous birth years. This trend should be monitored carefully.     

Risk factors of infant and child mortality in rural Burkina Faso

OBJECTIVE: The aim of the study was to quantify the effect of risk factors for childhood mortality in a typical rural setting in sub-Saharan Africa. METHODS: We performed a survival analysis of births within a population under demographic surveillance from 1992 to 1999 based on data from a demographic surveillance system in 39 villages around Nouna, western Burkina Faso, with a total population of about 30000. All children born alive in the period 1 January 1993 to 31 December 1999 in the study area (n = 10 122) followed-up until 31 December 1999 were included. All-cause childhood mortality was used as outcome variable. FINDINGS: Within the observation time, 1340 deaths were recorded. In a Cox regression model a simultaneous estimation of hazard rate ratios showed death of the mother and being a twin as the strongest risk factors for mortality. For both, the risk was most pronounced in infancy. Further factors associated with mortality include age of the mother, birth spacing, season of birth, village, ethnic group, and distance to the nearest health centre. Finally, there was an overall decrease in childhood mortality over the years 1993-99. CONCLUSION: The study supports the multi-causation of childhood deaths in rural West Africa during the 1990s and supports the overall trend, as observed in other studies, of decreasing childhood mortality in these populations. The observed correlation between the factors highlights the need for multivariate analysis to disentangle the separate effects. These findings illustrate the need for more comprehensive improvement of prenatal and postnatal care in rural sub-Saharan Africa.     

影响婴儿死亡的非疾病因素和高危疾病分析

目的 研究婴儿死亡的非疾病因素和高危疾病,探索进一步降低婴儿死亡率的措施.方法 对2001～2008年影响如皋市婴儿死亡的非疾病因素和高危疾病进行回顾性分析.结果 如皋市2001～2008年婴儿平均死亡率为8.38‰,新生儿平均死亡率为4.71‰.婴儿死亡非疾病因素:年龄越小、体重越低、一季度婴儿死亡率高,死于家中、途中占33.07%,一级医院、村卫生室诊断和未就医占35.90%.婴儿死亡高危疾病:先天畸形、肺炎、意外死亡、早产和低出生体重、出生窒息.结论 开展健康教育,加强孕前保健,落实围产期保健措施,提供连续高效的儿童保健服务,有效控制非疾病因素,可进一步降低婴儿死亡率.     

Risk factors for intestinal invasive amebiasis in Japan, 2003-2009

We determined yearly change in prevalence and risk factors for amebic colitis caused by intestinal invasive amebiasis among persons who underwent endoscopy and assessed differences between HIV-positive and HIV-negative persons in Japan. A total of 10,930 patients were selected for analysis, of whom 54 had amebic colitis. Prevalence was in 2009 (0.88%, 12/1360) compared with 2003 (0.16%, 3/1904). Male sex (odds ratio [OR] 8.39, 95% CI 1.99-35.40), age <50 years (OR 4.73, 95% CI 2.43-9.20), history of syphilis (OR 2.90, 95% CI 1.40-5.99), and HIV infection (OR 15.85, 95% CI 7.93-31.70) were independent risk factors. No differences in risk factors were identified between HIV-positive and HIV-negative patients. Contact with commercial sex workers was a new risk factor among HIV-negative patients. Homosexual intercourse, rather than immunosuppressed status, appears to be a risk factor among HIV-positive patients.     

Pregnancy outcome,infant mortality and mother's education in Piedmont from 1980 to 1995

The paper describes 1980-1995 trends in social differences in reproductive outcomes and infant mortality in Piedmont, Italy. By means of a logistic model, risk differences by mothers'educational level were calculated for low birthweight, stillbirth, neonatal, postneonatal and infant mortality in four time periods (1980-83, 1984-87, 1988-91, 1992-95). Odds ratios of low birthweight for children born to mothers in the lowest educational class compared to the highest are slightly increasing (from 1.43 to 1.57), while those between highest and intermediate educational groups are small and steady. After adjustment for selected confounding variables, for which data were available, these differences are confirmed. Differences in risk for neonatal mortality between highest and intermediate educational groups have strongly reduced from the beginning of the Nineties, while they have increased between highest and lowest classes. Adjusting for birthweight, differences disappear. Postneonatal mortality is strongly related to low educational level and differences are widening: OR for lowest educational level has increased from 1.96 to 2.60. Even within a fairly good health system, social differences are present. Hospital assistance has always been equitable to all new-borns; social differences generate in the environment where pregnant women and infants live. Due to the high attributable risk on infant mortality, reduction in social differences in low birthweight should be considered a priority in public health policy in Piedmont.     

Trends and regional variations in infant mortality rates in Japan, 1973-1998

OBJECTIVE: The purpose of the study was to investigate the trends and regional variations in infant mortality rates in Japan. METHOD: The data from 1973 to 1998 analysed in this paper were from the Vital Statistics Division, Ministry of Health, Labor and Welfare of Japan. RESULTS: Infant mortality rates declined significantly between 1973 and 1998 in all regions. Statistically significant differences in infant mortality rates among the regions were observed in 1973, 1974, 1976, 1977 and 1978. However, the regional differences in infant mortality rates were insignificant thereafter, indicating elimination of regional variations in infant mortality in Japan. CONCLUSION: The results of this study indicated declines in infant mortality rates in all regions, with elimination of regional variations in infant mortality in Japan in the last two decades. This may be attributable to both qualitative and quantitative improvements in health and medical services in Japan.     

Risk factors for mortality in non-pregnancy-related listeriosis

We examined non-pregnancy-related listeriosis cases in England and Wales reported to the Health Protection Agency between 1990 and 2009 (n=1864) using unconditional multivariate logistic regression analysis to identify factors independently associated with mortality. A subset analysis of cases between 2005 and 2009 (n=694) investigated the additional effect of antibiotic therapy on survival. In these cases particular malignancies, alcoholism, cardiovascular disease, increasing age, and treatment to reduce gastric acid secretion were positively associated with mortality. The absence of a concurrent condition and presence of autoimmune disease had a protective effect. The subset analysis identified illness in winter or spring as a risk factor and antibiotic therapy as a protective factor for mortality. The impact of antibiotic therapy, seasonality and reduced gastric acid status on survival should be further investigated. Policy-makers and clinicians need to more broadly advise those at risk of contracting this disease and dying as a consequence.     

Risk factors for early neonatal mortality

OBJECTIVE: To assess risk factors for early neonatal mortality. METHODS: A population-based case-control study was carried out with 146 early neonatal deaths and a sample of 313 controls obtained among survivals of the neonate period in the south region of the city of S?o Paulo, in the period of 8/1/2000 to 1/31/2001. Information was obtained through home interviews and hospital charts. Hierarchical assessment was performed in five groups with the following characteristics 1) socioeconomic conditions of mothers and families, 2) maternal psychosocial conditions, 3) obstetrical history and biological characteristics of mothers, 4) delivery conditions, 5) conditions of newborns RESULTS: Risk factors for early neonate mortality were: Group 1: poor education of household head (OR=1.6; 95% CI: 1.1;2.6), household located in a slum area (OR=2.0; 95% CI: 1.2;3.5) with up to one room (OR=2.2; 95% CI: 1.1;4.2); Group 2: mothers in recent union (OR=2.0; 95% CI: 1.0;4.2), unmarried mothers (OR=1.8; 95% CI: 1.1;3.0), and presence of domestic violence (OR=2.7; 95% CI: 1;6.5); Group 3: presence of complications in pregnancy (OR=8.2; 95% CI: 5.0;13.5), previous low birth weight (OR=2.4; 95% CI: 1.2;4.5), absence of pre-natal care (OR=16.1; 95% CI: 4.7;55.4), and inadequate pre-natal care (block 3) (OR=2.1; 95% CI: 2.0;3.5); Group 4: presence of clinical problems during delivery (OR=2.9; 95% CI: 1.4;5.1), mothers who went to hospital in ambulances (OR=3.8; 95% CI: 1.4;10.7); Group 5: low birth weight (OR=17.3; 95% CI: 8.4;35.6) and preterm live births (OR=8.8; 95% CI: 4.3;17.8). CONCLUSIONS: Additionally to proximal factors (low birth weight, preterm gestations, labor complications and unfavorable clinical conditions in gestation), the variables expressing social exclusion and presence of psychosocial factors were also identified. This context may affect the development of gestation and hinder the access of women to health services. Adequate prenatal care could minimize the effect of these variables.     

Risk factors for maternal mortality in five Kampala hospitals, 1980-1986

A case-control study assessing risk factors for maternal mortality was carried out in five Kampala hospitals covering a period of seven years (1 January 1980 to 31 December 1986). The major predictors of maternal mortality were the general condition on admission, the mode of delivery and the Apgar score of the newborn. These predictors indicate that women at high risk were those admitted to hospital for delivery in a poor state of health. We believe that the risk of maternal mortality can be reduced through appropriate action by health workers and that there is a need for a more complete view of risk factors for both maternal and perinatal mortality to be obtained through population-based studies rather than only those women who deliver in hospital.     

1995—2013年安顺市食源性疾病分析

目的分析近20年来安顺市食源性疾病发病规律以寻求降低食品风险的依据和食品安全措施。方法采用Excel2007和Epinfo软件对1995—2013年突发公共卫生事件报告管理信息系统中安顺食源性疾病报告事件作流行病学描述性和分析性研究。结果 1995—2013年共报告103起食源性疾病事件,发病3 587例,死亡61例。7、8月是高发季节。中毒原因以微生物为主,报告事件数为33起,占总事件数的32.04%（33/103）;中毒人数为1 419人,占总病例数的39.56%（1 419/3 587）。死亡原因以化学中毒尤其是鼠药中毒为主,占死亡病例的55.74%（34/61）;其次为不明原因死亡,占死亡病例的26.23%（16/61）。发病和死亡主要集中在农村人口中,中毒发病起数农村高于城市,中毒发病率城市高于农村（χ^2=153.077 8,P〈0.01）,但中毒病死率农村远高于城市（χ^2=28.177 8,P〈0.05）。结论安顺市食物中毒预防与控制重点在农村家庭与学校食堂,针对安顺市在高发季节对高发人群采取有效的干预措施可降低发病数和死亡数,以保障食品安全。