Dances of death: macabre mirrors of an unequal society

Objectives

Between 1400 and 1800, Dances of Death were a popular art form depicting a metaphorical encounter between Death and representatives of a stratified human society. We review the thematic development of Dances of Death and study the development of social critique.

Methods

We first assembled a full catalogue of all Dances of Death created between 1400 and 1800. We then analyzed patterns of spatiotemporal diffusion and made an in-depth hermeneutic study of the combined texts and images of a carefully selected set of 20 Dances of Death, comparing four distinct periods (1425–1525, 1525–1600, 1600–1650, and 1650–1800).

Results

We identified more than 500 Dances of Death. It was only in its first stage of development, coinciding with the Pre-Reformation (1425–1525), that social critique was very prominent. This was represented in four forms: explicit references to social (in) equality, to failures of the authorities, and to emancipated farmers, and a general social realism. In later phases social critique largely disappeared and was replaced by religious themes.

Conclusions

Dances of Death provide historical context to current analyses and debates of social inequalities in health. They remind us of the stubbornness of these inequalities, which despite progress in material well-being are still very much with us today.     

Follow-up study of recent graduates: the value of death education in their curriculum

Graduates from three coordinated dietetics programs who had participated in a research project in which a death education curriculum unit for dietetic students was developed, implemented, and evaluated, were mailed questionnaires to ask their opinion of their undergraduate preparation to work with terminally/seriously ill clients. Graduates agreed that including death education was important in their preparation as dietitians and suggested expanding the topics. For the subjects in this sample, neither death education as a student nor work experience with the dying since graduation has changed their attitude score on three scales: Death Fear, Disengagement from Death Fear, and Dietetic Attitude. Although this is a very small sample, the findings suggest that attitudes about death and working with the dying are resistant to change. Members of this group, both as students and as graduates, indicated that the unit was helpful to them in doing what they perceive as a difficult part of their job. This project suggests that developing support systems for students in their clinical experience and for professional dietitians to help manage the stress of working with seriously and terminally ill clients should be one of the goals of death education rather than trying to change attitudes toward death on either a pre-service or an in-service basis.     

Threats to the good death: the cultural context of stress and coping among hospice nurses

This study uses Australian data based on interviews with nurses and participant observation in an in-patient hospice and a community based hospice service to demonstrate how hospice nurses perceive stress in their work environment and cope with caring for dying patients. Stressors are discussed within a cultural context and are viewed as threats to the nurses' shared system of values which centres on the Good Death. The Good Death is conceptualised as a series of social events that involve the dying person as well as the other interactants who may include family, friends and health professionals. The death is defined as ‘good’ if there is an awareness, acceptance and preparation for death by all those concerned. The nurses' coping strategies and social supports are negotiated within the context of the hospice environment, and relate directly to the protection and affirmation of the nurses' shared value system.     

Comparability of mortality follow-up before and after the National Death Index

Prior to 1979, epidemiologic studies which included mortality follow-up on large cohorts relied on death certificates from last state of residence and expensive follow-up techniques to determine survival. Beginning with 1979, the National Death Index can be used to search death certificate files from all 50 states, the Virgin Islands, and Puerto Rico. This paper addresses the issue of whether mortality follow-up in epidemiologic studies based on a single state death certificate search using only data available in 1970-1975 can be compared with post-1979 mortality follow-up using the National Death Index. This question was addressed by following a cohort of 2,925 coronary heart disease and cerebrovascular disease 1980 hospital discharges from 1980 through 1983 with the use of both the National Death Index and the Minnesota Death Index (MINNDEX). Algorithms for evaluating potential death certificate matches were developed independently for both systems. The systems agreed on the survival status of 98% of the cohort, and both identified 31% as dead. This study supports the comparison of results of National Death Index follow-up to pre-National Death Index studies using algorithms such as the MINNDEX, and provides evidence that trend analyses relying on single state death searches pre-1979 and on the National Death Index from 1979 are valid, particularly in chronically ill persons.     

The experience of receiving a diagnosis of cystic fibrosis after age 20: implications for social work

Using the phenomenological approach of Van Manen, this study explored the lived experience of receiving a diagnosis of cystic fibrosis as an adult. Ten essential themes were generated from the stories of 36 participants: Awareness of Death, Change, Difference, Distraction, Family Indifference, Intrusion, Isolation, Normalizing, Time, and Uncertainty. Themes associated with gender, illness severity, and medical care were also developed. Although themes were similar to those in the chronic illness literature, late-diagnosis of CF was found to be a unique experience. Participants sought personal relationships with caregivers and educational materials targeted to their needs. Implications for social work are discussed.     

脑死亡判定精细化质控管理规范（2022版）

基于《全球脑死亡建议案:脑死亡/神经病学标准死亡的判定（2020年）》，国家卫生健康委员会脑损伤质控评价中心将质控重心转向脑死亡判定精细化管理。《脑死亡判定精细化质控管理规范（2022年）》包括质控体系、质控任务、质控流程、质控指标、质控技术、质控意见反馈、质控保密原则、病历记录规范、表单和报告单填写规范、质控管理指导共10个部分，使质控工作更加精准、严谨、系统和有序，确保脑死亡判定更加安全、可靠。     

The Experience of Receiving a Diagnosis of Cystic Fibrosis After Age 20

Abstract

Using the phenomenological approach of Van Manen, this study explored the lived experience of receiving a diagnosis of cystic fibrosis as an adult. Ten essential themes were generated from the stories of 36 participants: Awareness of Death, Change, Difference, Distraction, Family Indifference, Intrusion, Isolation, Normalizing, Time, and Uncertainty. Themes associated with gender, illness severity, and medical care were also developed. Although themes were similar to those in the chronic illness literature, late-diagnosis of CF was found to be a unique experience. Participants sought personal relationships with caregivers and educational materials targeted to their needs. Implications for social work are discussed.     

Surveillance of mortality among atomic bomb survivors living in the United States using the National Death Index

BACKGROUND: The National Death Index is a useful source to establish the death of an individual and to determine the cause of death. We identified deaths in atomic bomb survivors in the United States who were lost to follow-up through the National Death Index, and examined the completeness of mortality ascertainment in atomic bomb survivors in the US through the National Death Index. METHODS: Since 1977, biennial medical examinations of atomic bomb survivors in the US have been conducted. The 1,073 atomic bomb survivors in the US included 764 individuals who had medical examinations at least once in sixteen years from 1977 through 1993 and 309 individuals who reported atomic bomb survivorship to medical examination project themselves. Of the 1,073 survivors living in the US, 471 people who participated in the ninth health examinations of atomic bomb survivors living in the US in 1993 were removed, and two people among the remaining 602 individuals had no information about their birth dates and Social Security numbers. An investigation of those deceased between 1979 and 1993 was conducted among 600 of the atomic bomb survivors in the US. Death certificates for atomic bomb survivors in the US were requested from the National Death Index. A comparison was made between the information on the death certificates acquired through the National Death Index and the data ascertained from the medical examination project conducted from 1979 through 1993. RESULTS: Forty-nine death certificates were obtained using the National Death Index. By sex, the dominant cause of death in females was malignant neoplasm, accounting for 53%. In males, it was circulatory disease, accounting for 37%. The National Death Index and the medical examination project determined that 57 deaths had occurred between 1979 and 1993. The sensitivity and specificity of the National Death Index is 86% and 97% respectively. CONCLUSION: It is suggested that the National Death Index is useful to follow up mortality among atomic bomb survivors in the US.     

Dissection as a modulator of emotional attitudes and reactions of future health professionals

Context  There is ongoing discussion within the medical education community about dissection as an educational strategy and as a professional training tool in technical and emotional skills training.
Objectives  This study aimed to discover the emotional reactions, attitudes and beliefs of new students faced with human cadaver dissection; to evaluate the changes produced in these variables by the exhibition and practice of dissection; to analyse the level of anxiety students feel when faced with death, and to elucidate the possible relationships between these items.
Methods  The study used a sample of 425 students who were first-time enrolees in a human anatomy course. Three new instruments were designed, with items covering emotional reactions (cognitive, physiological and motor reactions), beliefs and attitudes related to what the student expects to experience or has experienced in dissection. Death anxiety was measured using the Death Anxiety Inventory.
Results  As students gained more experience of dissection, their emotional reactions were reduced and their attitudes and beliefs changed. Statistically significant differences in the level of death anxiety emerged, depending on the perceptions students had of their degree of preparation for dissection, and emotional control and deeper thoughts about life and death during dissection.
Discussion  The practice of anatomy allows the student to learn how to face up to and adapt his or her emotional reactions and attitudes; this gives human cadaver dissection great importance as an educational strategy and as a professional training tool in technical and emotional skills training.     

奉化市 2009—2011 年常住人口死亡漏报及死因监测质量评价简

[目的]了解奉化市死困监测工作的漏报情况,准确估计人群死亡率和婴儿死亡率。[方法]根据《全国疾病监测系统死因漏报调查方案》要求,采用捕获-标记-再捕获的原理,对样本乡镇2009--2011年的全部死亡病例进行回顾调查,通过“死因漏报系统”与《中国疾病预防控制信息系统》的死因报告登记系统进行比较,确定漏报率。[结果]样本镇经漏报调查确定死亡者共855例,经死因报告登记系统确定死亡者共853例,漏报2例,漏报率为0．23％。漏报调查死亡率为7．10‰。死者生前最高诊断单位为县级及以上医疗机构的比例为96．61％,未就诊比例为0．58％。编码不准确率为3．51％。[结论]奉化市2009--2011年全国疾病监测系统死因监测工作的漏报率较低,完整性较好,死因诊断质量可靠。     

What role do Death Doulas play in end‐of‐life care? A systematic review

Current health and social care systems do not always meet the needs of the dying in our communities. As a result, patients and families are choosing to place their trust in those who can advocate for them or fill the gaps in care. Birth Doulas have been working with women during pregnancy and after birth for many years, and we are now seeing a new role, that of a Death Doula emerging in the end‐of‐life care space. How Death Doulas work within health and social care systems is not understood and we conducted a systematic review to explore the published literature to explore the role and potential implications for models of care delivery. Following the PRISMA recommendations, we searched the literature in January 2018 via bibliographic databases and the grey literature without search date parameters to capture all published literature. We looked for articles that describe the role/work of a death doula or a death midwife in the context of end‐of‐life care, or death and dying. Our search retrieved 162 unique records of which five papers were included. We analysed the papers in relation to relationship to health service, funding source, number and demand for services, training, licensing and ongoing support, and tasks undertaken. Death Doulas are working with people at the end of life in varied roles that are still little understood, and can be described as similar to that of “an eldest daughter” or to a role that has similarities to specialist palliative care nurses. Death doulas may represent a new direction for personalised care directly controlled by the dying person, an adjunct to existing services, or an unregulated form of care provision without governing oversight.     

A comparison of the National Death Index and Social Security Administration databases to ascertain vital status

We compared vital status follow-up by the National Death Index and the Social Security Administration for a cohort of breast cancer patients. Only the National Death Index allowed follow-up for subjects with an unknown Social Security number. All of the deaths identified by the Social Security Administration were reported by the National Death Index. No subject reported to be alive by the Social Security Administration matched a National Death Index record. Subjects with inaccurate identifying information were more effectively followed up by the National Death Index. The National Death Index more accurately reported dates of death.     

Sharing the death process with the family: a nurse's experience in the pediatric ICU

Death is present in the daily reality of nurses who work with children in ICU. This research aimed to comprehend nurses' experience while taking care of children and his/her family experiencing the death process. Symbolic Interactionism was adopted as a theoretical reference framework, while Interpretative Interactionism was used as a methodological reference framework to analyze the biographical narratives of seven nurses who took part in the research. The events that determined the nurses' history in this context were: FACING THE DEATH OF THE CHILD, PROJECTING YOURSELF IN THE MOTHER'S ROLE and PROMOTING FAREWELL. The analyzed data made it possible to understand the nurses' experience in care for children and their families during the death process.     

Death anxiety and death competency: the impact of a palliative care volunteer training program

Before and immediately after the 2 most recent offerings of a local palliative care volunteer training program, 17 participants completed the Collett-Lester Fear of Death Scale and Bugen's Coping with Death Scale. The training program consisted of approximately 27 hours of training presented in 3-hour blocks during a 9-week period. Topics included the philosophy and goals of palliative care, spiritual issues from a multi-cultural and multifaith perspective, communication, the dying process, grief and bereavement, and the role of the volunteer. The results showed no differences in participants' pretraining and posttraining scores on the 4 subscales of the Fear of Death Scale. However, participants felt significantly more able to cope with death and dying after the training program than before. With proper training, volunteers will feel more prepared to handle situations involving terminal illness and death. In short, they will be more effective in their work with dying patients and their families.     

某矾矿职工死因特点调查分析

本文对某矾矿作业工人１９８６—１９９５十年间死亡原因进行回顾性调查。结果表明：该矾矿职工全死因死亡率为１１２３．９１／１０万，其中前三位死因分别为恶性肿瘤、呼吸系统疾病和脑血管病。恶性肿瘤死亡的前三位死因分别为食道癌、肺癌及肝癌。矾矿工人死亡水平高于该矿所在地居民的平均水平，主要死因与煤矿工人也有区别，呈现一定特点     

1996-2000年麻城市15～59岁人群伤害死亡和潜在寿命损失分析

目的探讨15～59岁人群伤害死因分布的特点,评价伤害对该人群造成的潜在寿命损失.方法数据来源于麻城市1996-2000年死亡报告系统,通过描述伤害死亡率,制定男女性全死因寿命表及去伤害死因寿命表,分析伤害造成的潜在寿命损失.结果男、女性死因顺位中损伤和中毒均为第二位,男女性伤害死亡率分别为75.60/10万和87.30/10万,分别占总构成的23.14%和31.37%.自杀是男女性第1位伤害死因,自杀死亡分别占男女性伤害死亡的49.9%和80.0%,死亡率分别为37.72/10万和69.84/10万.去除伤害死因后期望寿命达70.35岁和74.33岁.因伤害导致的潜在寿命损失年数女性和男性分别为52 860年和59 065年,潜在寿命损失率分别为27.97‰和33.48‰.结论15～59岁人群伤害死亡情况严重,其中自杀是造成伤害死亡的主要原因,对该人群的健康造成极大的损失,应采取干预措施控制15～59岁人群伤害死亡.     

Validation of Collett-Lester's Fear of Death Scale in a sample of nursing students

This study aims to evaluate the psychometric properties of Collett-Lester's Fear of Death Scale. A sample of 349 nursing students answered Fear of Death and Attitude toward death scales. Content validity was checked by expert review; reliability was proven using Cronbach's alpha; statistical analysis of the items, correlation between items and construct validity were checked by the correlation of the Scale with the Attitude toward death Scale. The multidimensionality of the scale was reviewed through factor analysis with varimax rotation. The Fear of Death Scale possesses good internal consistency and construct validity, confirmed by the significant correlation with the Attitude toward death Scale. Factor analysis partially supports content validity of the subscale items, but presented a modified multidimensional structure that points towards the reconceptualization of the subscales in this sample.     

贵州省中学生死亡焦虑影响因素分析

了解贵州省中学生死亡焦虑现状及其影响因素,为学校开展心理危机干预提供参考.方法 采用多阶段分层整群抽样的方法,在贵州省抽取3个地区共5 092名中学生,应用自编问卷、中文版死亡焦虑量表(Templer-Death Anxiety Scale,T-DAS)进行调查,数据采用SPSS 17.0和AMOS 21.0进行因子分析及构建结构方程模型.结果 中学生死亡焦虑总平均分为(7.28±3.02)分,其中非常害怕死亡、担心疾病的发生会带来死亡压力与痛苦、常会想到生命的短暂和会因为想到死亡而烦恼的中学生分别为2 702(53.06%),3 126(62.16%),2 890(56.76%)和2 248名(44.15%).不同性别、民族、学段及地区的中学生死亡焦虑得分差异均有统计学意义(P值均<0.05).危险因素中对死亡焦虑影响作用最大的是社会欺辱,总效应为0.10;其次是生死经历,总效应为0.01.保护因素为学校生命教育和亲密的家庭氛围,对死亡焦虑影响作用大小均为0.06.结论 贵州省中学生死亡焦虑的总体水平较高,社会欺辱对死亡焦虑的影响较为明显.学校需注重生命教育及心理健康教育;父母应重视家庭氛围的活跃性,多与孩子进行心理层面的交流.     

Evaluation of death certificate-based surveillance for traumatic brain injury--Oklahoma 2002

OBJECTIVES: Death certificate data are used to estimate state and national incidence of traumatic brain injury (TBI)-related deaths. This study evaluated the accuracy of this estimate in Oklahoma and examined the case characteristics of those persons who experienced a TBI-related death but whose death certificate did not reflect a TBI. METHODS: Data from Oklahoma's vital statistics multiple-cause-of-death database and from the Oklahoma Injury Surveillance System database were analyzed for TBI deaths that occurred during 2002. Cases were defined using the Centers for Disease Control and Prevention (CDC) ICD-10 code case definition. In multivariate analysis using a logistic regression model, we examined the association of case characteristics and the absence of a death certificate for persons who experienced a TBI-related death. RESULTS: Overall, sensitivity of death certificate-based surveillance was 78%. The majority (62%) of missed cases were due to listing "multiple trauma" as the cause of death. Death certificate surveillance was more likely to miss TBI-related deaths among traffic crashes, falls, and persons aged > or = 65 years. After adding missed cases to cases captured by death certificate surveillance, traffic crashes surpassed firearm fatalities as the leading external cause of TBI-related death. CONCLUSIONS: Death certificate surveillance underestimated TBI-related death in Oklahoma and might lead to national underreporting. More accurate and detailed completion of death certificates would result in better estimates of the burden of TBI-related death. Educational efforts to improve death certificate completion could substantially increase the accuracy of mortality statistics.