宁夏固原市原州区2006～2010年新生儿死亡原因分析

目的:了解原州区新生儿死亡情况并采取针对性的干预措施、提高产科和儿科的救治水平。方法:对辖区2006～2010年新生儿死亡时间地点、死因构成及相关因素进行回顾性分析。结果:出生窒息、早产及低出生体重、肺炎和其他先天异常是医院新生儿死亡的前4位原因;67.41%的新生儿在医院死亡;新生儿死前救治措施不适宜包括未按规范程序进行新生儿复苏、治疗和用药不规范、处理不及时、设施缺乏、未及时转诊和产、儿科缺乏沟通合作。结论:出生窒息是医院新生儿的首位死因。亟待加强基层产、儿科建设及基层医务人员的培训,提高新生儿的救治水平,加强产儿科合作是降低新生儿死亡率的关键。     

新生儿死亡情况评审资料分析

目的:了解新生儿死前在产科或儿科救治的情况及其死亡的直接原因或相关因素,为采取针对性措施提高产科和儿科的救治水平,降低新生儿死亡率提供依据。方法:对2006～2010年发生的109例死亡新生儿进行回顾性分析。结果:新生儿死亡占婴儿死亡的83.89%。早产和低出生体重、新生儿窒息、出生缺陷、新生儿肺炎是新生儿死亡的主要原因。结论:建立基层危重孕产妇、危重新生儿的急救通道,建立三级高危保健网络,提高新生儿疾病的诊疗技术,改善新生儿的监护环境,降低出生缺陷率,减少新生儿感染性疾病的发生,从而降低新生儿病死率。     

2005～2010年海南省城乡新生儿死亡监测分析

目的:分析海南省2005～2010年新生儿死亡监测资料,为确定今后新生儿保健工作重点提供依据。方法:比较城乡新生儿死亡率、死亡的主要死因及死亡前就医情况,了解海南省城乡新生儿死亡的现状。结果:2005～2010年海南省新生儿死亡率逐年下降,进一步分析显示城乡新生儿死亡率均有下降,而且每年农村新生儿死亡率均高于城市新生儿死亡率(P<0.01)。城市新生儿前四位的死因依次为早产低体重(34.27%)、出生窒息(24.48%)、先天异常(11.89%)和肺炎(3.50%),农村新生儿前四位的死因依次为早产低体重(41.81%)、出生窒息(15.20%)、肺炎(9.65%)和先天异常(9.16%)。新生儿死亡前就医城市住院率显著高于农村(P<0.01)。结论:海南省新生儿保健水平显著提高,城乡差异较大,加强农村围产期保健,提高儿科、产科的质量,扩大健康教育覆盖面是降低新生儿死亡率的重要措施。     

扶沟县崔桥乡1991-2002年5岁以下儿童生命监测分析

为掌握扶沟县崔桥乡5岁以下儿童死亡、死因及各年龄死亡率变化趋势,统计分析了1991-2002年12年监测上报的死亡登记及报表.结果:新生儿死亡率1998年最高为37.80‰,2002年16.61‰;婴儿死亡率1998年最高为48.82‰,2002年为23.99‰;1-4岁儿童死亡率1996年最高为2.68‰,2002年为1.09‰.历年新生儿与婴儿死亡构成比为66.67-100.00%;婴儿死亡与5岁以下儿童死亡构成比为50.00-93.04%.新生儿死因前5位依次为出生窒息、新生儿肺炎、早产低体重、先天异常、败血症.婴儿死因前5位依次为肺炎、出生窒息、早产低体重、先天异常、败血症.1-4岁儿童死因前5位依次为意外事故、溺水、脑炎、肺炎、意外窒息.5岁以下儿童死因前5位依次为肺炎、出生窒息、早产低体重、先天异常、败血症.     

2004年三明市5岁以下儿童死亡分析

目的:分析三明市5岁以下儿童死亡原因及保健服务状况,为降低死亡率提出有效干预措施。方法:按照《福建省5岁以下儿童死亡监测方案》,并进行了出生、死亡漏报审查,达到质控指标要求。结果:2004年三明市5岁以下儿童死亡率17.19‰,婴儿死亡率13.84‰,新生儿死亡率9.68‰。14岁儿童死因前5位顺位为溺水、肺炎、车祸、意外死亡、先天性心脏病(先心病);婴儿死因前5位顺位为早产和低出生体重、肺炎、出生窒息、其他先天性疾病、先心病;新生儿死因前5位顺位为早产和低出生体重、出生窒息、肺炎、其他先天性疾病、先心病。结论:有效降低儿童死亡率,应加强孕期保健及孕期监测,积极推广产科、儿科适宜技术,提高儿科医疗质量和急救技术;应提高儿童安全防范意识,减少意外事故发生;应提高产前诊断及筛查能力,降低缺陷儿出生率;应积极改善农村儿童的生存水平。     

扶沟县崔桥乡1991-2002年5岁以下儿童生命监测分析

为掌握扶沟县崔桥乡5岁以下儿童死亡、死因及各年龄死亡率变化趋势,统计分析了1991-2002年12年监测上报的死亡登记及报表。结果:新生儿死亡率1998年最高为37.80‰,2002年16.61‰;婴儿死亡率1998年最高为48.82‰,2002年为23.99‰;1-4岁儿童死亡率1996年最高为2.68‰,2002年为1.09‰。历年新生儿与婴儿死亡构成比为66.67-100.00%;婴儿死亡与5岁以下儿童死亡构成比为50.00-93.04%。新生儿死因前5位依次为出生窒息、新生儿肺炎、早产低体重、先天异常、败血症。婴儿死因前5位依次为肺炎、出生窒息、早产低体重、先天异常、败血症。1-4岁儿童死因前5位依次为意外事故、溺水、脑炎、肺炎、意外窒息。5岁以下儿童死因前5位依次为肺炎、出生窒息、早产低体重、先天异常、败血症。     

缙云县10年5岁以下儿童死亡分析

目的：掌握缙云县5岁以下儿童死亡情况及主要死因,探讨干预措施,进一步降低5岁以下儿童死亡率。方法：对缙云县10年儿童死亡情况、死因构成及死前保健等因素进行回顾性分析。结果：5岁以下儿童死亡率、婴儿死亡率、新生儿死亡均呈下降趋势（P〈0.01）;死因前5位主要是早产、出生窒息、先天异常、肺炎、溺水、先天性心脏病、意外窒息等;死前保健率逐步上升（P〈0.05）。结论：加强新婚体检、孕期保健、提高产科质量、强化新生儿窒息复苏新技术、提高儿科技术水平、普及妇幼保健知识是降低5岁以下儿童死亡率的关键。     

山西省1991～2004年新生儿死亡动态分析

目的:通过对山西省新生儿死亡率升降趋势的分析,为确定今后保健工作重点,制定降低新生儿死亡率提供依据。方法:通过比较新生儿死亡日龄、死亡动态、死亡的主要死因及死前保健服务情况,动态分析我省新生儿死亡的主要原因。结果:新生儿死亡率在1991年的基础上下降了55.59%,历年前5位死因为早产低出生体重、出生窒息、肺炎、先天异常及意外,但死因顺位有明显变化。结论:山西省新生儿死亡率呈先快后慢的趋势,死因顺位有明显变化,保健工作重点应做相应调整。     

115例新生儿死亡调查分析

针对１９９５年１月至１９９８年１２月期间,郑州市妇幼保健院５岁以下儿童死亡监测点新生儿死亡１１５例的监测资料进行分析,１９９８年比１９９５年新生儿死亡率下降了２７．２９％。前４位主要死因是出生窒息、肺炎、早产和低体重儿。早期新生儿死亡各占整体新生儿死亡的８０％,提示降低新生儿死亡率尤其是降低早产儿死亡率是降低婴儿和５岁以下儿童死亡率的关键。做好围产保健、产科、儿科三科联防,产科配备专职新生儿科医生     

132例新生儿死亡分析

对江西省南昌市某区妇幼保健所婴儿疾病监测点１９９１￣１９９５年１３２例新生儿死亡原因及时间进行回顾性调查分析。结果表明，新生儿死亡率为１４．４７‰，前４位死因依次为出生窒息、先天畸形、肺炎、早产儿和低出生体重。新生儿死亡无明显季节变化，死于出生后１周的占８４．８５％，而１周内死亡的新生儿中，５７．１４％是在出生后当天及第二天内死亡。     

Causes of death of adults and elderly and healthcare-seeking before death in rural Bangladesh

The health system of a country needs to be adjusted to patterns of morbidity and mortality to mitigate the income-erosion consequences of prolonged ill-health and premature death of adults. Population-based data on mortality by cause are a key to modifying the health system. However, these data are scarce, particularly for rural populations in developing countries. The objectives of this study were to determine the burdens of health due to major causes of death obtained from verbal autopsy of adults and the elderly and their healthcare-seeking patterns before death in a well-defined rural population. There were 2,397 deaths--613 were among adults aged 15-59 years and 1,784 among the elderly aged 60+ years--during 2003-2004 in the health and demographic surveillance area in Matlab, a rural area of Bangladesh. Trained interviewers interviewed close relatives of the deceased using a structured verbal-autopsy questionnaire to record signs and symptoms of diseases/conditions that led to death and medical consultations before death. Two physicians independently assigned the underlying causes of deaths with disagreements resolved by a third physician. The physicians were able to assign a specific cause in 91% of the cases. Rates and proportions were used for estimating the burden of diseases by cause. Of all deaths of adults and the elderly, communicable diseases accounted for 18% and non-communicable diseases for 66%, with the proportion of non-communicable diseases increasing with age. Leading non-communicable diseases were diseases of the circulatory system (35%), neoplasms (11%), diseases of the respiratory system (10%), diseases of the digestive system (6%), and endocrine and metabolic disorders (6%), all of which accounted for 68% of deaths. Injury and other external causes accounted for another 5% of the deaths. During terminal illness, 31% of the adults and 25% of the elderly sought treatment from medical doctors, and 14% of the adults and 4% of the elderly died in healthcare facilities. The findings suggest that the health managers and policy-makers of Bangladesh should recognize the importance of prevention and management of chronic diseases and place it on the health agenda for rural people.     

Social inequality and death as illustrated in late-medieval death dances.

Late-medieval murals and books of the then-popular "dances of death" usually represented the living according to their social standing. These works of art thus provide an interesting opportunity to study the relationship between social inequality and death as it was perceived by the works' commissioners or executers. The social hierarchy in these dances of death is mostly based on the scheme of the three orders of the feudal society; variations relate to the inclusion of female characters, new occupations, and non-Christian characters. Many dances of death contain severe judgments on highplaced persons and thus seem to be expressions of a desire for greater social equality. However, a more thorough analysis reveals that the equality of all before death that these dances of death proclaimed held nothing for the poor but only threatened the rich. Because of a lack of reliable data, it is not yet completely clear whether during the late Middle Ages all were indeed equally at risk for premature mortality. Available evidence, however, suggests that the clergy and nobility actually had a higher life expectancy than people placed lower in the social hierarchy. Despite modern changes in the perception of, and knowledge about, social inequality and mortality, these dances of death still capture the imagination, and they suggest that the phenomenon of socioeconomic inequalities in mortality could be used more to emphasize contemporary moral messages on social inequality.     

Good death and bad death in ancient Israel according to biblical lore

In the view of the ancient Israelites, as expressed in the Hebrew Bible, death is good or at least acceptable (1) after a long life, (2) when a person dies in peace, (3) when there is continuity in the relation with the ancestors and the heirs, and (4) when one will be buried in one's own land. Death is experienced as bad when (1) it is premature, (2) violent, especially when it is shameful (e.g., when a man is killed by a woman), (3) when a person does not have an heir, and (4) when one does not receive a proper burial. It is remarkable that in the literature of ancient Israel common elements like the cult of the dead and the belief in retribution after death, are not explicitly mentioned and therefore do not function as a comfort for death. Also, from a theological point of view emphasis is placed on this life. A positive attitude towards martyrdom is missing. This results in a way of coping with death which has many 'modern' elements or which may help modern people to face death.     

Contrasts in the multiple causes of stillbirth, neonatal death and postneonatal death.

A large sample of stillbirth and infant death certificates for England and Wales from 1979-81 was analysed for the frequency of appearance of maternal and fetal conditions anywhere on the certificate, not just as the underlying cause. The results suggest there is presently no need to extend the use of the new stillbirth and neonatal death certificates, introduced in 1986, to the postneonatal period. Periodic multicause analysis of the old style death certificate should be sufficient to reveal the detail of conditions incriminated in postneonatal deaths.     

Causes of death in Minamata disease: analysis of death certificates

Summary The causes of death in Minamata disease were analyzed and compared with those of control subjects. Of the 1422 Minamata disease patients in the Kumamoto Prefecture, 378 had died by the end of 1980. Of these 378, the first death occurred in 1954 with a peak incidence in 1956 when Minamata disease was officially reported for the first time. The number of deaths increased rapidly after 1972 with a second peak in 1976. The male: female ratio was 1.8: 1 and the mean age-at-death was 67.2 years (SD = ± 18.65). The mean age-at-death was younger in the cases of the initial outbreak than in those recently. There were, on the average, 2.8 causes of death per person. Of these cases, 157 (41.5%) had Minamata disease indicated on the death certificate, though 64 (16.9%) had Minamata disease coded as the underlying cause. Minamata disease and the noninflammatory diseases of the central nervous system (CNS) were the main underlying causes of death between 1954 and 1969, while, in the multiple cause data, pneumonia and non-ischemic heart disease were the most prevalent. Cerebrovascular diseases (18.0%) were the main underlying causes of death followed by malignant neoplasms (14.7%), cardiovascular diseases (14.1%) and Minamata disease (14.1%) in 1970 or later, while cardiovascular diseases (18.6%), Minamata disease (14.5%), cerebrovascular diseases (10.4%) and malignant neoplasms (7.1%) were the major multiple causes of death. As compared with the control, the proportions of deaths due to noninflammatory diseases of CNS and pneumonia were higher in the initial outbreak. Although the difference in the causes of death was less apparent recently, malignant neoplasms and hypertensive diseases tended to be lower. These results suggest that there is a need for a long-term follow-up of Minamata disease patients. The data also show the potential value of multiple causes of death coding in analyses of mortality.     

Life and death

In contrast with the other lectures given in the course on humanics and bioethics at the UOEH, which address the questions of life and death from the standpoint of the physician or the philosopher, this lecture considers these issues as seen by the cancer patient who has had a close encounter with death. The attitudes of Americans concerning abortion, the use of life-support systems, "mercy killings", suicide and the use of cancer chemotherapy are discussed with particular emphasis on restraints imposed by the courts, the churches and the family systems. An attempt is made to contrast the American and Japanese attitudes on these questions but this is difficult because of different cultural and religious backgrounds. The author describes his own experiences as a cancer patient who has approached death very closely and the changes in his own attitude toward life which results from the encounter with death. He also talks about the joy of being alive and describes his own experience with receiving cancer chemotherapy, the resulting discomfort and inconveniences and his feelings about a "tolerable" existence. Finally, the author considers the question of the "quality of life" for the cancer patient who has a violent reaction to certain forms of chemotherapy. This is a dilemma for the patient and the doctor who must consider the choice between death and a miserable existence.     

One or two types of death? Attitudes of health professionals towards brain death and donation after circulatory death in three countries

This study examined health professionals’ (HPs) experience, beliefs and attitudes towards brain death (BD) and two types of donation after circulatory death (DCD)—controlled and uncontrolled DCD. Five hundred and eighty-seven HPs likely to be involved in the process of organ procurement were interviewed in 14 hospitals with transplant programs in France, Spain and the US. Three potential donation scenarios—BD, uncontrolled DCD and controlled DCD—were presented to study subjects during individual face-to-face interviews. Our study has two main findings: (1) In the context of organ procurement, HPs believe that BD is a more reliable standard for determining death than circulatory death, and (2) While the vast majority of HPs consider it morally acceptable to retrieve organs from brain-dead donors, retrieving organs from DCD patients is much more controversial. We offer the following possible explanations. DCD introduces new conditions that deviate from standard medical practice, allow procurement of organs when donors’ loss of circulatory function could be reversed, and raises questions about “death” as a unified concept. Our results suggest that, for many HPs, these concerns seem related in part to the fact that a rigorous brain examination is neither clinically performed nor legally required in DCD. Their discomfort could also come from a belief that irreversible loss of circulatory function has not been adequately demonstrated. If DCD protocols are to achieve their full potential for increasing organ supply, the sources of HPs’ discomfort must be further identified and addressed.     

Fetal death and work in pregnancy

The relation between spontaneous abortion (n = 5010), stillbirth without congenital defect (n = 210), and working conditions was analysed in 22,613 previous pregnancies of 56,067 women interviewed, 1982-4, immediately after termination of their most recent (current) pregnancy. The 22,613 previous pregnancies were those in which at time of conception the women were employed 30 or more hours a week. Ratios of observed (O) to expected (E) fetal deaths after allowance by logistic regression for seven non-occupational confounding variables were calculated at four stages of pregnancy in 60 occupational groups and six main sectors for women whose work entailed various physical demands, environmental conditions, and exposure to chemicals. The O/E ratios for abortion were raised in the sales sector (1.13, p less than 0.05) and services sector (1.11, p less than 0.01) and for stillbirth in the sales sector (1.50, p less than 0.1). Substantially increased O/E ratios for late but not early abortion were found in operating room nurses (2.92, p less than 0.05), radiology technicians (3.82, p less than 0.01), and employees in agriculture and horticulture (2.40, p less than 0.05); in all categories the O/E ratio for stillbirth were also raised but only significantly (5.55, p less than 0.01) in the latter group. The O/E ratio for stillbirth was also raised in leather manufacture (3.09, p less than 0.01). In both individual and grouped analysis (the latter undertaken to minimise the possible effect of recall bias) significantly increased O/E ratios for abortion were found in women exposed to various high levels of physical stress, particularly weight lifting, other physical effort, and standing (p less than 0.01). Increased ratios for stillbirth at this level of significance (p less than 0.01) were found for other physical effort and vibration. Noteworthy chemical exposure was identified only in the health, services, and manufacturing sectors; the O/E ratio for stillbirth approached two in women exposed to solvents, almost all in manufacturing (p less than 0.01). In the latter sector exposed to solvents was also associated with an approximately 20% increase in abortion ratio at similar probability level.