Death rates from stroke in England and Wales predicted from past maternal mortality

Geographical differences in maternal mortality in England and Wales during 1911-4 correlate closely with death rates from stroke in the generation born around that time. The geographical distribution of stroke is more closely related to past maternal mortality than to any leading cause of death, past or present, except ischaemic heart disease, for which correlation coefficients with stroke are similar. This relation is new evidence that poor health and physique of mothers are important determinants of the risk of stroke among their offspring.     

洪灾地区卫生服务供给效果及其影响因素分析

目的:研究洪灾地区卫生服务供给效果及其影响因素.方法:随机抽取洞庭湖区1998年发生过洪灾的55个乡镇作为研究单位,对该区的卫生服务供给效果以及影响因素进行分析.结果:调查地区法定传染病年报告总发病率为11.7‰,慢性病的患病率51.2‰,新生儿死亡率为10.2‰,婴儿死亡率为43.1‰,总死亡率为554.3/10万.人均卫生事业费投入与法定传染病报告发病率,婴儿死亡率以及总死亡率相关,受灾时间以及灾前人均收入对卫生服务效果有一定的影响.结论:加大灾区卫生事业费的投入,增加灾区居民收入,缩短被淹时间对灾区居民的健康将产生积极影响.     

Health trends in Jamaica. Significant progress and a vision for the 21st century

Health trends in Jamaica have improved considerably during the past century. Life expectancy at birth increased from 38 years in 1900 to 72 years in 2000. The crude death and infant mortality rates declined significantly from 35.7 and 174.3 deaths to 5.1 and 24.4 deaths, respectively, in the same period. The seven leading causes of death in 1945 were infectious diseases while the main causes of mortality and morbidity are now the chronic non-communicable lifestyle diseases, and injuries. Over the past few decades, considerable progress has been made in controlling vaccine preventable diseases and eliminating poliomyelitis and measles. Rates of infectious syphilis, congenital syphilis and gonorrhoea have declined significantly in recent years although chlamydia and herpes are common and the HIV/AIDS epidemic is a growing concern. Over the past few decades health expenditure has grown more rapidly in the private health sector than in the public health sector although services in the public sector are provided at significantly lower cost. Jamaica provides good health at low cost. However, more funds are needed to support the public health system. The current health reform process needs to be informed by a better understanding of the factors that have contributed to Jamaica's achievements in health and needs a clear health focus. The Ministry of Health has articulated a vision of health for the 21st century that requires a significant reorientation of health staff as well as empowering people to take responsibility for adopting healthy lifestyles.     

The health of Indians in Canadian cities: a challenge to the health care system

It is well known that Canadian native people living on reserves have high morbidity and mortality rates, but less is known about the health of those who migrated to urban centres. Several studies have shown that these people have high rates of mental health problems, specific diseases, injuries, infant death and hospital admission. In addition, there is evidence that cultural differences create barriers to their use of health care facilities. The low socioeconomic status, cultural differences and discrimination that they find in cities are identified as the primary blocks to good health and adequate health care. More epidemiologic studies need to be done to identify health problems, needs and barriers to health care. Federal, provincial and civic governments along with the appropriate departments of faculties of medicine should begin working with native organizations to improve the health of native people living in Canada's cities.     

Inequalities in women's health: looking at mortality differentials using an alternative approach

Data obtained from follow up of the 1971 census sample in the Office of Population Censuses and Surveys longitudinal study of England and Wales were used to look at women's mortality differentials at ages 15-59. Women were grouped by combining information on marital state, own occupation, husband's occupation (if married), economic activity, and indicators of household wealth (housing tenure and access to a car). Large groups were found with considerable differences in mortality. High mortality was associated with working in manual occupations and living in rented housing with no car in the household. In contrast, low mortality was associated with non-manual occupations and living in owner occupied housing with a car. Among married housewives and single women these extreme groups contributed 44% of expected deaths, the disadvantaged group experiencing death rates two and a half times that of the advantaged group. Smaller differences were found among married women with an occupational class. These findings are further evidence of the "health divide" in England and Wales and show that accurately to reflect the relation between a woman's life circumstances and mortality it is necessary to utilise other measures than those based solely on occupation.     

Childhood respiratory infection and adult chronic bronchitis in England and Wales

The high mortality from chronic bronchitis in England and Wales and the excess of urban over rural mortality are unexplained. On dividing England and Wales into 212 local authority areas a strong geographical relation was found between death rates from chronic bronchitis and emphysema in 1959-78 and infant mortality from bronchitis and pneumonia during 1921-5. It was concluded that this relation provided strong evidence of a direct casual link between acute lower respiratory infection in early childhood and chronic bronchitis in adult life. Regression analysis suggested that infection in early childhood had a greater influence than cigarette smoking in determining the geographical distribution of chronic bronchitis. National time trends reflected the influence of both factors. Chronic air pollution in adult life may be less important a cause of chronic bronchitis than previously supposed.     

Maternal predictors of infant health outcomes among Hawaiians

Disaggregated data, vital statistics, and a comprehensive literature review were used to assess the relationship between Hawaiian maternal predictors and infant health outcomes. Despite near universal health care coverage, Hawaiians continue to use less prenatal care, have average rates of low birth weight and the highest infant mortality rates compared to other ethnic groups in Hawaii. Specific investigations and interventions are necessary to reduce the disparity of Hawaiian infant health outcomes.     

Infant mortality in West Virginia. Identifying risk factors for public health intervention

Because infant death rates vary within populations, it is important for program managers and planners to identify high-risk subgroups for whom effective interventions can be targeted. Matching infant death certificates with birth records permits us to describe infant mortality and calculate risks by a variety of maternal and infant characteristics recorded at birth. In this paper, we illustrate how several variables are associated with infant death, and show how analysis of a recent birth cohort in West Virginia can assist health officials in determining appropriate strategies for risk reduction. While efforts need to focus on reducing social and economic barriers to maternal and infant health, different strategies are required to address separately the neonatal and postneonatal components of infant mortality. Matched records can be used in a variety of ways to develop support for, and highlight the needs of, West Virginia's Maternal and Child Health programs, to monitor trends over time, to evaluate program achievements, and to modify program goals.     

Postsurgical mortality in Manitoba and New England

Per capita hospital expenditures in the United States exceed those in Canada, but little research has examined differences in outcomes. We used insurance databases to compare postsurgical mortality for 11 specific surgical procedures, both before and after adjustment for case mix, among residents of New England and Manitoba who were over 65 years of age. For low- and moderate-risk procedures, 30-day mortality rates were similar in both regions, but 6-month mortality rates were lower in Manitoba. For the two high-risk procedures, concurrent coronary bypass/valve replacement and hip fracture repair, both 30-day and 6-month mortality rates were lower in New England. Although no consistent pattern favoring New England for cardiovascular surgery was found, the increased mortality following hip fracture in Manitoba was found for all types of repair and all age groups. We conclude that for low- and moderate-risk procedures, the higher hospital expenditures in New England were not associated with lower perioperative mortality rates.     

上海实施国家基本公共卫生服务项目十年效果评价

目的 上海自1997年开始探索建立基本公共卫生服务体系以来,逐步建立健全基本公共卫生服务的网络体系。通过梳理过去十年的基本公共卫生服务项目数据,了解上海实施基本公共卫生服务项目十年的实施效果,总结上海提供基本公共卫生服务的特点,为后期更有效的提供卫生服务提出政策意见。 方法 收集2009—2019年度上海实施基本公共卫生服务项目的数据,通过年度纵向分析,获得十余年间各项指标具体变化及整体趋势,通过Wilcoxon秩和检验比较本市全面推广家庭医生制度前后各项指标数值的差异。 结果 上海开展的国家基本公共卫生服务项目数历年始终为100%。十年间,居民健康档案的建档人数逐年上升至1 992.01万人。妇女、儿童、高血压和糖尿病患者等重点管理对象的服务数量均达到国家要求的水平,孕产妇死亡率下降至3.51/10万,婴儿死亡率下降至3.06‰。儿童健康管理率达到98.47%。高血压和2型糖尿病患者管理率分别达84.77%和87.37%。Wilcoxon秩和检验表明,家庭医生制度的落地之于孕产妇死亡率、婴儿死亡率的下降及早孕建册率、产后访视率、高血压管理人群血压控制率等指标的提高,差异均具有统计学意义(均P<0.05)。 结论 上海实施基本公共卫生服务项目取得了显著成效,但仍需在电子健康档案标准化建设、公共卫生经费监管考核机制、强化公共卫生服务人才的引进力度等方面继续改进。      

Population 70 million: a consideration of health aspects

A 70 million population for Malaysia by the year 2010 has been officially targeted for in the mid-term review of the Fourth Malaysia Plan, 1981-1985. In response to this, a preliminary investigation was undertaken into the health aspects of population growth; infant mortality rates are used as the health indicators. In recognition of the relevance of the medical, economic, and education factors to health, trends in Malaysia's population ratio, per capita gross national product (GNP), and rates of school enrollment are also drawn. The characteristics associated with low mortality and high life expectancy are identified as low population growth, high literacy, and high per capita GNP. Whatever the ideology--Malthusian or Marxist--there is no doubt that population is closely linked to development variables, of which health is a part. Linear regressions on West Malaysian trends show a very high correlation between percent school enrollment and number of medical doctors. Selected cross-country comparisons show that the real issue is not the size of the population but its pace of growth and the social and economic climate at the time. The most dramatic reduction in mortalities from 1957-1980 has been for infant mortality rates (IMR), which have fallen from 76 to 25/1000 live births. Significant control over IMRs has been achieved by effective treatment of malaria, smallpox, tuberculosis, whooping cough, and diarrheal diseases. Attempting a prediction on health outcome at population 70 million, various health statistics from selected countries near that population size were compiled. It is apparent that certain relevant features are associated with low infant mortalities and high life expectancy at birth: 1) low population growth rates, crude birth rates, and fertility; 2) high literacy rates; and 3) high per capita GNP. Overall, health improved for the nation as a whole, and this is highly correlated with school enrollment and health service ratios.     

政府购买贫困地区农村妇幼卫生服务的效果评价

目的:评价贵州省贫困地区农村实施政府合同购买妇幼卫生服务的效果,为卫生经费投入模式改革提供依据.方法:通过对试点乡镇与对照乡镇的住院分娩率、5次以上产前检查率、3次以上产后访视率、孕产妇系统管理率和1岁以内婴儿死亡率的横向比较和试点乡镇试点前后的纵向比较,评价项目实施的效果.结果:3个试点乡镇2005年孕产妇系统管理率、住院分娩率、5次以上产前检查率、3次以上产后访视率均显著高于实施前的2003年和2004年,一岁以下婴儿死亡率显著下降.与对照乡镇比较,试点乡镇前述各项指标均显著改善.结论:合同购买妇幼卫生服务显著促进了试点乡镇妇幼保健工作.     

生存率用作居民健康状况指标

x死亡统计为基础,反映居民健康水平的指标有一般死亡率、婴儿死亡率、平均期望寿命、标准化死亡率等。本文提出尚可用出生到15岁、15～65岁、65～80岁的生存率作为反映一地方的儿童期、青壮年期及老年期的健康水平的指标。这一指标的数值越大表示健康状况越好。除了婴儿死亡率外,其他指标表示全部人口的健康水平。现用不同年龄阶段的生存率后可得不同年龄阶段的健康状况。     

10年剖宫产率,指征及围产儿死亡率分析

目的：探讨剖宫产率、指征及围产儿死亡率的变化。方法：对１０年剖宫产病例进行回顾性分析。结果：剖宫产率逐年增高，而围产儿死亡率未相应下降。剖宫产指征变化以社会因素所占比例逐年增高为主。结论：围产儿死亡率进一步降低不能依靠剖宫产率的提高，而有待于围产保健水平的全面提高。     

Diet and inequalities in health in three English towns

The diets of 2340 middle aged men and women living in three English towns were recorded. Consumption of fat and the other main nutrients was lowest in the northern industrial town, which had the highest death rates from ischaemic heart disease and from all causes combined. The findings suggest that differences in diet in middle age are not a major cause of differences in adult mortality between one part of Britain and another.     

Infant homicide and accidental death in the United States, 1940-2005: ethics and epidemiological classification

Potential ethical issues can arise during the process of epidemiological classification. For example, unnatural infant deaths are classified as accidental deaths or homicides. Societal sensitivity to the physical abuse and neglect of children has increased over recent decades. This enhanced sensitivity could impact reported infant homicide rates. Infant homicide and accident mortality rates in boys and girls in the USA from 1940 to 2005 were analysed. In 1940, infant accident mortality rates were over 20 times greater than infant homicide rates in both boys and girls. After about 1980, when the ratio of infant accident mortality rates to infant homicide rates decreased to less than five, and the sum of infant accident and homicide rates became relatively constant, further decreases in infant accident mortality rates were associated with increases in reported infant homicide rates. These findings suggest that the dramatic decline of accidental infant mortality and recent increased societal sensitivity to child abuse may be related to the increased infant homicide rates observed in the USA since 1980 rather than an actual increase in societal violence directed against infants. Ethical consequences of epidemiological classification, involving the principles of beneficence, non-maleficence and justice, are suggested by observed patterns in infant accidental deaths and homicides in the USA from 1940 to 2005.     

An international data analysis on the level of maternal and child health in relation to socioeconomic factors

International data on health and socioeconomic factors were analyzed to understand the trends and the determinants of maternal and infant mortality in the late years. Multivariate analyses were carried out to summarize the structure of the data. Multiple regression analyses were also carried out with these two mortality rates as dependent variables. The range of independent variables included health resource availability, immunization, GNP, illiteracy rates, distribution in working area, the indicators of living standards such as percentage of telephone lines and television sets per capita and the percentages of working children, population with access to safe water and sanitation, people living in urban areas, among others. In the preliminary analysis the indicators of living standards appeared highly correlated to maternal and infant mortality. Working area (industrial or agricultural) showed also an important correlation. In factor analysis indirect variables (economic and living condition) were summarized into two factors. Two regression analyses were executed. In the first the variables were used directly, while factors obtained by the factor analysis were used in the second. The second analysis confirmed the previous analysis: fertility rate, immunization and urbanization appeared as determinants of maternal mortality. Birth rate, percentage of females working in agriculture and total illiteracy appeared as determinants of infant mortality. The factors extracted in the factor analysis made a significant contribution to the second regression analysis. We concluded: 1) The factors extracted by factor analyses from indirect variables had high explanatory ability on infant mortality rates, 2) The presence of immunization together with birth rate and fertility rate in the regression models pointed out the importance of investing in birth rate reduction and disease prevention methods.     

Inconsistencies in coding of race and ethnicity between birth and death in US infants. A new look at infant mortality, 1983 through 1985.

OBJECTIVE--To ascertain the consistency of the racial and ethnic classification of US infants between birth and death and its impact on infant mortality rates. SUBJECTS--All US infants born from 1983 through 1985 who died within a year. DESIGN--We used the national linked birth/infant-death computer tape, augmented with information on infants' race and ethnicity at death, to compare the coding of race and Hispanic ethnicity at birth and at death. We also assessed infant mortality rates by race and ethnicity as defined (1) by the standard algorithm and (2) by the rule that, beginning in published tabulations for 1989, assigns newborns the race of their mothers. Finally, we estimated infant mortality rates based on consistent coding of race and ethnicity at birth and death. RESULTS--Inconsistency in the coding of race is low for whites (1.2%), greater for blacks (4.3%), and greatest for races other than white or black (43.2%). Most infants reclassified at death (87.3%) are classified as white at death. Inconsistency in coding is lower for non-Hispanic whites (3.5%) and non-Hispanic blacks (3.3%) than for Hispanic populations (30.3%). Compared with the standard algorithm for calculation of infant mortality, consistent definition at birth and death produces rates 2.1% lower for whites, and higher for all other groups--3.2% for blacks, 46.9% for American Indians, 33.3% for Chinese, 48.8% for Japanese, 78.7% for Filipinos, and 8.9% for Hispanics. CONCLUSIONS--The coding of race and ethnicity of infants at birth and death is remarkably inconsistent, with substantial impact on the estimation of infant mortality rates. A need exists to reconsider the nature and definition of race and ethnicity in public health.     

广州市荔湾区5岁以下儿童死因分析及相关干预对策

目的分析荔湾区5岁以下儿童死亡的主要原因,为进一步完善孕产妇保健管理和儿童保健管理模式提供依据。方法对2009~2013年荔湾区5岁以下儿童死亡资料及相关报表进行回顾性分析。结果 5年间荔湾区总人口的5岁以下儿童死亡率5.28‰,婴儿死亡率4.25‰,新生儿死亡率2.94‰,均维持在较低水平。流动人口的儿童死亡率大于常住人口儿童死亡率(χ2=30.341、15.431、5.679,P<0.05)且波动较大。常住人口的男童死亡率5.43‰大于女童3.42‰(χ2=6.371,P<0.05)。早产或低出生体重、其他新生儿病、其他先天异常、肺炎是5岁以下儿童主要死因。流动人口孕产妇孕期建卡、孕期保健覆盖率低,儿童保健管理覆盖率低。结论应制定相应措施,加强流动人口孕产妇与儿童的保健管理和健康宣教,提高孕妇的自我保健意识与获取保健的行为,向贫困的流动人口孕妇及儿童提供基本的免费保健服务,从而降低5岁以下儿童死亡。     

Infant mortality in Delaware: the need to improve maternal health and reduce premature births

Delaware's high infant mortality rate continues to be driven by an increasing number of premature births. Premature birth is a complex problem with both social and medical roots. Based on the CDC road map, programs aimed at improving preconception health of women of childbearing age are blossoming in Delaware. In addition, Delaware's infant mortality rate can only be reduced if we are able to diminish disparities in health care delivery, and improve the social factors influencing infant mortality. These factors include diminishing family support, low high school graduation rate, poor housing, and a lack of health insurance.