Burden, timing and causes of maternal and neonatal deaths and stillbirths in sub-Saharan Africa and South Asia: Protocol for a prospective cohort study

OBJECTIVES: The AMANHI mortality study aims to use harmonized methods, across eleven sites in eight countries in South Asia and sub–Saharan Africa, to estimate the burden, timing and causes of maternal, fetal and neonatal deaths. It will generate data to help advance the science of cause of death (COD) assignment in developing country settings. METHODS: This population–based, cohort study is being conducted in the eleven sites where approximately 2 million women of reproductive age are under surveillance to identify and follow–up pregnancies through to six weeks postpartum. All sites are implementing uniform protocols. Verbal autopsies (VAs) are conducted for deaths of pregnant women, newborns or stillbirths to confirm deaths, ascertain timing and collect data on the circumstances around the death to help assign causes. Physicians from the sites are selected and trained to use International Classification of Diseases (ICD) principles to assign CODs from a limited list of programmatically–relevant causes. Where the cause cannot be determined from the VA, physicians assign that option. Every physician who is trained to assign causes of deaths from any of the study countries is tested and accredited before they start COD assignment in AMANHI. IMPORTANCE OF THE AMANHI MORTALITY STUDY: It is one of the first to generate improved estimates of burden, timing and causes of maternal, fetal and neonatal deaths from empirical data systematically collected in a large prospective cohort of women of reproductive age. AMANHI makes a substantial contribution to global knowledge to inform policies, interventions and investment decisions to reduce these deaths

Palliative care needs in patients hospitalized with heart failure (PCHF) study: rationale and design

Abstract Aims The primary aim of this study is to provide data to inform the design of a randomized controlled clinical trial (RCT) of a palliative care (PC) intervention in heart failure (HF). We will identify an appropriate study population with a high prevalence of PC needs defined using quantifiable measures. We will also identify which components a specific and targeted PC intervention in HF should include and attempt to define the most relevant trial outcomes. Methods An unselected, prospective, near-consecutive, cohort of patients admitted to hospital with acute decompensated HF will be enrolled over a 2-year period. All potential participants will be screened using B-type natriuretic peptide and echocardiography, and all those enrolled will be extensively characterized in terms of their HF status, comorbidity, and PC needs. Quantitative assessment of PC needs will include evaluation of general and disease-specific quality of life, mood, symptom burden, caregiver burden, and end of life care. Inpatient assessments will be performed and after discharge outpatient assessments will be carried out every 4 months for up to 2.5 years. Participants will be followed up for a minimum of 1 year for hospital admissions, and place and cause of death. Methods for identifying patients with HF with PC needs will be evaluated, and estimates of healthcare utilisation performed. Conclusion By assessing the prevalence of these needs, describing how these needs change over time, and evaluating how best PC needs can be identified, we will provide the foundation for designing an RCT of a PC intervention in HF

Relative status and well-being: evidence from U.S. suicide deaths

This paper empirically assesses the theory of interpersonal income comparison using individual level data on suicide deaths in the United States. We model suicide as a choice variable, conditional on exogenous risk factors, reflecting an individual's assessment of current and expected future utility. Our empirical analysis considers whether suicide risk is systematically related to the income of others, holding own income and other individual factors fixed. We estimate proportional hazards and probit models of the suicide hazard using two separate and independent data sets: (1) the National Longitudinal Mortality Study and (2) the Detailed Mortality Files combined with the 5 percent Public Use Micro Sample of the 1990 decennial census. Results from both data sources show that, controlling for own income and individual characteristics, individual suicide risk rises with reference group income. This result holds for reference groups defined broadly, such as by county, and more narrowly by county and one demographic marker (e.g., age, sex, race). These findings are robust to alternative specifications and cannot be explained by geographic variation in cost of living, access to emergency medical care, mismeasurement of deaths by suicide, or by bias due to endogeneity of own income. Our results confirm findings using self-reported happiness data and are consistent with models of utility featuring "external habit" or "Keeping Up with the Joneses" preferences.Income distribution ; Suicide

Family Views of End-of-Life Care in Acute and Community Hospitals

The Hospice friendly Hospitals Programme (HfH) commissioned this study to assess the quality of end-of-life care in acute and community hospitals from the perspectives of bereaved relatives. A major rationale for the study was to develop and test methodology to survey bereaved relatives' views of end-of-life care that covers the HfH Programme themes of Integrated Care, Communication, Patient Autonomy and Design & Dignity. Another driver was to inform the set-up of a Nationwide Audit of End-of-Life Care (McKeown et al., 2010).The overall aim of the study was to assess the quality of end-of-life care in two acute and two community hospitals from the perspectives of bereaved relatives. Study subobjectives were to conduct a literature review to ascertain important ethical and methodological issues; to describe a census of deaths across study sites; to field test a survey instrument aimed evaluating the impact of the Hospice friendly Hospitals (HfH) Programme; to collect data about HfH Programme themes; and to establish if there were any differences in the pattern of results between acute and community hospitals

Effect of marital status on death rates. Part 1: High accuracy exploration of the Farr-Bertillon effect

The Farr-Bertillon law says that for all age-groups the death rate of married people is lower than the death rate of people who are not married (i.e. single, widowed or divorced). Although this law has been known for over 150 years, it has never been established with great accuracy. This even let some authors argue that it was a statistical artefact. It is true that the data must be selected and analyzed with great care, especially for age groups of small size such as widowers under 25. The observations reported in this paper were selected and designed in the same way as experiments in physics, that is to say with the objective of minimizing the error bars for all age-groups. It will be seen that data appropriate for mid-age groups may be unsuitable for young age groups and vice versa. The investigation led to the following results. (1) The FB effect is basically the same for men and women, except that on average it is about 20\% stronger for men. (2) There is a marked difference between single or divorced persons on the one hand, for whom the effect is largest around the age of 45, and widowed persons on the other hand, for whom the effect is largest around the age of 25. (3) When different causes of death are distinguished, the effect is largest for suicide and smallest for cancer. (4) For young widowers the death rates are up to 10 times higher than for married persons of same age. This extreme form of the FB effect will be referred to as the "young widower effect." A possible connection between the FB effect and Martin Raff's "Stay alive" effect for cells in an organism is discussed in the last section.Comment: 30 pages, 17 figure

Tuberculosis in Scottish military veterans: evidence from a retrospective cohort study of 57 000 veterans and 173 000 matched non-veterans

Objective: Tuberculosis was a major cause of morbidity and manpower loss in the Armed Forces during World War II. Military control programmes commenced in the 1950s but were initially limited in scope by the many recruits who were already tuberculin positive on enlistment. The aim of our study was to examine whether veterans have an increased risk of tuberculosis compared with non-veterans. Methods: Retrospective cohort study of 57 000 veterans born 1945–1985, and 173 000 people with no record of military service, resident in Scotland, matched for age, sex and area of residence, using Cox proportional hazard analysis to compare the risk of tuberculosis overall, by birth cohort, length of service and year of diagnosis and to examine comorbidities. Results: Over mean 29 years follow-up, 69 (0.12%) veterans were recorded as having tuberculosis, compared with 267 (0.15%) non-veterans (unadjusted HR 0.90, 95% CIs 0.69 to 1.19, p=0.463). Only the 1945–1949 veterans' birth cohort was at higher risk, unadjusted HR 1.54, 95% CIs 0.98 to 2.45, p=0.061, although the difference in risk did not achieve significance. Veterans born from 1950 were at significantly reduced risk of tuberculosis compared with non-veterans after adjusting for deprivation, HR 0.67, 95% CI 0.47 to 0.95, p=0.026. The most common comorbidities were smoking-related and alcohol-related disease. The risk of comorbid hepatitis B or C was very low, in both veterans and non-veterans. No length of service was associated with an increased risk of tuberculosis in comparison with non-veterans. Conclusions: Scottish veterans born before 1950 are at moderately increased risk of tuberculosis compared with age, sex and geographically matched civilians with no record of service, although the difference is not statistically significant. Scottish veterans born from 1950 show a reduction in risk compared with civilians. Tuberculosis should be considered in the differential diagnosis of respiratory disease in the older veteran

Reconstruction of continuous series of mortality by cause of death in West Germany for the years 1968-1997

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A Review of the Quality of Health Care for American Indians and Alaska Natives

Documents healthcare disparities for American Indians and Alaska Natives and reports on recent progress made to reduce or eliminate gaps in care. Reviews initiatives on the treatment and control of specific medical conditions, and offers recommendations

Tracking Foodborne Pathogens from Farm to Table: Data Needs to Evaluate Control Options

Food safety policymakers and scientists came together at a conference in January 1995 to evaluate data available for analyzing control of foodborne microbial pathogens. This proceedings starts with data regarding human illnesses associated with foodborne pathogens and moves backwards in the food chain to examine pathogen data in the processing sector and at the farm level. Of special concern is the inability to link pathogen data throughout the food chain. Analytical tools to evaluate the impact of changing production and consumption practices on foodborne disease risks and their economic consequences are presented. The available data are examined to see how well they meet current analytical needs to support policy analysis. The policymaker roundtable highlights the tradeoffs involved in funding databases, the economic evaluation of USDA's Hazard Analysis Critical Control Point (HACCP) proposal and other food safety policy issues, and the necessity of a multidisciplinary approach toward improving food safety databases.food safety, cost benefit analysis, foodborne disease risk, foodborne pathogens, Hazard Analysis Critical Control Point (HACCP), probabilistic scenario analysis, fault-tree analysis, Food Consumption/Nutrition/Food Safety,

Results and observations from the reconstruction of continuous time series of mortality by cause of death

Though many countries have been collecting cause-of-death information from death certificates for more than a century, these valuable data sources remain underexplored. This is certainly due in part to the frequent revisions of the International Classification of Diseases (ICD), which have caused breaks in data continuity. This paper describes the methodological background and the results of the transition between the eighth and the ninth revision of ICD for the territory of former West Germany. Using practical examples, we examine the difficulties encountered and discuss the solutions applied.causes of death, mortality, West Germany