Death Records Research Articles

Using GIS and death records to inform statewide school-based diabetes prevention interventions in Michigan.

Background: One of modifiable risk factors of diabetes is unhealthy diet which is related to obesity. Individuals with childhood obesity are at higher risk of adulthood obesity. School-based diabetes prevention programs are important to reduce childhood obesity. When resources are limited, evidence-based priority need to be undertaken. However, data related to childhood obesity was not widely available, the study used diabetes-related death records as the proxy of diabetes burden. This study aimed to map and identify geographic variation of diabetes-related mortality rate by school district level in Michigan to be used for policy-relevant information.Design and Methods: This study used death records in Michigan. Diabetes-related mortality rate and years potential life lost (YPLL) was calculated at the school district level. Spatial autocorrelation local Moran’s I and geographically weighted regression were used to evaluate spatial pattern of age-adjusted diabetes-related mortality rate by school districts.Results: The age-adjusted diabetes-related mortality rate ranged from 17.0 (95% CI, 8.6-25.5) to 171.3 (95% CI, 135.9-206.7) deaths per 100,000 population. The YPLL per person ranged from 0 to 19.3 years (95% CI, 15.5-23.1). High rates of diabetes-related mortality rate and YPLL clustered in East central and Southeastern region of Lower Peninsula Michigan including Flint, Kearsley, Beecher, Westwood Heights, Detroit, Ecorse, River Rouge, Taylor, Allen Park and Lincoln Consolidated school districts.Conclusions: There was variation in diabetes burden examined by diabetes-related mortality rate and YPLL at the school district level within Michigan State. The high cluster can be prioritized for the intervention programs.Significance for public healthChildren with obesity are at higher risk of having obesity during their adulthood. Because obesity is related to diabetes, having diabetes school-based prevention program that focused on reducing childhood obesity as well as diabetes is very beneficial. With limited resources, priority has to be made by the government based on diabetes burden in the area. To evaluate diabetes burden, the study used diabetes death records as the proxy because data related to diabetes risk factors among school children are not available at the school district level, and limited data of diabetes prevalence among youth at sub-county level. Our finding suggests the potential of using diabetes death record as the proxy to describe diabetes burden at the school district level. The results indicated the variation and clusters of diabetes in Michigan, which can be used for priority of the program. This approach also can be used in other public health program using available secondary data to provide policy-relevant information.

Abnormal and Euthyroid Ranges of Thyroid Hormones in Serum and Liver Cancer Mortality: A Cohort Study.

This study aimed to evaluate the relationship of serum thyrotropin (TSH) and thyroid hormone concentration with liver cancer mortality. A cohort of 517,996 Korean adults, who did not have liver cancer at baseline and attended a health screening including free thyroxine (FT4) and TSH, were followed for up to 16 years. High and low TSH and FT4 were defined as those above the upper bound of reference interval and those below the lower bound of reference interval of their corresponding reference intervals, respectively. Mortality information was ascertained through National Death Records. The adjusted HR (aHR) with 95% confidence interval (CI) were estimated using a Cox proportional hazard model. During a median follow-up of 8.1 years, 376 deaths from liver cancer were identified. Subjects with low FT4 levels were associated with an elevated risk of liver cancer mortality with a corresponding multivariable aHR 2.25 (95% CI: 1.62-3.12) compared with those with normal FT4 levels. Within the euthyroid range, there was also a dose-dependent inverse relationship between FT4 level and liver cancer mortality (P < 0.001). Levels of TSH and free T3 had no significant association with liver cancer mortality. The risk of liver cancer mortality increased as FT4 level decreased, both within the normal and abnormal ranges of thyroid function. Thyroid function within the abnormal and normal ranges might affect liver cancer mortality. Further study is warranted to elucidate the role of thyroid hormone in development of liver cancer including the underlying biological mechanism.

Spatiotemporal patterns and trends of community transmission of the pandemic COVID-19 in South Asia: Bangladesh as a case study

South Asian (SA) countries have been fighting with the pandemic novel coronavirus disease 2019 (COVID-19) since January 2020. Earlier, the country-specific descriptive study has been done. Nevertheless, as transboundary infection, the border sharing, shared cultural and behavioral practice, effects on the temporal and spatial distribution of COVID-19 in SA is still unveiled. Therefore, this study has been revealed the spatial hotspot along with descriptive output on different parameters of COVID-19 infection. We extracted data from the WHO and the worldometer database from the onset of the outbreak up to 15 May, 2020. Europe has the highest case fatality rate (CFR, 9.22%), whereas Oceania has the highest (91.15%) recovery rate from COVID-19. Among SA countries, India has the highest number of cases (85,790), followed by Pakistan (38,799) and Bangladesh (20,065). However, the number of tests conducted was minimum in this region in comparison with other areas. The highest CFR was recorded in India (3.21%) among SA countries, whereas Nepal and Bhutan had no death record due to COVID-19 so far. The recovery rate varies from 4.75% in the Maldives to 51.02% in Sri Lanka. In Bangladesh, community transmission has been recorded, and the highest number of cases were detected in Dhaka, followed by Narayanganj and Chattogram. We detected Dhaka and its surrounding six districts, namely Gazipur, Narsingdi, Narayanganj, Munshiganj, Manikganj, and Shariatpur, as the 99% confidence-based hotspot where Faridpur and Madaripur district as the 95% confidence-based spatial hotspots of COVID-19 in Bangladesh. However, we did not find any cold spots in Bangladesh. We identified three hotspots and three cold spots at different confidence levels in India. Findings from this study suggested the “Test, Trace, and Isolation” approach for earlier detection of infection to prevent further community transmission of COVID-19.

Increased risk of death with codeine use in the elderly over 85 years old and patients with respiratory disease: A case-control study using retrospective insurance claims database.

To investigate the risk of mortality associated with exposure to codeine, considering various risk groups, using population-based national insurance claims data.National sample cohort data from the National Health Insurance Service of South Korea (2002-2013) was used in this case-control study. Cases were defined as patients with a death record between January 1, 2002 and December 31, 2013. Each case was matched to 10 controls based on age, sex, baseline comorbidities, and year of death. Definition of exposure was codeine prescription in 30 days prior to death and sensitivity analyses were performed for 15 and 60-day exposures. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were estimated using conditional logistic regression adjusting for benzodiazepine, other opioids, anesthetics, hypnotics, CYP2D6 inducer, CYP3A4 inducer, and the Charlson comorbidity index.A total of 19,341 cases and 185,700 matched controls were included. The overall risk associated with codeine use and mortality risk was not significant (aOR 1.08, 95% CI 1.00-1.16). Sensitivity analyses with different exposure time window also presented similar insignificant results. However, in the subgroup analyses, codeine use was associated with an increased risk of mortality in the >85-year-old age group (aOR 2.38, 95% CI 1.26-4.48) and patients with respiratory disease (aOR 1.29, 95% CI 1.17-1.42).Although no statistically significant association was found in codeine exposure and mortality risk between cases and controls, we demonstrated that the elderly over 85 years old and patients with respiratory disease are associated with a higher risk with codeine exposure. Therefore, a more cautious practice of codeine prescription in these groups might be needed.

Associated factors with death among young women exposed to intimate partner violence in Brazil

Abstract Objective The objective of this study was to identify associated factors with death among young women exposed to intimate partner violence in Brazil. Methods Case-control study used a linked database containing nearly 800,000 violence against women notifications in Notifiable Diseases Information System over the period 2011 to 2016 and 16,200 deaths over the period 2011 and September/2017. Cases were women from 15 to 29 years old with notification of violence by an current or former intimate partner and death for any basic cause. Controls were women of the same age group, type of notification and living in the same municipalities as the cases, but without death record in that period. Odds ratios were estimated by multivariate logistic regression. Results 790 cases and 50,870 controls were included in the study. Most of the young women died from aggression (58,2%), transport accidents (6,1%) and malignant neoplasms (3,8%). According to the bivariate analysis, age, pregnancy, race, education, area of residence, disability, place of violence, means of aggression, nature of violence and chronic violence were significant. The results of the multivariate analysis showed that the greatest odds of death were in women whose violence was perpetrated by a firearm, a sharp or blunt weapons and residents of rural areas. Young women with disabilities also had an increased chance of death. On the other hand, the higher educational level appeared as a protective factor against death. A big effort is necessary to develop strategies to prevent these announced deaths. These findings may contribute to the surveillance system for violence in health services and its performance with the serviceś network for women in situation of violence. Key messages Young women exposed to intimate partner violence who lived in rural areas had an estimated odds to death higher than they who lived in urban areas. The higher educational level was a protective factor against death in young women exposed to intimate partner violence.

Fatal farm injuries to Canadian children

Children on Canadian farms are at high risk for fatal injury. Ongoing surveillance of these deaths is required to affirm recurrent patterns of injury, and to determine whether historical approaches to prevention have resulted in declines in the occurrence of these traumatic events. We analyzed epidemiological patterns and trends in the occurrence of fatal pediatric farm injuries over 23 years. Records of deaths were obtained from the Canadian Agricultural Injury Reporting system. To contrast more recent data with injury patterns described historically, cases were compared between two time periods. An intentional consensus process was used to finalize key patterns and their clinical or social importance. 374 fatal farm injuries to children in Canada were identified over the 23 years of study; 253 in period 1 and 121 in period 2. While machinery and non-machinery causes of death varied between the two study periods, mean annual rates of fatal injury (approximately 4 per 100,000 children) remained similar. Notably emergent types of injury in recent years included those caused by all-terrain vehicles, skid steer loaders, and drownings. Observed declines in the numbers of fatal farm injuries are most likely attributable to analogous declines in the number of registered farms in Canada. Our findings call into question the effectiveness of pediatric farm safety initiatives that primarily focus on education. Second, while CAIR fatality data are maintained, surveillance of hospitalized injuries has been disbanded and the fatality records require updating. Only by doing so will such surveillance findings provide comprehensive information to inform prevention.

The civil registration system is a potentially viable data source for reliable subnational mortality measurement in India

IntroductionThe Indian national Civil Registration System (CRS) is the optimal data source for subnational mortality measurement, but is yet under development. As an alternative, data from the Sample Registration System...

Future projection of the health and functional status of older people in Japan: A multistate transition microsimulation model with repeated cross-sectional data.

Accurate future projections of population health are imperative to plan for the future healthcare needs of a rapidly aging population. Multistate‐transition microsimulation models, such as the U.S. Future Elderly Model, address this need but require high‐quality panel data for calibration. We develop an alternative method that relaxes this data requirement, using repeated cross‐sectional representative surveys to estimate multistate‐transition contingency tables applied to Japan's population. We calculate the birth cohort sex‐specific prevalence of comorbidities using five waves of the governmental health surveys. Combining estimated comorbidity prevalence with death record information, we determine the transition probabilities of health statuses. We then construct a virtual Japanese population aged 60 and older as of 2013 and perform a microsimulation to project disease distributions to 2046. Our estimates replicate governmental projections of population pyramids and match the actual prevalence trends of comorbidities and the disease incidence rates reported in epidemiological studies in the past decade. Our future projections of cardiovascular diseases indicate lower prevalence than expected from static models, reflecting recent declining trends in disease incidence and fatality.

Accuracy of identifying incident stroke cases from linked health care data in UK Biobank.

ObjectiveIn UK Biobank (UKB), a large population-based prospective study, cases of many diseases are ascertained through linkage to routinely collected, coded national health datasets. We assessed the accuracy of these for identifying incident strokes.MethodsIn a regional UKB subpopulation (n = 17,249), we identified all participants with ≥1 code signifying a first stroke after recruitment (incident stroke-coded cases) in linked hospital admission, primary care, or death record data. Stroke physicians reviewed their full electronic patient records (EPRs) and generated reference standard diagnoses. We evaluated the number and proportion of cases that were true-positives (i.e., positive predictive value [PPV]) for all codes combined and by code source and type.ResultsOf 232 incident stroke-coded cases, 97% had EPR information available. Data sources were 30% hospital admission only, 39% primary care only, 28% hospital and primary care, and 3% death records only. While 42% of cases were coded as unspecified stroke type, review of EPRs enabled a pathologic type to be assigned in >99%. PPVs (95% confidence intervals) were 79% (73%–84%) for any stroke (89% for hospital admission codes, 80% for primary care codes) and 83% (74%–90%) for ischemic stroke. PPVs for small numbers of death record and hemorrhagic stroke codes were low but imprecise.ConclusionsStroke and ischemic stroke cases in UKB can be ascertained through linked health datasets with sufficient accuracy for many research studies. Further work is needed to understand the accuracy of death record and hemorrhagic stroke codes and to develop scalable approaches for better identifying stroke types.

Applying Endoscopic Submucosal Dissection for Treating Early Gastric Cancer

Introduction: Endoscopic submucosal dissection (ESD) is a standard method for the treatment of early gastric cancer and low risk of lymph node metastasis. Its advantage is to obtain a higher negative edge rate than mucosal resection and less trauma than surgery. Objectives: The short-term prognosis, pathological anatomy and long-term survival of ESD patients in our center were analyzed. Methods: Descriptive research. The clinical records of patients with early gastric injury treated with ESD from January 2008 to June 2012 were reviewed. Results: There were 15 patients included, 8 males and 7 females. The median age was 70 years (45–88). Tumor location: 2 cases in the upper third, 5 cases in the middle third and 8 cases in the lower third. The median tumor size was 13.5 mm (6–21). Most injuries are IIc. Among the postoperative complications, 1 case of gastrointestinal bleeding was treated by endoscopy and 3 cases of gastric perforation (gastric anastomosis) were treated by surgery. The average hospitalization was 3 days (1–23). There was no death record after operation. 86.7% of the cases had a negative edge. One case was positive at the deep edge after subtotal gastrectomy, and the other case was positive at the lateral edge. A new ESD treatment was used. The median follow-up was 16 months (7–61), and there was no pathological death of tumor. One case of tumor recurrence (51 months) was treated surgically. Conclusion: ESD is an alternative to the treatment of early gastric injury, allowing a high proportion of negative edges.

Implication of Vaginal and Cesarean Section Delivery Method in Black–White Differentials in Infant Mortality in the United States: Linked Birth/Infant Death Records, 2007–2016

Racial/ethnic disparities in infant mortality (IM) continue to persist in the United States, with Black/African Americans (AA) being disproportionally affected with a three-fold increase in mortality compared to Whites. Epidemiological data have identified maternal characteristics in IM risk such as preeclampsia, eclampsia, maternal education, smoking, maternal weight, maternal socioeconomic status (SES), and family structure. Understanding the social gradient in health including implicit bias, as inherent in the method of labor and delivery and the racial heterogeneity, may facilitate intervention mapping in narrowing the Black–White IM risk differences. We aimed to assess the temporal/racial trends and the methods of delivery, mainly vaginal vs. cesarean section (C-section) as an exposure function of IM. The United States linked birth/infant death records (2007–2016) were used with a cross-sectional ecological design. The analysis involved chi squared statistic, incidence rate estimation by binomial regression model, and period percent change. Of the 40,445,070 births between 2007 and 2016, cumulative mortality incidence was 249,135 (1.16 per 1000). The IM rate was highest among Black/AA (11.41 per 1000), intermediate among Whites (5.19 per 1000), and lowest among Asian /Pacific Islanders (4.24 per 1000). The cumulative incidence rate difference, comparing vaginal to cesarean procedure was 1.73 per 1000 infants, implying excess IM with C-section. Compared to C-section, there was a 31% decreased risk of IM among mothers with vaginal delivery, rate ratio (RR) = 0.69, 95% confidence interval (CI): 0.64–0.74. Racial disparities were observed in the method of delivery associated with IM. Black/AA mothers with vaginal delivery had a 6% decreased risk of IM compared to C-section, RR = 0.94, 95% CI: 0.92–0.95, while Whites with vaginal delivery had a 38% decrease risk of IM relative to C-section, RR= 0.68, 95% CI: 0.67–0.69, p < 0.001. Infant mortality varied by race, with Black/AA disproportionally affected, which is explained in part by labor and delivery procedures, suggestive of reliable and equitable intrapartum assessment of Black/AA mothers during labor, as well as implicit bias marginalization in the healthcare system.

Literature review of verbal autopsy

An sudden death is a case that occurs without prior health complaints, so that its cause cannot be identified. On a death certificate, a doctor needs to state a cause of death, so an autopsy is usually required to confirm the cause of the sudden death. Implementation of autopsies in cases of sudden deaths at the forensic medicine installation of Dr. Soetomo Hospital during 2014-2016 periods was only around 12%. This research is a literature review. A verbal autopsy is suggested to be useful to determine a valid cause of a death; therefore, recording of deaths in the hospital will be more accurate. WHO has published various standards of verbal autopsies in 2012. Validation of the verbal autopsies by questionnaires has shown an acceptable diagnostic accuracy to identify a cause of death compared to a cause of death obtained from medical records.

Analysis of Hospital Deaths at Tertiary Care Teaching Hospital

Recording of Death and its causes constitute an important component of health information system. The study was conducted on 90 hospital deaths during the period of six months from July-December of 2017, at Great Eastern Medical School and Hospital. Males more than 60 years of age group were the major victims in our study. Improving primary health care facilities in rural areas may reduce the Mortality and Morbidity.

Integrative survival analysis with uncertain event times in application to a suicide risk study

The concept of integrating data from disparate sources to accelerate scientific discovery has generated tremendous excitement in many fields. The potential benefits from data integration, however, may be compromised by the uncertainty due to incomplete/imperfect record linkage. Motivated by a suicide risk study, we propose an approach for analyzing survival data with uncertain event times arising from data integration. Specifically, in our problem deaths identified from the hospital discharge records together with reported suicidal deaths determined by the Office of Medical Examiner may still not include all the death events of patients, and the missing deaths can be recovered from a complete database of death records. Since the hospital discharge data can only be linked to the death record data by matching basic patient characteristics, a patient with a censored death time from the first dataset could be linked to multiple potential event records in the second dataset. We develop an integrative Cox proportional hazards regression in which the uncertainty in the matched event times is modeled probabilistically. The estimation procedure combines the ideas of profile likelihood and the expectation conditional maximization algorithm (ECM). Simulation studies demonstrate that under realistic settings of imperfect data linkage the proposed method outperforms several competing approaches including multiple imputation. A marginal screening analysis using the proposed integrative Cox model is performed to identify risk factors associated with death following suicide-related hospitalization in Connecticut. The identified diagnostics codes are consistent with existing literature and provide several new insights on suicide risk, prediction and prevention.

Causes of Deaths in Northern Cyprus: Implications for Accurate Recording and Prevention of Deaths

Background: Reporting the causes of deaths completely and correctly is important to develop interventions for reducing death rates in populations. Objective: This study aimed to evaluate the death rates, major causes of deaths and accuracy of recording of death causes in Northern Cyprus between 2007 and 2016. Methods: Data on death rates and causes of deaths between 2007 and 2016 were collected. The data were analyzed using SPSS 23 vs to determine the trends in death rates and to evaluate the ranking of causes of deaths. Results: There was an overall decrease in crude death rates between 2007 and 2016. The proportion of deaths in Northern Cyprus varied in terms of gender and age between 2007 and 2016, with death rates greater in males compared to females (1.89 times greater in 2007) and with higher death rates in people of older ages compared to younger people. The most common cause of death was ischemic heart diseases in all years, except in 2008, where senility was reported as the most common cause of death. Conclusion: There were decreasing trends in mortality rates in Northern Cyprus, with ischemic heart diseases reported as the top cause of deaths in the population. Accurate and complete reporting must be ensured for effective health policies and reduction of health expenditures.

Abstract P2-16-28: Younger age at diagnosis as a prognostic factor in Latin American triple negative breast cancer treated with neoadjuvant chemotherapy

Abstract Background: Triple negative breast cancer (TNBC) typically affects younger women and is associated with an aggressive natural history and worse prognosis. Anthracycline and taxane-based neoadjuvant chemotherapy (NACT) is a standard treatment option for locally advanced TNBC. Althtough baseline and post-NACT clinical and pathologic data provide important prognostic information, the prognostic value of age remains controversial. We aim to evaluate the prognostic impact of age in the outcomes of Latin-American TNBC patients (pts) treated with NACT in a real world scenario.Methods: We performed a retrospective analysis of TNBC pts treated with NACT and surgery between 2011 and 2018 in an academic cancer center. Pts were divided into 2 groups: (A) those younger 40 years old (y) or less and (B) those who were older than 40y ate the time of diagnosis. Electronic records were reviewed for data on clinical and demographic characteristics, treatment and outcomes. Overall survival (OS) was calculated from the date of diagnosis to date of death or last data record and disease-free survival (DFS) was calculated from the date of diagnosis until the date of recurrence. The Kaplan-Meier method was used for survival analysis and the log-rank test to compare survival curves. Prognostic factors were evaluated using Cox regression.Results: We analyzed a cohort of 441 TNBC pts treated with anthracycline and taxane-based NACT followed by surgical resection. For the overall TNBC population, median age was 53.7 years (range: 24-84y), 70.3% had clinical T3-T4 tumor and 68.9% had positive axillary nodes. Groups A and B were comprised of 63 pts (14,3%) and 377 pts (85.5%), respectively. Mean age was 36.0 y for and 56.7 y for Groups A and B, respectively. Baseline characteristics were balanced between groups A and B, including the proportion of T3-T4 tumors (81.0 vs 68.4%, p = 0.052), and rates of clinically positive lymph nodes (76.2 vs 67.9%, p = 0.238). Complete pathological response rates were 20.6% and 30.7% (p = 0.134), for groups A and B, respectively. In the multivariate analysis, clinical T1-2 tumors (HR 0.49, 95%CI 0.28 - 0.84), clinical N0 staging (HR 0.50, 95%CI 0.29 - 0.87), and complete pathological response (HR 0.17, 95%CI 0.08 - 0.38) were associated with better prognosis, while younger age was significantly and independently associated with worse prognosis (HR 1.98, 95%CI 1.20 - 3.27).Conclusion: In Latin American patients with TNBC treated with NACT followed by surgery, the younger age at diagnosis was independently associated with worse prognosis. The inclusion of this under-represented subgroup of patients in future trials is essential to characterize their singularities allowing the development of personalized therapeutic strategies in this group of patients with poor prognosis. Citation Format: Maria FernandaVicentini Neffa, Guilherme Nader Marta, Abraao FerreiraLopes Dornellas, Alessandro Leal, Laura Testa. Younger age at diagnosis as a prognostic factor in Latin American triple negative breast cancer treated with neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-16-28.

Neonatal mortality in the United States is related to location of birth (hospital versus home) rather than the type of birth attendant

Planned home births have leveled off in the United States in recent years after a significant rise starting in the mid-2000s. Planned home births in the United States are associated with increased patient-risk profiles. Multiple studies concluded that, compared with hospital births, absolute and relative risks of perinatal mortality and morbidity in US planned home births are significantly increased. To explore the safety of birth in the United States by comparing the neonatal mortality outcomes of 2 locations, hospital birth and home birth, by 4 types of attendants: hospital midwife; certified nurse-midwife at home; direct-entry ("other") midwife at home; and attendant at home not identified, using the most recent US Centers for Disease Control and Prevention natality data on neonatal mortality for planned home births in the United States. Outcomes are presented as absolute risks (neonatal mortality per 10,000 live births) and as relative risks of neonatal mortality (hospital-certified nurse-midwife odds ratio, 1) overall, and for recognized risk factors. We used the most current US Centers for Disease and Prevention Control Linked Birth and Infant Death Records for 2010-2017 to assess neonatal mortality (neonatal death days 0-27 after birth) for single, term (37+ weeks), normal-weight ( >2499 g) infants for planned home births and hospital births by birth attendants: hospital-certified nurse-midwives, home-certified nurse-midwives, home other midwives (eg, lay or direct-entry midwives), and other home birth attendant not identified. The neonatal mortality for US hospital midwife-attended births was 3.27 per 10,000 live births, 13.66 per 10,000 live births for all planned home births, and 27.98 per 10,000 live births for unintended/unplanned home births. Planned home births attended by direct-entry midwives and by certified nurse-midwives had a significantly elevated absolute and relative neonatal mortality risk compared with certified nurse-midwife-attended hospital births (hospital-certified nurse-midwife: 3.27/10,000 live births odds ratio, 1; home birth direct-entry midwives: neonatal mortality 12.44/10,000 live births, odds ratio, 3.81, 95% confidence interval, 3.12-4.65, P<.0001; home birth-certified nurse-midwife: neonatal mortality 9.48/10,000 live births, odds ratio, 2.90, 95% confidence interval, 2.90; P<.0001). These differences increased further when patients were stratified for recognized risk factors. The safety of birth in the United States varies by location and attendant. Compared with US hospital births attended by a certified nurse-midwife, planned US home births for all types of attendants are a less safe setting of birth, especially when recognized risk factors are taken into account. The type of midwife attending US planned home birth appears to have no differential effect on decreasing the absolute and relative risk of neonatal mortality of planned home birth, because the difference in outcomes of US planned home births attended by direct-entry midwives or by certified nurse-midwives is not statistically significant.

Deaths, Hospitalizations, and Emergency Department Visits From Food-Related Anaphylaxis, New York City, 2000-2014: Implications for Fatality Prevention.

Food-induced anaphylaxis is potentially fatal but preventable by allergen avoidance and manageable through immediate treatment. Considerable effort has been invested in preventing fatalities from nut exposure among school-aged children, but few population-based studies exist to guide additional prevention efforts. To describe the epidemiology and trends of food-related anaphylaxis requiring emergency treatment during a 15-year span in New York City when public health initiatives to prevent deaths were implemented and to understand the situational circumstances of food-related deaths. Retrospective death record review and analysis of inpatient hospital discharges and emergency department (ED) visits in New York City residents, 2000-2014. Vital statistics data, medical examiner reports, ED, and hospital discharge data were used to examine risk for death and incidence trends in medically attended food-related anaphylaxis. Potentially preventable deaths were those among persons with a known allergy to the implicated food or occurring in public settings. There were 24 deaths, (1.6 deaths/year; range: 0-5), 3049 hospitalizations, and 4014 ED visits, including 7 deaths from crustacean, 4 from peanut, and 2 each from tree nut or seeds and fish exposures. Risk for death among those hospitalized or treated in the ED was highest for persons older than 65 years and for those treated for crustacean reactions (relative risk 6.5 compared with those treated for peanuts, 95% confidence interval = 1.9-22.1). Eleven of 16 deaths with medical examiner data were potentially preventable. Hospitalizations (2000-2014) and ED visit rates (2005-2014) were highest for children and those with peanut exposure and increased across periods. Deaths from food-related anaphylaxis were rare; however, rates of hospitalization and ED visits increased. Prevention efforts related to peanut allergies among children should continue, and additional attention is needed to prevent and treat anaphylaxis among adults, particularly those with known crustacean allergies where case fatality is highest.

Built Environments and Cardiometabolic Morbidity and Mortality in Remote Indigenous Communities in the Northern Territory, Australia.

The health of Indigenous Australians is dramatically poorer than that of the non-Indigenous population. Amelioration of these differences has proven difficult. In part, this is attributable to a conceptualisation which approaches health disparities from the perspective of individual-level health behaviours, less so the environmental conditions that shape collective health behaviours. This ecological study investigated associations between the built environment and cardiometabolic mortality and morbidity in 123 remote Indigenous communities representing 104 Indigenous locations (ILOC) as defined by the Australian Bureau of Statistics. The presence of infrastructure and/or community buildings was used to create a cumulative exposure score (CES). Records of cardiometabolic-related deaths and health service interactions for the period 2010–2015 were sourced from government department records. A quasi-Poisson regression model was used to assess the associations between built environment “healthfulness” (CES, dichotomised) and cardiometabolic-related outcomes. Low relative to high CES was associated with greater rates of cardiometabolic-related morbidity for two of three morbidity measures (relative risk (RR) 2.41–2.54). Cardiometabolic-related mortality was markedly greater (RR 4.56, 95% confidence interval (CI), 1.74–11.93) for low-CES ILOCs. A lesser extent of “healthful” building types and infrastructure is associated with greater cardiometabolic-related morbidity and mortality in remote Indigenous locations. Attention to environments stands to improve remote Indigenous health.

COVID-19: preparedness, challenges, public health concern and government efforts in nepal.

The COVID-19 is an infectious disease caused by the severe acute respiratory syndrome (SARS) viruses-2 first identified and became epidemic in the Wuhan city. World Health Organization (WHO) termed that disease as COVID-19 on February 11, 2020.Nepal confirmed 8 imported cases, no death record and 1 local transmission case reported till the April 4, 2020. Country is under the lockdown since March 24, 2020 for the prevention and control of the transmission of COVID-19. Massive contact tracing and rapid test should be done appropriately in proper time to fight against the COVID-19.There is the necessity to manage basic facilities in the quarantine and isolation for the people.