Mortality Crisis Research Articles

The economics of pandemics: Some useful lessons from the past

The mortality crisis induced by historical pandemics has had relevant effects. It expressed a regulatory role in the balance between population and available resources. It reduced the human capital available to work, making greater its bargaining capacity, resulting in an increase in wages. The disappearance of some of the landowners favoured a process of unification of landed properties and a concentration of wealth. The regulatory function of economic processes fostered by the mortality crisis is attenuated with the start of the Industrial Revolution, to the point of almost extinguishing itself in today's pandemic crisis. This notwithstanding, the strategies to combat mortality impose high economic costs and intervene to alter the functionality of a globalized economy. Pandemics continue to represent an element of caesura between historical periods, with a clear distinction between a before and an after. This article describes past pandemics and identifies possible lessons that can be drawn in the economic field from those events, being aware of how distant our connected and globalized world is from those times. Covid-19 has so far caused the deaths of more than two million people. In relative terms the figure is very low in comparison to previous pandemics. The much lower mortality is matched by an incomparable economic damage.

Excess Mortality Estimation

Estimating the mortality associated with a specific mortality crisis event (for example, a pandemic, natural disaster, or conflict) is clearly an important public health undertaking. In many situations, deaths may be directly or indirectly attributable to the mortality crisis event, and both contributions may be of interest. The totality of the mortality impact on the population (direct and indirect deaths) includes the knock-on effects of the event, such as a breakdown of the health care system, or increased mortality due to shortages of resources. Unfortunately, estimating the deaths directly attributable to the event is frequently problematic. Hence, the excess mortality, defined as the difference between the observed mortality and that which would have occurred in the absence of the crisis event, is an estimation target. If the region of interest contains a functioning vital registration system, so that the mortality is fully observed and reliable, then the only modeling required is to produce the expected deaths counts, but this is a nontrivial exercise. In low- and middle-income countries it is common for there to be incomplete (or nonexistent) mortality data, and one must then use additional data and/or modeling, including predicting mortality using auxiliary variables. We describe and review each of these aspects, give examples of excess mortality studies, and provide a case study on excess mortality across states of the United States during the COVID-19 pandemic.

Why Aren't We Using Family Medicine to Help Confront the Maternal Mortality Crisis in the United States?

Why Aren't We Using Family Medicine to Help Confront the Maternal Mortality Crisis in the United States?

Substance use and psychiatric phenotypes of youth experiencing homelessness: A cluster analysis.

Due to the complex interactions of psychopathology, psychosocial stressors, and risk behaviors, characterizing high-risk phenotypic groups of transitional-age youth experiencing homelessness (TAY-EH) for targeted interventions remains difficult. We aimed to uncover specific phenotypes of TAY-EH based upon psychiatric and substance use disorder (SUD) diagnoses, and to assess relationships between these phenotypes and negative outcomes including suicidality and high-risk behaviors. Participants (N = 140; 57% male, 54% Black) were individuals aged 16-25 years accessing support at a psychosocial agency in the U.S. Northeast. Data were gathered via structured assessment. Cluster analysis identified sub-groups of TAY-EH with differing diagnostic patterns. Bivariate analyses examined associations between cluster membership and target outcomes. A four-cluster solution was identified. Cluster 1 (Co-occurring; N = 33) was characterized by high levels of comorbidity (i.e., major depressive disorder (MDD), SUD, and notable levels of other diagnoses). Clusters 2 (MDD alone; N = 47) and 3 (SUD alone; N = 18) were characterized by single diagnoses. Cluster 4 (None; N = 42) was characterized by low levels of psychopathology. Clusters differed significantly on several variables including suicidality, adverse childhood experiences, and social connectedness. Comorbid MDD and SUD were most strongly associated with high-risk behaviors and suicidality. These results highlight the importance of diagnosis and targeted interventions for co-occurring MDD and SUD to address the crisis of early mortality and other negative outcomes among TAY-EH. This study is the first to identify specific high-risk psychiatric and psychosocial phenotypes among the highly complex group of TAY-EH based upon structured diagnostic assessments.

Overdose as a complex contagion: modelling the community spread of overdose events following law enforcement efforts to disrupt the drug market

BackgroundThe opioid overdose mortality crisis in the USA is an ongoing public health epidemic. Ongoing law enforcement strategies to disrupt local unregulated drug markets can have an iatrogenic effect of...

Analysis of the impact of coronavirus infection on human health: epidemiological data, vaccination strategies, psychological aspect, consequences (literature review)

The COVID-19 (COronaVIrus Disease 2019) pandemic has caused widespread morbidity, mortality, and socioeconomic crisis around the world. Since its first outbreak in 2019, COVID-19 has evolved continuously, leading to the emergence of several variants that have gained greater transmission efficiency, severity, and immune evasion properties. Vaccination has proven to be an important strategy to control the spread of the virus and mitigate its impact. The development of multiple COVID-19 vaccines within 1 year of the virus's emergence was unprecedented. The purpose of the article was to analyze and summarize the scientific literature on the impact of COVID-19 on global health, including epidemiological data, vaccination strategies, psychological impact of the pandemic, and human health outcomes. The analysis found that COVID-19 vaccination has been very effective in reducing morbidity, hospitalizations and intensive care unit admissions. However, ongoing surveillance, monitoring of options and adaptive vaccination strategies are crucial to maximize the benefits of vaccination and effectively control the spread of the virus. Globally, the dramatic and rapid spread of COVID-19 has triggered social changes that have led to an increased burden of mental health and fear-related behaviors. The physical and social distancing imposed in many parts of the world has had a significant impact on how the general population communicates and interacts with each other. Extreme avoidance of the lack of social contact has created a sense of "disconnection" that has been further exacerbated by the inability to meet friends and family at social gatherings and supportive places such as churches, restaurants, workplaces, and sports facilities. The closure of schools and many businesses, along with rising unemployment, further exacerbated feelings of isolation, financial hardship, anxiety, and depression. The article provides information on the mental impact of COVID-19 on patients, namely, the virus contributes to mental distress, anxiety, depression, suicide risk, post-traumatic stress disorder, cognitive impairment and sleep disorders. Keywords: COVID, spread, vaccines, anxiety, depression.

Population screening for cirrhosis.

In response to the growing health crisis of liver-related morbidity and mortality, screening for liver cirrhosis has emerged as a promising strategy for early detection and timely intervention. By identifying individuals with severe fibrosis or compensated cirrhosis, screening holds the promise of enhancing treatment outcomes, delaying disease progression, and ultimately improving the quality of life of affected individuals. Clinical practice guidelines from international scientific societies currently recommend targeted screening strategies, investigating high-risk populations with known risk factors of liver disease. While there is good evidence that screening increases case finding in the population, and a growing number of studies indicate that screening may motivate beneficial lifestyle changes in patients with steatotic liver disease, there are major gaps in knowledge in need of clarification before screening programs of cirrhosis are implemented. Foremost, randomized trials are needed to ensure that screening leads to improved liver-related morbidity and mortality. If not, screening for cirrhosis could be unethical due to overdiagnosis, overtreatment, increased health care costs, negative psychological consequences of screening, and futile invasive investigations. Moreover, the tests used for screening need to be optimized toward lower false positive rates than the currently used FIB-4 while retaining few false negatives. Finally, barriers to adherence to screening and implementation of screening programs need to be elucidated. This review provides a comprehensive overview of the current landscape of screening strategies for liver cirrhosis and the promises and pitfalls of current methods for early cirrhosis detection.

Thirty Years of Midwifery Education in the Rural and Diverse State of New Mexico.

The purpose of this article is to discuss the evolution of the University of New Mexico (UNM) Nurse-Midwifery Education Program, its impact on New Mexico communities, and the vision moving forward for the program in a rural and culturally diverse state. New Mexico has a rich history of community-based midwifery and the UNM Nurse-Midwifery Education Program, founded in 1991, is rooted in this tradition. Graduates are prepared to practice in rural and underserved communities, advance birth equity, and decrease perinatal health disparities. Faculty have advanced the program mission to improve the health and well-being of New Mexico families through diversifying the midwifery workforce, growing community collaboration, and engaging in research and scholarship activities aimed at promoting access to care. Program faculty recognize the critical need to address factors underpinning the rising maternal morbidity and mortality crisis, including rurality, poverty, and structural racism. These efforts have yielded positive results, with 60% of program graduates serving New Mexico communities and increasingly diverse midwifery student cohorts (70% of currently enrolled students). Efforts to support midwifery student success are bolstered through a recently awarded Health Resources and Services Administration Maternity Care Nursing Workforce Expansion grant. Through such endeavors, the program will continue to strive toward social justice and human dignity.

Khat consumption and undernutrition among adult population in Ethiopia: A systematic review and meta-analysis.

In Ethiopia, malnutrition is a public health threat causing a significant burden of morbidity, mortality, and economic crisis. Simultaneously, khat consumption is alarmingly increasing among adults, yet it might contribute to the existing burden of malnutrition, where the current evidence is inconclusive. Hence, this review was to estimate the association between khat consumption and undernutrition among adults in Ethiopia. A comprehensive search for Google, Google Scholar, and PubMed, coupled with a thorough manual search of the literature, was done up to date, October 18, 2023, using relevant search terms: "impact," "effects," "khat chewing," "khat consumption," "Ethiopia," "nutritional status," and "undernutrition." An updated PRISMA guideline was used to select relevant literature. The extracted data was summarized in narrative summaries, descriptions, and meta-analyses. The risk of bias was assessed. The results are presented in forest plots and funnel plots to assess publication bias. A pooled effect size (odds ratio) with a 95% certainty level was reported. While a total of 17 articles (n = 45,679) were included in the narrative review, only 15 articles were included in the quantitative meta-analysis. The majority of studies had a low and moderate risk of bias (based on risk of bias assessment tool), mainly due to unclear exposure assessment and high study heterogeneity. A total of 11 studies were cross-sectional studies (71%), three were comparative studies (17.4%), and three were case control studies (17.4%). There is a higher risk of publication bias as evidenced by the funnel plot. Overall, five studies were from the Oromia region, and three studies were conducted at the national level. Overall, chewing had been shown to significantly increase the risk of undernutrition by 53% (pooled OR = 1.53; 95% CI: 1.09-2.16) under a random effect model. Under the fixed effect model, higher weight was given to national-level studies with higher samples, where chewing contributed to a 12% increased risk of undernutrition (AOR = 1.12; 95% CI: 1.01-2.23). Hence, khat chewing could raise the odds of undernutrition by 12-53%. There is evidence of an association between khat chewing and an increased risk of undernutrition among adults in Ethiopia, which highlights the need for public health interventions to address the potential adverse effects of khat chewing on nutritional status.

The 1919–21 influenza pandemic in Greenland

ABSTRACT In Alaska, the 1918–20 influenza pandemic was devastating, with mortality rates up to 90% of the population, while in other arctic regions in northern Sweden and Norway mortality was considerably lower. We investigated the timing and age-patterns in excess mortality in Greenland during the period 1918–21 and compare these to other epidemics and the 1889–92 pandemic. We accessed the Greenlandic National Archives and transcribed all deaths from 1880 to 1921 by age, geography, and cause of death. We estimated monthly excess mortality and studied the spatial-temporal patterns of the pandemics and compared them to other mortality crises in the 40-year period. The 1918–21 influenza pandemic arrived in Greenland in the summer of 1919, one year delayed due to ship traffic interruptions during the winter months. We found that 5.2% of the Greenland population died of the pandemic with substantial variability between counties (range, 0.1% to 11%). We did not see the typical pandemic age-pattern of high young-adult mortality, possibly due to high baseline mortality in this age-group or remoteness. However, despite substantial mortality, the mortality impact was not standing out relative to other mortality crises, or of similar devastation reported in Alaskan populations.

Dental health status of the medieval silver-mining community from Kutná Hora (Czech Republic, 13th–16th c.): Impact of socioeconomic changes and mortality crises

ObjectiveThe aim of the study was to evaluate the pathological conditions in teeth from skeletal remains found in the medieval burial ground at Kutná Hora (13th–16th centuries, Czech Republic). We focused on the effect on dental health of socioeconomic changes associated with the boom in silver mining at the site. DesignIn this study, dental caries and antemortem tooth loss were recorded for 469 sexed adults (10,558 permanent teeth). Pathologies were analysed and presented by teeth and alveoli, and the differences between their frequencies were tested in sex-, age-, and burial context-separated groups (mass vs. individual graves). ResultsThe oral conditions were characterised by a low frequency of caries and moderate frequency of antemortem tooth loss (AMTL). For caries, males and females showed the same frequencies while AMTL comparisons indicated a higher rate in females. Most differences emerged between age-separated and burial context-separated groups. The age progression of the pathologies was confirmed for both caries and AMTL. Skeletons from mass burials had higher caries and AMTL frequencies than those buried in individual graves. ConclusionsThe dataset exhibited low caries and below average AMTL rates compared to other medieval European skeletal series. We think that life in this mining centre had a positive effect on the dental health of its inhabitants. The relatively poorer dental health of those buried in mass graves reflected either the specific composition of the population in the first half of the 14th century or the lower resilience of these individuals when facing mortality crises.

US exceptionalism? International trends in midlife mortality.

Rising midlife mortality in the USA has raised concerns, particularly the increase in 'deaths of despair' (due to drugs, alcohol and suicide). Life expectancy is also stalling in other countries such as the UK, but how trends in midlife mortality are evolving outside the USA is less understood. We provide a synthesis of cause-specific mortality trends in midlife (25-64years of age) for the USA and the UK as well as other high-income and Central and Eastern European (CEE) countries. We document trends in midlife mortality in the USA, UK and a group of 13 high-income countries in Western Europe, Australia, Canada and Japan, as well as seven CEE countries from 1990 to 2019. We use annual mortality data from the World Health Organization Mortality Database to analyse sex- and age-specific (25-44, 45-54 and 55-64years) age-standardized death rates across 15 major cause-of-death categories. US midlife mortality rates have worsened since 1990 for several causes of death including drug-related, alcohol-related, suicide, metabolic diseases, nervous system diseases, respiratory diseases and infectious/parasitic diseases. Deaths due to homicide, transport accidents and cardiovascular diseases have declined since 1990 but saw recent increases or stalling of improvements. Midlife mortality also increased in the UK for people aged 45-54year and in Canada, Poland and Sweden among for those aged 25-44 years. The USA is increasingly falling behind not only high-income, but also CEE countries, some of which were heavily impacted by the post-socialist mortality crisis of the 1990s. Although levels of midlife mortality in the UK are substantially lower than those in the USA overall, there are signs that UK midlife mortality is worsening relative to that in Western Europe.

Expanding Medical Education to Include Substance Use Disorders During Pregnancy and Postpartum: Preliminary Effectiveness of a Pilot Curriculum for Medical Students.

To effectively combat the simultaneous overdose and maternal mortality crises, a multimodal approach is needed. The aim of this study is to evaluate the preliminary effectiveness of a pilot, experiential learning, substance use disorder (SUD) curriculum embedded into a third-year medical student obstetrics and gynecology clerkship to improve self-reported confidence in SUD clinical skills. This SUD curriculum was designed and implemented in an outpatient clinic, which provides integrated obstetric, gynecologic, and addiction medicine services for pregnant and parenting people with SUD. Third-year medical students on their obstetrics and gynecology clerkship rotated 1 full day through the OB MOTIVATE clinic between August 2020 and April 2022 and completed this curriculum. Students completed preclinic assignments and in-clinic tasks (eg, practicing SBIRT under supervision: screening, brief intervention, referral to treatment). Paired t tests assessed changes in outcomes, with increasing scores (range 1-5) demonstrating improvement. Sixty-three students rotated through the OB MOTIVATE clinic; 57 completed the curriculum and surveys. Results from the self-assessment tools demonstrated significant improvements in confidence in SUD clinical skills, including performing SBIRT (2.46 ± 0.80 vs 4.07 ± 0.59, P < 0.01), motivational interviewing (2.98 ± 0.86 vs 4.16 ± 0.65, P < 0.01), using evidence-based medicine (2.91 ± 1.09 vs 4.23 ± 0.66, P < 0.01), and collecting an SUD history (3.25 ± 1.04 vs 4.35 ± 0.55, P = 0.01). The integration of interventional curriculums into medical school and residency programs could be an effective avenue to reinforce addiction knowledge and teach new skills. This practical 1-day pilot curriculum demonstrated preliminary effectiveness at introducing third-year medical students to the complexities of SUD in pregnancy and postpartum. Further investigations of feasible and acceptable SUD educational interventions are warranted.

Subjective Well-Being and Burnout Among the Maternal and Child Health Workforce.

This study investigates burnout and subjective well-being among the Maternal and Child Health (MCH) workforce, considering recent events such as the Dobbs decision, the maternal mortality crisis, and the COVID-19 pandemic. An anonymous web-based, cross-sectional survey was conducted among 313 MCH professionals in the United States. Data were collected using validated measures, including the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and the Oxford Happiness Questionnaire (OHQ) short scale. Sociodemographic characteristics and factors associated with burnout and subjective well-being were examined using univariate statistics and multivariable models. Analysis revealed moderate levels of burnout among MCH professionals, particularly in emotional exhaustion. However, subjective well-being levels were relatively high. After controlling for covariates, significant associations were found between subjective well-being and burnout dimensions, as well as sociodemographic factors such as sex and race. The study's findings indicate that higher subjective well-being is significantly associated with lower burnout, emotional exhaustion, and higher personal accomplishment. Variations in burnout and well-being are also influenced by sociodemographic factors such as age, sex, race, and occupation. Tailored interventions addressing the specific needs of MCH professionals are essential for building a resilient workforce. Organizational reforms and legislative measures are crucial for fostering supportive workplace environments and ensuring access to care and services amidst workforce challenges.

Maternal Mortality: A National Institutes of Health Pathways to Prevention Panel Report.

The National Institutes of Health's (NIH) Pathways to Prevention panel on postpartum health provides a consensus statement on the evidence, research gaps, and future priorities to prevent maternal morbidity and mortality. The panel reviewed an NIH-commissioned evidence review and workshop that included epidemiologic studies, demonstration interventions, and other maternal morbidity and mortality research to create these national recommendations. The panel concludes that a maternal morbidity and mortality crisis reflects a systemic failure of current U.S. health care, research efforts, and social policies. The panel recommends improving maternal health through a "maternal morbidity and mortality prevention moonshot" that adopts a comprehensive, multilevel life course conceptual framework; strengthens the research methods used within the science of maternal health; establishes and conducts national prevention, treatment, and policy interventions; and reimburses evidence-informed clinical approaches to improve maternal health across the life course. Without a national focus on fundamentally transformative interventions and other initiatives aimed at redressing structural racism and inequities in health care, current interventions and clinical advances in maternal morbidity and mortality prevention will remain tragically insufficient.

The impact of hostile abortion legislation on the United States maternal mortality crisis: a call for increased abortion education.

The growing restrictive abortion policies nationwide and the Supreme Court decision on Dobbs v. Jackson Women's Health Organization place increasing barriers to abortion access in the United States. These restrictions disproportionately affect low-income people of color, immigrants, and non-English speakers, and have the potential to exacerbate already existing racial inequities in maternal and neonatal outcomes. The United States is facing a Black maternal health crisis where Black birthing people are more than twice as likely to experience maternal mortality and severe maternal morbidity compared to White birthing people. Restrictions creating geographic, transportation, and financial barriers to obtaining an abortion can result in increased rates of maternal death and adverse outcomes across all groups but especially among Black birthing people. Restrictive abortion laws in certain states will decrease already limited training opportunities in abortion care for medical professionals, despite the existing abortion provider shortage. There is an immediate need for federal legislation codifying broad abortion care access into law and expanding access to abortion training across medical education. This commentary explores the impact of restrictive abortion laws on the Black maternal health crisis through multiple pathways in a logic model. By identifying current barriers to abortion education in medical school and residency, we created a list of action items to expand abortion education and access.

Dead Ringers and the Horror of Childbirth on the Small Screen

The streaming series Dead Ringers (Amazon), loosely adapted from David Cronenberg’s 1988 body horror film about twin male gynecologists, viscerally represents the too-often-violent act of childbirth in order to address the crisis of maternal health care in America. As a series for the small screen, it exploits television’s capacities to show and tell as a form of public education, directing our attention to social issues, including the maternal mortality crisis and the racist history of gynecology and obstetrics. FQ contributing editor Laurie Ouellette argues that the series is “uncomfortable television” by feminist design, in that it deploys corporeal aesthetics and social criticism to unsettle audiences.

Death in the Time of Pandemic: A Tuscan Cholera Cemetery at Benabbio (1855)

Cholera was one of the great killers of the 19th century. The pandemic waves that took place between 1823 and 1899 caused hundreds of thousands of deaths in the Mediterranean region and across Europe. However, the excavation of cholera cemeteries is very rare. This article presents the results of excavations at the cholera cemetery of Benabbio, a mountain village near Lucca (northwest Tuscany) in which cholera broke out in the late summer–early autumn of 1855, causing 46 deaths in a population of around 900 inhabitants. The excavation made it possible to detect for the first time the material characteristics of a cholera cemetery. The findings provide a new source for anthropologically reading the reaction of a community facing the mortality crisis, which fluctuated between acceptance of regulations imposed by the authorities and local strategies of resistance.

Telehealth for Equitable Obstetric Care: Addressing Gaps for Patients, Providers, and Payers

In June 2022, President Biden and Vice President Harris released their blueprint for addressing the maternal health crisis, stating their “vision for the future is that the United States will be considered the best country in the world to have a baby.” Currently, it is one of the worst among industrialized countries despite the US spending nearly double the average amount on healthcare per capita. The US is amidst a maternal mortality crisis, particularly for Black and American Indian/Alaska Native pregnant people, with more than 80% of the deaths preventable. Telehealth in obstetrics has the potential to reach pregnant people who are not currently being served by the medical system and to improve rates of severe maternal morbidity and mortality; however, more research is needed to understand and monitor its equity, costs, and optimal usage. Extant research shows that telehealth can produce a small positive effect for certain obstetric health outcomes, but these research findings are rarely stratified by pregnant patients’ demographics. To prevent the perpetuation of existing health inequities, gaps in obstetric telehealth research will need to be addressed. Key knowledge gaps for researchers and policy makers include outcomes, access, satisfaction by patients and providers, potential time savings for patients, and health system cost savings. Im​plementation of equitable obstetric coverage of telehealth services requires clarity from private and public payers for inter-state provisions of care, liability and risk, and service and payment parity.Note: While we use pregnant and postpartum people where possible here to recognize that not all pregnant people identify as women, we occasionally use maternal to reflect terminology used in federal, state, and local data.

Determinants of maternal mortality in south-western Nigeria: Midwives’ perceptions

BackgroundMaternal mortality remains one of Nigeria's most significant public health challenges. In order to address this issue sustainably, it is necessary to consider the perceptions of all stakeholders involved, including midwives. ObjectivesTo examine the determinants of maternal mortality in south-western Nigeria from the midwife's perspective. DesignA cross-sectional study was employed using mixed methods with a semi-structured questionnaire and an in-depth interview guide. ParticipantsQuantitative data were obtained from 215 midwives using a convenience sampling technique. Qualitative data were obtained from 25 midwives from five government health centres, selected using a stratified sampling technique. MethodsQuantitative data were analysed using SPSS Version 20 using descriptive and inferential statistics with 95 % confidence intervals, while qualitative data were analysed using thematic analyses. FindingsThe mean age and work experience of the participants were 35.2 ± 9.3 years and 8.4 ± 7.0 years, respectively. The midwives perceived that the main determinants of maternal mortality were postpartum haemorrhage (86.5 %), hypertensive disorder in pregnancy (80.9 %), mismanagement at mission homes/traditional birth attendant centres (MH/TBAs) (79.1 %) and sepsis (70.1 %). Some of the priority target areas to improve the well-being of pregnant women as identified by the midwives, were increased awareness of pregnancy danger signs (97 %), destigmatising caesarean section (CS) (96 %), regulation of MH/TBAs (92 %), and increased accessibility of hospitals (84 %). Findings from the qualitative data also affirmed that regulating MH/TBAs, destigmatising CS and subsidising healthcare expenses were prerequisites to curbing maternal mortality. Inferential analysis revealed that determinants such as unsafe abortion (p < 0.001), ectopic pregnancy (p = 0.001), domestic violence (p = 0.023), malaria (p = 0.029), short interbirth interval (p = 0.03), and patients’ negative perceptions of CS delivery (p = 0.036) were more commonly perceived to be associated with maternal mortality by younger midwives (age 17–34 years) compared with older midwives. Key conclusionThe results indicate that resolving the maternal mortality crisis sustainably in Nigeria will require increased accessibility to basic health care and health promotion campaigns to counteract unhelpful sociocultural norms. Implications for practiceFuture interventions must be tailored to address both traditional and emerging causes of maternal mortality in southwestern Nigeria.