Mortality Survey Research Articles

Factors associating different antenatal care contacts of women: A cross-sectional analysis of Bangladesh demographic and health survey 2014 data.

Antenatal care (ANC) contacts have long been considered a critical component of the continuum of care for a pregnant mother along with the newborn baby. The latest maternal mortality survey in Bangladesh suggests that progress in reducing maternal mortality has stalled as only 37% of pregnant women have attended at least four ANC contacts. This paper aims to determine what factors are associated with ANC contacts for women in Bangladesh. We analysed the data, provided by Bangladesh demographic and health survey 2014, covering a nationally representative sample of 17,863 ever married women aged 15-49 years. A two-stage stratified cluster sampling was used to collect the data. Data derived from 4,475 mothers who gave birth in the three years preceding the survey. Descriptive, inferential, and multivariate statistical techniques were used to analyse the data. An overall 78.4% of women had ANC contacts, but the WHO recommended ≥8 ANC contacts and ANC contacts by qualified doctors were only 8% for each. The logistic regression analysis revealed that division, maternal age, women's education, husband's education, wealth index and media exposure were associated with the ANC contacts. Likewise, place of residence, women's education, religion, and wealth index were also found to be associated with the WHO recommended ANC contacts. Furthermore, the husband's education, division, religion and husband's employment showed significant associations with ANC contacts by qualified doctors. However, Bangladeshi women in general revealed an unsatisfactory level of ANC contacts, the WHO recommended as well as ANC contacts by qualified doctors. In order to improve the situation, it is necessary to follow the most recent ANC contacts recommended by the WHO and to contact the qualified doctors. Moreover, an improvement in education as well as access to information along with an increase of transports, care centres and reduction of service costs would see an improvement of ANC contacts in Bangladesh.

Trends of female reproductive health status in Bangladesh from 1999 to 2018

Objective: To analyze the changes of relevant indicators in reproductive health status among Bangladeshi women from 1999 to 2018 and to assess whether the 2030 Sustainable Development Goals (SDGs) can be achieved. Methods: Data were obtained from both the Bangladesh Demographic and Health as well as from the Maternal Mortality and Health Care Surveys. The trends of SDGs indicators related to reproductive health from 1999 to 2018 were analyzed and compared, and the average annual rate of change was calculated. Development index was used to assess the difficulty of achieving the SDGs. Results: The maternal mortality rate increased first and then leveled off from 2001 to 2016. From 1999 to 2018, the coverage of reproductive health care services and the proportion of women who had the right to make the decision on their own health care service, were generally increasing. Proportion of the following areas as: "contraceptive needs, women who consider that partner violence is justified, the rate of early marriage, and the rate of early childbearing etc.", were declining at various degrees. Development index of the antenatal care coverage, rate of delivery in medical facilities, percentage of live births attended by medically trained providers and the rate of postnatal care etc., were less than 1. The development indices of the maternal mortality rates were close to 1, while all the other indicators were greater than 1. Conclusions: The reproductive health-related SDGs indicators in Bangladesh appeared somehow degrees of progress from 1999 to 2018. However, for most indicators, the average annual rate of change was still lower than the expected to achieve the 2030 target which called for acceleration in the next few years.

Maternal Mortality in Georgia: Incidence, Causes and Level of Underreporting: A National Reproductive Age Mortality Study 2014.

IntroductionAccurate data on maternal mortality are essential for assessing progress towards Sustainable Development Goals (SDG).The aim of the study was to determine the incidence and causes of maternal deaths in Georgia, then explore the potential for improvement of quality of maternal health care. The study’s secondary aims were to identify the level of underreporting of maternal deaths in Georgian vital statistics over 1 year (2012) and to compare these results with previous data from 2006. The study findings allow to support the country in developing evidence-based policies and tracking progress towards meeting SDG targets.MethodsA national Reproductive Age Mortality Survey (RAMOS) was conducted in Georgia in 2014–15. Multiple data sources were used to identify deaths of women aged 15–49 years between January and December 2012. All deaths in women of reproductive age were investigated through verbal autopsy (VA) diagnoses. Deaths in women during pregnancy or one-year postpartum were further investigated by conducting interviews and medical record reviews at the last medical facility which provided health care for the woman during her fatal condition. A specialist panel reviewed these cases and assigned underlining causes of deaths.ResultsWe found that 98% of deaths among women of reproductive age were registered by Georgia's civil registration and vital statistics system (CRVS). A total of 918 deaths met the study inclusion criteria. Thirty-six (4.1%) women died during pregnancy or within one-year postpartum. Among these 36 deaths, 23 (63.8%) were maternal deaths, 15 early (either during pregnancy or 42 days postpartum) and eight late (43–365 days postpartum) deaths (65.2% vs 34.8%). The remaining 13 of 36 deaths were coincidental deaths. Fourteen maternal deaths were reported by official statistics and nine deaths were not included in these statistics. Thus, the underreporting rate was 39%. Direct obstetric causes accounted for 73.9% (n=17) of maternal deaths, whereas 26.1% (n=6) were indirect. The leading causes of direct maternal deaths were infection (21.7%), hemorrhage (17.4%), pulmonary embolism (13.0%), and pregnancy-induced hypertension (8.7%). The RAMOS study calculated a maternal mortality ratio (early maternal deaths) of 26.3 per 100,000 live births compared with the official figure of 22.8 per 100,000 live births.DiscussionsRegistration of early maternal deaths significantly improved since last survey in 2008, while indirect and late maternal deaths continue to be unrecognized, as reflected in official Georgian statistics. The difference between RAMOS study findings and officially reported maternal mortality rates is minimal, showing improvements in detection of maternal deaths by the national maternal mortality surveillance system. The greatest number of direct obstetric deaths occur in the first week postpartum, which likely reflects deficiencies in quality of care.

Postmortem Evaluation of Reintroduced Migratory Whooping Cranes (Grus americana) in Eastern North America.

We reviewed necropsy records of 124 Whooping Cranes (Grus americana) recovered following reintroduction of 268 individuals from 2001 to 2016 in the eastern US. Causes of death were determined in 62% (77/124) of cases facilitated by active monitoring that limited decomposition and scavenging artifact. The greatest proportions of mortality were caused by predation (0.468; 95% confidence interval 0.356-0.580; 36/77), collision with power lines or vehicles (0.260; 0.162-0.358; 20/77), and gunshot (0.169; 0.085-0.253; 13/77). Six deaths were attributed to infection (0.078; 0.018-0.138; 6/77), including bacterial and fungal etiologies. Lead analysis of 50 liver samples yielded two results with elevated concentrations (3.65 and 10.97 ppm wet weight), and 10 bone samples from partial carcasses lacking suitable liver tissue resulted in one elevated result (48.82 ppm dry weight). These data indicate that underlying subclinical or clinical lead toxicosis may be a factor in up to 5% of deaths attributed to predation or impact trauma. Brain cholinesterase activity testing indicated no exposure to organophosphate or carbamate pesticides (mean±SD=17.32±2.90 µmol/min/g, 31/71). The causes of death and potential underlying factors summarized in this study constitute the first definitive mortality survey of migratory Whooping Cranes based on a high carcass recovery rate. Causes of death by infectious etiologies remained comparatively rare in this study, and occurred as single cases with no evidence of sustained transmission among reintroduced Whooping Cranes.

Socio-Demographic Determinants of Mortality from Chronic Noncommunicable Diseases in Women of Reproductive Age in the Republic of Georgia: Evidence from the National Reproductive Age Mortality Study (2014).

PurposeWorldwide, noncommunicable diseases (NCDs) are the leading cause of premature death of women, taking the highest toll in developing countries. This study aimed to identify key socio-demographic determinants of NCD mortality in reproductive-aged women (15–49 years) in Georgia.Materials and MethodsThe study employed the verbal autopsy data from the second National Reproductive Age Mortality Survey 2014. Univariate and multivariate logistic regression models were fitted to explore the association between each risk factor and NCD mortality, measured by crude and adjusted odds ratio (AOR) with respective 95% confidence intervals (95% CI).ResultsIn the final sample of 843 women, 586 (69.5%) deaths were attributed to NCDs, the majority of which occurred outside a hospital (72.7%) and among women aged 45–49 years (46.8%), ethnic Georgians (85.2%), urban residents (60.1%), those being married (60.6%), unemployed (75.1%) or having secondary and higher education (69.5%), but with nearly equal distribution across the wealth quintiles. After multivariate adjustment, the odds of dying from NCDs were significantly higher in women aged 45–49 years (AOR=17.69, 95% CI= 9.35 to 33.50), those being least educated (AOR=1.55, 95% CI= 1.01 to 2.37) and unemployed (AOR=1.47, 95% CI= 1.01 to 2.14) compared, respectively, to their youngest (15–24 years), more educated and employed counterparts. Strikingly, the adjusted odds were significantly lower in “other” ethnic minorities (AOR=0.29, 95% CI= 0.14 to 0.61) relative to ethnic Georgians. Contrariwise, there were no significant associations between NCD mortality and women’s marital or wealth status, place of residence (rural/urban) or place of death.ConclusionAge, ethnicity, education, and employment were found to be strong independent predictors of young women’s NCD mortality in Georgia. Further research on root causes of inequalities in mortality across the socioeconomic spectrum is warranted to inform equity- and life course-based multisectoral, integrated policy responses that would be conducive to enhancing women’s survival during and beyond reproduction.

Temporal patterns of bird mortality due to road traffic collisions in a Mediterranean region

ABSTRACT Capsule: There was significant variation on the incidence of road traffic mortality across bird species, due to seasonal and weather effects but also due to differences between years. Aims: To assess patterns of mortality due to traffic collision for six common bird species over a period of nine years in relation to seasonality and weather. Methods: Road mortality surveys were performed on four road sections from 2005 to 2013 in southern Portugal. The analysis controlled for survey frequency, and carcass persistence and detectability. Results: Overall, bird mortality decreased over time and was generally higher during spring and summer months. The lack of strong relationships between the weather variables and the observed mortality patterns suggests the existence of additional factors important in explaining the observed trends. Conclusions: Our study provides evidence that bird mortality due to collision with vehicles may change between years and was highest during the breeding season. This could have population consequences, and highlights the need to further address large temporal scales in roadkill research.

Mortality pattern among tuberculosis patients on treatment in Nigeria: A systematic review and meta-analysis

Background: Tuberculosis (TB) has continued to be associated with a substantial number of deaths, even in the era of effective antimicrobials. Nigeria is one of the countries with a high tuberculosis burden and has sub-optimal documentation of TB related deaths. Vital statistics/registration is not robust, and mortality surveys are rarely undertaken. In this study, we aimed to determine a precise estimate of TB related deaths on treatment and the trends in death rate while on TB treatment in Nigeria. Methods: We searched electronic databases for eligible studies from 1st January 2000 to 31st December 2017. We generated pooled death rate estimates using random-effects models and determined trends using meta-regression. Results: We identified 546 studies, of which 28 fulfilled the criteria for quantitative analysis. Overall, studies reported on 64,999 individuals. The pooled TB death rate during treatment was 6.6% (95% CI; 5.2-8.1%). There was a non-significant rise in TB related deaths on treatment of 0.2% per year (p-value = 0.454). Conclusion: We found a low TB related deaths on treatment, death rate and slight temporal rise over the study years. There is a need for continuous vital registration, including TB related death, and mortality survey among TB patients.

TREE MORTALITY IN BLUE OAK WOODLAND DURING EXTREME DROUGHT IN SEQUOIA NATIONAL PARK, CALIFORNIA

Blue oak woodlands in California have been a focus of conservation concern for many years. Numerous studies have found that existing seedling and sapling numbers are inadequate to sustain current populations, and recent work has suggested that blue oak woodlands might be particularly vulnerable to a warming climate. California has recently experienced a drought of historically unprecedented severity, resulting in the mortality of tens of millions of trees, including an apparent spike in mortality in oak communities. Here we present the results of a survey of tree mortality and composition in blue oak woodlands in Sequoia National Park. We found that 18% (95% CI = 14–24,) of all standing trees and 23% (95% CI = 17–30) of standing Quercus douglasii Hook. & Arn. (blue oak) were dead, substantially higher than proportions of dead trees recorded in pre-drought datasets, which showed 4% (95% CI = 2–9) standing dead for all trees and 5% (95% CI = 4–7) dead or 8% (95% CI = 4–16) standing dead for blue oak. Furthermore, much of this mortality appeared to be recent. Based on foliage or fine twig retention, 19% (95% CI = 14–26) of blue oak and 23% (95% CI = 16–31) of Quercus wislizeni A. DC. (interior live oak) appear to have died recently. In contrast, only 5% (95% CI = 3–8) of Aesculus californica (Spach) Nutt. (California buckeye) and 5% (95% CI = 2–11) of Fraxinus dipetala Hook. & Arn. (California ash) appear to have died recently. Even after such high mortality, with blue oak basal area dropping by 26% (from 9.5 m2/ha [95% CI = 7.4–11.6] to 7.0 m2/ha [95% CI = 5.3–8.7]), blue oak remains the dominant species in these ecosystems. However, given the lack of recruitment and the apparent vulnerability to extreme drought, blue oak populations may be at risk for severe decline if such mortality events become more frequent.

Comprehensive analysis of bird mortality along power distribution lines in Slovakia

Abstract Collisions and electrocutions on power lines are known to kill large numbers of birds annually on a global scale. We conducted comprehensive research focused on bird mortality caused by 22 kV and 110 kV distribution power lines in 13 Special Protection Areas in Slovakia. In the period between December 2014 and February 2016, 6,235 km of power lines were inspected twice during two periods (12/2014–03/2015 and 04/2015–02/2016) of field survey. In addition an intensive study was conducted during the second field survey at one-month intervals on power lines identified as the most dangerous for birds to collide with. As a result, 4,353 bird carcasses and bird remains representing 84 bird species and 14 orders were identified. Electrocution was suspected for 76.72% and collision for 23.28% of fatalities. Raptors were associated with 40% of all identified victims of electrocution. Two peaks of incidence were recorded, the first in March with a high rate of electrocutions as well as collisions of swans, pheasants, common blackbirds, ducks and herons, and the second in September predominantly featuring electrocution of raptors, magpies and corvids. We were unable to quantify seasonal patterns of mortality due to the limited sample of repeated mortality surveys resulting from the large grid of inspected power lines. We conducted comprehensive statistical analysis of more than 100 configurations of pylons and calculated their potential risk towards birds. Strong spatial correlation was revealed in the data set. Metal branch pylons and corner pylons with exposed jumper wires passing over the supporting insulators above the cross arms were the most dangerous configuration, accounting for 34.72% of total recorded electrocution fatalities (0.13 carcass/pylon). Cases of electrocution were also recorded for two bird species of major conservation concern in Slovakia: saker falcon (Falco cherrug) and eastern imperial eagle (Aquila heliaca). The results of this study may substantially improve conservation management and policies needed to reduce bird mortality.

Mortality and health survey, Walikale, Democratic Republic of the Congo, 2017: an example of the use of survey data for humanitarian program planning

BackgroundDuring humanitarian crises, health information systems are often lacking and surveys are a valuable tool to assess the health needs of affected populations. In 2013, a mortality and health survey undertaken by Médecins Sans Frontières (MSF) in the conflict affected Walikale territory of North Kivu, Democratic Republic of the Congo (DRC), indicated mortality rates exceeding humanitarian crisis thresholds and a high burden of mortality and morbidity due to malaria. In late 2017, after a period of relative stability, MSF reassessed the health status of the population through a second survey to guide ongoing operations.MethodsA two-stage cluster survey, selecting villages using probability proportional to size and households using random walk procedures, was conducted. Household members were interviewed on morbidity and mortality, healthcare use, vaccination status, and bednet availability.ResultsThe sample included 5711 persons in 794 households. The crude mortality rate (CMR) and under-five mortality rate (U5MR) were 0.98 per 10,000 persons/day (95% confidence interval (CI) 0.78–1.2) and 1.3 per 10,000 persons/day (95% CI): 0.82–2.0), respectively. The most frequently reported causes of death were fever/malaria (31%), diarrhoea (15%) and respiratory infections (8%). In 89% of households at least one person was reported as falling ill in the previous 2 weeks, and 58% sought healthcare. Cost was the main barrier amongst 58% of those who did not seek healthcare. Coverage of measles-containing-vaccine was 62% in under-fives. Sufficient bednet coverage (1 bednet/2 people) was reported from 17% of households.ConclusionThe second survey illustrates that although mortality is now just below crisis thresholds, the area still experiences excess mortality and has substantial health needs. The study results have supported the further expansion of integrated community case management to improve access to care for malaria, diarrhoea and respiratory infections. Such surveys are important to orient operations to the health needs of the population being served and also highlight the ongoing vulnerability of populations after humanitarian crises.

Dairy calves’ mortality survey and associated management practices in smallholding, pasture-based herds in southern Brazil

Our retrospective, cross-sectional study aimed to identify the mortality rate of preweaned heifer calves and associated herd-management factors in family-run dairy holdings in the state of Rio Grande do Sul, Brazil. A survey was made available through an online platform to all the municipalities (n = 494) with a state official extension office (Emater), allowing for any milk producer in RS raising the calves on-farm to take part in the study. A total of 1451 farmers responded to the survey between October 2014 and December 2015. Yearly total mortality, stillbirths and post-natal mortality to weaning were calculated from responses. The association of herd characteristics and practices with herd mortality was evaluated using multilevel multivariable logistic regression models. Herd mortality was modelled as a two vector binded variable that included the number of failures (n = female calves born alive but dead before weaning) and successes (n = weaned female calves) on-farm in the past 12 months. Models included region as random effect. The herds had 13 lactating cows (median, range 1–130). Pure breed herds, especially Holstein, predominated (81 %). Milk production was 190 L/d (median, range 7–4000). Total mortality rate was 8.5 % (1065/12563, median 0.0 %, Q1 - Q3 0.0–14.3 %/farm), and stillbirths 1.7 % (207/12563; median 0.0 %, Q1 - Q3 0.0 – 0 %/farm). Post-natal mortality rate was 6.9 % (858/12356, median 0.0 %, Q1 - Q3 0.0–11.1 %/farm). In 89.2 % of the farms, no stillborn calf was reported, and in only 2.8 % there was more than one case. In 67 % of farms, no death calf born alive was reported; in 33 %, an average of 2 deaths/farm (range 1–12 deaths/farm) was reported. In 16 % of the farms, mortality was ≥ 20 %, and in 4.3 % it was ≥ 50 %. The main reported causes of death were diarrhoea and unknown causes. Higher mortality was associated with herds with mixed breeds (OR = 1.3, CI = 1.09–1.59), performing unattended calvings (OR = 1.2; IC = 1.04–1.40), leaving the calf for long periods with the cow (OR = 1.21, CI = 1.00–1.45), and housing various calves in a pen (OR = 1.4, CI = 1.20–1.60). Furthermore, reduced mortality was associated with medium size herds (i.e. 21–40 lactating cows; OR = 0.82, CI = 0.69-0.97). Although the mortality rate observed is conservatively lower or equal to other international reports, it is higher than could be desired. The factors identified as associated to mortality are understood as proxies for the poor quality of management of the practices adopted. Thus, reduction of mortality is at hand without representing major infrastructural changes.

Is recent Afghanistan survey data suitable for fertility analysis? A regional investigation based on fertility inhibiting determinants

Afghanistan has been a country blighted by war over the past five decades and limited research is available on its demography. This study seeks to assess the suitability of recent survey data for Afghanistan (the 2010 Afghanistan Mortality Survey (AMS)and the 2015 Afghanistan Demographic and Health Survey (ADHS)) for estimating levels and trends in fertility. As several fertility measures rely on the quality of age data, we first apply demographic tools for the identification of age misreporting, finding evidence that it is severe. We then explore the consistency of fertility reporting across the two surveys, finding that the 2015 ADHS reports higher fertility among older women than the 2010 AMS although the seasonal pattern of fertility is consistent across the two surveys. We then estimate total fertility rates in 2008–2010 and 2012–2015 and measures of Bongaarts’s key proximate determinants of fertility for Afghanistan and its provinces for urban and rural areas separately. The results show that fertility is similar in urban and rural Afghanistan. Although most of the provincial data on the proximate determinants is reasonably consistent with the fertility rates, there are anomalies in some provinces which indicate the possible under-reporting of births. Overall, we conclude that the fertility data in the two surveys can be used with care to give an indication of broad regional fertility patterns and trends in the country.

Survey and Reduction of Mortality in Peridialysis Uremic Patients Via Intervention of Risk Factors

Survey and Reduction of Mortality in Peridialysis Uremic Patients Via Intervention of Risk Factors

Ambient Air Pollution and Sudden Infant Death Syndrome in Korea: A Time-Stratified Case-Crossover Study.

Sudden infant death syndrome (SIDS) is an occasional cause of unexpected mortality in infancy. While various etiological factors have been hypothesized, air pollution has been consistently presented as an environmental factor. In this study, we aimed to estimate the risk of SIDS in relation to exposure to air pollution and the effects of its modifying factors. A mortality dataset with supplementary infant mortality survey data from Statistics Korea was used and combined the concentration of ambient air pollution data from AirKorea based on the date of death and residential addresses of the SIDS cases. Odds ratios (ORs) were estimated according to birthweight, gestational age, maternal age, and infant age using a time-stratified case-crossover study design. The risk of exposure to particulate matter of less than 10 μm in diameter (PM10), nitrogen dioxide (NO2), carbon monoxide (CO), and sulfur dioxide was estimated. The number of deaths due to SIDS was 454 (253 males and 201 females). The OR per 27.8 µg/m3 increment of PM10 was 1.14 (95% confidence interval [CI]: 1.03–1.25) and that per 215.8 ppb of CO was 1.20 (95% CI: 1.03–1.40) in all infants. In females, an increase in NO2 and CO levels was associated with a higher risk of SIDS in low-birthweight and preterm infants. The OR per 15.7 ppb increment in NO2 was highest among preterm infants, with a value of 5.12 (95% CI: 1.27–20.63), and low-birthweight individuals, with a value of 4.11 (95% CI: 1.74–9.72), at a moving average of 0 to 3 days. In males, however, no significant association was found. In the present study, exposure to air pollution was associated with an increased risk of SIDS. This association was more evident in susceptible infants with a low-birthweight or in cases of preterm birth.

Economic costs of diseases and deaths attributable to bidi smoking in India, 2017

ObjectiveTo estimate the economic burden of diseases and deaths attributable to bidi smoking in India for persons aged 30–69 years.MethodsThe National Sample Survey data on healthcare expenditures, data on bidi...

Trend of mortality and decomposition on malignant tumors in Shandong province, 1970-2013

Objective: To describe the mortality trend of major malignant tumors in Shandong province, from 1970 to 2013. Methods: Data related to cancer mortality were obtained from the Shandong Death Registration System and three nationwide retrospective cause-of-death surveys. Trends of overall mortality and major causes of death were described using the indicators as: mortality rates and age-standardized mortality rates, through comparing the three large-scale mortality surveys in Shandong province. Difference decomposing method was applied to estimate the contribution of demographic and non-demographic factors for the change of mortality. Results: From 1970 to 2013, the crude mortality rate of malignant tumors in Shandong was increasing. The age standard mortality rate was increasing and then decreasing. The composition of cancer deaths in the all-cause-deaths was seen increasing and then decreasing as well. Both demographic and non-demographic factors contributed to the increase of crude cancer mortality rate. With the gradual increase of the proportion of population, its role exceeded the non-demographic factors. The age-standardized mortality rate of malignant tumors in 2011-2013 was lower than that in 2004-2005. Lung cancer mortality rose from the fifth to the first place, with an increase of 6.81 times from 1970-1974 to 2011-2013. Ranking of gastric cancer mortality dropped from first to the third place, with esophageal cancer dropped from second to the fourth. After adjusted by China's standard population in 1964, the mortality rate of lung cancer was still rapidly increasing, but the age-standardized mortality rates of esophageal cancer was gradually decreasing. The crude and age-standardized mortality rates of cervical cancer showed a rapid downward trend, reduced 87.00% and 93.00% respectively from 1970-1974 to 2011-2013. Conclusions: Malignant tumors were still major threats to the residents of Shandong province. The changing trend of different malignant tumors presented an inconsistent nature which called for different intervention strategies be carried out, accordingly.

Mitral valve replacement via minimally invasive totally thoracoscopic surgery versus traditional median sternotomy: a propensity score matched comparative study.

To compare surgical outcomes after mitral valve replacement via either minimally invasive thoracoscopic (MIs) or traditional median sternotomy (MS) surgery and determine the short- and mid-term clinical outcomes of the MI approach. All patients who received either MIs (n=405) or MS (n=691) mitral valve replacement surgery at the Guangdong Cardiovascular Institute between January 2012 and July 2015 were analyzed for outcome differences due to surgical approach using propensity score matching. The best 202 matches from the MI group and the MS group were analyzed. The clinical data of the two groups were collected, including preoperative cardiac function, operative data, postoperative complications, and follow-up. A final total of 404 patients were included in this study after propensity score matching; the MIs group and the MS group each contained 202 patients. The two groups were similar in age, weight, pathological changes, and surgical approach. Compared with the MS group, the MIs group had a longer cardiopulmonary bypass time (P<0.001), aortic cross-clamping time (P<0.001), and total procedure time (P<0.001). There were no significant differences between the groups regarding in-hospital mortality, stroke, pneumonia, acute renal failure, arrhythmia, and chylothorax. The MS group had significantly more patients with poor wound healing than the MIs group (P=0.004). The MI group had a lower rate of transfusion (P=0.037), shorter ventilation time (P=0.041), shorter ICU stay (P=0.033), reduced chest tube drainage and length of chest tube stay (P<0.001), and shorter hospital stay (P<0.001). There was no significant difference between the groups in hospital re-admission for bleeding, but the total hospitalization cost was higher in the MIs group (P=0.002). The mean follow-up was 26.59±12.33 months, the 1-year postoperative survival rate was 98.86%, and the overall survival rate was 97.44%. Compared with the MS group, the MIs group recovered earlier (P<0.05), and returned to work or study earlier (P<0.05). More patients in the MIs group were satisfied with the wound (P<0.001). The MS group had a higher incidence of postoperative osteomyelitis than the MIs group (P=0.028). There were no significant differences between groups in rates of mortality, stroke, pacemaker, reoperation, or 36-item Short Form Health Survey score. Compared with the MS approach, the MIs method of mitral valve replacement has longer cardiopulmonary bypass time and aortic cross-clamp time; however, it does not increase the risk of mortality and complications. Furthermore, MIs causes less trauma, fewer transfusions, less wound infection, faster recovery, faster return to work or study, and greater satisfaction with the incision in the mid-term. MI cardiac surgery is safe, effective, and feasible.

Child mortality trends and causes of death in South Africa, 1997 - 2012, and the importance of a national burden of disease study.

The Rapid Mortality Surveillance System has reported reductions in child mortality rates in recent years in South Africa (SA). In this article, we present information about levels of mortality and causes of death from the second SA National Burden of Disease Study (SA NBD) to inform the response required to reduce child mortality further. To estimate trends in and causes of childhood mortality at national and provincial levels for the period 1997 - 2012, to highlight the importance of the SA NBD. Numbers of registered child deaths were adjusted for under-reporting. Adjustments were made for the misclassification of AIDS deaths and the proportion of ill-defined natural causes. Non-natural causes were estimated using results from the National Injury Mortality Surveillance System for 2000 and the National Injury Mortality Survey for 2009. Six neonatal conditions and 11 other causes were consolidated from the SA NBD and the Child Health Epidemiological Reference Group lists of causes of death for the analysis. The NBD cause-fractions were compared with those from Statistics South Africa, the United Nations Children's Fund (UNICEF) and the Institute for Health Metrics and Evaluation (IHME). Under-5 mortality per 1000 live births increased from 65 in 1997 to 79 in 2004 as a result of HIV/AIDS, before dropping to 40 by 2012. The neonatal mortality rate declined from 1997 to 2001, followed by small variations. The death rate from diarrhoeal diseases began to decrease in 2008 and the death rate from pneumonia from 2010. By 2012, neonatal deaths accounted for 27% of child deaths, with conditions associated with prematurity, birth asphyxia and severe infections being the main contributors. In 1997, KwaZulu-Natal, Free State, Mpumalanga and Eastern Cape provinces had the highest under-5 mortality, close to 80 per 1 000 live births. Mortality rates in North West were in the mid-range and then increased, placing this province in the highest group in the later years. The Western Cape had the lowest mortality rate, declining throughout the period apart from a slight increase in the early 2000s. The SA NBD identified the causes driving the trends, making it clear that prevention of mother-to-child transmission of HIV, the Expanded Programme on Immunisation and programmes aimed at preventing neonatal deaths need to be equitably implemented throughout the country to address persistent provincial inequalities in child deaths. The rapid reduction of childhood mortality since 2005 suggests that the 2030 Sustainable Development Goal target of 25 per 1 000 for under-5 mortality is achievable for SA. Comparison with alternative estimates highlights the need for cause-of-death data from civil registration to be adjusted using a burden-of-disease approach.

Are associations between psychosocial stressors and incident lung cancer attributable to smoking?

PurposeTo learn whether reported associations between major psychosocial stressors and lung cancer are independent of smoking history.MethodsSubjects were at least 25 years old and without lung cancer at enrollment in the United States Census Bureau’s National Longitudinal Mortality Survey in 1995–2008. Follow-up via Surveillance Epidemiology and End Results and National Death Index continued until lung cancer diagnosis, death, or December 2011. Involuntary unemployment, widowhood, and divorce, stratified by sex, were tested for association with subsequent lung cancer using proportional hazards regression for competing risks. Smoking status, years smoked, cigarettes per day, and years since quitting were imputed when missing.ResultsAt enrollment, subjects (n = 100,733, 47.4% male, age 49.1(±15.8) years) included 17.6% current smokers, 23.5% former smokers. Of men and women, respectively, 11.3% and 15.0% were divorced/separated, 2.9% and 11.8% were widowed, and 2.9% and 2.3% were involuntarily unemployed. Ultimately, 667 subjects developed lung cancer; another 10,071 died without lung cancer. Adjusted for age, education, and ancestry, lung cancer was associated with unemployment, widowhood, and divorce/separation in men but not women. Further adjusted for years smoked, cigarettes per day, and years since quitting, none of these associations was significant in either sex.ConclusionsOnce smoking is accounted for, psychosocial stressors in adulthood do not independently promote lung cancer. Given their increased smoking behavior, persons experiencing stressors should be referred to effective alternatives to smoking and to support for smoking cessation.

Characteristics and Psychological Consequences of Sexual Assault in Haiti

Abstract More than 1 in 10 females (13%) reported being a victim of sexual assault in the 2012 Mortality, Morbidity, and Service Utilization Survey conducted in Haiti. This study aimed to describe ...