Preventable Deaths Research Articles

Comparison of gauze packing, sponge-based, and hemostatic surgicel wound stasis dressings to treat hemorrhages from grade IV liver injuries: An experimental study

BackgroundUncontrolled bleeding is still the major factor leading to preventable deaths following trauma. This study sought to assess the effectiveness of mini sponge-based wound stasis, cellulose-based local hemostatic, and traditional gauze dressings for the control of hemorrhages resulting from grade 4 liver injuries in rats. MethodsThirty Sprague-Dawley rats were divided into three equal groups. In the first group, a liver laceration was treated with gauze packing. The second group received XStat minisponge dressing (MDS), and the third group was administered a combination of MDS dressing and Surgicel hemostatic agent. After gaining access to the intra-abdominal cavity, a liver laceration measuring 10 mm in length, 5 mm in depth, and extending to the middle lobe was created. The dressings were removed after 2 and 10 min to assess the amount of bleeding, and any bleeding was documented again after 48 h. Intraperitoneal adhesions were evaluated during euthanasia. ResultsAt 2 min post-injury, the gauze packing group had an average bleeding volume of 0.97 ± 0.15 mL, compared to 1.08 ± 0.25 mL in the MDS group (P = 0.26) and 1.02 ± 0.18 mL in the MDS + Surgicel group (P = 0.69). At 10 min, the bleeding volumes were 0.13 ± 0.05 mL, 0.22 ± 0.01 mL (P = 0.09), and 0.14 ± 0.05 mL (P = 0.19), respectively. At 48 h, significant differences were observed in bleeding volumes (gauze: 0.55 ± 0.18 mL, MDS: 1.15 ± 0.21 mL, MDS + Surgicel: 0.82 ± 0.06 mL, P < 0.001). Mortality rates after 14 days were 0 % in the gauze packing group, 60 % in the MDS group (P = 0.001), and 60 % in the MDS + Surgicel group (P = 0.001). The gauze packing group displayed no adhesions, while the other groups exhibited adhesions in the liver, bowel, omentum, and abdominal wall. ConclusionOur results indicate that, when it comes to managing bleeding in severe liver injuries, traditional gauze packing remains the tried-and-true method, showing superior effectiveness in terms of blood loss and mortality when compared to XStat minisponge dressings and the fibrillar Surgicel hemostatic agents.

Long-Term Effectiveness of a Quitline for Smoking Cessation: Results of a Randomized Controlled Trial

Plain Language SummarySmoking is a major global health problem, causing many preventable deaths and disabilities each year. Telephone counselling is a recommended method to help people quit smoking because it provides accessible support. This study examined the long-term effectiveness of the national German Smokers Quitline. Daily smokers who wanted to quit smoking were divided into two groups. One group received up to six phone calls from the national German Smokers Quitline, the other group received a self-help brochure. We measured how many participants stopped smoking for at least 7 days 12 months after the start of the intervention (7-day point prevalence of abstinence). We assessed long-term cigarette and tobacco abstinence, i.e., how many participants abstained from cigarettes/tobacco for a period of 9 months after the start of the intervention. We also examined the use of other cessation aids. A total of 905 participants took part in the study. The telephone counselling group had higher rates of long-term cigarette (31.7% vs. 17.8%) and tobacco abstinence (30.8% vs. 15.2%) compared to the other group. The odds of quitting were significantly higher in the telephone counselling group. However, the 7-day point prevalence of abstinence did not differ between the groups. Many participants used additional cessation aids, with e-cigarettes being the most common. In conclusion, telephone counselling provided by the national German Smokers Quitline is effective in helping people quit smoking long term. Increasing its awareness could improve smoking cessation rates in Germany. Counselling should include information about the risks and benefits of new nicotine consumer products.

Deaths and clashes induced by rivalry among fans during FIFA World Cup 2022 in Bangladesh.

International sports events like the Football World Cup affect the collective emotions of the global community. Usually, major sports events like the Football World Cup show beneficial effects on the community. However, many unwanted consequences such as accidents, premature deaths and violent supporter rivalries have been noticed during it. We aimed to report preventable premature deaths and clashes induced by rivalry among fans during the FIFA World Cup 2022 in Bangladesh. We monitored local newspaper reports for data collection during the World Cup 2022 event and collected data for age, sex, the possible cause of death, and precipitating events related to the event. We found 23 World Cup Football-related deaths, 35 hospitalizations, and 45 injuries related to clashes between the rival fans of Argentina and Brazil. The median age of deceased was 20 years. The majority of the deaths happened in young males due to fall while hoisting flags. Deaths in the late age happened due to sudden emotional upsurge during the game day. And, clashes between rival fans mostly happened due to social bullying favoring and disfavoring a team. This report indicates an important area of potentially preventable death related to World Cup Football and warrants public health attention even in a non-participating country, both locally and internationally.

The effect of drugs and guns on life expectancy in the United States, 2000–2020

ObjectivesThis study estimated the effect of changing trends in drug- and firearm-related mortality on life expectancy in the U.S. over the last two decades. Study designRetrospective cross-sectional study. MethodsWe used national vital registration data from CDC WONDER, stratified by sex, to estimate the mortality rate due to accidental and intentional poisoning (ICD Codes X40-X49, X60-X69, Y10-Y19 and X85), and firearm deaths (ICD codes W32-W34, X72-X74, X93-X95, Y22-Y24) for the period 2000–2020. We applied standard life table methods to all cause mortality rates with and without these mortality causes to estimate the life expectancy at each age over this period. ResultsIn 2020, mortality due to drugs and firearms combined reduced male life expectancy by1.67 years compared to 0.67 years in 2000, and without the effect of these two causes of death, male life expectancy in 2019 would have been 78.02 years. For women, drugs and firearm-related mortality reduced life expectancy by 0.20 years in 2000 and 0.63 years in 2020, and female life expectancy would have been 82.25 years in 2019 without the retarding effect of these two preventable causes. ConclusionsDrug- and firearm-related deaths have increased so rapidly, especially among younger populations, that life expectancy at birth is significantly reduced by these causes of death. Without urgent action to tackle these preventable causes of death, US life expectancy will continue to stagnate and may even decline, even without the effect of COVID-19.

The 2024 Public Health Emergency of International Concern: A Global Failure to Control Mpox.

On August 14, 2024, following a regional declaration by the Africa Centres for Disease Control and Prevention, the World Health Organization declared mpox a Public Health Emergency of International Concern, marking the second such declaration in two years. A series of outbreaks involving the more virulent clade I virus (compared to clade II, which caused a global outbreak in 2022), has now spread in 13 African countries, exposing the inadequacies of the public health infrastructure in these settings. There was significant investment during the 2022 global outbreak, but these efforts failed to address vaccine access and treatment in the Global South. Regulatory delays, unequal access to vaccines, and a lack of compassionate use treatments for severe cases have resulted in preventable cases and deaths, especially among vulnerable populations such as pregnant women, children, and the immunocompromised. The current outbreak also underscores critical knowledge gaps in our understanding of mpox, including its transmission, pathogenesis, and viral evolution. We join intensified calls for global solidarity and action to control mpox, emphasizing immediate containment measures and long-term local and international investment in African public health systems, to prevent future epidemics.

High-resolution modeling and projection of heat-related mortality in Germany under climate change.

Heat has become a leading cause of preventable deaths during summer. Understanding the link between high temperatures and excess mortality is crucial for designing effective prevention and adaptation plans. Yet, data analyses are challenging due to often fragmented data archives over different agglomeration levels. Using Germany as a case study, we develop a multi-scale machine learning model to estimate heat-related mortality with variable temporal and spatial resolution. This approach allows us to estimate heat-related mortality at different scales, such as regional heat risk during a specific heatwave, annual and nationwide heat risk, or future heat risk under climate changescenarios. We estimate a total of 48,000 heat-related deaths in Germany during the last decade (2014-2023), and the majority of heat-related deaths occur during specific heatwave events. Aggregating our results over larger regions, we reach good agreement with previously published reports from Robert Koch Institute (RKI). In 2023, the heatwave of July 7-14 contributes approximately 1100 cases (28%) to a total of approximately 3900 heat-related deaths for the whole year. Combining our model with shared socio-economic pathways (SSPs) of future climate change provides evidence that heat-related mortality in Germany could further increase by a factor of 2.5 (SSP245) to 9 (SSP370) without adaptation to extreme heat under static sociodemographic developments assumptions. Our approach is a valuable tool for climate-driven public health strategies, aiding in the identification of local risks during heatwaves and long-term resilience planning.

Behavior change, health, and health disparities 2024: Smoking and other tobacco use among women and girls

This Special Issue (SI) of Preventive Medicine is the 11th in an annual series on behavior change, health, and health disparities. The theme of this 2024 issue is Smoking and Other Tobacco Use among Women and Girls. Cigarette smoking remains the single most preventable cause of death in the U.S., causing the premature death of more than 200,000 U.S. women annually, a mortality rate that far exceeds levels from conditions more commonly associated with premature death in women (e.g., breast cancer). Of course, cigarette smoking among women and girls is also a well-known cause of intergenerational adverse health effects. Women and girls are also using e-cigarettes and many other tobacco products that are flooding the U.S. tobacco marketplace. This SI includes eleven peer-reviewed articles that advance knowledge across a wide range of topics on disproportionate adverse effects, prevalence, and risk factors for cigarette smoking and other tobacco use in women and girls.

Exposure to nicotine and withdrawal in Wistar rats: an electrophysiological study.

Throughout the world, smoking is one of the principal causes of preventable death. Nicotine, the primary active component of tabacco, acts as a psychostimulant and modulates the electrical activity of a number of the areas of the brain involved in addiction. Abstinence from nicotine will also impact the functional state of the brain, which is reflected in symptoms of craving and susceptibility to relapse. In addition, given the increase in the sympathetic tone of the heart and pulse rate promoted by nicotine, its consumption can contribute to tachyarrhythmia. The present study investigated the electroencephalographic (EEG) and electrocardiographic (ECG) patterns of Wistar rats submitted to acute or chronic exposure to nicotine, followed by withdrawal for 24 or 48 hours, and the re-administration (or not) of nicotine, to simulate episodes of relapse. The EEG data revealed an increase in all types of brainwaves, with emphasis on high-frequency (alpha, beta, and gamma) brain oscillations following both acute and chronic exposure to nicotine (14 days), whereas in withdrawal, there was a predominancy of delta waves. When exposure to nicotine was reinstated after withdrawal, the observed EEG profile was similar to that found in chronic exposure. The electrocardiogram reads showed that both acute and chronic exposure to nicotine caused abnormalities in the atrioventricular conduction and that, while these changes improve with substance withdrawal, relapse can worsen these parameters. The results of this study indicate that high-frequency brainwaves are correlated with nicotine dependence, while slow brain oscillations are consistent with drug craving, and episodes of nicotine relapse can reproduce brain activity patterns linked to dependence. Finally, exposure to nicotine predisposes the individual to heart rhythm abnormalities, which are attenuated by withdrawal, but may nevertheless be restored rapidly with re-exposure to the substance. This study demonstrated that nicotine increases high-frequency brain oscillations, which is associated with addiction, whereas withdrawal elevates the delta wave power, suggesting craving. Re-exposure to nicotine following withdrawal restores rapidly the EEG profile of chronic dependence. In addition, nicotine has deleterious impacts on cardiac activity, which are linked to fatal arrhythmias. This implies that stopping smoking is beneficial for the amelioration of the alterations in heart rhythm caused by nicotine addiction. This study elucidates the functional states of the brain and heart during both sporadic and chronic nicotine use, and the electrophysiological explanation for substance dependence and drug relapse after craving episodes.

Comprehensive guide to tobacco control policy implementation

Background: Tobacco use remains one of the leading causes of preventable death and disease worldwide. Effective tobacco control policies are essential in mitigating these health risks. The Framework Convention on Tobacco Control (FCTC), adopted by the World Health Organization (WHO) in 2003, provides a comprehensive framework for implementing evidence-based tobacco control measures globally. This project aims to develop and implement robust tobacco control policies to reduce tobacco consumption and its associated health risks. Methods and Materials: The project involved a comprehensive review of existing tobacco control policies, data collection on tobacco use and related health outcomes, and the development of a multi-sectoral task force. Key strategies included setting clear goals, stakeholder engagement, public awareness campaigns, and the drafting of legislative and policy documents. Implementation mechanisms such as enforcement and evaluation systems were also established to ensure compliance and measure the policy's impact. Results: The implementation of the tobacco control policies resulted in a significant reduction in smoking prevalence and exposure to secondhand smoke. Public awareness of the health risks associated with tobacco use increased, and there was enhanced support for smoking cessation services. The project also identified best practices and strategies that can be adopted by other regions to achieve similar outcomes. Conclusion: This project highlights the importance of comprehensive research, effective coordination, and well-planned implementation in developing and executing tobacco control policies. The findings and recommendations presented serve as a valuable resource for policymakers and public health professionals aiming to reduce smoking rates and protect public health. Continued collaboration and adaptation of these strategies are essential for sustaining the progress made in tobacco control.

Gene expression differences associated with alcohol use disorder in human brain.

Excessive alcohol consumption is a leading cause of preventable death worldwide. To improve understanding of neurobiological mechanisms associated with alcohol use disorder (AUD) in humans, we compared gene expression data from deceased individuals with and without AUD across two addiction-relevant brain regions: the nucleus accumbens (NAc) and dorsolateral prefrontal cortex (DLPFC). Bulk RNA-seq data from NAc and DLPFC (N ≥50 with AUD, ≥46 non-AUD) were analyzed for differential gene expression using modified negative binomial regression adjusting for technical and biological covariates. The region-level results were meta-analyzed with those from an independent dataset (NNAc = 28 AUD, 29 non-AUD; NPFC = 66 AUD, 77 non-AUD). We further tested for heritability enrichment of AUD-related phenotypes, gene co-expression networks, gene ontology enrichment, and drug repurposing. We identified 176 differentially expressed genes (DEGs; 12 in both regions, 78 in NAc only, 86 in DLPFC only) for AUD in our new dataset. After meta-analyzing with published data, we identified 476 AUD DEGs (25 in both regions, 29 in NAc only, 422 in PFC only). Of these DEGs, 17 were significant when looked up in GWAS of problematic alcohol use or drinks per week. Gene co-expression analysis showed both concordant and unique gene networks across brain regions. We also identified 29 and 436 drug compounds that target DEGs from our meta-analysis in NAc and PFC, respectively. This study identified robust AUD-associated DEGs, contributing novel neurobiological insights into AUD and highlighting genes targeted by known drug compounds, generating opportunity for drug repurposing to treat AUD.

An Extensive Analysis of Liver Cirrhosis’s Genesis, Pathophysiology, Epidemiology, And Diagnosis

Portal hypertension and liver failure can arise as a result of liver cirrhosis, a chronic illness characterized by the fibrosis and renewal of nodules in the liver. A number of long-term conditions can lead to cirrhosis, a progressive disease. after a few years or perhaps decades. Liver cirrhosis is one public health concern. Metabolic syndrome, autoimmune diseases, storage diseases, drug use, alcohol consumption, viral hepatitis, and toxic chemicals are the usual causes. Cirrhosis is the fourteenth most prevalent cause of death in adults. placing ninth overall and fourth in Europe and the US. Because this condition is symptomatic and often remains undiagnosed in its early stages, its frequency is underestimated. It typically progresses to the decompensated stage at a rate of 5 to 7% annually. Here, we discuss the pathophysiology, epidemiology, diagnosis, and etiology of liver cirrhosis.

Point-of-care biochemistry for primary healthcare in low-middle income countries: a qualitative inquiry

BackgroundAccess to essential diagnostics is crucial for primary healthcare (PHC) in low-and-middle income countries (LMICs). Many LMICs have invested in equipping PHC with point-of-care (PoC) diagnostics for infectious diseases, however there has been no similar investment to improve PHC capacities for clinical chemistry. The biochemistry gap is among the deterrents to universal health coverage.MethodsA social sciences project was conducted with the aim to understand the key PHC stakeholders’ insights on the pertinence of PoC biochemistry for PHC in LMICs. Data generation was conducted between July-November 2023 in Mongolia, Nigeria and Peru. Decision-makers in healthcare delivery, healthcare professionals, and patient and community advocates were engaged using a combination of sampling techniques. Unstructured individual and group conversations, and non-participant observation were conducted. Analysis involved an inductive line-by-line coding on printed transcripts, followed by a deductive coding and theme-by-theme analysis on digitized transcripts.ResultsFifteen, 51 and 20 informants from Mongolia, Nigeria and Peru, respectively, participated. Fifty-five of the 94 informants were female. Most informants considered that PoC biochemistry in PHC would be pertinent, from a clinical and a resources-saving perspective. Those households that currently bear the burden of referrals (i.e., the poor, the bedridden, the older adults) would benefit the most from the deployment of PoC biochemistry for essential biochemistry parameters. Improved access to PoC glycated hemoglobin (HbA1c), lipid, liver and kidney profile was perceived as helpful to inform clinicians’ decision-taking. The value of PoC biochemistry for the management of noncommunicable diseases (diabetes, hypertension) and infectious conditions (dengue, malaria, tuberculosis), to improve child health outcomes (severe dehydration in children with diarrhea and/or malnutrition) and to reduce preventable causes of death (dengue-related renal failure) was highlighted.ConclusionsPoC biochemistry holds potential to revert the impact that the biochemistry gap has for patient care in some LMICs’ PHC settings. PoC equipment for parameters such as HbA1c, urea, creatinine or electrolytes could enhance community-level management of preventable causes of mortality, improve service delivery for patients affected by locally-prevalent infectious conditions, and improve the psychosocial and economic wellbeing of patients facing the burden of referrals to remote biochemistry-equipped centers.Trial RegistrationNot applicable.

Infection Mortality in Acute Promyelocytic Leukemia in Children

Abstract Background Acute promyelocytic leukemia (APL) is a rare entity in children. The percentage of APL patients is 5-7% of all pediatric acute myeloid leukemia cases; a higher frequency (about 20%) is reported in children of Latino/Hispanic ancestry. The introduction of trans retinoic acid has been crucial for both antileukemic efficacy in APL and for prevention of early deaths. Furthermore, the use of arsenic trioxide (ATO) demonstrated to be highly effective in achieving high cure rates with reduced toxicity. However, there is a paucity of data concerning infection related deaths in APL. The objective was to describe the percentage of infection-related-deaths in APL in children; to describe the event free survival (EFS) and describe other main complications observed. Methods We identified 30 patients, as part of the Hospital Alejandro Posadas registry from a single center. We conducted a retrospective observational descriptive analysis. The patients were treated with the GIMEMA-AIDA 2000 protocol (n=23, 76.7%) and 1-LPA pediatrico-18-GALTA/CLEHOP (n=6, 20%). One patient died before treatment was given. The patients were diagnosed between 2000 to 2022. We used frequencies for descriptive variables, Chi2 /Fisher test for categorical data and time to event techniques for survival analysis. Any cause of mortality was extracted and analyzed. Results There were 66.7% of males; and median age was 12-year (IQR 8-15). PML-Rar alfa was positive (cytogenetics) in 23 (76.7%); Negative 6 (20%) and failed in 1 patient (3.3%). 100% had positive molecular biology for PML-rarAlfa transcript. Median white cells were 3.35x 109 /l (IQR 1.675-13.25). The patients were classified as high-risk (n=10, 33.3%) and standard risk (n=20, 66.7%). Four patients showed molecular relapse, 2 had CNS and one bone marrow involvement. Three patients died (10%), 2 due to endocranial hemorrhage, 1 as a consequence of complications of a hematological relapse. No patient died due to microbiologically documented infection or febrile neutropenia. With a mean estimated survival time (median not achieved) in years of 17.7 years, (CI 95% 14.6-20.7) the event free survival was 79% (SE 0.75), with 6 events. Cumulative competitive incidence of relapse 14% (SE 0.65). Conclusion In patients with APL, we could not find infections as cause of death. The overall results of APL management were very promising. Figure 1. Event Free Survival Acute Promyelocytic Leukemia.

Aintree Catheter Versus Gum Elastic Bougie for Airway Exchange Using the i-Gel Supraglottic Device: A Cadaver Study.

Airway compromise is the third leading cause of preventable death on the battlefield. Most combat medics carry supraglottic airway (SGA) devices for airway management. However, exchanging an SGA device for a definitive airway can be challenging, especially in austere environments. This study aims to compare the Aintree intubation catheter (AIC) to the gum elastic bougie (GEB) as adjuncts for performing airway device exchange with the i-gel SGA device in place. This randomized crossover cadaver study of 48 participants examined the success rate of two endotracheal introducers (AIC and GEB) when performing a blind airway exchange with an i-gel in place. Study participants were combat medics (MOS 68W), physician assistant students, physician assistant staff, emergency medicine (EM) physician residents, and emergency medicine attending physicians attending classes at the installation Medical Simulations Training Center. Each participant performed up to three attempts using both endotracheal tube introducers on the same cadaver. The primary outcome was successful airway exchange rate with each device, and the secondary outcome was time to successful airway exchange. Although the AIC had a slightly higher success rate of 33% compared to the GEB success rate of 30%, this result was not statistically significant, P = .56. Similarly, participants completed successful airway exchanges with the AIC faster, with a mean time of 86.5 seconds (95% CI: 71.2 to 101.9) versus 101.2 seconds (95% CI: 85.5 to 116.9) with the GEB. However, this result was also not statistically significant, P = 0.18. This study demonstrates no significant difference in success rate and time to completion of successful iterations of airway exchanges between the two devices. Although the AIC performed slightly better overall, these results are not statistically significant. Additionally, blind exchange intubations appear to be of high risk with minimal success, so we recommend against this technique in routine practice.

Effectiveness of Lifestyle Modification to Control the Blood Pressure among Hypertensive Patient of Morang District

Background: Hypertension is a strong, independent and etiologically relevant risk factor for cardiovascular diseases and therefore, the leading cause of preventable death worldwide. The purpose of this study was to determine the effect of multifaceted lifestyle modification intervention on blood pressure among hypertensive patients. Methods: A quasi-experimental study was conducted among 67 participants in the medical OPD through convenience sampling method. The studied multifaceted intervention includes motivational interviews and 60 minutes 3 training session on dietary patterns and exercise and 4 phone call follow-ups. BP was measured before and after intervention and compared between them. Results: The differences between the mean changes in before and after intervention are systolic (-7.65 ± 4.45), and diastolic (5.74± 4.45) Conclusion: The studied multifaceted lifestyle intervention promoted and reduced systolic and diastolic BP. Thus, the use of this method as a supplementary treatment is recommended during visit to medical OPD

The Impact of Migration on Smoking among Colombian Migrants

Background: Colombian migration globally has had many consequences. This study focuses solely on the smoking behavior of Colombian migrants. This study addresses how the act of international migration impacts the likelihood of smoking among Colombian migrants. Smoking has been found to be the leading cause of preventable death, and so it is a health risk for Colombian migrants. This study pertains to the communities sampled in Colombia, where the migrants originated. Methods: This study uses the Latin American Migration Project to address how migration impacts the smoking behavior of Colombian migrants. Using logit regression, the statistical analysis predicts the likelihood of smoking among Colombian migrants. This study compares the smoking behavior of current and former Colombian migrants, which is compared to that of Colombian non-migrants. Because current and former migrants were surveyed, the study is able to control for health selectivity. Results: After accounting for health selectivity, the study finds that migration, as measured by time abroad, is positively and significantly related with the smoking of migrants relative to non-migrants. Additionally, this study shows that former migrants are more likely to smoke than current migrants, providing support for the salmon effect. Conclusion: This study adds to the literature on smoking by studying an understudied group, Colombian migrants, and provides a better measure of the impact of migration on smoking behavior by accounting for health selectivity and the salmon bias. The findings are consistent with assimilation theory, as more time abroad is associated with negative health behaviors that are common in the culture of the receiving country, but the fact that such behaviors are harmful to the migrant is consistent with the immigrant health paradox.

Inequality in green space distribution and its association with preventable deaths across urban neighbourhoods in the UK, stratified by Index of Multiple Deprivation

BackgroundThis study investigated inequalities in the distribution of green space (GS) and the association between inequalities in amounts of GS and preventable deaths across urban neighbourhoods with different Index of...

Evaluating the accuracy of International Classification of Disease Perinatal Mortality (ICD-PM) codes assigned on death certificates before and after expert panel review: a mixed methods observational study

IntroductionThe present study was conducted with the aim of evaluating the accuracy of International Classification of Disease Perinatal Mortality (ICD-PM) codes assigned on death certificates before and after an expert panel review.MethodThe present study was a mixed methods observational study conducted at Umm al-Benin Hospital, the sole specialized obstetrics and gynecology center affiliated with Mashhad University of Medical Sciences. The study comprised three distinct stages: (1) Collecting primary ICD-PM codes assigned to perinatal death certificates, along with other relevant information, from October 2021 to March 2022; (2) Examining the circumstances of each perinatal death case and re-identifying the causes of death through a consensus process involving a panel of experts comprising pediatricians, obstetrics and gynecology specialists, and nursing and midwifery experts; presenting the new ICD-PM code; (3) Comparing the ICD-PM codes assigned to perinatal death certificates before and after the expert panel’s evaluation.ResultDuring the study period, a total of seven specialized panels were conducted to examine perinatal deaths. Out of the 71 cases, 41 were carefully reviewed by experts. These cases included 32 stillbirths and nine neonatal deaths. The examination process followed specific inclusion and exclusion criteria. The findings revealed that there were no significant changes in the causes of neonatal deaths. However, it was notable that 80% of the previously unknown causes of stillbirths were successfully identified. Notably, the occurrence of stillbirths increased by 78% due to maternal causes and conditions.ConclusionConvening panels of experts to discuss the causes of perinatal deaths can effectively reduce the percentage of unknown causes, as classified by ICD-PM. This approach also guarantees the availability of essential data for implementing effective interventions to decrease preventable perinatal deaths.

Prehospital blood transfusion : Opportunities and challenges for the German emergency medical services

Exsanguination is the leading cause of preventable death in severe trauma. Immediate hemorrhage control and transfusion of blood products are critical to maintain oxygen delivery and address trauma-induced coagulopathy. While prehospital blood product transfusion (PHBT) is established in neighboring countries, the fragmented configuration of Germany's emergency medical service (EMS) infrastructure has delayed the adoption of widespread PHBT programmes. This review aims to provide an updated perspective on the evolution, international practices and research needs of PHBT within the German context. This narrative review is based on aPubMed search using the search terms "prehospital" and "blood*". From an initial 4738 articles, 333 were directly related to PHBT and were subjected to further detailed examination. The literature, including referenced studies, was categorized into areas such as history, rationale, international practices, and evidence, and analyzed for quality. The benefit of early blood transfusion in major trauma has been established since WW1, explaining the efforts to initiate this lifesaving intervention as early as possible in the care pathway, including the prehospital field. Recent randomized trials have faced design and recruitment challenges, reflecting the complexity of the research question. These trials have yielded inconclusive results regarding the survival benefits of PHBT in civilian settings. This scenario raises doubts about the capability of randomized trials to resolve questions concerning survival advantages. Despite these difficulties, there is adiscernible trend indicating potential improvements in patient outcomes. In Germany, the incidence of trauma-associated shock stands at 38per 100,000 individuals per year. It is estimated that between 300 and 1800 patients annually possibly benefit from PHBT. Prehospital Blood Transfusion appears to be promising but identifying patient groups most likely to benefit as well as the most suitable blood products remain unresolved issues. In Germany PHBT programs are not yet widely established. Paradoxically, this situation, paired with the extensive German Trauma Registry, provides aprime opportunity for comprehensive prospective cohort studies, addressing the balance between PHBT benefits, logistical feasibility, and implementation strategies. Such studies are essential for establishing guidelines and integrating PHBT efficiently into German trauma care protocols.

A guide to global access to HPV vaccination to all women in low- and middle-income countries; a minireview of innovation and equity.

Cervical cancer is caused by the human papillomavirus (HV), and accounts for more than 311,000 preventable deaths annually, with 85% occurring in low-and middle-income countries. Despite being preventable through screening and screening, significant barriers to implementing HPV vaccination persist in developing nations. This review study aims to identify these barriers and propose innovative, evidence-based solutions to improve vaccination rates and reduce cervical cancer mortality. A systematic review search was conducted using PubMed, Embase, and Cochrane Database of Systemic Reviews. Keywords related to HPV vaccination barriers and implementation strategies in developing countries were used. Relevant demonstration projects, pilot studies, and evidence-based research articles were reviewed. Identifiable barriers to a successful vaccine implementation program in a developing country include vaccine costs, societal, cultural resistance, misinformation, logistical challenges in vaccine delivery, and inadequate human resources. Solutions to these barriers include a subsidized vaccine pricing, community sensitization, education and well-trained media professionals to dispel misinformation, and partnerships with both public and private sector for efficient vaccine distribution. These findings highlight critical barriers that impede HPV vaccination efforts in developing countries and offers practical solutions to overcome these challenges. This aggregate of data can help inform future developing countries' implementation programs to further the World Health Assembly mission to vaccinate 90% of eligible girls globally by 2030.