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Robaix M, Mathais Q, de Malleray H, Guigues S, Meaudre E, Bordes J, Cardinale M. Independent factors of preventable death in a mature trauma center: a propensity-score analysis. Eur J Trauma Emerg Surg 2024; 50:477-487. [PMID: 37749282 DOI: 10.1007/s00068-023-02367-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/09/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The rate of potentially preventable deaths (PPD) and preventable deaths (PD) can reach more than 20% of overall trauma mortality. Bleeding is the leading cause of preventable mortality. The aim of our study is to define the independent factors of preventable or potentially preventable mortality in our mature trauma system. MATERIALS AND METHODS We conducted a single-center retrospective study in the Sainte Anne Military Teaching Hospital, Toulon, France, including all severe trauma patients admitted to our trauma center and discharged alive as well as all severe trauma patients who died with a death considered preventable or potentially preventable from January 2013 to December 2020. We matched the two groups using a propensity score and searched for independent factors using a generalized linear model. RESULTS 846 patients were included and analyzed. After matching, our cohort consisted of 245 patients in the survivor group and 49 patients in the preventable deaths group. Pre-hospital delays (73 min vs 54 min P = 0.003) as well as delays before incision in the operating room (80 min vs 52 min P < 0.001) were significantly longer in the PD group. These delays were independent factors of preventable mortality OR 10.35 (95% CI [3.44-31.11] P < 0.001) and OR 37.53 (95% CI [8.51-165.46] P < 0.001) as well as pelvic trauma OR 6.20 (95% CI [1.53-25.20] P = 0.011). CONCLUSION Delays in pre-hospital care, delays in access to the operating room from arrival at the trauma center, and pelvic injuries are independent factors associated with an increased risk of preventable mortality in trauma.
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Affiliation(s)
- Marion Robaix
- Anaesthesiology and Intensive Care Department, Military Teaching Hospital Sainte Anne, Toulon, France
| | - Quentin Mathais
- Anaesthesiology and Intensive Care Department, Military Teaching Hospital Sainte Anne, Toulon, France
| | - Hilaire de Malleray
- Anaesthesiology and Intensive Care Department, Military Teaching Hospital Sainte Anne, Toulon, France
| | - Sarah Guigues
- Anaesthesiology and Intensive Care Department, Military Teaching Hospital Sainte Anne, Toulon, France
| | - Eric Meaudre
- Anaesthesiology and Intensive Care Department, Military Teaching Hospital Sainte Anne, Toulon, France
- Ecole du Val de Grâce, French Military Medical Academy, Paris, France
| | - Julien Bordes
- Anaesthesiology and Intensive Care Department, Military Teaching Hospital Sainte Anne, Toulon, France
- Ecole du Val de Grâce, French Military Medical Academy, Paris, France
| | - Michael Cardinale
- Anaesthesiology and Intensive Care Department, Military Teaching Hospital Sainte Anne, Toulon, France.
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Petrelli A, Ventura M, Di Napoli A, Pappagallo M, Simeoni S, Frova L. Socioeconomic inequalities in avoidable mortality in Italy: results from a nationwide longitudinal cohort. BMC Public Health 2024; 24:757. [PMID: 38468229 DOI: 10.1186/s12889-024-18205-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/24/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Disparities in avoidable mortality have never been evaluated in Italy at the national level. The present study aimed to assess the association between socioeconomic status and avoidable mortality. METHODS The nationwide closed cohort of the 2011 Census of Population and Housing was followed up for 2012-2019 mortality. Outcomes of preventable and of treatable mortality were separately evaluated among people aged 30-74. Education level (elementary school or less, middle school, high school diploma, university degree or more) and residence macro area (North-West, North-East, Center, South-Islands) were the exposures, for which adjusted mortality rate ratios (MRRs) were calculated through multivariate quasi-Poisson regression models, adjusted for age at death. Relative index of inequalities was estimated for preventable, treatable, and non-avoidable mortality and for some specific causes. RESULTS The cohort consisted of 35,708,459 residents (48.8% men, 17.5% aged 65-74), 34% with a high school diploma, 33.5% living in the South-Islands; 1,127,760 deaths were observed, of which 65.2% for avoidable causes (40.4% preventable and 24.9% treatable). Inverse trends between education level and mortality were observed for all causes; comparing the least with the most educated groups, a strong association was observed for preventable (males MRR = 2.39; females MRR = 1.65) and for treatable causes of death (males MRR = 1.93; females MRR = 1.45). The greatest inequalities were observed for HIV/AIDS and alcohol-related diseases (both sexes), drug-related diseases and tuberculosis (males), and diabetes mellitus, cardiovascular diseases, and renal failure (females). Excess risk of preventable and of treatable mortality were observed for the South-Islands. CONCLUSIONS Socioeconomic inequalities in mortality persist in Italy, with an extremely varied response to policies at the regional level, representing a possible missed gain in health and suggesting a reassessment of priorities and definition of health targets.
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Affiliation(s)
- Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Rome, Italy.
| | - Martina Ventura
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Rome, Italy
| | - Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25/a, 00153, Rome, Italy
| | - Marilena Pappagallo
- National Institute of Statistics (Istat), Viale Liegi 13, 00198, Rome, Italy
| | - Silvia Simeoni
- National Institute of Statistics (Istat), Viale Liegi 13, 00198, Rome, Italy
| | - Luisa Frova
- National Institute of Statistics (Istat), Viale Liegi 13, 00198, Rome, Italy
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Golinelli D, Guarducci G, Sanna A, Lenzi J, Sanmarchi F, Fantini MP, Montomoli E, Nante N. Regional and sex inequalities of avoidable mortality in Italy: A time trend analysis. Public Health Pract (Oxf) 2023; 6:100449. [PMID: 38028252 PMCID: PMC10643453 DOI: 10.1016/j.puhip.2023.100449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/18/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives This study provides a comprehensive analysis of avoidable mortality (AM), treatable mortality (TM), and preventable mortality (PM) across Italy, focusing on region- and gender-specific inequalities over a 14-year period. Study design Time-trend analysis (2006-2019). Methods The study was conducted using mortality data from the Italian Institute of Statistics to evaluate the extent and patterns of AM, TM, and PM in Italy. Biennial age-standardized mortality rates were calculated by gender and region using the joint OECD/Eurostat list. Results The overall AM rates showed a large reduction from 2006/7 (221.0 per 100,000) to 2018/9 (166.4 per 100,000). Notably, females consistently displayed lower AM rates than males. Furthermore, both gender differences and the North-South gap of AM decreased during the period studied. The regions with the highest AM rates fluctuated throughout the study period. The highest percentage decrease in AM from 2006/7 to 2018/9, for both males (-41.3 %) and females (-34.2 %), was registered in the autonomous province of Trento, while the lowest reduction was observed in Molise for males (-17.4 %) and in Marche for females (-10.0 %). Conclusions Remarkable gender and regional differences in AM between 2006 and 2019 have been recorded in Italy, although they have decreased over years. Continuous monitoring of AM and the implementation of region- and gender-specific interventions is essential to provide valuable insights for both policy and public health practice. This study contributes to the efforts to improve health equity between Italian regions.
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Affiliation(s)
- Davide Golinelli
- Post Graduate School of Public Health, University of Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, Italy
| | | | - Andrea Sanna
- Post Graduate School of Public Health, University of Siena, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Emanuele Montomoli
- Department of Molecular and Developmental Medicine, University of Siena, Italy
- VisMederi S.r.l., Siena, Italy
| | - Nicola Nante
- Post Graduate School of Public Health, University of Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, Italy
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Nikoloski Z, Shkolnikov VM, Mossialos E. Preventable mortality in the Russian Federation: a retrospective, regional level study. Lancet Reg Health Eur 2023; 29:100631. [PMID: 37180281 PMCID: PMC10172901 DOI: 10.1016/j.lanepe.2023.100631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 05/16/2023]
Abstract
Background Avoidable mortality, including both treatable and preventable deaths, is frequently used as an indicator of health system performance. Whilst the term treatable mortality refers to deaths that might be averted by medical interventions, preventable mortality generally reflects the impact of system-wide health policies. The concept of preventable mortality has not been evaluated extensively in the Russian Federation, particularly at the regional or sub-national (oblast) level. Methods We calculated total preventable mortality as well as individual rates for males and females in each oblast using data from the Russian Fertility and Mortality Database (RusFMD) and computed the contributions of specific preventable causes of death to the overall rates. We also evaluated the relationship between preventable mortality and its main correlates during the years 2014-2018 using panel fixed effects modelling with variables that reflected both, behavioural risk factors and access to health care. Findings Overall preventable mortality in the Russian Federation has been on a downward trend. Whilst 548 preventable deaths per 100,000 person-years were reported in the year 2000, only 301 per 100,000 person-years were reported in 2018. Whilst mortality due to cancer, cardiovascular, and alcohol-related diseases has declined (albeit unevenly) amongst both males and females, deaths resulting from complications of diabetes and human immunodeficiency virus infection have increased. Our findings also revealed significant heterogeneity in preventable mortality at the oblast level. For example, in 2018, deaths due to preventable causes were concentrated primarily in Siberia and the Far East. Smoking and the availability of nurses were identified as significant correlates of preventable mortality at the oblast level. Interpretations Efforts designed to strengthen the current health care system, notably those serving the rural and less densely populated oblasts, might reduce the rate of preventable mortality in Russia. These efforts might be coupled with an ongoing focus on programs designed to reduce smoking. Funding None.
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Affiliation(s)
- Zlatko Nikoloski
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom
- Corresponding author.
| | - Vladimir M. Shkolnikov
- Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Rostock 18057, Germany
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom
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Mühlichen M, Lerch M, Sauerberg M, Grigoriev P. Different health systems - Different mortality outcomes? Regional disparities in avoidable mortality across German-speaking Europe, 1992-2019. Soc Sci Med 2023; 329:115976. [PMID: 37356189 DOI: 10.1016/j.socscimed.2023.115976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/08/2023] [Accepted: 05/18/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Evaluating the impact of health systems on premature mortality across different countries is a very challenging task, as it is hardly possible to disentangle it from the influence of contextual factors such as cultural differences. In this respect, the German-speaking area in Central Europe (Austria, Germany, South Tyrol and large parts of Switzerland) represents a unique 'natural experiment' setting: While being exposed to different health policies, they share a similar culture and language. METHODS To assess the impact of different health systems on mortality differentials across the German-speaking area, we relied on the concept of avoidable mortality. Based on official mortality statistics, we aggregated causes of death below age 75 that are either 1) amenable to health care or 2) avoidable through primary prevention. We calculated standardised death rates and constructed cause-deleted life tables for 9 Austrian, 96 German, 1 Italian and 5 Swiss regions from 1992 to 2019, harmonised according to the current territorial borders. RESULTS There are strong north-south and east-west gradients in amenable and preventable mortality across the studied regions to the advantage of the southwest. However, the Swiss regions still show significantly lower mortality levels than the neighbouring regions in southern Germany. Eliminating avoidable deaths from the life tables reduces spatial inequality in life expectancy in 2017/2019 by 30% for men and 28% for women. CONCLUSIONS The efficiency of health policies in assuring timely and adequate health care and in preventing risk-relevant behaviour has room for improvement in all German regions, especially in the north, west and east, and in eastern Austria as well.
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Affiliation(s)
- Michael Mühlichen
- Federal Institute for Population Research (BIB), Friedrich-Ebert-Allee 4, 65185, Wiesbaden, Germany.
| | - Mathias Lerch
- Swiss Federal Institute of Technology in Lausanne (EPFL), Route Cantonale, 1015, Lausanne, Switzerland
| | - Markus Sauerberg
- Federal Institute for Population Research (BIB), Friedrich-Ebert-Allee 4, 65185, Wiesbaden, Germany
| | - Pavel Grigoriev
- Federal Institute for Population Research (BIB), Friedrich-Ebert-Allee 4, 65185, Wiesbaden, Germany
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Milton R, Modibbo F, Gillespie D, Alkali FI, Mukaddas AS, Kassim A, Sa'ad FH, Tukur FM, Khalid RY, Muhammad MY, Bello M, Edwin CP, Ogudo E, Iregbu KC, Jones L, Hood K, Ghazal P, Sanders J, Hassan B, Belga FJ, Walsh TR. Incidence and sociodemographic, living environment and maternal health associations with stillbirth in a tertiary healthcare setting in Kano, Northern Nigeria. BMC Pregnancy Childbirth 2022; 22:692. [PMID: 36076161 PMCID: PMC9454147 DOI: 10.1186/s12884-022-04971-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background Almost two million stillbirths occur annually, most occurring in low- and middle-income countries. Nigeria is reported to have one of the highest stillbirth rates on the African continent. The aim was to identify sociodemographic, living environment, and health status factors associated with stillbirth and determine the associations between pregnancy and birth factors and stillbirth in the Murtala Mohammed Specialist Hospital, Kano, Nigeria. Methods A three-month single-site prospective observational feasibility study. Demographic and clinical data were collected. We fitted bivariable and multivariable models for stillbirth (yes/no) and three-category livebirth/macerated stillbirth/non-macerated stillbirth outcomes to explore their association with demographic and clinical factors. Findings 1,998 neonates and 1,926 mothers were enrolled. Higher odds of stillbirth were associated with low-levels of maternal education, a further distance to travel to the hospital, living in a shack, maternal hypertension, previous stillbirth, birthing complications, increased duration of labour, antepartum haemorrhage, prolonged or obstructed labour, vaginal breech delivery, emergency caesarean-section, and signs of trauma to the neonate following birth. Interpretation This work has obtained data on some factors influencing stillbirth. This in turn will facilitate the development of improved public health interventions to reduce preventable deaths and to progress maternal health within this site. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04971-x.
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Affiliation(s)
- Rebecca Milton
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - F Modibbo
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - D Gillespie
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - F I Alkali
- Department of Biochemistry, Bayero University, Kano, Nigeria
| | - A S Mukaddas
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - A Kassim
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - F H Sa'ad
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
| | - F M Tukur
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - R Y Khalid
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - M Y Muhammad
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - M Bello
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - C P Edwin
- Department of Microbiology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - E Ogudo
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - K C Iregbu
- Department of Medical Microbiology, National Hospital Abuja, Abuja, Nigeria
| | - L Jones
- Department of Medical Microbiology Cardiff, Public Health Wales, University Hospital of Wales, Cardiff, UK
| | - K Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - P Ghazal
- Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - B Hassan
- Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - F J Belga
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - T R Walsh
- Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK.,Department of Zoology, Ineos Institute of Antimicrobial Research, University of Oxford, Oxford, UK
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Khomenko S, Cirach M, Barrera-Gómez J, Pereira-Barboza E, Iungman T, Mueller N, Foraster M, Tonne C, Thondoo M, Jephcote C, Gulliver J, Woodcock J, Nieuwenhuijsen M. Impact of road traffic noise on annoyance and preventable mortality in European cities: A health impact assessment. Environ Int 2022; 162:107160. [PMID: 35231841 DOI: 10.1016/j.envint.2022.107160] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/01/2022] [Accepted: 02/21/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND Road traffic is the main source of environmental noise in European cities and one of the main environmental risks to health and wellbeing. In this study we aimed to provide an in-depth assessment of available road traffic noise data and to estimate population exposure and health impacts for cities in Europe. METHODS We conducted the analysis for 724 cities and 25 greater cities in 25 European countries. We retrieved road traffic strategic noise maps delivered under the Environmental Noise Directive (END) or available from local sources. We assessed noise exposure using the 24 h day-evening-night noise level indicator (Lden) starting at exposure levels of 55 dB Lden - based on data availability - for the adult population aged 20 and over (n = 123,966,346). For the adults exposed to noise levels above 55 dB Lden we estimated the health impacts of compliance with the World Health Organization (WHO) recommendation of 53 dB Lden. Two primary health outcomes were assessed: high noise annoyance and Ischemic Heart Disease (IHD), using mortality from IHD causes as indicator. Exposure Response Functions (ERFs) relating road traffic noise exposure to annoyance and IHD mortality were retrieved from the literature. Uncertainties in input parameters were propagated using Monte Carlo simulations to obtain point estimates and empirical 95% Confidence Intervals (CIs). Lastly, the noise maps were categorized as high, moderate and low quality following a qualitative approach. RESULTS Strategic noise map data was delivered in three distinct formats (i.e. raster, polygon or polyline) and had distinct noise ranges and levels of categorization. The majority of noise maps (i.e. 83.2%) were considered of moderate or low quality. Based on the data provided, almost 60 million adults were exposed to road traffic noise levels above 55 dB Lden, equating to a median of 42% (Interquartile Range (IQR): 31.8-64.8) of the adult population across the analysed cities. We estimated that approximately 11 million adults were highly annoyed by road traffic noise and that 3608 deaths from IHD (95% CI: 843-6266) could be prevented annually with compliance of the WHO recommendation. The proportion of highly annoyed adults by city had a median value of 7.6% (IQR: 5.6-11.8) across the analysed cities, while the number preventable deaths had a median of 2.2 deaths per 100,000 population (IQR: 1.4-3.1). CONCLUSIONS Based on the provided strategic noise maps a considerable number of adults in European cities are exposed to road traffic noise levels harmful for health. Efforts to standardize the strategic noise maps and to increase noise and disease data availability at the city level are needed. These would allow for a more accurate and comprehensive assessment of the health impacts and further help local governments to address the adverse health effects of road traffic noise.
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Affiliation(s)
- Sasha Khomenko
- Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Marta Cirach
- Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jose Barrera-Gómez
- Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Evelise Pereira-Barboza
- Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Tamara Iungman
- Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Natalie Mueller
- Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria Foraster
- Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; PHAGEX Research Group, Blanquerna School of Health Science, Universitat Ramon Llull (URL), Barcelona, Spain
| | - Cathryn Tonne
- Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Meelan Thondoo
- Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Calvin Jephcote
- Centre for Environmental Health and Sustainability (CEHS), University of Leicester, Leicester, United Kingdom
| | - John Gulliver
- Centre for Environmental Health and Sustainability (CEHS), University of Leicester, Leicester, United Kingdom
| | - James Woodcock
- Institute for Global Health (ISGlobal), Barcelona, Spain; MRC Epidemiology unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Mark Nieuwenhuijsen
- Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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Milton R, Alkali FI, Modibbo F, Sanders J, Mukaddas AS, Kassim A, Sa'ad FH, Tukur FM, Pell B, Hood K, Ghazal P, Iregbu KC. A qualitative focus group study concerning perceptions and experiences of Nigerian mothers on stillbirths. BMC Pregnancy Childbirth 2021; 21:830. [PMID: 34906118 PMCID: PMC8670111 DOI: 10.1186/s12884-021-04207-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To explore the experiences and perceptions of stillbirth among mothers from a tertiary medical centre in Kano, Northern Nigeria. Design Qualitative, interpretative. Setting Tertiary healthcare facility, Murtala Muhammad Specialist Hospital (MMSH), Kano, Northern Nigeria. Sample Mothers who had given birth to a liveborn baby at the MMSH in the prior 6 months (n = 31). In order to capture the experiences and perception of stillbirth within this cohort we approached mothers who had in a previous pregnancy experienced a stillbirth. Of the 31 who attended 16 had a previous stillbirth. Methods Semi-structured Focus Group Discussions, consisting of open-ended questions about stillbirth, beliefs, experiences and influences were held in MMSH, conducted over 1 day. Results Our findings highlight that this is a resource-poor tertiary facility serving an ever-growing population, increasing strain on the hospital and healthcare workers. Many of the participants highlighted needing permission from certain family members before accessing healthcare or medical treatment. We identified that mothers generally have knowledge on self-care during pregnancy, yet certain societal factors prevented that from being their priority. Judgement and blame was a common theme, yet a complex area entwined with traditions, superstitions and the pressure to procreate with many mothers described being made to feel useless and worthless if they did not birth a live baby. Conclusions As access to healthcare becomes easier, there are certain traditions, family and social dynamics and beliefs which conflict with scientific knowledge and act as a major barrier to uptake of healthcare services. The findings highlight the need for investment in maternity care, appropriate health education and public enlightenment; they will help inform appropriate interventions aimed at reducing stigma around stillbirth and aide in educating mothers about the importance of appropriate health seeking behaviour. Stillbirths are occurring in this area of the world unnecessarily, globally there has been extensive research conducted on stillbirth prevention. This research has highlighted some of the areas which can be tackled by modifying existing successful interventions to work towards reducing preventable stillbirths. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04207-4.
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Affiliation(s)
- R Milton
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - F I Alkali
- Department of Biochemistry, Bayero University, Kano, Nigeria
| | - F Modibbo
- Murtala Muhammad Specialist Hospital, Kano, Nigeria
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - A S Mukaddas
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - A Kassim
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - F H Sa'ad
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
| | - F M Tukur
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - B Pell
- Centre for the Development and Evaluation of Complex Intervention for Public Health Improvement, Cardiff University, Cardiff, UK
| | - K Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - P Ghazal
- Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - K C Iregbu
- Department of Medical Microbiology, National Hospital, Abuja, Nigeria
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Niedhammer I, Milner A, Geoffroy-Perez B, Coutrot T, LaMontagne AD, Chastang JF. Psychosocial factors at work from the job strain model and preventable mortality in France: The STRESSJEM prospective study. Prev Med 2021; 153:106178. [PMID: 32603796 DOI: 10.1016/j.ypmed.2020.106178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 01/28/2023]
Abstract
The study aimed to explore the prospective associations between psychosocial factors at work from the job strain model and preventable mortality, including smoking- and alcohol-related mortality as well as external causes of death. The study was based on prospective data and relied on a sample of 1,511,456 individuals for which data on job history, mortality and causes of death were linked over the 1976-2002 period. Exposures were the factors from the job strain model imputed through a job-exposure matrix. Various time-varying measures of exposure were used including current exposure and two measures of cumulative exposure. Preventable mortality was defined using the OECD/Eurostat list of preventable causes of death. The associations between exposures and outcomes were studied using Cox proportional hazards models. Effect modification by gender was also assessed. Over the study period, 57,264 preventable deaths occurred before the age of 75 years. Low decision latitude, low social support, job strain, iso-strain, passive job, and high strain were associated with preventable mortality, and associations of stronger magnitude were found for job strain and isostrain among men. Stronger associations were observed for alcohol-related mortality than for smoking-related mortality and external causes of death. The fractions of preventable mortality attributable to current exposure to job strain and isostrain were significant among men only (5.1% and 3.3%). Psychosocial factors at work from the job strain model may play a role on preventable mortality. Intensifying research and prevention towards the psychosocial work environment may be helpful to reduce risky health-related behaviours and related mortality.
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Eftekhari A, DehghaniTafti A, Nasiriani K, Hajimaghsoudi M, Fallahzadeh H, Khorasani-Zavareh D. Identification and Prioritization of Key Components Influencing Prehospital Emergency Related to Preventable Road Traffic Injuries Deaths in Iran; A Delphi Study. Bull Emerg Trauma 2019; 7:381-389. [PMID: 31858001 DOI: 10.29252/beat-070407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective To identify and prioritize the key Components of prehospital emergency system to prevent mortality in road traffic injuries. Methods A total of 25 emergency medicine practitioners, emergency ward nurses, and managers of prehospital emergency centers participated in this adjusted Delphi study in three rounds. After extracting the primary components through reviewing systematic studies and interviewing experts, the Delphi rounds were performed with the presence of experts. The data were analyzed with both qualitative content analysis and quantitative analysis using SPSS20 software. For the analysis and selection of the final priorities, the coefficient of agreement of over 70% was used. Results After doing three Delphi rounds, in the final Delphi round, 10 superior components were selected respectively as follows: correct history taking of the victim, examining possible cervical injury, the time spent from the first call to arrival of technicians to the scene, the time spent from arriving at the scene to the time of hospital transport, passing of re-education courses by EMS technicians, coordination among the rescue organizations, police, the Red Crescent, fire station, and healthcare organizations, integrated commandership at scene, police attendance in the scene before EMS arrival at the scene, proper ambulance equipment with respect to the required equipment (A, B, C) on the basis of victim's condition, and coordination with the target hospital for patient transport. Conclusion This study determined the most applicable managerial methods of prehospital emergency components pertaining to preventable fatal road traffic injuries through empowerment of EMS systems in the fields of victim assessment, time management indices, personnel training, coordination between the involved organs, and the presence of the main commander in the scene.
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Affiliation(s)
- Adel Eftekhari
- Department of Health in Emergencies and Disasters, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Abbasali DehghaniTafti
- Department of Health in Emergencies and Disasters, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Khadijeh Nasiriani
- Department of Nursing, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Majid Hajimaghsoudi
- Trauma Research Center, Shahid Rahnemoon Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Fallahzadeh
- Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Davoud Khorasani-Zavareh
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
Tobacco smoke, active or passive exposure was the major cause of preventable morbidity and mortality in the world during twentieth century and will continue to be the same in the twenty-first century also if the current trends continue. Both active and passive smoking are having significance in relation to child health. Exposure starts antenatally from placenta to the fetus and later phases through passive exposure to experimental and regular smoking and ultimately addiction and habitual smoking. Evidences are in favour of causal relationship with intrauterine growth restriction, sudden infant death syndrome, decreased pulmonary function, increased risk for respiratory tract infection, otitis media, wheeze, asthma, neurobehavioral disorders, cleft palate and triggering pathogenesis of fetal and childhood onset of adult diseases, especially pulmonary and cardio vascular diseases. All these facts stress the importance of behavioral changes in the population as well as stringent public health measures and legislation for ensuring smoke free work places, public places and households for children. M POWER- Package by WHO is a novel global initiative taking us closer to the target of achieving tobacco free environment for children in the near future.
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Affiliation(s)
- R Remesh Kumar
- Department of Pediatrics, N.S.S. Medical Mission Hospital, Pandalam, Pathanamthitta Dist., Kerala, 689501, India.
| | - P R Jayakumar
- Department of Neonatology, Government Medical College Hospital, Kottayam, Kerala, India
| | - R Krishna Mohan
- Department of Pediatrics, Kerala Government Health Services, Kozhikode, Kerala, India
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Le Lagadec MD, Dwyer T. Scoping review: The use of early warning systems for the identification of in-hospital patients at risk of deterioration. Aust Crit Care 2017; 30:211-8. [PMID: 27863876 DOI: 10.1016/j.aucc.2016.10.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 10/24/2016] [Accepted: 10/31/2016] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Early warning systems (EWS) were developed as a means of alerting medical staff to patient clinical decline. Since 85% of severe adverse events are preceded by abnormal physiological signs, the patient bed-side vital signs observation chart has emerged as an EWS tool to help staff identify and quantify deteriorating patients. There are three broad categories of patient observation chart EWS: single or multiple parameter systems; aggregated weighted scoring systems; or combinations of single or multiple parameter and aggregated weighted scoring systems. OBJECTIVE This scoping review is an overview of quantitative studies and systematic reviews examining the efficiency of the adult EWS charts in the recognition of in-hospital patient deterioration. METHOD A broad search was undertaken of peer-reviewed publications, official government websites and databases housing research theses, using combinations of keywords and phrases. DATA SOURCES CINAHL with full text; MedLine, PsycINFO, MasterFILE Premier, GreenFILE and ScienceDirect. Also, the Cochrane Library database, Department of Health government websites and Ethos, ProQuest and Trove databases were searched. EXCLUSIONS Paediatric, obstetric and intensive care studies, studies undertaken at the point of hospital admission or pre-admission, non-English publications and editorials. RESULTS Five hundred and sixty five publications, government documents, reports and theses were located of which 91 were considered and 21 were included in the scoping review. Of the 21 publications eight studies compared the efficacy of various EWS and 13 publications validated specific EWS. CONCLUSIONS There is low level quantitative evidence that EWS improve patient outcomes and strong anecdotal evidence that they augment the ability of the clinical staff to recognise and respond to patient decline, thus reducing the incidence of severe adverse events. Although aggregated weighted scoring systems are most frequently used, the efficiency of the specific EWS appears to be dependent on the patient cohort, facilities available and staff training and attitude. While the review demonstrates support for EWS, researchers caution that given the contribution of human factors to the EWS decision-making process, patient EWS charts alone cannot replace good clinical judgment.
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Melchor I, Nolasco A, Moncho J, Quesada JA, Pereyra-Zamora P, García-Senchermés C, Tamayo-Fonseca N, Martínez-Andreu P, Valero S, Salinas M. Trends in mortality due to motor vehicle traffic accident injuries between 1987 and 2011 in a Spanish region (Comunitat Valenciana). Accid Anal Prev 2015; 77:21-28. [PMID: 25667203 DOI: 10.1016/j.aap.2015.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To analyse the time evolution of the rates of mortality due to motor vehicle traffic accidents (MVTA) injuries that occurred among the general population of Comunitat Valenciana between 1987 and 2011, as well as to identify trend changes by sex and age group. METHODS An observational study of annual mortality trends between 1987 and 2011. We studied all deaths due to MVTA injuries that occurred during this period of time among the non-institutionalised population residing in Comunitat Valenciana (a Spanish Mediterranean region that had a population of 5,117,190 inhabitants in 2011). The rates of mortality due to MVTA injuries were calculated for each sex and year studied. These rates were standardised by age for the total population and for specific age groups using the direct method (age-standardised rate - ASR). Joinpoint regression models were used in order to detect significant trend changes. Additionally, the annual percentage change (APC) of the ASRs was calculated for each trend segment, which is reflected in statistically significant joinpoints. RESULTS For all ages, ASRs decrease greatly in both men and women (70% decrease between 1990 and 2011). In 1990 and 2011, men have rates of 36.5 and 5.2 per 100,000 men/year, respectively. In the same years, women have rates of 8.0 and 0.9 per 100,000 women/year, respectively. This decrease reaches up to 90% in the age group 15-34 years in both men and women. ASR ratios for men and women increased over time for all ages: this ratio was 3.9 in 1987; 4.6 in 1990; and 5.8 in 2011. For both men and women, there is a first significant segment (p<0.05) with an increasing trend between 1987 and 1989-1990. After 1990, there are 3 segments with a significant decreasing APC (1990-1993, 1993-2005 and 2005-2011, in the case of men; and 1989-1996, 1999-2007 and 2007-2011, in the case of women). CONCLUSION The risk of death due to motor vehicle traffic accidents injuries has decreased significantly, especially in the case of women, for the last 25 years in Comunitat Valenciana, mainly as of 2006. This may be a consequence of the road-safety measures that have been implemented in Spain and in Comunitat Valenciana since 2004. The economic crisis that this country has undergone since 2008 may have also been a contributing factor to this decrease. Despite the decrease, ASR ratios for men and women increased over time and it is still a high-risk cause of death among young men. It is thus important that the measures that helped decrease the risk of death are maintained and improved over time.
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Affiliation(s)
- Inmaculada Melchor
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias (Mortality and Health Statistics Research and Analysis Unit), Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante. Campus de San Vicente del Raspeig s/n, Apartado 99, 03080-Alicante, Spain; Registro de Mortalidad de la Comunidad Valenciana. Servicio de Estudios Epidemiológicos y Estadísticas Sanitarias, Subdirección General de Epidemiología y Vigilancia de la Salud, Conselleria de Sanitat, Plaza de España 6, 03010 Alicante, Spain.
| | - Andreu Nolasco
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias (Mortality and Health Statistics Research and Analysis Unit), Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante. Campus de San Vicente del Raspeig s/n, Apartado 99, 03080-Alicante, Spain.
| | - Joaquín Moncho
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias (Mortality and Health Statistics Research and Analysis Unit), Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante. Campus de San Vicente del Raspeig s/n, Apartado 99, 03080-Alicante, Spain.
| | - José A Quesada
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias (Mortality and Health Statistics Research and Analysis Unit), Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante. Campus de San Vicente del Raspeig s/n, Apartado 99, 03080-Alicante, Spain.
| | - Pamela Pereyra-Zamora
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias (Mortality and Health Statistics Research and Analysis Unit), Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante. Campus de San Vicente del Raspeig s/n, Apartado 99, 03080-Alicante, Spain.
| | - Carmen García-Senchermés
- Registro de Mortalidad de la Comunidad Valenciana. Servicio de Estudios Epidemiológicos y Estadísticas Sanitarias, Subdirección General de Epidemiología y Vigilancia de la Salud, Conselleria de Sanitat, Plaza de España 6, 03010 Alicante, Spain.
| | - Nayara Tamayo-Fonseca
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias (Mortality and Health Statistics Research and Analysis Unit), Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante. Campus de San Vicente del Raspeig s/n, Apartado 99, 03080-Alicante, Spain.
| | - Purificación Martínez-Andreu
- Registro de Mortalidad de la Comunidad Valenciana. Servicio de Estudios Epidemiológicos y Estadísticas Sanitarias, Subdirección General de Epidemiología y Vigilancia de la Salud, Conselleria de Sanitat, Plaza de España 6, 03010 Alicante, Spain.
| | - Socorro Valero
- Registro de Mortalidad de la Comunidad Valenciana. Servicio de Estudios Epidemiológicos y Estadísticas Sanitarias, Subdirección General de Epidemiología y Vigilancia de la Salud, Conselleria de Sanitat, Plaza de España 6, 03010 Alicante, Spain.
| | - Manuel Salinas
- Registro de Mortalidad de la Comunidad Valenciana. Servicio de Estudios Epidemiológicos y Estadísticas Sanitarias, Subdirección General de Epidemiología y Vigilancia de la Salud, Conselleria de Sanitat, Plaza de España 6, 03010 Alicante, Spain.
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Uggla C, Mace R. Someone to live for: effects of partner and dependent children on preventable death in a population wide sample from Northern Ireland. EVOL HUM BEHAV 2015; 36:1-7. [PMID: 25593513 PMCID: PMC4286120 DOI: 10.1016/j.evolhumbehav.2014.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 07/22/2014] [Indexed: 01/30/2023]
Abstract
How to allocate resources between somatic maintenance and reproduction in a manner that maximizes inclusive fitness is a fundamental challenge for all organisms. Life history theory predicts that effort put into somatic maintenance (health) should vary with sex, mating and parenting status because men and women have different costs of reproduction, and because life transitions such as family formation alter the fitness payoffs from investing in current versus future reproduction. However, few tests of how such life history parameters influence behaviours closely linked to survival exist. Here we examine whether specific forms of preventable death (accidents/suicides, alcohol-related causes, and other preventable diseases) are predicted by marital status and dependent offspring in a modern developed context; that of Northern Ireland. We predict that men, non-partnered individuals and individuals who do not have dependent offspring will be at higher risk of preventable death. Running survival analyses on the entire adult population (aged 16-59, n = 927,134) controlling for socioeconomic position (SEP) and other potential confounds, we find that being single (compared to cohabiting/married) increases risk of accidental/suicide death for men (but not for women), whereas having dependent children is associated with lower risk of preventable mortality for women but less so for men. We also find that the protective effect of partners is larger for men with low SEP than for high SEP men. Findings support life history predictions and suggest that individuals respond to variation in fitness costs linked to their mating and parenting status.
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Affiliation(s)
- Caroline Uggla
- Department of Anthropology, University College London, UK
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Gupta M, Fuchs B, Cutilli C, Cintolo J, Reinke C, Kean C, Fishman N, Sullivan P, Kelz RR. Preventable mortality: does the perspective matter when determining preventability? J Surg Res 2013; 184:54-60. [PMID: 23773717 DOI: 10.1016/j.jss.2013.05.069] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 04/13/2013] [Accepted: 05/15/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND We report a novel approach to mortality review using a 360° survey and a multidisciplinary mortality committee (MMC) to optimize efforts to improve inpatient care. METHODS In 2009, a 16-item, 360° compulsory quality improvement survey was implemented for mortality review. Descriptive statistics were performed to compare the responses by provider specialty, profession, and level of training using the Fisher exact and chi-square tests, as appropriate. We compared the agreement between the MMC review and provider-reported classification regarding the preventability of each death using the Cohen kappa coefficient. A qualitative review of 360° information was performed to identify the quality opportunities. RESULTS Completed surveys (n = 3095) were submitted for 1683 patients. The possibility of a preventable death was suggested in the 360° survey for 42 patients (1.40%). We identified 502 patients (29.83%) with completed 360° surveys who underwent MMC review. The inter-rater reliability between the provider opinions regarding preventable death and the MMC review was poor (kappa = 0.10, P < 0.001). Of the 42 cases identified by the 360° survey as preventable deaths, 15 underwent MMC review; 3 were classified as preventable and 12 were deemed unavoidable. Qualitative analyses of the 12 discrepancies did reveal quality issues; however, they were not deemed responsible for the patients' death. CONCLUSIONS The mortality survey yielded important information regarding inpatient deaths that historically was buried with the patient. Poor agreement between the 360° survey responses and an objective MMC review support the need to have a multipronged approach to evaluating inpatient mortality.
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El-Shafei M. Lessons learned from maternal mortality study to reduce deaths in Egypt. Int J Gynaecol Obstet 1995; 50 Suppl 2:S109-S111. [PMID: 29645161 DOI: 10.1016/0020-7292(95)02497-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To identify causes of maternal death in Egypt and with that knowledge to effect its reduction, the Ministry of Health launched a study, a unique aspect of which was exploration of avoidable factory at home, in medical facilities, and during transportation from one to the other. The country must make better use of existing personnel and buildings.
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Affiliation(s)
- M El-Shafei
- Ministry of Health, Bab El Louk, Cairo Egypt
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