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Labelled 'the shadow pandemic' by UN Women, violence against women received considerable global public attention during 2020–21. Underpinning this moment of public concern, there lies a substantial history of efforts to document the nature of, and campaign against, the extent of violence against women globally. This is also the case in relation to femicide. Whilst we recognise that this is a contested term, for the purposes of this paper we use femicide to refer to the killing of women and girls because they are female by male violence. Femicide, as a death to be specifically counted in law only exists in a small number of jurisdictions. Where it is so recognised, primarily in South American countries as feminicidio, such deaths represent only the tip of the iceberg of such killings globally. This paper, in drawing on empirical data from a range of different sources (including administrative data, media analysis, and Femicide Observatory data) gathered throughout 2020, considers: what it means to call a death femicide, what implications might follow if all the deaths of women at the hands of men were counted as femicide, and the extent to which extraordinary times have any bearing on this kind of ordinary death. [ABSTRACT FROM AUTHOR]

This paper utilises empirical data to explore the value of 'body work' performed by last responders charged with the duty of dead body management, with a focus on the Global South. While frontline staff work to save lives, little is known about the experiences and roles of those who care for the dead in global health in times of crises and even during normal times. This paper discusses ethical and socio-cultural challenges pathologists face in 'working on the bodies of others' while conducting any form of post-mortem procedures – necessary for ascertaining and recording the causes of death. Identifying and reporting the cause of death have significant public health benefits and provide closure for bereaved families. Despite the foregoing, the pathology field does not attract funding from governments or donors, and it is overlooked compared to other disciplines. Autopsy procedure bears social stigma – as it is associated with body mutilation and therefore disrespecting the dead; certain cultural beliefs or taboos about impurity and death persist, further raising some social and ethical tensions. As a result, the dearth of autopsy procedures contributes to the cause of death uncertainty in global health. [ABSTRACT FROM AUTHOR]

This paper critically analyses deaths in prison in England and Wales. It focuses on how the state's 'truth' about the nature and extent of these deaths has been challenged and develops an alternative perspective which situates these deaths in the context of a system built on violence and systemic indifference and where state agents are protected by a culture of immunity and impunity. It also illustrates the often-abysmal treatment of the families of dead prisoners and the struggles they have engaged in, alongside the charity INQUEST1, to establish the actual truth about the deaths of their relatives and to hold to account those responsible for these deaths, many of which were preventable. The paper concludes by outlining a range of radical alternatives to the current baleful situation including humanising prisoners and removing the stigma of less eligibility which has prevailed for 200 years and has legitimated the pain and punishment inflicted on them by the state. [ABSTRACT FROM AUTHOR]

Turbulent socio-economic development, recent political challenges, and remarkable regional diversity with deep historical roots make Ukraine an important case study for understanding mortality trends in Eastern Europe. In this paper, we provide the first comprehensive, spatially detailed analysis of cause-specific mortality trends and patterns in Ukraine, focusing on the period 2006–19. We rely on official mortality data and use various demographic and spatial analysis techniques. Our results suggest a notable attenuation of the long-standing West–East and West–South–East mortality gradients. Cardiovascular mortality at older ages largely explains the gap between the vanguard (lowest mortality) and laggard (highest mortality) areas, especially for females and in the most recent period. By contrast, the impact of mortality from external causes has greatly diminished over time. Hotspot analyses reveal strong and persistent clustering of mortality from suicide, HIV, and lung cancer. Further research should focus on in-depth assessment of the mechanisms causing the observed patterns. [ABSTRACT FROM AUTHOR]

The study investigates the prevalence of substance use disorder and role of institutions in preventing it in Gangtok, a capital city of the northern Indian state of Sikkim. A survey of 816 respondents was undertaken using a short and easy-to-understand questionnaire. Results reveal that 64% of respondents identified persons with harmful drug use in their immediate families or in their neighborhoods and nearly same percentage of people conceal the actual cause of death in cases where death occurred due to drug overuse. The paper uncovers that cases of substance use disorder have increased and a considerable number of people are reported dying due to it, but families often hide the actual cause of death. The role of institutions is found to be limited in preventing it, as the process of knowledge transmission among families and patients with heavy drug use is abysmally slow. The study argues to empowering society with a potential tool, that is, knowledge transmission, and enabling them to devise meaningful tools to tackle rising cases of substance use disorder. [ABSTRACT FROM AUTHOR]

Malignant tumor is one of the most important causes of death in the world today. At present, the successful cure cases of tumor patients are mainly due to the timely treatment of tumors. Therefore, it has become one of the urgent problems for human beings to find tumors as soon as possible and how to completely eradicate them. The technology of simultaneous imaging and treatment through photoinitiation is a promising strategy to fight cancer. In the previous research, we developed a new small molecule p-QM2AF for photothermal therapy, but the low fluorescence efficiency (QY) in the NIR-II range made it necessary to modify it. In this paper, we obtained better imaging and photothermal conversion performance by grafting two 9- methylene nonadecanes onto the p-QM2AF sub-receptor. [ABSTRACT FROM AUTHOR]

Suicide remains a leading cause of death worldwide, with an estimated 700,000 suicide deaths per year. The World Health Organization identifies reducing alcohol use as one component of comprehensive approaches to suicide prevention. This paper conducted a rapid review of the evidence on alcohol-related suicide prevention interventions. PubMed, Embase and Web of Science were searched for articles related to alcohol, suicide, prevention, and policies, published between 1990 and 2020. 5293 articles were identified; after deduplication, 2567 studies were screened at the title and abstract level. 402 articles underwent full-text review. 69 articles were ultimately included and underwent data extraction. Interventions were categorized as policy interventions, community-based interventions, and clinical interventions. While there is evidence that policy interventions targeting alcohol may be associated with lower suicide rates, more evidence using stronger study designs is needed. The evidence for community interventions was mixed and supported the need for further research on these types of interventions. Pharmaceutical and therapy-based clinical interventions also showed some promise, with more research needed. Overall, despite evidence of alcohol's role in suicide attempts and deaths, few interventions have been developed with the purpose of addressing alcohol-related suicide. More research is needed to identify effective interventions to prevent alcohol-related suicide. [ABSTRACT FROM AUTHOR]

Changed health behaviours can contribute significantly to improved health. Consequently, significant investments have been channelled towards health behaviour change initiatives in Africa. Health behaviour change initiatives that address social, economic and environmental levers for behaviour change can create more sustained impact. Through a scoping study of the literature, we explored the literature on behaviour change initiatives in Africa, to assess their typologies. We explored whether the availability of initiatives reflected country demographic characteristics, namely life expectancy, gross domestic product (GDP), and population sizes. Finally, we assessed topical themes of interventions relative to frequent causes of mortality. We used the Behaviour Change Wheel intervention categories to categorise each paper into a typology of initiatives. Using Pearson's correlation coefficient, we explored whether there was a correlation between the number of initiatives implemented in a country in the specified period, and socio-demographic indicators, namely, GDP per capita, total GDP, population size, and life expectancy. Almost 64% of African countries were represented in the identified initiatives. One in five initiatives was implemented in South Africa, while there was a dearth of literature from Central Africa and western parts of North Africa. There was a positive correlation between the number of initiatives and GDP per capita. Most initiatives focused on addressing sexually transmitted infections and were short-term trials and/or pilots. Most initiatives were downstream focused e.g. with education and training components, while upstream intervention types such as the use of incentives were under-explored. We call for more emphasis on initiatives that address contextual facilitators and barriers, integrate considerations for sustainable development, and consider intra-regional deprivation. [ABSTRACT FROM AUTHOR]

Global health practitioners and policymakers have become increasingly vocal about the complex challenges of identifying and quantifying the causes of death of the world's poorest people. To address this cause-of-death uncertainty and to minimise longstanding sensitivities about full autopsies, the Bill and Melinda Gates Foundation have been one of the foremost advocates of minimally invasive autopsy technology (MIA). MIA involves using biopsy needles to collect samples from key organs and body fluids; as such, it is touted as potentially more acceptable and less invasive than a complete autopsy, which requires opening the cadaver. In addition, MIA is considered a good means of collecting accurate bodily samples and can provide the crucial information needed to address cause-of-death uncertainty. In this paper, we employ qualitative data to demonstrate that while MIA technology has been introduced as a solution to the enduring cause-of-death uncertainty, the development and deployment of technologies such as these always constitute interventions in complex social and moral worlds; in this respect, they are both the solutions to and the causes of new kinds of uncertainties. We deconstruct the ways in which those new dimensions of uncertainty operate at different levels in the global health context. [ABSTRACT FROM AUTHOR]

As recent suicide statistics reveal, suicide can affect people of all demographics and regions. At an international level, suicide is one of the leading causes of death. Although it is unclear as to why suicide rates are increasing across the globe, proposed reasons include economic instability, the opioid crisis, and a lack of meaning. Therefore, it becomes critical to both educate and provide interventions to people contemplating suicide to help prevent an increase in suicides. The 7-Step Integrative Healing Model and telephone lifelines can serve as useful interventions as well as educational tools on emotional management and psychological care. In this paper, we present a case study of the establishment of a suicide prevention lifeline in Armenia, with emphasis on lessons learned from grassroots partnerships between MeaningfulWorld and the local communities. [ABSTRACT FROM AUTHOR]

This paper draws upon the notion of slow emergency as a framework to interpret ethnographic and qualitative findings on the challenges faced by Puerto Ricans with chronic conditions and health-sector representatives throughout the island during and after Hurricane María. We conducted participant observation and qualitative interviews with chronic disease patients (n = 20) health care providers and administrators (n = 42), and policy makers (n = 5) from across the island of Puerto Rico in 2018 and 2019. Many Puerto Ricans coping with chronic diseases during and after María experienced bureaucratic red tape as a manifestation of the colonial legacies of disaster management and health care. They describe a precarious existence in perpetual 'application pending' status, waiting for services that were not forthcoming. Drawing on ethnographically informed case examples, we discuss the effects of these bureaucratic barriers on persons with three chronic conditions: renal disease, opioid dependency, and HIV/AIDS. We argue that while emergency management approaches often presume a citizen-subject with autonomous capacity to prepare for presumably transient disasters and envision a 'post-disaster future' beyond the immediate crisis, Puerto Rican voices draw attention to the longer, sustained, slow emergency of colonial governance. [ABSTRACT FROM AUTHOR]

In the light of the Corona Virus pandemic which prematurely killed an unknown number of disabled people, the main purpose of this Current Issue paper is to raise questions about how historians can investigate the subject of premature death given the fact that any records which name individual patients are closed due to 'patient confidentiality'. It makes links between historic failures to investigate premature death, and recent examples, and argues that we need to challenge the blanket assumption that people are protected by having information about them kept confidential. [ABSTRACT FROM AUTHOR]

Traffic crashes are one of the most severe problems that affect communities worldwide. Despite that only 25% of all motor vehicle miles occur at night, about 50% of all traffic fatalities occur during night. In Jordan, traffic crashes were responsible for 4.5% of fatalities in 2007 and ranked as the third cause of death in 2010. The effect of lighting on crash reduction was evaluated in many countries around the world but none of these was in Jordan. This paper evaluates the effectiveness of roadway lighting on night-time crash reduction in Jordan before and after continuous lighting system installation. Crash data collected from the Jordanian Central Traffic Department were analysed statistically. Several variables were considered, out of them, five were statistically significant: Crash year, road surface, whether the crash occurred during the day or the night, number of vehicles involved and lighting condition. Results confirmed that lighting reduces expected crashes. [ABSTRACT FROM AUTHOR]

This paper reviews the history of the radium dial workers in the United States, summarizes the scientific progress made since the last evaluation in the early 1990s, and discusses current progress in updating the epidemiologic cohort and applying new dosimetric models for radiation risk assessment. The discoveries of radiation and radioactivity led quickly to medical and commercial applications at the turn of the 20th century, including the development of radioluminescent paint, made by combining radium with phosphorescent material and adhesive. Workers involved with the painting of dials and instruments included painters, handlers, ancillary workers, and chemists who fabricated the paint. Dial painters were primarily women and, prior to the mid to late 1920s, would use their lips to give the brush a fine point, resulting in high intakes of radium. The tragic experience of the dial painters had a significant impact on industrial safety standards, including protection measures taken during the Manhattan Project. The dial workers study has formed the basis for radiation protection standards for intakes of radionuclides by workers and the public. The mortality experience of 3,276 radium dial painters and handlers employed between 1913 and 1949 is being determined through 2019. The last epidemiologic follow-up was 30 years ago when most of these workers were still alive. Nearly 65% were born before 1920, 37.5% were teenagers when first hired, and nearly 50% were hired before 1930 when the habit of placing brushes in mouths essentially stopped. Comprehensive dose reconstruction techniques are being applied to estimate organ doses for each worker related to the intake of 226Ra, 228Ra, and associated photon exposures. Time dependent dose-response analyses will estimate lifetime risks for specific causes of death. The study of radium dial workers is part of the Million Person Study of low-dose health effects that is designed to evaluate radiation risks among healthy American workers and veterans. Despite being one of the most important and influential radiation effects studies ever conducted, shifting programmatic responsibilities and declining funding led to the termination of the radium program of studies in the early 1990s. Renewed interest and opportunity have arisen. With scientific progress made in dosimetric methodology and models, the ability to perform a study over the entire life span, and the potential applicability to other scenarios such as medicine, environmental contamination and space exploration, the radium dial workers have once again come to the forefront. [ABSTRACT FROM AUTHOR]

Smoking remains the leading preventable cause of death and disease in the US. While e-cigarettes (EC) are undeniably harmful when used by adolescents and nonsmokers, the perpetuation of the increasing negative perceptions of EC and widespread false belief that EC are equal or more harmful than combustible cigarettes (CC) represents a significant missed public health opportunity. EC have great potential to serve as a mechanism for smoking harm reduction among hard-to-treat populations of smokers who have failed to quit with currently available treatments. In this paper, we outline why we need to overcome the hostile EC research environment to explore the potential use of EC as a harm-reduction strategy in hard-to-treat populations. [ABSTRACT FROM AUTHOR]

This paper describes the experience of mitigation experts in first degree murder cases in the penalty phase of the trial. The first author, who is a sociologist, has worked in capital murder cases since 1988, as a mitigation expert in over 200 such cases. The second author assists in the mitigation process by analyzing mental health and educational records. The focus of the paper is a discussion of a specific case in which the defendant committed suicide before the case went to trial. [ABSTRACT FROM AUTHOR]

This paper will be published in two parts. It will consider the Victorian campaign for an exclusively medical coronership with special reference to Lancashire and will relate the same to contemporary problems. It will show how the English system of lay coroners without, until 1926, any professional qualifications, confronted the challenges of the modern state and its demands for accurate death registration. It will stress that coroners were locally elected judicial officers dealing with local deaths with individualistic approaches and considerable autonomy. It will focus on coronial qualifications after 1836, when the required medical certification of causes of death meant that doctors played a key role in the inquest system in distinguishing natural from unnatural deaths. It will emphasize the fragmented nature of legislation relating to coroners and in quests. In the second part of the paper (to be published in Mortality 9:3) the Lancashire elections and appointments will be placed in a national context. It will look to the past to understand present coronial problems. The paper will ask whether, if medical campaigns had succeeded, the departmental committees of inquiry of 1910, 1936 and 1971 would have been commissioned and whether the 2003 Shipman Inquiry and the 2003 Luce Fundamental Review would have been needed. Finally, it will ask if the former Inquiry and latter Report will be implemented by legislation in whole or in part or whether they will experience the fate of previous governmental inquiries into coronial reforms. [ABSTRACT FROM AUTHOR]

Recent data show that MDMA (3,4 methylenedioxymethamphetamine) related deaths (MRDs) are on the rise in several countries. This rise in MRDs has caught the attention of public health officials and treatment practitioners. Although MDMA is not a new drug, misinformation regarding the root causes of MRDs is still widespread. For example, MRDs continue to be reported as “overdoses” in the media and by government. This erroneously gives the impression that these deaths are caused by ingesting too high a dose, when in fact MRDs are usually due to factors such as hyperthermia, dehydration, drug interactions, or hyponaetremia. When the real culprits behind MRDs are obscured, we are left with an inaccurate picture about the extent and nature of the risk of consuming the drug. This also inhibits the implementation of effective drug education and risk reduction messages. The purpose of this paper, therefore, is to explore MRDs further by: 1) providing a brief history of MDMA, 2) summarizing international prevalence rates of MRDs, 3) discussing factors that contribute to MRDs, and 4) identifying promising interventions to reduce MRDs. The information presented in this paper is particularly important given the international resurgence of recreational MDMA use (as molly) and the renewed interest in the drug’s therapeutic benefits. [ABSTRACT FROM AUTHOR]

Synthetic cathinones are the second most frequently seized group of new psychoactive substances. They are sold as replacements for controlled stimulants such as amphetamine, cocaine and MDMA. Synthetic cathinones are often determined in biological material collected from both living people and fatally intoxicated with these substances. The interpretation of analytical results usually requires a comparison to previously published cases, therefore, a referenced compilation of concentration ranges would be useful. Data collection was based on a search of PubMed and Google search engine. All the available data from articles where synthetic cathinones concentrations have been measured in whole blood, serum or plasma were included in the data analysis. Presented table lists the observed concentrations in fatal and non-fatal cases involving 47 synthetic cathinones. A reference list with original papers has been added for each compound, which makes it easy to find the source data. Conclusions regarding cause of death should be based upon the concentrations and knowledge of the clinical situation. Where there is clinical suspicion of death due to synthetic cathinones, postmortem blood concentrations >1 μg/mL (in person without developed tolerance) can be cautiously considered as lethal concentrations, however the exact ranges cannot be established. [ABSTRACT FROM AUTHOR]

Training a skilled healthcare workforce is an essential part in reaching the United Nations Sustainable Development Goal to end preventable deaths in children and neonates. The greatest burden of mortality lies in low and lower-middle income countries (LLMIC). Short term, in-service courses have been implemented in many LLMIC to improve the quality of care delivered, but the evaluation methods of these courses are inconsistent. Studies describing evaluations of course and outcome measures were included if the course lasted seven days or less with postgraduate participants, included paediatric or neonatal acute or emergency training and was based in a LLMIC. This narrative review provides a detailed description of evaluation methods of course content, delivery and outcome measures based on 'Context, Input, Process and Product' (CIPP) and Kirkpatrick models. 5265 titles were screened with 93 articles included after full-text review and quality assessment. Evaluation methods are described: context, input, process, participant satisfaction, change in learning, behaviour, health system infrastructure and patient outcomes. Outcomes, including mortality and morbidity, are rightly considered the fundamental aim of acute-care courses in LLMIC. Course evaluation can be difficult, especially with low resources, but this review outlines what can be done to guide future course organisers in providing well-conducted courses with consistent outcome measures for maximum sustainable impact. [ABSTRACT FROM AUTHOR]

Recent declines in life expectancy in the US, especially for middle-aged White persons, have called attention to mortality from deaths of despair – deaths due to alcohol, drugs, and suicide. Using data from the Centers for Disease Control and the U.S. Census Bureau, this paper examined deaths of despair by race/ethnicity, age, cause of death, birth cohort, and sex in Missouri. We focused on Area Agencies on Aging as geographic units of interest to increase usefulness of our findings to public administrators. Deaths of despair began trending up for all age groups beginning in 2007–2009, with the sharpest increases occurring for Black or African American non-Hispanics beginning in 2013–2015. The most dramatic increases occurred for the population age 50–59 in St. Louis City and Area Agency on Aging regions in southern Missouri. For older adults, considerable variation in rates, trends, and cause of deaths of despair is evident across the state. [ABSTRACT FROM AUTHOR]

Background: Because most deaths in Africa and Asia are not well documented, estimates of mortality are often made using scanty data. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering all deaths over time and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective: To build a large standardised mortality database from African and Asian sites, detailing the relevant methods, and use it to describe cause-specific mortality patterns. Design: Individual demographic and verbal autopsy (VA) data from 22 INDEPTH sites were collated into a standardised database. The INDEPTH 2013 population was used for standardisation. The WHO 2012 VA standard and the InterVA-4 model were used for assigning cause of death. Results: A total of 111,910 deaths occurring over 12,204,043 person-years (accumulated between 1992 and 2012) were registered across the 22 sites, and for 98,429 of these deaths (88.0%) verbal autopsies were successfully completed. There was considerable variation in all-cause mortality between sites, with most of the differences being accounted for by variations in infectious causes as a proportion of all deaths. Conclusions: This dataset documents individual deaths across Africa and Asia in a standardised way, and on an unprecedented scale. While INDEPTH sites are not constructed to constitute a representative sample, and VA may not be the ideal method of determining cause of death, nevertheless these findings represent detailed mortality patterns for parts of the world that are severely under-served in terms of measuring mortality. Further papers explore details of mortality patterns among children and specifically for NCDs, external causes, pregnancy-related mortality, malaria, and HIV/AIDS. Comparisons will also be made where possible with other findings on mortality in the same regions. Findings presented here and in accompanying papers support the need for continued work towards much wider implementation of universal civil registration of deaths by cause on a worldwide basis. [ABSTRACT FROM AUTHOR]

Background: Myanmar is a country undergoing rapid transitions in health. Its national strategic policy for young people's health is being revised but there is a paucity of population data to inform local priorities and needs. Objective: In this paper we describe a comprehensive profile of adolescent health in Myanmar to focus policy and health actions. Methods: We used available primary data, and modelled estimates from the GBD 2017, to describe health outcomes (mortality and morbidity), health risks and determinants for adolescents in Myanmar between 1990–2017. A governance group of key stakeholders guided the framing of the study, interpretation of findings, and recommendations. Results: Overall health has improved for adolescents in Myanmar since 1990, however adolescent mortality remains high, particularly so for older adolescent males; all-cause mortality rate for 10–24 years was 70 per 100,000 for females and 149 per 100,000 for males (16,095 adolescent deaths in 2017). Overall, the dominant health problems were injuries for males and non-communicable disease for females in a context of ongoing burden of communicable and nutritional diseases for both sexes, and reproductive health needs for females. Health risks relating to undernutrition (thinness and anaemia) remain prevalent, with other health risks (overweight, binge alcohol use, and substance use) relatively low by global and regional standards but increasing. Gains have been made in social determinants such as adolescent fertility and modern contraception use; however, advances have been more limited in secondary education completion and engagement in employment and post education training. Conclusions: These results highlight the need to focus current efforts on addressing disease and mortality experienced by adolescents in Myanmar, with a specific focus on injury, mental health and non-communicable disease. [ABSTRACT FROM AUTHOR]

The suicide rates officially reported by most countries are widely believed to be lower than actual rates, attributable partly to inaccuracy of registration of deaths and misclassification of cause of death. In this review paper, we discuss under-counting of deaths and of suicides, referring to findings from international research. We then describe the three main ICD-10 cause of death categories that possibly harbour 'hidden suicides': ill-defined or unknown causes of death, events of undetermined intent (EUI), and accidental deaths. We used the 2017 Australian mortality statistics to illustrate these three categories. The World Health Organization (WHO) data and international research show (1) that mortality data provided to the WHO by a large number of its Member States are of questionable quality and not timely; and (2) substantial variations among countries in rates of suicide, ill-defined or unknown deaths, EUIs, and accidental deaths (notably, poisoning). Accurate reporting of suicides is needed to advance research on suicide prevention and develop more effective suicide prevention programmes. Nations should endeavor to obtain, publish and analyse data regarding annual rates of deaths coded as of ill-defined/unknown cause, EUI, and accidental poisoning and other relevant types of accident. [ABSTRACT FROM AUTHOR]

Stroke is a leading cause of death in women. Landmark studies comparing carotid endarterectomy with medical management in both asymptomatic and symptomatic patients have shown results in women that are inferior to those of men. Over the past decade, carotid stenting has been used with increasing enthusiasm as a less invasive method for treating patients with significant carotid artery stenosis. The paper under evaluation offers results from a similar sized cohort of women who were treated with carotid stenting or carotid endarterectomy. Results of this nonrandomized retrospective study demonstrate that selected women can undergo carotid stenting with statistically similar results to the gold standard treatment, carotid endarterectomy. [ABSTRACT FROM AUTHOR]

Families are subjected to a number of social, economic, political and demographic challenges. In recent years, the AIDS epidemic has constituted a major challenge for already poor families due to its wide reaching social, economic and health consequences. The devastating consequence of HIV and AIDS is being seen through the prolonged illness and death of family members of prime working age which impacts on family livelihoods and the ability to provide for and protect its members. This paper forms part of a review - commissioned by the Joint Learning Initiative on Children and HIV/AIDS - of qualitative studies of how families in southern Africa have changed, and are changing, as a result of the impact of HIV and AIDS. This paper presents results of how extended family childcare arrangements are changing as a result of the AIDS epidemic. In a southern African context, family denotes a wider array of relations than biological parents and their children - with children growing up amongst a multitude of relations sharing responsibility for their care and upbringing (Chirwa, 2002; Verhoef, 2005). Recently, there has been growing interest in the capacity of the extended family to care for the increasing number of children whose parents have died. However, literature on the role of the extended family in caring for orphaned children remains contradictory. One approach - the social rupture thesis (Chirwa, 2002) - suggests that the extended family network is collapsing under the strain of AIDS. On the other hand, families are portrayed as resilient and dynamic entities which are adapting their systems of childcare in response to the epidemic (Kuo,2007). In line with Abebe and Aase (2007) and Adams, Cekan, and Sauerborn (1998), this paper proposes a continuum of survival rather than a polarisation of extended family childcare arrangements. [ABSTRACT FROM AUTHOR]

A systematic review and meta-analysis of prospective cohort studies was conducted to examine the association of potato consumption and risk of all-cause, cancer and cardiovascular mortality in adults. We searched PubMed, Scopus databases up to September 2018 for all relevant published papers. All analyses were performed on HRs or RRs and 95% CIs. In twenty prospective studies, 25,208 cases were reported for all-cause mortality, 4877 for cancer mortality and 2366 for CVD mortality. No significant association was found between potato consumption and risk of all-cause (0.90; 95% CI: 0.8, 1.02, p = 0.096) and cancer (1.09; 95% CI: 0.96, 1.24, P = 0.204) mortality. In addition, no significant linear association was found between each 100 g/d increments in potato consumption and risk of all-cause (P = 0.7) and cancer (P = 0.09) mortality. Moreover, nonlinear association between potato consumption and risk of cancer mortality was non-significant (P-nonlinearity = 0.99). In addition, two of three studies which examined the association of potato consumption with CVD mortality did not find any significant relationship. There was no evidence for publication bias in this study. We failed to find significant association between potato consumption and risk of mortality. Further studies are required to confirm this issue. [ABSTRACT FROM AUTHOR]

Just as Freedman's original concept of clinical equipoise was not only influential but highly contested even 30 years later (Hey et al [2]), I suspect that Dahlen's chiral equipoise will raise considerable controversy also. This ambiguity means "Cause of Death Arguments" cannot prove anything and at the same time results in responders to such arguments either granting or making false claims as well. I suspect that most readers will, like me, be unfamiliar with the concept of chirality. [Extracted from the article]

Background: The objective of the current paper is to estimate the all-cause mortality rates for people who have been in treatment for substance use disorders (SUD) in Belgium. Methods: Data from the national register of people who were in treatment for SUD between 2011–2014 was linked to mortality data gathered through the seven Belgian health insurance agencies (N = 30,905). Four comparators were matched on age, sex, and place of residence to each subject in treatment for SUD (N = 123,497). A Cox proportional hazards model was utilized to test the risk of all-cause mortality for being in treatment for SUD or not. A second Cox proportional hazards model tested the risk of all-cause mortality for several drug-related covariates for people in treatment for SUD. Results: The overall mortality rate for people in treatment reached 15.59 per 1,000 person-years. Being in treatment for illicit substance use disorders was associated with a nearly 11-fold increase in all-cause mortality, whereas being in treatment for licit drugs raised the likelihood of a premature death sevenfold. Conclusions: The results have implications for interventions seeking to reduce the elevated SUD-related mortality, and they highlight the need to intensify harm reduction strategies for people with SUD to significantly reduce drug-related mortality. [ABSTRACT FROM AUTHOR]

Background: Psychiatric disorders tend to be developmental, and longitudinal settings are required to examine predictors of psychiatric phenomena. Replicating and combining data and results from different birth cohorts, which are a source of reliable data, can make research even more valuable. The Finnish Psychiatric Birth Cohort Consortium (PSYCOHORTS) project combines birth cohorts in Finland. Aim: The aim of this paper is to introduce content, plans and perspectives of the PSYCOHORTS project that brings together researchers from Finland. In addition, we illustrate an example of data harmonization using available data on causes of death. Content: PSYCOHORTS includes eight Finnish birth cohorts. The project has several plans: to harmonize different data from birth cohorts, to incorporate biobanks into psychiatric birth cohort research, to apply multigenerational perspectives, to integrate longitudinal patterns of marginalization and inequality in mental health, and to utilize data in health economics research. Data on causes of death, originally obtained from Finnish Cause of Death register, were harmonized across the six birth cohorts using SAS macro facility. Results: Harmonization of the cause of death data resulted in a total of 21,993 observations from 1965 to 2015. For example, the percentage of deaths due to suicide and the sequelae of intentional self-harm was 14% and alcohol-related diseases, including accidental poisoning by alcohol, was 13%. Conclusions: PSYCOHORTS lays the foundation for complex examinations of psychiatric disorders that is based on compatible datasets, use of biobanks and multigenerational approach to risk factors, and extensive data on marginalization and inequality. [ABSTRACT FROM AUTHOR]

This paper introduces a special issue of The History of the Family on sanitation and urban mortality. The special issue contains papers which focus on the impact of sanitary reforms on mortality change in Australia, Switzerland, Finland, Sweden, and England and Wales. The current paper outlines the main features of the debate over the causes of mortality change and the role played by sanitary reforms in this. It then highlights some of the methodological and other challenges posed by the definition of 'urban' areas, the identification of relevant sanitary reforms, and the choice of dependent variables. The paper then proceeds to summarise the main features of the individual papers before drawing some conclusions for future research. [ABSTRACT FROM AUTHOR]

This paper presents a new analysis of the contribution of particular causes of death to the decline of mortality in England and Wales between 1851 and 1910. We examine deaths in a set of 588 registration areas based on the registration districts but amalgamated where necessary so that the boundaries of the areas are consistent over time. The deaths are classified by cause, and the paper discusses changes in the classification of causes of death between 1851 and 1910 and attempts to use as congruent a set of classes as is possible. The results show that declines in deaths from waterborne diseases and scarlet fever had their greatest impact between the 1860s and the 1880s, pulmonary tuberculosis declined steadily throughout the period, and diseases of the lungs were important between the 1890s and 1901–1910. The paper then examines cause-specific death rates in urban and rural areas, using definitions of 'urban' based on both population density and settlement size. The results are largely insensitive to the definition of what constitutes an urban area. They reveal that mortality from typhus/typhoid and pulmonary tuberculosis declined in parallel in urban and rural areas. Mortality from scarlet fever converged to very low levels in all areas by 1901–1910. There were, however, differences between town and countryside in the pace and timing of the decline of mortality from diarrhoeal diseases. Where there were differences, it was often the smaller urban areas that stood apart: there was no gradation from rural areas through small towns to larger towns. The paper concludes with some remarks on the implications of our findings for the role of public investment in mortality decline. [ABSTRACT FROM AUTHOR]

Half of the world's deaths and their causes pass unrecorded by routine registration systems, particularly in low- and middle-income countries. Verbal autopsy (VA) collects information on medical signs, symptoms and circumstances from witnesses of a death that is used to assign likely medical causes. To further contextualise information on mortality, understanding underlying determinants, such as logistics, barriers to service utilisation and health systems responses, is important for health planning. Adding systematic methods for categorising circumstantial determinants of death to conventional VA tools is therefore important. In this context, the World Health Organization (WHO) leads the development of international standards for VA, and added questions on the social and health systems circumstances of death in 2012. This paper introduces a pragmatic and scalable approach for assigning relevant Circumstances Of Mortality CATegories (COMCATs) within VA tools, and examines their consistency, reproducibility and plausibility for health policy making, as well as assessing additional effort and cost to the routine VA process. This innovative COMCAT model is integrated with InterVA-5 software (which processes WHO-2016 VA data), for assigning numeric likelihoods to six circumstantial categories for each death. VA data from 4,116 deaths in the Agincourt Health and Socio-Demographic Surveillance System in South Africa from 2012 to 2016 were used to demonstrate proof of principle for COMCATs. Lack of resources to access health care, poor recognition of diseases and inadequate health systems responses ranked highest among COMCATs in the demonstration dataset. COMCATs correlated plausibly with age, sex, causes of death and local knowledge of the demonstration population. The COMCAT approach appears to be plausible, feasible and enhances the functionality of routine VA to account for critical limiting circumstances at and around the time of death. It is a promising tool for evaluating progress towards the Sustainable Development Goals and the roll-out of Universal Health Coverage. [ABSTRACT FROM AUTHOR]

The minimally invasive autopsy (MIA), an innovative approach for obtaining post-mortem samples of key organs, is increasingly being recognized as a robust methodology for cause of death (CoD) investigation, albeit so far limited to pilot studies and research projects. A better understanding of the real causes of death in middle- and low-income countries, where underlying causes of death are seldom determined, would allow improved health planning, more targeted prioritization of available resources and the implementation of coherent public health policies. This paper discusses lessons learnt from the implementation of a Feasibility and Acceptability (F&A) study evaluating the MIA approach in five countries: Gabon, Kenya, Mali, Mozambique and Pakistan. This article reports the methodological choices made to document sociocultural and religious norms around death, to examine community and relatives' attitudes and perceptions towards MIA, and to identify factors motivating the MIA's acceptance and refusal. We used ethnography, grounded theory and framework method approaches. In-depth and semi-structured interviews and focus group discussions with key informants, including next of kin of deceased individuals and healthcare providers, were conducted. Participant observation and direct observation of procedures and ceremonies around death were organized in all study sites. In Mozambique, MIA procedures were observed and case studies conducted. The implementation of this F&A protocol has provided critical lessons that could facilitate the future implementation of post-mortem procedures for CoD investigation. These include the need for early community engagement, staff training and preparedness, flexibility to adapt the protocol, gathering qualitative data from diverse sources, and triangulation of the data. We have applied a rigorous, effective and culturally sensitive methodological approach to assess the F&A of MIA in resource-constrained settings. We strongly recommend that such an approach is applied in settings where MIAs or similar post-mortem sensitive procedures are to be introduced. [ABSTRACT FROM AUTHOR]

Background: Bangladesh has achieved remarkable gains in health indicators during the last four decades despite low levels of economic development. However, the persistence of inequities remains disturbing. This success was also accompanied by health and demographic transitions, which in turn brings new challenges for a nation that has yet to come to terms with pre-transition health challenges. It is therefore important to understand the causes of death and their relationship with socioeconomic status (SES). Objective: The paper aims to assess the causes of death by SES based on surveillance data from a rural area of Bangladesh, in order to understand the situation and inform policy makers and programme leaders. Design: We analysed population-based mortality data collected from the Chakaria Health and Demographic Surveillance System in Bangladesh. The causes of death were determined by using a Bayesian-based programme for interpreting verbal autopsy findings (InterVA-4). The data included 1,391 deaths in 217,167 person-years of observation between 2010 and 2012. The wealth index constructed using household assets was used to assess the SES, and disease burdens were compared among the wealth quintiles. Results: Analysing cause of death (CoD) revealed that non-communicable diseases (NCDs) were the leading causes of deaths (37%), followed by communicable diseases (CDs) (22%), perinatal and neonatal conditions (11%), and injury and accidents (6%); the cause of remaining 24% of deaths could not be determined. Age-specific mortality showed premature birth, respiratory infections, and drowning were the dominant causes of death for childhood mortality (0-14 years), which was inversely associated with SES (pB0.04). For adult and the elderly (15 years and older), NCDs were the leading cause of death (51%), followed by CDs (23%). For adult and the elderly, NCDs concentrated among the population from higher SES groups (pB0.005), and CDs among the lower SES groups (pB0.001). Conclusions: Epidemiologic transition is taking place with a shift from the dominance of CDs to NCDs. SES inequity in mortality still persists - the poor suffer from CDs in all age groups, whereas those better off suffer more from NCDs than CDs. Policy makers thus need to consider the social distribution of diseases before developing any public health action targeted towards reducing mortality and the extent of disease burden in an equitable manner. [ABSTRACT FROM AUTHOR]

The maternal mortality ratio (MMR) of Nigeria remains high. This retrospective study aims to suggest evidence-based strategies towards achieving the sustainable development goal target 3.1 at the Obafemi Awolowo University Teaching Hospital (OAUTHC), Nigeria by providing contemporary data on MMR between October 2012 and September 2015. There were 86 maternal deaths and 5243 live births over the triennium, with annual MMRs of 1744, 1622 and 1512/100,000 live births, respectively. Fifty-six (65.2%) were postpartum deaths, while 44 (51.2%) occurred within 12 hours of admission. Using the WHO ICD-10 system, the causes of mortality were pregnancy-related infections; 26 (30.2%), haemorrhage; 20 (23.3%), hypertension; 13 (15.2%) and pregnancies with abortive outcomes; 11 (12.7%). Financial constraints, misdiagnosis and delayed referrals constituted the predominant contributors. The MMR at OAUTHC, Nigeria in the last triennium of the MDG was 'Extremely High'. Improved aseptic techniques, blood transfusion services, antimicrobial sensitivity evaluation, Universal Health Coverage, training-retraining of skilled birth-attendants and effective referral systems are advocated. IMPACT STATEMENT What is already known on the subject of the paper: Nigeria now contributes the largest proportion (19%) of the burden of maternal mortality worldwide, despite constituting just 2% of the global population. Reversing this adverse trend during the sustainable development goal (SDG) period demands effective strategies, which can only be predicated on reliable data at the hospital, regional and national levels.What This Study Adds: This article provides the contemporary maternal mortality data of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, during the last triennium of the Millennium Development Goal era. The findings from the study revealed that the average maternal mortality ratio (MMR) of the Hospital over the three years was 1640/100,000 live births, and that pregnancy-related infection is now the leading cause of maternal death, followed by obstetric haemorrhage. What the implications are for clinical practice: Improvement in aseptic techniques, evaluation of antimicrobial sensitivity patterns and efficient blood transfusion services, as well as Universal Health Insurance coverage and Skilled Birth Attendants will improve the maternal health indices of the hospital, and ultimately the country during the SDG execution period. [ABSTRACT FROM AUTHOR]

'Nothing prepared me for this' was a project of Support After Suicide which is a suicide bereavement counselling service in Victoria. It aimed to provide people bereaved by suicide the space to find words and give voice to this often silent experience. It consisted of writing, publication and performance components and was funded by an Arts Victoria grant. This grant enabled the second author to conduct weekly writing workshops which ran for 5 months in 2011, with 15 participants completing this process. The writing workshops culminated in a book published in 2012 with work contributed by all the participants. Participants then attended further weekly workshops in 2012 to prepare for performance of their work in May 2012. This paper will present the story of this project, its conceptualisation, implementation and outcomes. A mixed method evaluation was carried out at three points: pre-workshops; at the conclusion of the writing workshops; and at the conclusion of the performances. Both quantitative and qualitative measures reflected overall positive outcomes for participants. At the conclusion of the project, interviews were also conducted and filmed with participants. Their direct feedback on the project was highly positive. This paper will aim to disseminate what has been learned from this project for the benefit of other such programmes. [ABSTRACT FROM AUTHOR]

Sepsis, the tenth-leading cause of death in the United States, accounts for more than $16.7 billion in annual health care costs. A significant factor in these costs is hospital length of stay. The lack of standardized hospital discharge policies and an inadequate understanding of sepsis progression have resulted in unnecessarily long hospital lengths of stay. In this paper, a general model of when to discharge a patient with pneumonia-related sepsis from the hospital is presented. The model is parameterized using patient-based disease progression data from a large clinical study in order to characterize optimal discharge policies for various problem instances. In the presented experiments, patient health is represented by SOFA scores, which are commonly used to assess sepsis severity. Control-limit policies for specific patient cohorts defined by age and race are demonstrated. [ABSTRACT FROM AUTHOR]

This paper offers an ethnographic analysis of the conflict surrounding the identification of dead Israeli soldiers, which is being performed both scientifically (by the Institute of Forensic Medicine) and religiously (by the army rabbinate). Despite the Institute's claims for superior objectivity and accuracy, it is the army rabbinate that has the final authority over identification and burial. The paper discusses cultural and organizational aspects of the conflict over identification, and explores related issues such as DNA repositories. It is argued that Israeli and Jewish identities, although sometimes discursively (politically) separated, are still closely tied in more fundamental, non-discursive practices of body identification. This traditional fusion, however, has been recently challenged by public and civil discontent with the performance of the army rabbinate. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine the possible causes and social background of the rising suicide rate among middle-age or older Japanese male workers, particularly a certain type of suicide called karo-jisatsu (suicide by overwork). The image of Japan as a culture that considers suicide a method of personal distress resolution is widespread overseas. Although such a cultural explanation holds somewhat true, other social structural factors should be taken into consideration before resorting to the historical and cultural explanations. This paper presents, based on the existing data and facts, a balanced view of both cultural and social structural explanatory models, analyzes the changing situation at Japanese workplaces, and strives to deepen the understanding of the reality of suicide in today's Japan. Pressures resulting from a long economic recession, a new evaluation system in the workplace, and the widening gap between the traditional concept of work and a new reality are some of the reasons behind karo-jisatsu. [ABSTRACT FROM AUTHOR]

The question we raise in this paper is whether the educational gradient in avoidable mortality differs from overall and non-avoidable mortality among men and women in Norway. By avoidable deaths we refer to deaths caused by diseases that are either treatable if given appropriate medical care, or preventable if available preventive measures were implemented. The data set is derived from official administrative registers and includes all Norwegian men (1 107 427) and women (1 087 842) aged 25-67 years with information about status alive/dead during the period 1994-1999. Adjusted for sociodemographic and socioeconomic factors, education forms a marked and independent gradient in overall and non-avoidable mortality and an even steeper gradient in avoidable mortality - in particular in ischemic heart disease and preventable deaths. The educational gradient is shallower for deaths considered treatable by health care, but is still present. These patterns apply to men and women alike. The findings of our study suggest that health care and health policies may play a role in reducing inequalities in deaths that are 'avoidable, unnecessary and unjust'. [ABSTRACT FROM AUTHOR]

The topic of this paper turns upon the relevance of suicide studies for moral and ethical questions of agency and autonomy. The paper - for sociological reasons - focuses upon literary and artistic suicides, arguing that these afford some insight into the notion of the aesthetic problematic of suicide more generally, in other words those suicides that are held to be something like pure acts of autonomous will. Arguing against any too one-dimensional an uptake of this purely voluntaristic view of suicide, the paper attempts to explore the implications of the consideration that there is something inevitably passive and reactive about any act of suicide; a consideration which has consequences for the way in which we might regard suicide not just from literary and aesthetic but also from moral, ethical and social points of view. [ABSTRACT FROM AUTHOR]

The first half of this paper reviews the personal and professional experiences of the authors after having a client die by suicide (the first author) or make a serious attempt (the second author). The second half reviews research on training and graduate students' experience with suicide and attempted suicide and then reviews supervisors' interventions. The paper ends with sets of suggestions for trainees, supervisors, and clinical programs. [ABSTRACT FROM AUTHOR]

The suicide of a client can have a profound effect on both the therapist and the supervisory relationship. This paper addresses some of the known reactions to client suicide and clinical themes as noted in the literature and in the experiences of several therapists. It also provides some beginning considerations and suggestions for the supervisory relationship, as well as notes some directions for research in this area. [ABSTRACT FROM AUTHOR]

This paper provides a psychoanalytic framework for working with adolescents at risk of suicide, which, it is argued, is essential for understanding the wide range of presentations of suicidality in adolescence, and for making sense of the powerful emotional impact of this work on the worker. The paper locates the discussion in the context of current knowledge of patterns of suicidality, and focuses on discussing internal dynamics and the adolescents' relationships with the body. It concludes that a containing reflective space is the most effective way of reducing suicide risk in each individual case. [ABSTRACT FROM AUTHOR]

A review of cases where inhalation of helium had been a cause of, or a major contributor to, death was undertaken at Forensic Science South Australia (FSSA) over a five-year period from 1 January 2010 to 31 December 2014. The data were compared with a previous study in the same population from 1985 to 2009. Sixteen cases were identified (age range 21–84 years; mean 44 years; median 37 years). The male to female ratio was 11:5. The study has shown that helium suicides in South Australia are still increasing, with a doubling of the numbers in the period 2010–2014 compared with 2005–2009. This increase is not due to changes in the total population numbers. Although suicides utilising helium are still only a small percentage of suicides overall for the region (16/888; 1.8%), the rate of increase of these deaths is noteworthy. [ABSTRACT FROM PUBLISHER]

Among the various brain diseases, stroke is the major cause of death worldwide, next to heart attack. This paper proposes an algorithm in predicting the ischaemic stroke lesion using midline sketching and histogram bin-based technique. The visible ischaemic stroke lesion region and the normal region of the same computed tomography image are segmented with the help of histogram bins and the features are extracted. The first- and second-order statistical features for both regions are analysed. The differences in the features are utilised to categorise the lesion and non-lesion region. The statisticalt-test analysis-based observations with a confidence interval of 95% for each feature are tabulated. These observations indicate that among the nine features, as per the statistical analysis, six features provide the clear differentiation between normal and abnormal regions. [ABSTRACT FROM AUTHOR]

The analysis of mortality by cause usually relies on groups of causes created by consolidating items from the International Classification of Diseases (ICD). However, this type of grouping is not a very efficient means of describing the real trends in pathological processes. In this paper an alternative classification based on aetiological definitions is proposed. Redistributing deaths between eight aetiological categories offers a different perception of the main determinants of health transition and of mortality prospects. It also provides a view of inter-country differences which may help explain recent variation in trends. It is regrettable that, in the tenth revision of the International Classification of Diseases, the World Health Organisation (WHO) did not adopt the idea of a dual classification system combining an anatomical axis with an aetiological one. The present paper, it is hoped, will encourage further developments in this direction. [ABSTRACT FROM AUTHOR]

Suicide is the leading cause of death in America's jails and the rate of suicide is nearly three times higher in jails than in prisons or the general public. Fatal suicides represent a small proportion of individuals who threaten or attempt suicide while incarcerated, or otherwise engage in serious self-harm. Yet, there is little research to date on the risk factors for jail detainees engaging in suicidal and/or self-harm behavior while incarcerated. Using logistic regression, we examine the risks factors for attempting and threatening suicide and/or self-harm during incarceration using a mixed-sex sample of 736 individuals incarcerated in a large metropolitan jail in the Midwest using the lens of the Interpersonal Theory of Suicide (ITS). We found support for ITS, as individuals with higher perceived burdensomeness and thwarted belongingness were more likely to attempt and/or threaten suicide and self-harm. Among the measures that proxied the belongingness-burdensomeness construct – mental health issues, drug dependence, direct and indirect victimization in jail, and psychological distress – were all associated with higher odds of threatening or attempting suicide and self-harm. We discuss the need for future research on suicidality and serious self-harm in jail, as well as recommendations for managing those most at-risk. [ABSTRACT FROM AUTHOR]

Death by suicide is the leading cause of death in American jails. Closely linked with suicides are self-injurious thoughts and behaviors. Even with this knowledge, the risk factors for self-harm ideation and self-harm behaviors have received little empirical work within a jail population. This study couples an integrated importation and deprivation model with an ideation-to-action approach to examine environmental and psychological correlates of self-harm ideation and self-harm behaviors among a sample of 231 individuals incarcerated in jail. Results from the ordinary least squares regression models demonstrate that both deprivation (institutional misconduct) and importation (hopelessness) factors are important when identifying self-harm ideation and self-harm behaviors. In addition, the results of this test of the integrated model offer a proposed new direction for integrated theory testing. Finally, a discussion of policy implications and actionable programs are suggested. [ABSTRACT FROM AUTHOR]