Sustainability in transformation of maternal mortality by interaction based approach in Dairi, Indonesia

Introduction: Health and mortality problems are closely related to the maternal mortality rate (MMR). Efforts to reduce MMR have been carried out by many countries, including the Indonesian government. Materials and Methods: This research was conducted using two approaches, namely quantitative and qualitative or mixed methods and 149 respondents and 26 informants, to reduce MMR in Dairi Regency. This study was also carried out to determine the dominant variable that affects mother's behavior in an effort to reduce MMR in accordance with the existing theory. Result: Mother's intention to contribute to the reduction of MMR in this study was influenced by the good factor directly or indirectly. This is indicated by the score p<0.005. The study also shows that it is very important for the health workers to be able to communicate well with individuals and communities. Conclusion: The present study will help to reduce maternal fatalities, and will help to build systems and processes that will allow control the behaviour of the pregnant women and determine the cause of death as well as its contributing factors.

Self-Reported Sensory Impairments in Older Adults and their Association with Self-Rated Health and Mortality Outcomes

Objectives This study assessed the relationship between self-reported impairments of vision, hearing, and dual sensory impairment, and change in self-rated health/mortality status over a 5-year period. Methods Data came from the National Health and Aging Trends Study, a nationally representative survey of Medicare beneficiaries ages 65 and older. Analyses consisted of a series of ordinal logistic regressions stratified by sex. Results For both women and men, self-reported sensory impairments were not statistical predictors of self-rated health/mortality, when other dimensions of health, such as physical functioning, participation, and activities of daily living functioning were included in models. Discussion Understanding how self-reported sensory impairments impact self-rated health could assist in targeting rehabilitation strategies to older adults who experience sensory impairments.

Magnitude, global variation, and temporal development of the COVID-19 infection fatality burden

How deadly is an infection with SARS-CoV-2 worldwide over time? This information is critical for developing and assessing public health responses on the country and global levels. However, imperfect data have been the most limiting factor for estimating the COVID-19 infection fatality burden during the first year of the pandemic. Here we leverage recently emerged compelling data sources and broadly applicable modeling strategies to estimate the crude infection fatality rate (cIFR) in 77 countries from 28 March 2020 to 31 March 2021, using 2.4 million reported deaths and estimated 435 million infections by age, sex, country, and date. The global average of all cIFR estimates is 1.2% (10th to 90th percentile: 0.2% to 2.4%). The cIFR varies strongly across countries, but little within countries over time, and it is often lower for women than men. Cross-country differences in cIFR are largely driven by the age structures of both the general and the truly infected population. While the broad trends and patterns of the cIFR estimates are more robust, we show that their levels are uncertain and sensitive to input data and modeling choices. In consequence, increased efforts at collecting high-quality data are essential for accurately estimating the cIFR, which is a key indicator for better understanding the health and mortality consequences of this pandemic.

Do Loneliness and Social Isolation Predict Mortality Because of Hazardous Drinking?

Introduction: Subjective feelings of loneliness and objective social isolation have been consistently connected with ill-health and mortality, though little work has empirically examined the mechanisms explaining the adverse effects. This study examines whether alcohol consumption explains the connection of loneliness and social isolation on mortality in different age and gender groups. Methods: The sample comprised a representative 1994 Finnish sample (n = 8,650) matched with 22-year follow-up mortality data. A multigroup path analysis with discrete survival time analyses was conducted. Results: There were unique differences in the associations between loneliness, social isolation, alcohol consumption, and mortality based on age and gender groups. Loneliness and particularly social isolation predicted mortality partly through subjective intoxication for women under 40 and men 40–65. Discussion: Loneliness and social isolation are associated with mortality, partly through subjective intoxication. Interventions targeted at reducing loneliness and social isolation may help address underlying causes of excess alcohol consumption and mortality.

The Link Between Environment, Age, and Health in a Large Cohort of Companion Dogs from the Dog Aging Project

Exposure to social environmental adversity strongly predicts health and survival in many species such as non-human primates, wild mammals, and humans. However, little is known about how the health and mortality effects of these social determinants vary across the lifespan. Using the companion dog, which serves as a powerful comparative model for human health and aging due to our shared biology and environment, we examined which components of the social environment impact health, and how the effects vary with age, in dogs. We first drew on detailed survey data from owners of 27,547 dogs from the Dog Aging Project and identified six factors that together explained 35% of the variation in dog’s social environment. These factors all predicted measures of health, disease, and mobility, when controlling for dog age and weight. Factors capturing measures of financial and household adversity were linked to poorer companion dog health, while factors associated with the social companions, like dogs and adults, were linked to better health. Interestingly, some of these effects differed across a dog’s lifespan: for instance, the effect of neighborhood disadvantage on disease instances was strongest in older dogs. Together, our findings point to similar links between adversity and health in companion dogs, and set up future work on the molecular and biological changes associated with environmental variation in order to identify ways to mitigate or even reverse the negative environmental effects.

Setting up child health and mortality prevention surveillance in Ethiopia

Background: Mortality rates for children under five years of age, and stillbirth risks, remain high in parts of sub-Saharan Africa and South Asia. The Child Health and Mortality Prevention Surveillance (CHAMPS) network aims to ascertain causes of child death in high child mortality settings (>50 deaths/1000 live-births). We aimed to develop a “greenfield” site for CHAMPS, based in Harar and Kersa, in Eastern Ethiopia. This very high mortality setting (>100 deaths/1000 live-births in Kersa) had limited previous surveillance capacity, weak infrastructure and political instability. Here we describe site development, from conception in 2015 to the end of the first year of recruitment. Methods: We formed a collaboration between Haramaya University and the London School of Hygiene & Tropical Medicine and engaged community, national and international partners to support a new CHAMPS programme. We developed laboratory infrastructure and recruited and trained staff. We established project specific procedures to implement CHAMPS network protocols including; death notifications, clinical and demographic data collection, post-mortem minimally invasive tissue sampling, microbiology and pathology testing, and verbal autopsy. We convened an expert local panel to determine cause-of-death. In partnership with the Ethiopian Public Health Institute we developed strategies to improve child and maternal health. Results: Despite considerable challenge, with financial support, personal commitment and effective partnership, we successfully initiated CHAMPS. One year into recruitment (February 2020), we had received 1173 unique death notifications, investigated 59/99 MITS-eligible cases within the demographic surveillance site, and assigned an underlying and immediate cause of death to 53 children. Conclusions: The most valuable data for global health policy are from high mortality settings, but initiating CHAMPS has required considerable resource. To further leverage this investment, we need strong local research capacity and to broaden the scientific remit. To support this, we have set up a new collaboration, the “Hararghe Health Research Partnership”.

Precarious Work in Midlife: Long-Term Implications for the Health and Mortality of Women and Men

Although prior research documents adverse health consequences of precarious work, we know less about how chronic exposure to precarious work in midlife shapes health trajectories among aging adults. The present study uses longitudinal data from the Health and Retirement Study to consider how histories of precarious work in later midlife (ages 50–65) shape trajectories of health and mortality risk after age 65. Results show that greater exposure to unemployment, job insecurity, and insufficient work hours in midlife predicts more chronic conditions and functional limitations after age 65. Characteristics of precarious work also predict increased mortality risk in later life. Findings indicate few gender differences in linkages between precarious work and health; however, women are more likely than men to experience job insecurity throughout midlife. Because precarious work is unlikely to abate, results suggest the need to reduce the health consequences of working in precarious jobs.