Evaluation of Medical Certification of Cause of Death of Tertiary Cancer Hospitals of Northern India

BackgroundMedical Certification of Cause of Death (MCCD) can provide valuable health status data regarding disease incidence, prevalence and mortality in a community. It can guide local health policy and help in setting priorities. On the contrary, incomplete and inaccurate MCCD data can significantly impair the precision of a national health information database. In the current study, the accuracy of death certificates at two tertiary cancer care hospitals in Northern India, has been evaluated.MethodsThis retrospective study has been conducted at Tata Memorial Centres namely, Mahamana Pandit Madan Mohan Malaviya Cancer Centre and Homi Bhabha Cancer Hospital, Varanasi, India on MCCD over a period of two and a half years. Medical records and death certificates of all the deceased were examined. The demographic characteristics, administrative details, co-morbidities and cause of death from death certificates were collected using an approved standardized form. The accuracy of this information was validated using the medical records. Errors in the death certificates were classified according to Haque’s grading scale.1Results778 deaths occurred during the study period between May 2018 to December 2020, and all certificates were accessed for analysis. Only 30 (4%) certificates were error-free. 591(75.9%) death certificates had an inappropriate immediate cause of death. 231(29.7%) death certificates had incorrectly labelled mode of death, such as cardiopulmonary arrest as the immediate cause of death. 585 (75.2%) death certificates had an incorrect underlying cause of death. Majority of the death certificates were prepared by the post MBBS junior residents and this was significantly associated with higher certification errors.ConclusionA high rate of errors was identified in the death certificates completed at our hospitals. Inaccurate death certificates related to cancers can potentially influence the cancer statistics of the defined region and thereby affect policymaking for cancer prevention and control. There is a pressing need for appropriate intervention/s to resolve this important issue. In an attempt to improve the quality of certification, it is envisaged to conduct training for all consultants and residents in proper death certification.

A multilevel transition perspective on embedding intersectoral action in local health policies

Summary Intersectoral action is advocated as a social practice that can effectively address health inequalities and related social issues. Existing knowledge provides insight into factors that may facilitate or hinder successful intersectoral action, but not much is known about how intersectoral action evolves and becomes embedded in local health policies. This is where this study aims to make its contribution, by adopting the multilevel perspective on transitions, which is increasingly used to study social innovation in sustainability transitions but has not yet been applied to public health and health promotion. Through this perspective, it was unravelled how intersectoral action between youth-care organizations and community sports clubs became embedded in local health policies of Rotterdam, a large city in the Netherlands. A single explorative case study was conducted based on content analysis of policy documents and 15 in-depth interviews with policy officers, managers and field workers operating in the fields of youth and sports in Rotterdam. The findings showed that intersectoral action between community organizations and policymakers evolves through congruent processes at different levels that changed institutional logics. Moreover, it emerged that policymakers and other actors that advocate novel social practices and act as boundary spanners can adopt multiple strategies to embed these practices in local health policy. The multi-level perspective adds value to earlier approaches to research intersectoral collaboration for health promotion as it allows to better capture the politics involved in the social innovation processes. However, further sharpening and more comprehensive application of transition concepts to study transitions in public health and health promotion is needed.

Overcoming the gap between professional domains: A Dutch case study tackling childhood obesity

Background and Aim In the Netherlands about one in seven 1- to 11-year-old children are overweight. The multifaceted nature of childhood overweight requires joining forces across the medical, social and public sector. This study evaluated an integrated network approach of preventive care (INPC) for overweight children focusing on the process of intersectoral professional collaboration. Methods Fourteen network partners from the three sectors were interviewed face to face with semi-structured topic lists to determine the extent of collaboration in and outside sectors, the perceived outcomes and the hindering and facilitating factors. Results Collaboration within each sector was adequately established and all partners were in contact with the central care provider who functions as linking pin in the INPC. However, collaboration across sectors was not optimally realized. Both the medical and public domain partners indicated to have minimal contact with professional partners from the social domain, while they were perceived important in the INPC. Main hindering factors were related to the complexity of the childhood overweight problem, a lack of knowledge about network partners, unclarity in referrals, feedback, roles and responsibilities. In addition, frequent changes in policy, in personnel, lacking a visible leader, funding and time, were also hindering. Facilitating factors were: a general positive attitude towards intersectoral collaboration, knowing each other, short communication lines, a shared vision, trusting each other's expertise, and also formalized agreements and local health policy, and periodic meetings with partners. Conclusions Realizing professional collaboration across domains to tackle childhood overweight requires specific attention to structural factors enabling professionals to do so in their daily work. Stable funding and policies, clear responsibilities on the one side, getting to know each other, trust and positive attitudes on the other. Key messages An integrated approach for childhood overweight requires professionals to work across borders. However, in daily practice professionals experience structural factors hindering such collaboration. The functioning of networks linking professionals from public health, medical and social domains, essential in preventing childhood overweight, requires specific attention for organizational aspects.

Primary headache disorders among the adult population of Mongolia: prevalences and associations from a population-based survey

Background In the ongoing Global Campaign endeavour to improve knowledge and awareness of headache prevalence worldwide, Mongolia is a country of interest. It sits between Russia and China, in which prevalence is, respectively, much higher and much lower than the estimated global mean. We conducted a population-based study in Mongolia both to add to knowledge and to inform local health policy. Methods Using standardized methodology with cluster random sampling, we selected Mongolian adults (aged 18–65 years) from five regions reflecting the country’s diversities. They were interviewed by trained researchers, cold-calling at their homes, using the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) structured questionnaire following pilot-testing. ICHD-3 beta diagnostic criteria were applied. Results N = 2043 (mean age 38.0 [±13.4] years, 40% urban-dwelling and 60% rural), with a non-participation proportion of 1.7%. Males were somewhat underrepresented, for which corrections were made. The crude 1-year prevalence of any headache was 66.1% (95% CI: 64.0–68.2%), with a strong female preponderance (OR: 2.2; p < 0.0001). Age- and gender-adjusted prevalences were: migraine 23.1% (for females, OR = 2.2; p < 0.0001); tension-type headache (TTH) 29.1% (no gender difference); probable medication-overuse headache (pMOH) 5.7% (trending towards higher in females); other headache on ≥15 days/month 5.0% (for females, OR = 2.2; p = 0.0008). Unclassified cases were only 35 (1.7%). Any headache yesterday was reported by 410 (20.1%; for females, OR = 2.4; p < 0.0001). Only pMOH showed a strong association with age, peaking in middle years with a 5-fold increase in prevalence. Migraine showed a consistent association with educational level, while pMOH showed the reverse, and was also more common among other groups than among participants who were single (never married). Migraine was less common among rural participants than urban (OR: 0.80; p = 0.0326), while pMOH again showed the reverse (OR: 2.4; p < 0.0001). Finally, pMOH (but not migraine or TTH) was significantly associated with obesity (OR: 1.8; p = 0.0214). Conclusion Headache disorders are common in Mongolia, with, most notably, a very high prevalence of headache on ≥15 days/month corroborated by the high prevalence of headache yesterday. The picture is very like that in Russia, and dissimilar to China. There are messages for national health policy.

Eating for Eye Health: Engaging patients with dry age-related macular degeneration in community cookery to support lifestyle change and positive health

There are limited treatment options available upon diagnosis of dry age-related macular degeneration (AMD), a leading cause of blindness in older people, which progressively threatens central vision and quality of life. Community engagement has the potential to support 'positive health' of individuals with untreatable eye conditions. Eating for Eye Health is an award-winning public-engagement project that aims to raise awareness of research suggesting that nutrition might help protect against progression of AMD and to encourage patients to cook and eat antioxidant-rich food in a community environment. The project engaged patients who had a diagnosis of dry AMD through a focus group and a community cookery day organized in partnership with the healthy food outlet, Pod, and the Manor Gardens Community Kitchen Project, Islington, London. A focus group highlighted participants' potential barriers to engagement with research about lifestyle modification and identified that a co-designed community cookery project could help to address unmet needs for support. Individuals with dry AMD reported increased levels of confidence in cooking skills after participating in the community cookery day. The combination of these methods within the context of AMD highlights how a focus on patient needs and expectations can establish and grow mutually beneficial relationships. There is potential for Eating for Eye Health, or similar community kitchen approaches, to be implemented within the community setting through NHS 'social prescribing' initiatives. In conclusion, Eating for Eye Health is unique in its combination of elements of community consultative and collaborative forms of engagement. These methods could be adopted as part of Sustainability and Transformation Plans (STPs) in local health policy development in the community.

Pregnant women’s and healthcare professionals’ preferences in decision-making process for prenatal screening: world experience

Многие страны внедряют неинвазивное пренатальное тестирование (НИПТ) в систему общественного здравоохранения в качестве контингентного скрининга для беременных, что позволяет повысить эффективность выявления хромосомных аномалий (ХА) у плода и снизить количество необоснованных инвазивных процедур. Анализ литературных источников показал, что большинство врачей и беременных из групп высокого и промежуточного рисков готовы воспользоваться НИПТ в качестве дополнительного скрининга в связи с его безопасностью, высокой чувствительностью и возможностью раннего получения результатов. Однако обнаружены различия в выборе метода раннего пренатального скрининга ХА между странами, которые зависели от этнических, социо-демографических и религиозных характеристик опрошенных, а также от особенностей политики местного здравоохранения, связанных с необходимостью частичной или полной оплаты пренатального теста и доступностью прерывания беременности. Сделан вывод, что для каждой страны необходимы свои руководства, разработанные с учетом социального контекста, а вопрос о внедрении НИПТ в рутинную практику должен решаться по результатам социологических исследований в больших группах беременных и врачей страны. Many countries are introducing a non-invasive prenatal test, NIPT, into the public health system as a contingent screening for pregnant women, which improves the detection of chromosomal abnormalities of the fetus and reduces the number of unwarranted invasive procedures. Analysis of the literature showed that the majority of doctors and pregnant women from the high and intermediate risk groups are ready to use NIPT as an additional screening due to its safety, high sensitivity and the possibility of early reception of results. However, there were found differences between countries in choosing the method of prenatal screening for chromosomal abnormalities of the fetus, which depend on the ethnic, sociodemographic and religious characteristics of the respondents, as well as on the peculiarities of the local health policy related to the need for partial or full payment of the prenatal test and the availability of abortion. It was concluded that each country needs its own guidelines, developed with taking into account the social context, and the issue of introducing NIPT into routine practice should be decided by the results of sociological research among large groups of pregnant women and healthcare professionals in the country.

Mapping the Slums of Dhaka from 2006 to 2010

Background. Rapid urban growth in low and middle income countries is frequently characterized by informal developments. The resulting social segregation and slums show disparities in health outcomes for the populations of the world’s megacities. To address these challenges, information on the spatial distribution of slums is necessary, yet the data are rarely available. The goal of this study was to use a remote sensing based approach to map urban slums in Dhaka, the second fastest growing megacity in the world. Methods. Slums were mapped through the visual interpretation of Quickbird satellite imagery between the years 2006 and 2010. Ancillary references included the 2005 census and mapping of slums, Google Earth, and geolocated photographs. The 2006 slums were first delineated and filtered in GIS to avoid small, isolated slums. For 2010, changes to the 2006 slums were defined over the latter’s polygons to retain border consistency. Conclusions. The dataset presented here can be considered a stepping stone for further research on slums and urban expansion in Dhaka. The slum distribution dataset is useful to be pooled with other data to reveal trends of informal settlement growth for local health policy advice in Dhaka.