Suchergebnisse

Medical Certificate of Cause of Death, commonly called Death Certificate, is the most frequently issued certificate, at least by a government employed medical officer, if not by a private practitioner. It is common knowledge that many medical officers, even some of those with incomparable medical knowledge and expertise, do not fill up this document of immense medical and legal importance correctly. The reasons may be many, ranging from ignorance to indifference. Medical officers of Armed Forces Medical Services attending refresher courses (MOJC) have always requested the authors for a class on this topic. Considering these aspects, the authors have tried to clarify different issues concerning the question.

Infant mortality is still a major problem in our country as its level has
remained relatively high by European standards. This points to the need for
better preventive measures particularly as regards infant mortality and
other adverse consequences of pregnancy, as key indicators of health and
health care for mother and child. Namely, the analysis of movement in infant
mortality in low mortality countries shows that it can be decreased
relatively easily if certain social and health care measures are undertaken.
For that reason, it is necessary to engage in permanent organized research
to explain and measure both the relative impact of individual factors or
groups of factors in our country which are significant in terms of infant
mortality and their mutual relationships. We should also try to gain from
the experiences of other countries which had already made progress in this
respect. One of the elements of prevention is certainly the analysis of
causes of infant morbidity and mortality primarily during the pre-natal
period with the aim of specifying the most frequent causes of death to
enable their elimination and to induce a subsequent decline in infant
mortality. Besides showing the efficiency of health service activities, data
on causes of infant death also point to the specific measures that should be
undertaken and may be used as a base for planning and programming the
development of health services, i.e. implementation of health policy as part
of the population policy. With the decline in infant mortality in our
country there has also been registered a change in the composition of
diseases as the most frequent cause of death. During the initial observation
period when the general level of infant mortality was exceptionally high,
the share of infectious diseases and those of the respiratory system was
very large. These deaths were mainly induced by exogenous factors, that is
the diseases which the society in general and health services in particular
could most easily have checked both by measures to improve the general
living conditions and by preventive and curative health care measures. The
period from 1989 to 1996 is characterized by endogenous causes of infant
mortality primarily during the neonatal period and have to do with the
constitutional features of the live-born children, congenital anomalies,
premature birth, respiratory distress, etc. Thus, from the socio-medical
point of view, the primary causes of infant mortality in this period are
genetically induced or can be attributed to the mother in labour birth which
modern men and modern medicine cannot influence to a larger extent. The
analysis of infant death frequency by group of causes of death points that
there still exist possibilities of eliminating the exogenous causes of death
(as the same causes prevail in the socio-economically least developed
regions of the country). Besides, some improvement can also be expected in
the area of endogenous mortality (improvement in pre-natal diagnostics and
other measures of health care for pregnant women and those who have just
given birth, better conditions for child delivery and application of modern
techniques to care for the prematurely born children. The semanatal
mortality is probably the major socio-medical problem in our country both
because it accounts for the highest percentage in neo-natal mortality and
because it displays an almost negligible downward tendency. This justifies
another request - for a more extensive and comprehensive analysis of this
problem as well as for participation of other scientific disciplines besides
medicine. Among the leading causes of semanatal mortality in the most recent
observation period are premature birth, congenital anomalies, respiratory
distress syndrome and intrauterine hypoxia and asphyxia at birth.

SummaryMany studies have suggested that following the experience of 'stressful' life events the risks of accidents, myocardial infarctions and other diseases are elevated. In the OPCS Longitudinal Study, routinely collected data on deaths, and deaths of a spouse occurring in a 1% sample of the population of England and Wales in the period 1971–81 are linked together, and with 1971 Census records of sample members. The timing and patterns of death following the very stressful event of conjugal bereavement may thus be analysed.Overall the mortality of widowers was about 10% in excess of that in all males in the sample whereas that of widows was only slightly raised. Some increases in death rates shortly after widow(er)hood are observed. Unusually, these increases in all-cause mortality rates are more marked in widows than in widowers, with a two-fold increase in mortality from all causes in the first month after widowhood. Marked peaks of post-bereavement mortality from accidents and violent causes are clear in both sexes. Possible explanations for the increased mortality rates are examined.

PROBLEM NUMBER 1: THE SHIFTING ECOLOGY OF DISEASEWe all know that human disease is a constant and natural expression of conflicting forces and agents. As biological phenomena, diseases are never
static. Influenced by physical and social agents, sickness shifts constantly in specific ecological settings. In infectious diseases, for example, constant readjustments within changing physical environments occur between pathogenic agents such as micro-organisms and viruses and their human hosts. As do other complex organisms, humans display a series of adaptive mechanisms which can both prevent or create illness; a lifetime of such encounters categorized as 'wear and tear' phenomena leads to distinctions between chronological and physiological age that are useful in assessing susceptibility to disease and life expectancy.To understand the broad contours of human disease and periodic epidemiological changes in various parts of the globe – what physicians have called the 'ebb and flow' of disease – many historians therefore subscribe to the idea of a shifting ecology of disease. This dynamic concept presupposes complex interactions between both biological and non-biological factors which are ultimately responsible for different and changing patterns of sickness in time and space, exemplified, at least superficially, by McNeill's popular book Plagues and peoples. By highlighting the interconnectedness of various possible factors, including those which could ultimately cause death, the ecological model is quite useful to both historians and demographers.

On November 11–14 1993, Indiana University hosted a conference on the 'History of Registration of Causes of Death', with funding from the US National Institute on Aging and the National Institute of Child Health and Human Development. The conference brought together historians of medicine and historically-oriented demographers and epidemiologists to discuss the origins of the recording of
causes of death and the possible uses of these documents in demographic and epidemiological research. Demographers and epidemiologists would like to use long-run series of causes of death to examine the effects of social and economic conditions, the availability of health care, and specific risk factors on mortality. Many important questions (such as the effects of early health experiences on old-age morbidity and mortality) are best studied with data on changes over long periods of time. However, it is very difficult to construct a consistent series of deaths by cause over time because advances in medical theory and practice have led to significant changes in the classification of diseases. For example, it is unclear whether the prevalence of heart disease was increasing, decreasing, or constant before 1940, because heart disease was often classified under other categories.The essays in this special number of
Continuity and Change offer a range of insights on the historical circumstances in which cause-of-death registration emerged. They help us to see the ways in which medical theory, medical practitioners, and their increasingly influential professional organizations shaped the conceptualization of reporting of causes of death. Günter Risse's
'Causes of death as a historical problem' serves as an overview of the problems that social historians of medicine find underlying any continuous history of mortality experience. Above all, he argues, medical historians react as historians, wary
of Whiggish confidence in state records without attention to the ideologies governing their creation.

Large cities concentrate a substantial part of the educated, highly qualified, and economically active populations. Such social "selection" with the peculiarities of lifestyle determines the distinctive characteristics of the level and structure of mortality. Even though data on deaths by causes of death for the large cities are available in Ukraine, very few studies have analyzed cause-specific mortality in these cities. The objective of the study is to make a comparative analysis of mortality from the most influential causes of death in large cities. The novelty lies in the comparative analysis done for Dnipro, Kyiv, Lviv, Odesa, and Kharkiv for the first time. The study uses the direct method of standardization to calculate standardized death rates by sex in 2005-2019. The results indicate lower all-cause mortality rates for the large city residents compared to the corresponding average country-level indicators. Kyiv, Lviv, and Odesa have lower death rates compared to Dnipro and Kharkiv. In Kyiv and Lviv, this is attributed to lower mortality from almost all major causes of death, while in Odesa this mainly resulted from the extremely low ischemic heart disease mortality. Relatively high mortality from circulatory diseases is observed in Kharkiv and Dnipro. However, in Dnipro, this is associated with a high death rate from coronary heart disease and a very low contribution of cerebrovascular disease, whereas in Kharkiv coronary and cerebrovascular disease death rates are quite high. Mortality rates from diseases of the digestive system in the large cities are found to be the closest to the average in Ukraine (except for Lviv). The neoplasms are the only large group of diseases with a mortality rate that exceeds the average level in Ukraine, in particular for women. Overall, the death rates from most of the causes of death in the large cities demonstrated a positive trend in 2005-2019, with some exceptions. External causes and infectious diseases showed the most decrease while mortality from AIDS and ill-defined causes increased. Also, there were uncertain dynamics of deaths due to suicide and injuries with undetermined intent. Given some specific mortality differences between the cities, some concerns have been raised over the accuracy of the coding of diagnoses. In particular, unusually low mortality from ischemic heart disease was found in Odesa and from cerebrovascular disease in Dnipro, very rare deaths from alcoholic liver disease in Odesa, accidental alcohol poisoning in Kyiv, and a group of other liver diseases in Dnipro. We also assume misclassification of suicides as injuries with undetermined intent in Kharkiv. Our findings highlight the importance of the implementation of automated coding and selection of causes of death that can minimize the number of subjective decisions made by coders and lead to significant improvements in the quality of data.