Russian Mortality Crisis and the Quality of Vital Statistics

Mortality from ill-defined conditions in Russia has the fastest rate of increase compared to all other major causes of death. High proportion of deaths in this category is indicative for low quality of mortality statistics. This article examines the trends and possible causes of mortality from ill-defined conditions in Russia. During 1991–2005, mortality from ill-defined conditions in Russia increased in all age groups. The pace of increase was particularly high at working ages and the mean expected age at death from ill-defined conditions has shifted to younger ages, particularly for men. The analysis of individual medical death certificates issued in Kirov and Smolensk regions of Russia demonstrate that 89–100% of working-age deaths from ill-defined conditions correspond to human bodies found in a state of decomposition. Data from Smolensk region shows that over 60% of these decedents were unemployed. Temporal trends of mortality from ill-defined conditions and injuries of undetermined intent in Moscow city suggest that deaths from the latter cause were probably misclassified as ill-defined conditions. This practice can lead to underestimation of mortality from external causes. Growing number of socially isolated marginalized people in Russia and insufficient investigation of the circumstances of their death contribute to the observed trends in mortality from ill-defined conditions.     

Effects of Cooking Smoke and Environmental Tobacco Smoke on Acute Respiratory Infections in Young Indian Children

Background Reliance on biomass for cooking and heating exposes many women and young children in developing countries to high levels of air pollution indoors. Environmental tobacco smoke also contributes to this indoor air pollution. This study estimates the effects of these sources of air pollution on acute respiratory infections (ARI) in children below 36 months of age in India.Methods The analysis is based on 29,768 children age 0–35 months included in India’s 1998–1999 National Family Health Survey (NFHS-2). Logistic regression is used to estimate effects.Results In NFHS-2, children living in households using only biomass fuels for cooking or heating are almost twice as likely to have suffered from ARI during the 2 weeks before interview as children in households using cleaner fuels (OR = 1.82; 95% CI: 1.58, 2.09). This effect is somewhat reduced when exposure to environmental tobacco smoke (ETS) and a number of other factors are statistically controlled (OR = 1.58; 95% CI: 1.28, 1.95). With these other variables controlled, children in households using a mix of biomass and cleaner fuels also have a higher risk of ARI than children in households using only cleaner fuels (OR = 1.41; 95% CI: 1.17, 1.70). With controls, the effect of biomass fuel use on ARI is stronger for boys (OR = 1.68; 95% CI: 1.26, 2.23) than for girls (OR = 1.49; 95% CI: 1.11, 2.01). The effect of ETS on ARI is also positive and significant, but smaller when other variables (including type of cooking fuel) are controlled (OR = 1.12; 95% CI: 1.01, 1.23). No modifying effects of cooking smoke and ETS are observed.Conclusions Findings support previous research showing positive effects of cooking smoke and ETS on ARI in young children. The relationship needs to be further investigated using more direct measures of smoke exposure and measures of outcome that are more specific to acute lower respiratory infections (ALRI), which are the most important component of overall ARI from a public health standpoint.Medical subject headings (MeSH) air pollution; indoor; biomass; smoke; environmental tobacco smoke; respiratory tract infections; child; India.Please address Correspondence to Vinod Mishra, DHR Division, ORC Macro, 11785 Beltsville Drive, Calverton, MD 20705, USA; e-mail: Vinod.Mishra@orcmacro.com     

The Protective Effect of Marriage for Survival: A Review and Update

The theory that marriage has protective effects for survival has itself lived for more than 100 years since Durkheim’s groundbreaking study of suicide (Durkheim 1951 [1897]). Investigations of differences in this protective effect by gender, by age, and in contrast to different unmarried statuses, however, have yielded inconsistent conclusions. These investigations typically either use data in which marital status and other covariates are observed in cross-sectional surveys up to 10 years before mortality exposure, or use data from panel surveys with much smaller sample sizes. Their conclusions are usually not based on formal statistical tests of contrasts between men and women or between never-married, divorced/separated, and widowed statuses. Using large-scale pooled panel survey data linked to death registrations and earnings histories for U.S. men and women aged 25 and older, and with appropriate contrast tests, we find a consistent survival advantage for married over unmarried men and women, and an additional survival “premium” for married men. We find little evidence of mortality differences between never-married, divorced/separated, and widowed statuses.     

The Relationship between Country of Residence, Gender and the Quality of Life in Australian and Taiwanese Midlife Residents

A growing global aging population is presenting more opportunities for health professionals to interact with other cultures. The specific aims of this study were to: (1) compare the quality of life of midlife men and women in Australian and Taiwan; and (2) to explore the impact of country of residence and gender on quality of life. A cross-sectional survey was conducted using census data and a probability proportional sampling (PPS) strategy on a general population of men and women aged 40–59 years-old who live permanently in Taiwan and Australia. The sample consisted of 278 Australians and 398 Taiwanese men and women. Analysis showed that country of residence does have an impact on quality of life with significant differences seen between midlife Australian and Taiwanese men and women (F 4, 666 = 59.31, p < 0.001). The results suggest that midlife Australian men and women have a better quality of life than midlife Taiwanese men and women. The mean score for the four domains of quality of life by gender indicated that midlife women consider that they have a better quality of life than midlife men in both Australia and Taiwan. Midlife Australian men in this study reported they are more dissatisfied with their sleep and rest (χ ² = 10.57, df = 4, p = 0.03) and more dissatisfied with their sexual activities (χ ² = 9.42, df = 4, p = 0.05) in contrast to midlife Australian women. This study has addressed and contributed to the assessment of multi-cultural quality of life research and has important implications for both health providers and policy makers of both countries.     

Sex differences in the development of mild cognitive impairment and probable Alzheimer’s disease as predicted by hippocampal volume or white matter hyperintensities

This study examined biological sex differences in the development of mild cognitive impairment (MCI) and probable Alzheimer’s disease (AD) development as predicted by changes in the hippocampus or white matter hyperintensities. A secondary data analysis of the National Alzheimer’s Coordinating Center Uniform Data Set was conducted. We selected samples of participants with normal cognition at baseline who progressed to MCI (n = 483) and those who progressed to probable AD (n = 211) to determine if hippocampal volume or white matter hyperintensities (WMH) at baseline predicted progression to probable AD or MCI and whether the rate of progression differed between men and women. The survival analyses indicated that changes in hippocampal volumes affected the progression to probable AD (HR = 0.535, 95% CI [0.300–0.953]) only among women. White men had an increased rate of progression to AD (HR = 4.396, CI [1.012–19.08]; HR = 4.665, 95% CI [1.072–20.29]) compared to men in other race and ethnic groups. Among women, increases in hippocampal volume ratio led to decreased rates of progressing to MCI (HR = 0.386, 95% CI [0.166–0.901]). Increased WMH among men led to faster progression to MCI (HR = 1.048. 95% CI [1.011–1.086]). Women and men who were older at baseline were more likely to progress to MCI. In addition, results from longitudinal analyses showed that women with a higher CDR global score, older age at baseline, or more disinhibition symptoms experienced higher odds of MCI development. Changes in hippocampal volumes affect the progression to or odds of probable AD (and MCI) more so among women than men, while changes in WMH affected the progression to MCI only among men.     

Adult population parameters and life tables of an epilachnine beetle (Coleoptera: Coccinellidae) feeding on bitter cucumber in Sumatra

Summary The population dynamics of an epilachnine beetle, which is closely related toEpilachna sparsa Dieke (henceforth called “sp. C”) and feeds on bitter cucumberMomordica charantia, was studied by mark-recapture of adults and the construction of life tables. The study was repeated three times, i.e., March–May, July–September and October–December in 1982, in Padang, Sumatra, Indonesia. After the establishment of the host plants, adults of “sp. C” soon colonized, and each study period ended in the death of the plants due to defoliation by the larvae and adults. The estimated mean length of residence of adults ranged from 6–11 days, but this was probably much shorter than the actual longevity, because the adults were so active that they flew away, or dropped off the plants, when they were approached or slightly disturbed. Life tables indicated that egg mortality ranged from 17.8–53.9%, and a parasitic waspTetrastichus sp. B made up 41.1–64.2% of egg mortality. Two wasps,Tetrastichus sp. C andPediobius foveolatus killed 1.2–19.4% (7.6–100%)^* of 4th instars and only the latter species attacked the pupae, killing 24.6–59.1% (45.1–72.4%). Parasitism and starvation by overcrowding contributed most to the total mortality from egg to adult emergence, which ranged from 89.4–99.5%. “Sp. C” had a higher diversity and level of parasitism than the Japanese species,E. vigintioctopunctata. The high dispersal power of “sp. C”, coupled with the prolongedl _x−m_x schedules shown under laboratory conditions, was advantageous for exploiting the food plant which was available throughout the year, but was rather patchily distributed in space.     

Validation of the WeDQoL-Goals-Thailand Measure: Culture-Specific Individualised Quality of Life

The aim of this study was to validate an individualised measure of quality of life (WeDQoL-Goals-Thailand). Three hundred and sixty-nine Thai people completed the WeDQoL by interview. Respondents rated (0–2) the perceived necessity for wellbeing of 51 goals (goal necessity), then rated (0–3) their satisfaction with the same goals (goal satisfaction). Weighted goal attainment (possible range 0–6) was computed (necessity x satisfaction). Psychometric validation used frequency distributions, Principal Components Analysis (PCA), and Cronbach’s alpha. Analysis of variance, t-tests, Kruskal–Wallis, Mann–Whitney U, Spearman’s correlation and multiple regression explored socio-demographic, geographic and economic differences. Respondents were aged 15–89 (mean 45.7, SD 18.0); 169 men, 200 women. For weighted goal attainment scores, PCA found a 44-item scale (α = 0.91) and three subscales (community/social/health, α = 0.90; house and home, α = 0.80; nuclear family, α = 0.81). Thai Individualised Goal Attainment (TIGA) scale and the three subscales were computed as the mean of contributing weighted goal attainment scores, after excluding goals considered ‘not necessary’ to each individual. Unweighted and individualised scores differed significantly with socio-demographic, geographic and economic indicators. In multiple regression, both Thai Unweighted Goal Satisfaction (TUGS) and TIGA scale scores were predicted by being married, living in the South and in a non-urban location. TIGA scores were also predicted by being over 25 years old. WeDQoL-Goals-Thailand has excellent psychometric properties. Individualised scores reflect each person’s perspective on wellbeing and are sensitive to subgroup differences. However, unweighted satisfaction scores give a broadly similar picture and involve less complex computation.     

Polygyny and child survival in Nigeria: Age-dependent effects

Mortality risks under age five are estimated using data from the 1990 Nigerian Demographic and Health Survey for children in monogamous and polygynous families. Integrating existing theories on polygyny’s relationship with infant and child mortality and some demographic concepts, the study shows that polygyny has different effects on infant and child mortality at different ages. The results indicate that polygyny does not have a significant effect on neonatal mortality (age less than one month). In contrast to the results of previous research, polygyny is significantly associated with lower child mortality during the post-neonatal period (1–11 months), but not during childhood (12–59 months). The study found socio-economic factors to be important confounders of the relationship between polygyny and mortality during the neonatal and post-neonatal periods. The protective effect of polygyny during the post-neonatal period suggests the need to further investigate circumstances that may favour post-neonatal child survival in polygynous families including availability of childcare.     

‘Expressive-Instrumental Traits and Sexist Attitudes among Spanish University Professors’

In this study we analyze the link between Instrumental/Expressive traits and sexist attitudes. The sample is made up of 496 male and female Spanish university professors (230 women and 266 men). In addition to collecting sociodemographic information from the participants, the following scales were administered: the Personal Attributes Questionnaire by Spence and Helmreich (PAQ, 1978); the Ambivalent Sexism Inventory [ASI, Glick and Fiske: 1996, Journal of Personality and Social Psychology 70, pp. 491–512]; and the Neosexism Scale [Tougas et al.: 1995, Personality and Social Psychology Bulletin, 21(8), pp. 842–849]. The data reveal that while the participants in our study subscribe less to sexist attitudes than the general population, the men continue to hold more hostile and benevolent sexist attitudes than do the women in our study. Surprisingly, however, we find that both female and male professors are less favorable toward affirmative action aimed at increasing women’s presence in the public sphere than the general population. As expected, women and men are equally instrumental, although women continue to show a greater number of expressive traits than men. Conversely, men score higher on instrumentality/expressiveness, which correlates positively with instrumentality and negatively with expressiveness. We also find some significant differences in levels of instrumentality and expressiveness when comparing the male and female professors and taking field of study into account. Lastly, we find negative correlations between expressiveness and Hostile Sexism (HS) and between masculinity and HS among women, and between expressiveness and Benevolent Sexism (BS) among men. To conclude, we offer some insight into the potential implications of these results.     

Informal Networks Social Capital of Fathers: What Does the Social Engagement Survey Tell Us?

Using the General Social Survey on Social Engagement conducted by Statistics Canada in 2003, this paper examines social capital derived from informal networks and its variation among men categorized as: (1) men with no children, and (2) men living with children in (a) intact, (b) step, and (c) lone parent families. The focus on men stems from a concern that their role in families has not been as extensively studied as that of women. The results show that married men living with children have higher social capital – measured in terms of the number of friends, relatives, and neighbors, and in their level of trust in them – than lone fathers or step fathers in cohabiting unions. Compared to child-free men, married fathers have higher social capital but also tend to have friends who are more similar to themselves in age, education, or income.     

Does midwifery continuity of care make a difference to women with perinatal mental health conditions: A cohort study,from Australia

BackgroundPerinatal mental health (PMH) conditions are associated with an increased risk of adverse perinatal outcomes including preterm birth. Midwifery caseload group practice (continuity of care, MCP) improves perinatal outcomes including a 24 % reduction of preterm birth. The evidence is unclear whether MCP has the same effect for women with perinatal mental health conditions.AimTo compare perinatal outcomes in women with a mental health history between MCP and standard models of maternity care. The primary outcome measured the rates of preterm birth.MethodsA retrospective cohort study using routinely collected data of women with PMH conditions between 1st January 2018 – 31st January 2021 was conducted. We compared characteristics and outcomes between groups. Multivariate logistic regression models were performed adjusting for a-priori selected variables and factors that differ between models of care.ResultsThe cohort included 3028 women with PMH, 352 (11.6 %) received MCP. The most common diagnosis was anxiety and depression (n = 723, 23.9 %). Women receiving MCP were younger (mean 30.9 vs 31.3, p = 0.03), Caucasian (37.8 vs 27.1, p < 0.001), socio-economically advantaged (31.0 % vs 20.2, p < 0.001); less likely to smoke (5.1 vs 11.9, p < 0.001) and with lower BMI (mean 24.3 vs 26.5, p < 0.001) than those in the standard care group. Women in MCP had lower odds of preterm birth (adjOR 0.46, 95 % CI 0.24–0.86), higher odds of vaginal birth (adjOR 2.55, 95 % CI 1.93–3.36), breastfeeding at discharge (adj OR 3.06, 95 % CI 2.10–4.55) with no difference in severe adverse neonatal outcome (adj OR 0.79, 95 % CI 0.57–1.09).ConclusionsThis evidence supports MCP for women with PMH. Future RCTs on model of care for this group of women is needed to establish causation.     

Geographic Ancestry and Cause-specific Mortality in a National Population

There are marked differentials in mortality risks across regions in Finland. No exhaustive explanation to this variation has been provided, however. The aim of this paper is to analyse how geographic ancestry, as proxied by persons’ birth region and population group, interrelates with cause-specific mortality risks. Focusing on people aged between their mid-thirties and late-forties, we use longitudinal population register data that offer opportunities to account for variables that represent both persons’ social background and their own social status at young adult age. Results of Cox proportional hazard models say that these variables have substantial effects on mortality of different causes, but only a marginal impact on the variation in death rates by birth region and population group. The geographic mortality pattern is found to be specifically prominent for causes of death that are fairly unrelated to persons’ lifestyles. Our findings suggest that genetic predisposal as expressed in terms of geographic ancestry might play a relevant role in understanding mortality variation within the population of Finland.     

Midwife-led continuity of care increases women’s satisfaction with antenatal,intrapartum, and postpartum care: North Shoa,Amhara regional state,Ethiopia: A quasi-experimental study

BackgroundThe provision of midwife-led continuity of care (MLCC) is effective in high-resource settings in improving maternal satisfaction. This study aimed to evaluate the effect of MLCC on women’s satisfaction with care in a low-income/resource setting.MethodA study with a quasi-experimental design was conducted from August 2019 to September 2020 in four primary hospitals in the north Shoa zone, Amhara regional state, Ethiopia. A total of 1178 low-risk women were allocated to one of two groups; the MLCC (intervention group) that received all antenatal, intrapartum, and immediate postnatal care from a primary midwife or backup midwife) (n = 589) and the shared model of care (SMC) group that received care following established practice in Ethiopia, care from different staff members at different times) (n = 589). Data for this paper were collected using face-to-face interviews at the women’s home at the end of the postpartum period. The study’s outcome was the mean sum-score of satisfaction with care through the antenatal, intrapartum, and postnatal period continuum, where mean sum-scores range from 1 (lowest) to 5 (highest).FindingsCompared with SMC, MLCC was associated with statistically significantly higher satisfaction with all continuity of care (4.07 vs. 2.79 adjusted mean difference 1.27, 95% CI 1.18–1.35; p < 0.001), during antenatal care (4.14 vs. 2.81 adjusted mean difference 1.33 (95% CI 1.22–1.52), intrapartum care (3.83 vs. 2.71 adjusted mean difference 1.06 (95% CI 0.88–1.23) and postnatal care (5.46 vs. 3.71 adjusted mean difference 1.75 (95% CI 1.54–1.94)).ConclusionMLCC increased women's satisfaction with maternity care for women at low risk of medical complications. These findings confirm that the MLCC model will be applicable in the Ethiopian health care system with similar settings.     

Sex Differences in the Relationship between Military Service Status and Functional Limitations and Disabilities

This paper examines the relationship between military service status (active duty, veteran, never served), sex, and six functional limitations/disabilities using data from the 5% sample of the 2000 U.S. Census. We estimate multivariate logistic regression models separately for men and women, and evaluate sex differences by comparing coefficients across models using a Wald chi-square test and computing predicted probabilities. For both men and women, the highest rates of functional limitation/disability are observed among veterans, while the lowest rates are recorded among active duty personnel. The increased odds of functional limitations/disabilities associated with veteran status is higher among women than men, whereas the decreased odds of functional limitations/disabilities associated with active duty status is lower among women than men. The predicted probabilities, which are based on a subgroup of 40–49 year olds with select sociodemographic characteristics, indicate that veteran women’s probabilities of many types of functional limitations/disabilities equal or exceed those of veteran men. Overall, the findings suggest women experience a more detrimental effect of past military service and a less beneficial effect of current military service. More life course analysis with longitudinal data that accounts for factors that influence sex-differentiation with respect to selection into military service, experiences in the military, and the short- and long-term consequences of military service is needed to fully understand sex differences in the relationship between military service and functional limitations/disabilities.     

Labor market institutions and demographic employment patterns

We study collective bargaining’s effect on relative employment for youth, women, and older individuals. Our model of collective wage setting predicts that unionization reduces employment more for groups with relatively elastic labor supply: youth, older individuals, and women. We test this implication using data from 17 Organization for Economic Cooperation and Development (OECD) countries over the 1960–1996 period. We find that time-varying indicators of unionization decrease the employment–population ratio of young and older individuals relative to the prime-aged, and of prime-aged women relative to prime-aged men, and unionization raises the unemployment rate of prime-aged women and, possibly, young men compared to prime-aged men.

Maternal mortality in South Africa: an update from the 2007 Community Survey

The 2007 Community Survey conducted in South Africa included questions on maternal deaths in the previous 12 months (pregnancy-related deaths). The Maternal Mortality Ratio (MMR) was estimated at 702 per 100,000 live births, some 30% more than at the 2001 census. This high level occurred despite a low proportion of maternal deaths (4.3%) among deaths of women aged 15–49 years, which is even lower than the proportion of time spent in the maternal risk period (7.6%). The high level of MMR was due to the astonishingly high level of adult mortality, which increased by 46% since 2001. The main reasons for these excessive levels were HIV/AIDS and external causes of death (accidents and violence). Differentials in MMR were very marked, and similar to those found in 2001 with respect to urban residence, race, province, education, income, and wealth. Provincial levels of MMR correlated primarily with HIV/AIDS prevalence. Maternal mortality defined as ‘pregnancy-related death’ appears no longer as a proper indicator of ‘safe motherhood’ in this situation.     

Social,behavioral, and biological factors,and sex differences in mortality

Few studies have examined whether sex differences in mortality are associated with different distributions of risk factors or result from the unique relationships between risk factors and mortality for men and women. We extend previous research by systematically testing a variety of factors, including health behaviors, social ties, socioeconomic status, and biological indicators of health. We employ the National Health and Nutritional Examination Survey III Linked Mortality File and use Cox proportional hazards models to examine sex differences in adult mortality in the United States. Our findings document that social and behavioral characteristics are key factors related to the sex gap in mortality. Once we control for women’s lower levels of marriage, poverty, and exercise, the sex gap in mortality widens; and once we control for women’s greater propensity to visit with friends and relatives, attend religious services, and abstain from smoking, the sex gap in mortality narrows. Biological factors—including indicators of inflammation and cardiovascular risk—also inform sex differences in mortality. Nevertheless, persistent sex differences in mortality remain: compared with women, men have 30% to 83% higher risks of death over the follow-up period, depending on the covariates included in the model. Although the prevalence ofriskfactors differs by sex, the impact of those riskfactors on mortality is similar for men and women.     

Male-female differences in labor market outcomes during the early transition to market: The cases of Estonia and Slovenia

Changes in women's relative wages and employment are analyzed, using social security data from Slovenia (1987–1992) and a retrospective labor force survey in Estonia (1989–1994). Estonia adopted liberal labor market policies. Slovenia took an interventionist approach. Nevertheless, relative wages for women rose in both countries. Factors favoring women included: returns to human capital rose in transition, benefiting women; relative labor demand shifted toward predominantly female sectors; low-wage women had a disproportionate incentive to exit the labor market, especially in Estonia. However, women were less mobile across jobs in both countries, so men disproportionately filled new jobs in expanding sectors. Received: 27 November 1997/Accepted: 20 December 1998