Traditional birth attendants’ roles and homebirth choices in Ethiopia: A qualitative study

BackgroundIn Ethiopia, it is encouraged that labour and delivery care are performed under the observation of skilled/trained midwifery or medical professionals. However, 70% of all births occur outside the healthcare system under the care of unskilled birth attendants, family members, or without any assistance at all.ObjectiveThis study aimed to assess the reasons for choosing homebirth and the role of traditional birth attendants in Arba Minch Health and Demographic Surveillance Site.MethodA qualitative, exploratory study was carried out between May and June 2017. Twenty-nine semi-structured interviews were conducted with various respondent groups such as traditional birth attendants, pregnant women, skilled birth attendants, and health extension workers. Data were transcribed and for analysis, structured as per the participants’ responses, sorted and categorized as per the topic guide, and presented in narrative form.FindingsThe study revealed that traditional birth attendants are actively engaged in assisting homebirths in the selected area. It was also found that many women still prefer traditional birth attendants for childbirth assistance. Reasons for choosing homebirth included lack of transport to health care facilities, distance to health care facilities, lack of respectful care at health care facilities, and the friendliness of traditional birth attendants. Lack of formal partnerships between traditional birth attendants and the health system was also observed.ConclusionsThere is a need to incorporate traditional birth attendants as a link between healthcare facilities and pregnant women; thereby, improving respectful care at the healthcare facilities.     

基于极端分位数回归模型的国际原油与天然气市场相依关系研究

针对国际原油价格与天然气价格之间的相依性问题,提出了金融时间序列极端分位数回归模型,解决市场之间相依关系刻画问题。考虑到金融经济活动和极端危机事件可能会影响到原油和天然气市场之间的依赖程度,首先检测样本内的结构突变点,再引入虚拟变量,运用分位数回归理论时间序列模型进行实证分析。研究结果表明：国际原油价格与天然气价格之间存在动态相依关系,且在熊市和牛市期间两者之间均呈正相关,说明消费者和投资者在能源期货市场消费和投资行为存在显著的羊群效应;此外,原油价格波动引起天然气价格的变化在不同分位点表现出非对称效应,两者之间的动态相依关系受到极端金融危机事件和经济活动的影响,极端条件下依赖程度更强。     

Valuation of contingent claims with stochastic interest rate and mortality driven by Lévy processes

Abstract

In this paper, we consider a model with stochastic interest rate and stochastic mortality, which is driven by a Lévy process. Under the assumption that the stochastic mortality and interest rate are dependent, we discuss the valuation of life insurance contracts. Employing the method of change of measure together with the Bayes’ rule, we present the pricing formulas in closed form for the survival and death benefit models. Finally, numerical experiments illustrate the effects of some parameters.     

老龄多人口死亡率联合建模与一致性预测

退休年龄以上的老年人群死亡率预测是养老金精算和长寿风险度量的基础。针对我国大陆地区退休年龄以上人群死亡率数据量较小且波动较大的问题,借助多人口联合建模思想,基于单人口CBD模型,提出了一个适用于老龄死亡率建模的Logistic多人口模型。通过加入更多相关人口数据信息来预测我国老年人口死亡率,选取我国台湾地区分性别死亡率相关数据,与我国大陆地区分性别死亡率数据进行联合建模。研究发现,Logistic多人口死亡率模型比单人口CBD模型表现出更好的拟合效果和长期预测一致性效果。     

Cystatin C as a predictor of mortality in elderly patients with chronic kidney disease

Background: The prevalence of chronic kidney disease (CKD) in the elderly is high. Serum cystatin C is an accurate marker of kidney function and it also has prognostic utility in CKD patients. The aim of our study was to determine the prediction of serum cystatin C and other markers of kidney function on long-term survival in elderly CKD patients.

Methods: Fifty eight adult Caucasian patients, older than 65 years, without known malignancy, thyroid disease and/or not on steroid therapy were enrolled in the study. In each patient, ⁵¹CrEDTA clearance, serum creatinine, serum cystatin C, and estimated glomerular filtration rate using different equations were determined on the same day and patients were then followed for 11 years or until their death.

Results: The means are as follows: ⁵¹CrEDTA clearance 53.3?±?17.4?ml/min/1.73?m², serum creatinine 1.62?±?0.5?mg/dl, serum cystatin C 1.79?±?0.5?mg/l, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation 40.1?±?14?ml/min/1.73?m², Berlin Initiative Study 2 (BIS2) equation 38.9?±?10.7?ml/min/1.73?m², full age spectrum (FAS) creatinine equation 43.8?±?13.8?ml/min/1.73?m², FAS cystatin C equation 40.1?±?11.7?ml/min/1.73?m². In the follow up period, 47 (81%) patients died. Cox regression analysis showed different hazard ratios (HRs) for death: for ⁵¹CrEDTA clearance HR 1.022 (95% CI 1.004–1.042; p?=?.015), serum creatinine HR 1.013 (95% CI 1.006–1.019; p?=?.001), serum cystatin C HR 2.028 (95% CI 1.267–3.241; p?=?.003), CKD-EPI creatinine equation HR 1.048 (95% CI 1.019–1.076; p?=?.001), BIS2 equation HR 1.055 (95% CI 1.021–1.088; p?=?.001), FAS creatinine equation HR 1.046 (95% CI 1.017–1.074; p?=?.001), FAS cystatin C equation HR 1.039 (95% CI 1.010–1.071; p?=?.009).

Conclusions: Our results showed the highest HR for serum cystatin C among kidney function markers for prediction of outcome in elderly CKD patients.     

Forecasting Spanish Natural Life Expectancy

Knowledge of trends in life expectancy is of major importance for policy planning. It is also a key indicator for assessing future development of life insurance products, substantiality of existing retirement schemes, and long-term care for the elderly. This article examines the feasibility of decomposing age-gender-specific accidental and natural mortality rates. We study this decomposition by using the Lee and Carter model. In particular, we fit the Poisson log-bilinear version of this model proposed by Wilmoth and Brouhns et al. to historical (1975-1998) Spanish mortality rates. In addition, by using the model introduced by Wilmoth and Valkonen we analyze mortality-gender differentials for accidental and natural rates. We present aggregated life expectancy forecasts compared with those constructed using nondecomposed mortality rates.     

Family Structure and Child Mortality in Sub‐Saharan Africa: Cross‐National Effects of Polygyny

This study applies multilevel logistic regression to Demographic and Health Survey data from 22 sub‐Saharan African countries to examine whether the relationship between child mortality and family structure, with a specific emphasis on polygyny, varies cross‐nationally and over time. Hypotheses were developed on the basis of competing theories on the relationship between child health and family structure. Although children of mothers in polygynous marriages are more likely to die than those of mothers in monogamous unions, the relationship is constant across time. Familial factors including education, socioeconomic status (SES), and urban residence accounted for most of the observed cross‐national variation associated with polygyny. Consequently, improving maternal education and household SES would greatly benefit child health in sub‐Saharan Africa.     

2000-2010年福建省人口死亡统计分析

人口死亡水平的变动与趋势包含了与社会发展互为因果的潜在信息,对其进行挖掘可以为人口数量与素质、城市化与劳动就业、人口分布与资源环境承载力以及人口老龄化等问题的解决提供重要参考。基于“五普”、“六普”的人口普查数据,文章利用模型生命表方法对福建省的人口死亡率进行了校正;宏观角度对比分析了2000年-2010年福建省人口死亡水平与模式变化,微观多角度剖析了设区市之间预期寿命、婴儿死亡的差异及其原因。研究结论为：一是福建省人口死亡率显著降低,人口健康水平大幅提升,婴儿死亡漏报、错报问题明显减少;二是九个设区市之间的死亡模式存在地区差异,城市化水平、生育水平及社会卫生条件是差异产生的显著性影响因素,但经济发展、教育水平和公共医疗卫生的作用不明显。     

基于VaR方法的长寿风险自然对冲模型

随着死亡率的下降与预期寿命的提高,保险公司面对着不容忽视的长寿风险。基于VaR方法探讨了长寿风险管理中的自然对冲策略,然后在对中国男性人口死亡率预测的基础上,给出了保险公司自然对冲长寿风险所需的最优产品结构,并进一步考查了利率、签单年龄、缴费方式等因素对最优产品结构的影响。     

245例老年住院患者死因分析

目的了解干部病房老年住院患者的死因现状。方法对2006年至2008年三年间在我院干部病房住院期间245例老年死亡患者的临床资料进行统计分析。结果三年间干部病房老年住院患者的前三位死因依次为：恶性肿瘤、循环系统疾病、呼吸系统疾病。结论恶性肿瘤、心脑血管疾病、呼吸系统疾病是危害老年人生命的头三位严重疾患。