Comparing two survey methods for estimating maternal and perinatal mortality in rural Cambodia

PURPOSE: We need solid estimates of maternal mortality rates (MMR) to monitor the impact of maternal care programs. Cambodian health authorities and WHO report the MMR in Cambodia at 450 per 100,000 live births. The figure is drawn from surveys where information is obtained by interviewing respondents about the survival of all their adult sisters (sisterhood method). The estimate is statistically imprecise, 95% confidence intervals ranging from 260 to 620/100,000. The MMR estimate is also uncertain due to under-reporting; where 80-90% of women deliver at home maternal fatalities may go undetected especially where mortality is highest, in remote rural areas. The aim of this study was to attain more reliable MMR estimates by using survey methods other than the sisterhood method prior to an intervention targeting obstetric rural emergencies. PROCEDURES: The study was carried out in rural Northwestern Cambodia where access to health services is poor and poverty, endemic diseases, and land mines are endemic. Two survey methods were applied in two separate sectors: a community-based survey gathering data from public sources and a household survey gathering data direct from primary sources. FINDINGS: There was no statistically significant difference between the two survey results for maternal deaths, both types of survey reported mortality rates around the public figure. The household survey reported a significantly higher perinatal mortality rate as compared to the community-based survey, 8.6% versus 5.0%. Also the household survey gave qualitative data important for a better understanding of the many problems faced by mothers giving birth in the remote villages. There are detection failures in both surveys; the failure rate may be as high as 30-40%. PRINCIPLE CONCLUSION: Both survey methods are inaccurate, therefore inappropriate for evaluation of short-term changes of mortality rates. Surveys based on primary informants yield qualitative information about mothers' hardships important for the design of future maternal care interventions.     

中国老年人虚弱指数与死亡风险及队列差异

利用中国老年人健康长寿影响因素调查（ CLHLS ）2002－2011年跟踪调查数据,通过多种健康指标构建中国老年人虚弱指数,运用增长曲线模型和Cox等比例风险函数的研究方法,对中国老年人虚弱指数和死亡风险及其队列差异进行了深入分析。研究发现,女性虚弱指数比男性高,增长速度也比男性快,但是死亡风险比男性低;出生较晚的队列与出生早的队列相比,虚弱指数会更高,他们的增长程度更快;受教育程度高的老年人虚弱指数低,但是其增长速度却比受教育程度低的老年人要高。     

The impact of water supply and sanitation on infant mortality: Individual-level evidence from Tartu,Estonia, 1897–1900

Evidence from a number of historical studies has demonstrated a strong impact of the provision of clean water on mortality risks, while no clear effect has been reported in others. We investigated the relationship between water supply, sanitation, and infant survival in Tartu, a university town in Estonia, 1897–1900. Based on data from parish registers, which were linked to the first census of the Russian Empire, the analysis reveals a clear disadvantage for infants in households using surface water, compared with families that acquired water from groundwater or artesian wells. The impact is stronger in the later stages of infancy. Competing-risk analysis shows that the effect is more pronounced for deaths caused by diseases of the digestive system. Our findings suggest that it may have been possible to improve the water supply, and consequently reduce infant mortality, before the introduction of piped water and sewage systems.     

Number of children and later-life mortality among Finns born 1938–50

We investigated the association between number of offspring and later-life mortality of Finnish men and women born 1938–50, and whether the association was explained by living conditions in own childhood and adulthood, chronic conditions, fertility timing, and unobserved characteristics common to siblings. We used a longitudinal 1950 census sample to estimate mortality at ages 50–72. Relative to parents of two children, all-cause mortality is highest among childless men and women, and elevated among those with one child, independently of observed confounders. Fixed-effect models, which control for unobserved characteristics shared by siblings, clearly support these findings among men. Cardiovascular mortality is higher among men with no, one, or at least four children than among those with two. Living conditions in adulthood contribute to the association between the number of children and mortality to a greater extent than childhood background, and chronic conditions contribute to the excess mortality of the childless.     

A lost family-planning regime in eighteenth-century Ceylon

Based on Dutch colonial registers (thombos), this paper reconstructs fertility for two districts in Ceylon, 1756–68. It overcomes challenges in data quality by establishing the outer bounds of plausible estimates in a series of scenarios. Among these, total fertility rates (TFRs) averaged 5.5 in one district, but only 2.7 in the other. These figures exclude the victims of infanticide, a custom noted in European travelogues between about 1660 and 1820. Sex ratios among children differed depending on the number of older siblings, and overall, 27?per cent of girls are missing in one district and 57?per cent in the other. There was little significant variation either in the TFR or the sex ratio by socio-economic status, suggesting that poverty was not a key factor in motivating infanticides. Instead, we argue that at least parts of Ceylon had a forward-looking culture of family planning in the eighteenth century, which was lost in subsequent decades.     

Till Death Do Us Part: Marital Status and U.S. Mortality Trends, 1986 – 2000

Although the association of being married and a lower mortality rate has been well established, most previous research on marital status and mortality did not consider potential change in this relationship over time. In this study, I adopted a survey cohort perspective to examine both overall and cause‐specific mortality trends by marital status from 1986 to 2000 in the United States. On the basis of data from the National Health Interview Survey‐Longitudinal Mortality Follow‐up (N = 517,314), I found that mortality generally decreased or remained stable for the married from the 1986 to 2000 NHIS cohort, except for diabetes deaths. There is evidence showing divergent mortality trends between the married and unmarried, especially the widowed. Race and gender variations are examined.     

An Empirical Model of Perceived Mortality Risks for Selected U.S. Arsenic Hot Spots

Researchers have long recognized that subjective perceptions of risk are better predictors of choices over risky outcomes than science‐based or experts’ assessments of risk. More recent work suggests that uncertainty about risks also plays a role in predicting choices and behavior. In this article, we develop and estimate a formal model for an individual's perceived health risks associated with arsenic contamination of his or her drinking water. The modeling approach treats risk as a random variable, with an estimable probability distribution whose variance reflects uncertainty. The model we estimate uses data collected from a survey given to a sample of people living in arsenic‐prone areas in the United States. The findings from this article support the fact that scientific information is essential to explaining the mortality rate perceived by the individuals, but uncertainty about the probability remains significant.     

母性：杜拉斯笔下的一方圣土

母爱的缺失和找寻循环贯穿于杜拉斯的一生，由此形成的“母性情结”反映在写作中，使得其文本中的母亲形象表现出偏执、扭曲、神圣、慈善等多面性的母性特征。杜拉斯的母性情结及其文本中的母性书写体现了作家对父权文化的矛盾态度。     

“母性思维”与当代中国家庭教育中的关怀叙事

关怀伦理学主张从母性实践出发，在与子女建立亲密关系的过程中给予子女保护性的爱，对子女进行精神上的教养，帮助子女形成社会化人格等，文章以关怀伦理学中的母性思维为视角，以池莉等作家依据自身母性实践创作的关怀叙事作品为例，与柏杨、余华等人作品中父职角色在家庭中充当道德权威的书写对比，探讨了"母性思维"观念对于当代中国家庭教育的积极意义，即促进家庭中亲密关系和信赖关系的产生，同时父职身份也应该受到"母性思维"观念的影响相应地进行转化，从道德权威转变为道德关怀。     

呼唤自然母性情怀——论铁凝小说的母性意识

女作家铁凝在小说中塑造了形形色色的母亲形象，表达了对自然母性情怀的强烈呼唤，在当代女性文学中凸显了独特、厚重、深刻的母性意识的特质。即对传统母亲形象的理性审视、对现实母亲的“审丑”意识以及歌颂自然母性的伟力。