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.     

Estimating infant mortality in Colombia: some overdispersion modelling approaches

It is common to fit generalized linear models with binomial and Poisson responses, where the data show a variability that is greater than the theoretical variability assumed by the model. This phenomenon, known as overdispersion, may spoil inferences about the model by considering significant parameters associated with variables that have no significant effect on the dependent variable. This paper explains some methods to detect overdispersion and presents and evaluates three well-known methodologies that have shown their usefulness in correcting this problem, using random mean models, quasi-likelihood methods and a double exponential family. In addition, it proposes some new Bayesian model extensions that have proved their usefulness in correcting the overdispersion problem. Finally, using the information provided by the National Demographic and Health Survey 2005, the departmental factors that have an influence on the mortality of children under 5 years and female postnatal period screening are determined. Based on the results, extensions that generalize some of the aforementioned models are also proposed, and their use is motivated by the data set under study. The results conclude that the proposed overdispersion models provide a better statistical fit of the data.     

基于新医改背景下的妇幼保健管理系统实践研究——以连云港市为例

为促进妇幼卫生服务的提供公平均等,连云港市卫生局结合妇幼保健工作的实际需求,设计研发了业务、管理、服务、科研四位一体的妇幼保健管理系统,经过全市范围半年的实践应用,取得了理想的效果。文章重点介绍了该系统的研究背景、设计思路和创新点。     

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。     

Creating a reference to a complex emergency situation using time series methods: war in Guinea-Bissau 1998-1999

Impacts of complex emergencies or relief interventions have often been evaluated by absolute mortality compared to international standardized mortality rates. A better evaluation would be to compare with local baseline mortality of the affected populations. A projection of population-based survival data into time of emergency or intervention based on information from before the emergency may create a local baseline reference. We find a log-transformed Gaussian time series model where standard errors of the estimated rates are included in the variance to have the best forecasting capacity. However, if time-at-risk during the forecasted period is known then forecasting might be done using a Poisson time series model with overdispersion. Whatever, the standard error of the estimated rates must be included in the variance of the model either in an additive form in a Gaussian model or in a multiplicative form by overdispersion in a Poisson model. Data on which the forecasting is based must be modelled carefully concerning not only calendar-time trends but also periods with excessive frequency of events (epidemics) and seasonal variations to eliminate residual autocorrelation and to make a proper reference for comparison, reflecting changes over time during the emergency. Hence, when modelled properly it is possible to predict a reference to an emergency-affected population based on local conditions. We predicted childhood mortality during the war in Guinea-Bissau 1998-1999. We found an increased mortality in the first half-year of the war and a mortality corresponding to the expected one in the last half-year of the war.     

An individual measure of relative survival

Summary.  Relative survival techniques are used to compare survival experience in a study cohort with that expected if background population rates apply. The techniques are especially useful when cause-specific death information is not accurate or not available as they provide a measure of excess mortality in a group of patients with a certain disease. Whereas these methods are based on group comparisons, we present here a transformation approach which instead gives for each individual an outcome measure relative to the appropriate background population. The new outcome measure is easily interpreted and can be analysed by using standard survival analysis techniques. It provides additional information on relative survival and gives new options in regression analysis. For example, one can estimate the proportion of patients who survived longer than a given percentile of the respective general population or compare survival experience of individuals while accounting for the population differences. The regression models for the new outcome measure are different from existing models, thus providing new possibilities in analysing relative survival data. One distinctive feature of our approach is that we adjust for expected survival before modelling. The paper is motivated by a study into the survival of patients after acute myocardial infarction.     

西方血族文化绽放的人性和谐之花

血族文化作为西方文化中一个特别的现象,有其深远的历史文化内涵,它的诞生与发展和宗教文化紧密相关。人类死亡意识的加强,促使人去按照自己的主观想象建构了严密而完善的血族文化社会体系。作为反映人性的一面镜子,血族文化中的“吸血鬼”形象在文学和影视作品中又有了现代延伸。抛弃迷信,现代吸血鬼形象仍具检讨人性得失、有益社会和谐之积极价值。     

The Migrant Mortality Advantage: A 70 Month Follow-up of the Brussels Population

There is considerable evidence that first generation immigrants to developed countries tend to have lower mortality than does the population as a whole at their destination. This advantage is usually ascribed to a selection process which makes migrants more robust than the local population and/or an acculturation process whereby third-world migrants lose their natural healthy life style as they take on modern urban dietary and living habits. We investigate immigrant-local mortality differences using a 6-year follow-up of the complete Brussels population aged 25–55, as enumerated at the Belgian census, 1991. We show that adult migrants have lower mortality than their native-born counterparts, despite their often poorer living arrangements, work status and human capital. This effect differs by origin group. The effects of age on mortality are similar for all groups, with mortality increasing about 8% a year. This increase is slightly greater for the Belgian born than for immigrants, which makes the selectivity explanation unlikely. Years since migration does not significantly increase the mortality risk for most groups, contradicting the acculturation hypothesis. Thus, explanations ascribing immigrants' mortality advantage to migrant selectivity, pre-modern cultural practices, or an artefact of population recording practices are insufficient. We propose, instead, an explanation based on the meaning migration has for the immigrant, and the hope engendered in the move, particularly that from a lesser to a more developed country.     

南京市妇幼保健院剖宫产率升高的影响因素及应对措施

目的:分析南京市孕产妇剖宫产升高的原因及其影响因素.方法:采用整群调查的方式收集南京市妇幼保健院产科2011年1～12月选择剖宫产的4 793名产妇及其家庭成员进行问卷调查.结果:剖宫产指征中社会心理因素占69.27％、经济因素(家庭收入和医疗保险等)占17.24％、医学指征因素占13.49％.高学历、高收入和高龄产妇选择剖宫产术显著高于普通产妇(P＜0.01).多因素Logistic回归分析显示,与选择剖宫产术相关的危险因素有年龄、受教育程度、家庭收入、医疗保险、婚姻状况、产妇及家庭心理干预.结论:加强孕产妇围产期保健及分娩知识宣教,强化高危人群的筛查和规范化管理,广泛开展无痛分娩和住院服务,正确把握剖宫产指征与时机,将有利于降低剖宫产率.     

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.