Learning Causes of Functional Dynamic Targets: Screening and Local Methods.

This paper addresses the challenge of identifying causes for functional dynamic targets, which are functions of various variables over time. We develop screening and local learning methods to learn the direct causes of the target, as well as all indirect causes up to a given distance. We first discuss the modeling of the functional dynamic target. Then, we propose a screening method to select the variables that are significantly correlated with the target. On this basis, we introduce an algorithm that combines screening and structural learning techniques to uncover the causal structure among the target and its causes. To tackle the distance effect, where long causal paths weaken correlation, we propose a local method to discover the direct causes of the target in these significant variables and further sequentially find all indirect causes up to a given distance. We show theoretically that our proposed methods can learn the causes correctly under some regular assumptions. Experiments based on synthetic data also show that the proposed methods perform well in learning the causes of the target.

Caracterización de la mortalidad por diabetes mellitus en la provincia Cienfuegos durante los primeros nueve meses del 2020

Fundamento: según la Organización Mundial de la Salud la diabetes causa 300 000 muertes al año en América Latina y el Caribe y en la provincia Cienfuegos desde el año 2020 se ubica como séptima causa de fallecimientos. Objetivo caracterizar la mortalidad por diabetes mellitus en la provincia Cienfuegos en los primeros nueve meses del año 2020. Métodos: se realizó una investigación en sistemas y servicios de salud de tipo descriptiva a partir de una serie de casos para caracterizar la mortalidad por diabetes mellitus en Cienfuegos en los primeros nueve meses del año 2020. Los fallecidos se compilaron teniendo en cuenta: sexo, edad, color de la piel, nivel de escolaridad, lugar de residencia, estrato territorial, enfermedad, factores de riesgo asociados y causas de muertes directas. Se emplearon la media aritmética y la desviación estándar. Los resultados se presentan en forma de tablas y gráficos. Resultados la mayor afectación estuvo en las últimas décadas de la vida para el género femenino, así como la residencia en un territorio urbano, están entre las primeras causas directas de muerte el tromboembolismo pulmonar, así como la insuficiencia renal crónica agudizada, se destaca el desequilibrio hidroelectrolítico en un número considerable de las defunciones. Conclusiones las últimas décadas de la vida fueron las más afectadas y el sexo femenino, las principales causas de muerte fueron: el tromboembolismo pulmonar y la insuficiencia renal crónica agudizada. El desequilibrio hidroelectrolítico sobresale en un considerable número de los fallecidos.

Foundation: according to the World Health Organization, diabetes causes 300,000 deaths a year in Latin America and the Caribbean and in the Cienfuegos province since 2020 it ranks as the seventh cause of death. Objective: to characterize mortality from diabetes mellitus in the Cienfuegos province in the first nine months of 2020. Methods: a descriptive investigation was carried out on health systems and services based on a series of cases to characterize mortality from diabetes mellitus in Cienfuegos in the first nine months of 2020. The deceased were compiled taking into account: sex, age, skin color, educational level, place of residence, territorial stratum, disease, associated risk factors and direct causes of death. The arithmetic mean and standard deviation were used. The results are presented in the form of tables and graphs. Results: the greatest affectation was in the last decades of life for the female gender, as well as residence in an urban territory, among the first direct causes of death are pulmonary thromboembolism, as well as acute chronic renal failure; hydroelectrolytic imbalance stands out in a considerable number of deaths. Conclusions: the last decades of life were the most affected and the female sex, the main causes of death were: pulmonary thromboembolism and acute chronic renal failure. The hydroelectrolytic imbalance stands out in a considerable number of the deceased.

Trends and causes of maternal death at the Lagos University teaching hospital, Lagos, Nigeria (2007-2019).

BACKGROUND: Nigeria has one of the worst global maternal mortality ratios (MMR). Institutional audit is invaluable in providing useful information for formulating preventive interventions. OBJECTIVE: To evaluate the trends, causes and socio-demographic characteristics of maternal mortality at a tertiary institution in South-western Nigeria over a period of 13 years (2007-2019). METHODOLOGY: Cross sectional and temporal trend analysis of maternal deaths were conducted using chart reviews from 2007 to 2019. Socio-biological characteristics, booking status and ranking of clinical causes of maternal deaths were derived from patients' chart review (2007-2019). Bivariate analysis and Annual percent change (APC) of the observed trends was respectively conducted using Stata version 17 and Joinpoint version 4.5.0.1 software respectively. RESULTS: In the period 2007-2019, the mean age at maternal death was 30.8 ± 5.9 years and 88.8% of mortalities occurred among the "unbooked" women. The leading causes of direct maternal mortality were Hypertension (27.0%), Sepsis (20.6%) and haemorrhage (18.7%), while anaemia in pregnancy (3.2%), Human Immunodeficiency Virus (3.2%) and Sickle Cell Disease (2.4%) were the leading indirect causes of maternal mortality Joinpoint estimates showed a statistically significant increase in MMR of about 3.4% per annum from 2211 per 100,000 live births in 2007 to 3555.6 per 100,000 live births in 2019 (APC: +3.4%, P-value < 0.001). CONCLUSION: Contrary to some other reports, there was an increase in the institutional MMR between 2007 and 2019 even though the leading causes of death remained similar. Targeted interventions based on accurate data are urgently required in order to achieve the Sustainable Development Goal (SDG) 3.1.

Scoping maternal care through the lens of maternal deaths: A retrospective analysis of maternal mortality in Georgia.

INTRODUCTION: Reduction of the maternal mortality ratio (MMR) to 12 per 100,000 live births by 2030 is a priority target in Georgia. This study aims to assess and classify MM in Georgia by direct and indirect causes of death from 2014 to 2017, using data from the national surveillance system and in accordance with internationally approved criteria. MATERIAL AND METHODS: In this secondary study, MM data was retrieved from the Maternal and Children's Health Coordinating Committee and validated with data from the Vital Registry System and the Georgian Birth Registry. The study sample comprised 61 eligible MM cases. Relevant information was transferred to case-report forms to review and classify MM cases by direct and indirect causes of maternal death. RESULTS: The MMR during the study period was 26.7 per 100,000 live births. The proportion of direct causes of maternal death exceeded that of indirect causes, at 62% and 38%, respectively. The leading direct cause of maternal death was haemorrhage, while infection was the most frequent indirect cause. 52.5% of MM cases had no pre-existing medical condition, 62.3% had frequent adherence to antenatal care, and 52.5% had emergency caesarean sections. CONCLUSION: In Georgia, direct causes of maternal death exceed indirect causes in MM cases, with haemorrhage and infections, respectively, being most common. These findings are important to ensure optimal and continuous care and to accelerate progress in the reduction of MM in the country.

Magnitude and determinants of obstetric case fatality rate among women with the direct causes of maternal deaths in Ethiopia: a national cross sectional study.

BACKGROUND: In sub-Saharan Africa, maternal death due to direct obstetric complications remains an important health threat for women. A high direct obstetric case fatality rate indicates a poor quality of obstetric care. Therefore, this study was aimed at assessing the magnitude and determinants of the direct obstetric case fatality rate among women admitted to hospitals with direct maternal complications. METHODS: In 2015, the Ethiopian Public Health Institute conducted a national survey about emergency obstetric and newborn care in which data about maternal and neonatal health indicators were collected. Maternal health data from these large national dataset were analysed to address the objective of this study. Descriptive statistics were used to present hospital specific characteristics and the magnitude of direct obstetric case fatality rate. Logistic regression analysis was performed to examine determinants of the magnitude of direct obstetric case fatality rate and the degree of association was measured using an adjusted odds ratio with 95% confidence interval at p < 0.05. RESULTS: Overall, 335,054 deliveries were conducted at hospitals and 68,002 (20.3%) of these women experienced direct obstetric complications. Prolonged labour (23.4%) and hypertensive disorders (11.6%) were the two leading causes of obstetric complications. Among women who experienced direct obstetric complications, 435 died, resulting in the crude direct obstetric case fatality rate of 0.64% (95% CI: 0.58-0.70%). Hypertensive disorders (27.8%) and maternal haemorrhage (23.9%) were the two leading causes of maternal deaths. The direct obstetric case fatality rate varied considerably with the complications that occurred; highest in postpartum haemorrhage (2.88%) followed by ruptured uterus (2.71%). Considerable regional variations observed in the direct obstetric case fatality rate; ranged from 0.27% (95% CI: 0.20-0.37%) at Addis Ababa city to 3.82% (95% CI: 1.42-8.13%) at the Gambella region. Type of hospitals, managing authority and payment required for the service were significantly associated with the magnitude of direct obstetric case fatality rate. CONCLUSIONS: The high direct obstetric case fatality rate is an indication for poor quality of obstetric care. Considerable regional differences occurred with regard to the direct obstetric case fatality rate. Interventions should focus on quality improvement initiatives and equitable resource distribution to tackle the regional disparities.

Review of Maternal Mortality at a Tertiary Care Hospital: What Have we Achieved?

BACKGROUND: Mothers are the nurturing pillar of the family. When a woman dies or becomes ill, either during or after giving birth, the consequences have the potential to affect not only the woman herself, but her family, society and the nation as well. OBJECTIVES: The study was designed to evaluate the maternal mortality ratio in a tertiary care hospital, assess the demographic profile, causes of maternal mortality, type of delay, and to suggest remedial measures for improvement. METHODS: A retrospective study was done from Jan 2013 to Dec 2016 at a tertiary care hospital in New Delhi. The medical records of all maternal deaths over a period of 4 years were reviewed and analyzed. RESULTS: The Maternal mortality ratio in the study period was 361.71/100,000 live births. The number of maternal death was 364. Unbooked cases accounted for the majority, i.e., 322, booked being 29 and registered 13. Two hundred and eleven cases were referred from other centers. Maximum deaths occurred between 21 and 30 years (73.07%). Anemia was widely prevalent. Most maternal deaths were due to direct causes like hypertensive disorders (28.02%), pregnancy-related infections (20.87%), and hemorrhage (12.36%). Among indirect causes, anemia, hepatitis, heart disease and respiratory illness accounted for 15.93, 11.53, 3.29 and 5.49%, respectively. Type I delay was most common (64.28%). CONCLUSION: Strengthening of the peripheral centers, hiring competent staffs and adequate blood bank facilities together with reference linkages must be done. Auditing the causes for maternal mortality is extremely helpful to identify the preventable causes and delays.

Maternal mortality in rural South Africa: the impact of case definition on levels and trends.

BACKGROUND: Uncertainty in the levels of global maternal mortality reflects data deficiencies, as well as differences in methods and definitions. This study presents levels and trends in maternal mortality in Agincourt, a rural subdistrict of South Africa, under long-term health and sociodemographic surveillance. METHODS: All deaths of women aged 15 years-49 years occurring in the study area between 1992 and 2010 were investigated, and causes of death were assessed by verbal autopsy. Two case definitions were used: "obstetrical" (direct) causes, defined as deaths caused by conditions listed under O00-O95 in International Classification of Diseases-10; and "pregnancy-related deaths", defined as any death occurring during the maternal risk period (pregnancy, delivery, 6 weeks postpartum), irrespective of cause. RESULTS: The case definition had a major impact on levels and trends in maternal mortality. The obstetric mortality ratio averaged 185 per 100,000 live births over the period (60 deaths), whereas the pregnancy-related mortality ratio averaged 423 per 100,000 live births (137 deaths). Results from both calculations increased over the period, with a peak around 2006, followed by a decline coincident with the national roll-out of Prevention of Mother-to-Child Transmission of HIV and antiretroviral treatment programs. Mortality increase from direct causes was mainly due to hypertension or sepsis. Mortality increase from other causes was primarily due to the rise in deaths from HIV/AIDS and pulmonary tuberculosis. CONCLUSION: These trends underline the major fluctuations induced by emerging infectious diseases in South Africa, a country undergoing rapid and complex health transitions. Findings also pose questions about the most appropriate case definition for maternal mortality and emphasize the need for a consistent definition in order to better monitor and compare trends over time and across settings.

Razão de mortalidade materna na região sul do Brasil no período de 1996 a 2005 / Maternal mortality ratio in southern Brazil from 1996 to 2005

Objetivo: avaliar a mortalidade materna na região Sul do Brasil, do período de 1996 a 2005. Métodos: estudo ecológico descritivo, avaliando-se todas as mortes maternas de mulheres entre 10 e 49 anos no banco de dados do DATASUS. Resultados: a Razão de Mortalidade Materna foi de 59,48/100.000 nascidos vivos. A avaliação do banco de dados fornecido para o estudo evidenciou que 63% dos óbitos maternos ocorreram por causas diretas, sendo as etiologias mais frequentes as doenças hipertensivas, e hemorrágicas O puerpério foi o período menos frequente de mortes maternas sendo que a grande maioria dos casos ocorreram em ambiente hospitalar. Conclusão: esses resultados demonstram a deficiência da saúde pública e a necessidade de desenvolver-se programas que visem melhorar a qualidade da assistência médica durante a gestação, o parto e o puerpério além de criar estratégias eficazes pra se prevenir a morte materna, uma vez que a grande maioria desses óbitos são passíveis de prevenção.

Objective: to assess maternal mortality in Southern Brazil, the period from 1996 to 2005. Methods: an ecological descriptive study, assessing all the maternal deaths of women between 10 and 49 years in the database of DATASUS. Results: the Ratio of Maternal Mortality was 59.48 per 100,000 live births. The evaluation of the database provided for the study showed that 63% of maternal deaths occurred due to direct, and the most frequent etiologies hypertensive diseases, hemorrhagic and infectious period of puerperal respectively. The most common period in which the maternal deaths has occurred during pregnancy, childbirth or abortion and the vast majority of cases occurred in hospitals. Conclusion: these results demonstrate the deficiency of public health and the need to develop programs that improve the quality of medical care during pregnancy, delivery and puerperium and create effective strategies for preventing maternal deaths is because the large most of these deaths are likely to prevention.