II Congreso Nacional de Pediatría. La lucha contra la mortalidad infantil / II National Congress of Paediatrics: The fight against child mortality

En el presente trabajo se presenta una aproximación a los contenidos de las ponencias del IICongreso Nacional de Pediatría, celebrado en San Sebastián en 1923, con ocasión del centenario del mismo. Se destaca como hilo conductor de las mismas el problema de la mortalidad infantil, que en aquellos años era muy elevada en España y era una preocupación de políticos, de intelectuales y de la clase médica. Se constata que alguna de las propuestas y preocupaciones de los pediatras que asistieron a dicho congreso siguen vigentes hoy en día.(AU)

In this work, we present an overview of the contents of the communications presented at the Second National Congress of Paediatrics, held in San Sebastian in 1923, on the occasion of the 100th year anniversary. The problem of infant mortality stands out as a common thread, which in those years was very high in Spain and was a concern of politicians, intellectuals and the medical profession. It is worth noting that some of the proposals and concerns of the paediatricians who attended that congress continue to be relevant today.(AU)

Disparities in Neonatal Outcomes: Past, Present, and Our Future?

Neonatal outcomes and infant mortality rates have improved significantly in the past century. However, the disparities in outcomes linked to racial and ethnic variations have persisted and actually increased. Those differences in outcomes have been acknowledged for years as care providers strive to improve care for all of our most vulnerable and youngest individuals. Trends in neonatal outcomes are summarized.

Ensayos nutricionales sobre lactancia artificial en la España ilustrada: el trabajo de Joaquín Xavier Úriz en Pamplona / Nutritional trials on artificial lactation in Enlightenment Spain: the work of Joaquín Xavier Úriz in Pamplona

Introducción: la continuidad actual de publicaciones sobre la infancia abandonada durante la Ilustración española, desde las mismas perspectivas del control social que se establecieron a finales del siglo XX, desvirtúa el esfuerzo de algunos ilustrados por encontrar alternativas de nutrición artificial a la lactancia mediante nodrizas. Objetivo: analizar los ensayos nutricionales efectuados por Joaquín Xavier Úriz (1747-1829) en la inclusa de Pamplona. Método: revisión, análisis e interpretación de su obra "Causas prácticas de la muerte de los niños expósitos en sus primeros años" , publicada en 1801. Resultados: tras justificar su necesidad, plantear objetivos y diseñar un experimento controlado, realizó dos ensayos con lactantes, uno con niños sanos mediante suplementos de agua de arroz a la leche de nodriza y otro con niños enfermos mediante lactancia mixta de cabra y nodriza. Ambos se realizaron inicialmente con uno y dos sujetos, respectivamente, para ampliarlo tras buenos resultados a una muestra mayor no aleatorizada (12 sujetos en el caso de los enfermos). Aunque los resultados iniciales no fueron concluyentes, se constata un descenso de la mortalidad lactante posterior. Conclusiones: los ensayos responden a la aplicación de un método científico más apreciable que el observado en textos didácticos de autores más relevantes, como es el caso de Iberti. El utilitarismo imperante no oculta el valor dado a la vida del expósito sobre cualquier otro, siendo Úriz un claro ejemplo de las excepciones al enfoque predominantemente punitivo de la historiografía. El descenso posterior de la mortalidad del lactante sugiere la posibilidad de una exitosa causa-efecto de los ensayos (AU)

Introduction: the current continuity of publications on abandoned children during the Spanish Enlightenment, from the same perspectives of social control that were established at the end of the 20th century, undermines the efforts of some Enlightenment scholars to find artificial nutrition alternatives to breastfeeding through wet nurses. Aim: to analyse the nutritional trials carried out by Joaquín Xavier Úriz (1747-1829) in the Pamplona foundling home. Method: review, analysis and interpretation of his work "Causas prácticas de la muerte de los niños expósitos en sus primeros años" , published in 1801. Results: after justifying its necessity, setting out objectives, and designing a controlled experiment, he carried out two trials with infants, one with healthy children using rice water supplements to the wet-nurse's milk and the other with sick children using mixed goat and wet-nurse breastfeeding. Both were initially conducted with one and two subjects, respectively, to be extended after good results to a larger, non-randomised sample (12 subjects in the case of sick children). Although the initial results were inconclusive, a decrease in subsequent infant mortality was noted. Conclusions: the trials are based on the application of a more appreciable scientific method than in didactic texts by more relevant authors, as in the case of Iberti. The prevailing utilitarianism does not hide the value given to the life of the foundling over any other, Úriz being a clear example of the exceptions to the predominantly punitive approach of historiography. The subsequent decline in infant mortality suggests the possibility of a successful cause-effect of the trials (AU)

La Institución de la Gota de Leche en la provincia de Toledo (1906-1966) / A Instituição de Gota de Leche na província de Toledo (1906-1966) / The Institution of the Drop of Milk in the province of Toledo (1906-1966)

The objective of this historical investigation is to discover if the Institution called "LaGota de Leche" existed in Toledo. Methodology by means of the heuristic method, the historicalpress is analyzed and other primary archival sources are reviewed. Results, although its creationwas tedious and its operation was subject to criticism, its benefits were soon seen through thematernal and child health indicators. The institution between 1906 and 1966, was present in boththe urban and rural areas of Toledo. Since the creation the mother received health care throughoutthe gestational period; she acquired habits on child hygiene and obtained health education toestablish adequate breastfeeding. Conclusion La Gota de Leche Toledana was a School ofChildcare and Maternology, a fact that allowed to carry out prevention, care and educationactivities throughout the gestational period. Thus, the results obtained were extremelysatisfactory, since it was possible to reduce infant mortality during the first half of the 20thcentury, through the improvement of maternal and child health indicators

El objetivo de esta investigación histórica es descubrir sí en Toledo existió la Institucióndenominada «La Gota de Leche». Metodología por medio del método heurístico se analiza laprensa histórica y se revisan otras fuentes primarias archivísticas. Resultados, aunque su creaciónfue tediosa y su funcionamiento estuvo sujeto a críticas, sus beneficios pronto se dejaron ver, através de los indicadores salud materno-infantil. La institución entre 1906 y 1966, estuvo presentetanto en el ámbito urbano como rural de Toledo. Desde la creación la madre recibía atenciónsanitaria durante todo el periodo gestacional; adquiría hábitos sobre higiene infantil y obteníaeducación sanitaria para establecer una lactancia materna adecuada. Conclusión La Gota de LecheToledana fue una Escuela de Puericultura y Maternología, hecho que permitió llevar a caboactividades de prevención, asistencia y educación durante todo el periodo gestacional. De modoque los resultados obtenidos fuero sumamente satisfactorios, pues se logró reducir la mortalidadinfantil durante la primera mitad del siglo XX, a través de la mejoría de los indicadores de la saludmaterno-infantil.

O objetivo desta investigação histórica é descobrir se a Instituição chamada "La Gota deLeche" existia em Toledo. Metodologia por meio do método heurístico, a imprensa histórica éanalisada e outras fontes arquivísticas primárias são revisadas. Resultados, embora sua criaçãotenha sido tediosa e seu funcionamento sujeito a críticas, seus benefícios logo foram percebidosatravés dos indicadores de saúde materno-infantil. A instituição entre 1906 e 1966, esteve presentetanto na zona urbana como rural de Toledo. Desde a criação a mãe recebeu cuidados de saúdedurante todo o período gestacional; adquiriu hábitos de higiene infantil e obteve educação emsaúde para estabelecer o aleitamento materno adequado. Conclusão La Gota de Leche Toledanafoi uma Escola de Puericultura e Maternologia, fato que possibilitou a realização de atividades de123Cultura de los Cuidados. 1º Cuatrimestre 2022. Año XXVI. nº 62prevenção, cuidado e educação durante todo o período gestacional. Assim, os resultados obtidosforam extremamente satisfatórios, uma vez que foi possível reduzir a mortalidade infantil durantea primeira metade do século 20, por meio da melhoria dos indicadores de saúde materno-infantil.

Lactancia materna: transición alimentaria durante la guerra y posguerra española (1936-1949) / Breastfeeding: food transition during the Spanish war and post-war period (1936-1949) / Amamentação: transição alimentar durante a guerra espanhola e o período pós-guerra (1936-1949)

Durante los años 1900 hasta 1936, la salud infantil comenzaba a ganar importancia en Europa. En España, la mortalidad infantil era elevada. Para contrarrestar esta situación, el estado propuso medidas sanitarias, educativas y alimentarias. OBJETIVO: Analizar la Guerra Civil Española (1936-1939), que continuó con los "años del hambre" durante la posguerra (1939-1949), conocidos por el racionamiento de alimentos y decadencia de la salud materno-infantil. MÉTODO: Estudio histórico descriptivo con fuentes primarias y secundarias. Que trata sobre, el contexto sociosanitario y la transición alimentaria, que vivieron los infantes durante la guerra y posguerra española (1936-1949). RESULTADOS: El gobierno realizó una promoción de la lactancia materna guiada por pediatras de la época, no obstante, la leche de fórmula ganó importancia, debido a la modificación de la estructura familiar básica. La figura clásica de la mujer se fracturó, en favor del trabajo en las fábricas o, en última instancia, como participantes activas en la guerra. CONCLUSIONES: Las instituciones sanitarias, se centraron en el cuidado de heridos, cuestión que repercutió en la atención del niño enfermo. Esta situación dio lugar a altas tasas de morbimortalidad infantil, las cuales se mantuvieron hasta el final de la posguerra

During the years 1900 to 1936, children's health began to gain importance in Europe. In Spain, infant mortality was high. To counteract this situation, the state proposed health, educational and food measures. OBJECTIVE: To analyze the Spanish Civil War (1936-1939), which continued with the "hungry years" of the post-war period (1939-1949), known for food rationing and the decline of mother and child health. Method. Historical descriptive study with primary and secondary sources. It deals with the socio-health context and the food transition experienced by infants during the Spanish war and post-war period (1936-1949). RESULTS: The government carried out a promotion of breastfeeding guided by pediatricians of the time, however, formula gained importance, due to the modification of the basic family structure. The classic figure of the woman was fractured, in favour of working in factories or, ultimately, as active participants in the war. CONCLUSIONS: Health institutions focused on the care of the wounded, an issue that impacted on the care of the sick child. This situation resulted in high rates of child morbidity and mortality, which continued until the end of the post-war period

Durante os anos de 1900 a 1936, a saúde das crianças começou a ganhar importância na Europa. Em Espanha, a mortalidade infantil foi elevada. Para contrariar esta situação, o Estado propôs medidas sanitárias, educativas e alimentares. OBJECTIVO: Analisar a Guerra Civil Espanhola (1936-1939), que continuou com os "anos de fome" do pós-guerra (1939-1949), conhecida pelo racionamento de alimentos e pelo declínio da saúde materna e infantil. MÉTODO: Estudo descritivo histórico com fontes primárias e secundárias. Trata do contexto sócio-sanitário e da transição alimentar vivida pelos bebés durante a guerra espanhola e o período pós-guerra (1936-1949). RESULTADOS: O governo realizou uma promoção da amamentação orientada por pediatras da época, mas a fórmula ganhou importância, devido à modificação da estrutura básica da família. A figura clássica da mulher foi fracturada, a favor de trabalhar em fábricas ou, em última análise, como participante activa na guerra. CONCLUSÕES: As instituições de saúde concentraram-se no cuidado dos feridos, uma questão que teve impacto no cuidado da criança doente. Esta situação resultou em elevadas taxas de morbilidade e mortalidade infantil, que se mantiveram até ao final do período pós-guerra

[That daily trickle of death: Infant mortality and the dawn of pediatric medicine in the province of Santiago, Chile, 1870-1913]. / Esa diaria gotera de la muerte: Mortalidad infantil y los albores de la medicina pediátrica en la provincia de Santiago, Chile, 1870-1913.

This article deals with the problem of infant mortality in Santiago, Chile, and the development of pediatric medicine during the second half of the nineteenth century and the beginning of the twentieth century. Emphasis is placed on the specialists who contributed to organizing the knowledge and practices that structured their professional field. In order to pursue the objective and systematize this new medical field, our analysis suggests the decisive role of the establishment of the Faculty of Medicine and the appearance of coursework dedicated specifically to childhood diseases. Our research is based on various historical sources including the press, medical literature, thesis archives, and the Anuario Estadístico de la República de Chile [Statistical Yearbook of the Republic of Chile]. Likewise, the inauguration of children's hospitals expresses an institutional setting where physicians position their work, put scientific treatments into practice, and most importantly, they become spaces that allow for the reduction of infant mortality.

Este artículo aborda el problema de la mortalidad infantil en la provincia de Santiago, Chile, y el desarrollo de la medicina pediátrica durante la segunda mitad del siglo XIX e inicios del XX, a través de especialistas que contribuyeron a organizar los conocimientos y prácticas que estructuraron su ejercicio profesional. Para emprender este objetivo y sistematizar este nuevo campo médico, se analizan los antecedentes relativos a la formación de la Facultad de Medicina y el quiebre que representó la aparición de una asignatura dedicada a las enfermedades de la niñez. La investigación se encuentra respaldada en diversas fuentes históricas, entre ellas, la prensa escrita, bibliografía médica, memorias de titulación y el Anuario Estadístico de la República de Chile. La inauguración de los hospitales de niños expresa una institucionalidad, en la que los facultativos posicionaron su labor, pusieron en práctica los tratamientos científicos y, lo más importante, se convirtieron en espacios que permitieron la disminución de la mortalidad infantil.

The Relationship between Birth Weight Discordance and Adverse Infant Mortality among Monozygotic and Dizygotic Twins in Japan, 1995-2008.

Using vital statistics in Japan (1995-2008), 154,578 live-born twin pairs (128,236 monozygotic [MZ] and 180,920 dizygotic [DZ]) were identified. The proportion of severe discordance among live-born twin births was twice as high in Japanese than Caucasian infants. There were 1858 MZ and 1620 DZ infant deaths. Computation of the relationship between infant mortality rate and birth weight discordance among the twins was performed. Discordance levels were classified into seven groups: <5%, five groups from 5-9% to 25-29%, and ≥30%.The mortality rate was significantly higher in MZ than DZ twins for discordances except at 5-9% and 10-14%. The lowest rate for MZ twins was at 5-9% (7.5 per 1000 live twins) and significantly increased from 10-14% (9.4) to ≥30% (83.4), while the lowest rate for DZ twins was at <5% (6.7), which significantly increased at 10-14% (8.0) and from 25-29% (12.1) to ≥30% (35.5). The relationship was also computed in two gestational age groups (<28 and ≥28 weeks). For births at <28 weeks, three discordances (after 20-24%) in MZ twins were associated with adverse mortality rate. For births at ≥28 weeks, the same relationship was obtained after 10-14% in MZ and after 20-24% in DZ twins. The relationship from 2002 to 2008 showed that the mortality rates significantly increased after 10-14% for both types of twins. In conclusion, five discordance levels in MZ and three levels in DZ twins were associated with adverse mortality rates.

Revisiting the effect of time of birth on neonatal, infant, and child mortality in rural Spain, 1830-1929.

OBJECTIVES: This article aims to determine whether different patterns of mortality occurred among children born during the day and the night respectively, between 1830 and 1929. METHODS: The data include the time of birth and death of 9814 individuals from 10 villages in rural Spain between 1830 and 1929, within a context of natural births at home with little medical support. These data were subjected to a comparative analysis relating to the time of birth and the age at death. RESULTS: Neonatal, infant, and child mortality was higher for children born during daytime. The day-to-night mortality pattern diverged until children were at least 5 years old. CONCLUSIONS: The results confirm that the mortality patterns differed according to the time of birth. Possibly some of these children experienced longer or problematic deliveries that, in the absence of good medical assistance, had health consequences during the following days and years of life.

Esa diaria gotera de la muerte: Mortalidad infantil y los albores de la medicina pediátrica en la provincia de Santiago, Chile, 1870-1913 / That daily trickle of death: Infant mortality and the dawn of pediatric medicine in the province of Santiago, Chile, 1870-1913

RESUMEN Este artículo aborda el problema de la mortalidad infantil en la provincia de Santiago, Chile, y el desarrollo de la medicina pediátrica durante la segunda mitad del siglo XIX e inicios del XX, a través de especialistas que contribuyeron a organizar los conocimientos y prácticas que estructuraron su ejercicio profesional. Para emprender este objetivo y sistematizar este nuevo campo médico, se analizan los antecedentes relativos a la formación de la Facultad de Medicina y el quiebre que representó la aparición de una asignatura dedicada a las enfermedades de la niñez. La investigación se encuentra respaldada en diversas fuentes históricas, entre ellas, la prensa escrita, bibliografía médica, memorias de titulación y el Anuario Estadístico de la República de Chile. La inauguración de los hospitales de niños expresa una institucionalidad, en la que los facultativos posicionaron su labor, pusieron en práctica los tratamientos científicos y, lo más importante, se convirtieron en espacios que permitieron la disminución de la mortalidad infantil.

ABSTRACT This article deals with the problem of infant mortality in Santiago, Chile, and the development of pediatric medicine during the second half of the nineteenth century and the beginning of the twentieth century. Emphasis is placed on the specialists who contributed to organizing the knowledge and practices that structured their professional field. In order to pursue the objective and systematize this new medical field, our analysis suggests the decisive role of the establishment of the Faculty of Medicine and the appearance of coursework dedicated specifically to childhood diseases. Our research is based on various historical sources including the press, medical literature, thesis archives, and the Anuario Estadístico de la República de Chile [Statistical Yearbook of the Republic of Chile]. Likewise, the inauguration of children's hospitals expresses an institutional setting where physicians position their work, put scientific treatments into practice, and most importantly, they become spaces that allow for the reduction of infant mortality.

Análise da saúde da criança no estado de Santa Catarina. Brasil: de 1982 a 2018 / Análisis de la salud infantil en el estado de Santa Catarina. Brasil: de 1982 a 2018 / Analysis of child health in the state of Santa Catarina. Brazil: from 1982 to 2018

RESUMO Objetivo Analisar as políticas e os programas direcionados à saúde da criança, no estado de Santa Catarina (SC), Brasil, entre 1982 e 2018, bem como suas contribuições para a redução da mortalidade infantil no estado. Método Pesquisa histórica, com abordagem qualitativa. Os dados foram coletados por meio de pesquisa documental, com busca manual e eletrônica; os documentos obtidos foram submetidos à análise de conteúdo. Resultados Apontam-se as estratégias de vigilância em saúde e atenção primária à saúde, voltadas ao público materno-infantil e neonatal, como as principais responsáveis pelo avanço da saúde da criança, em SC. Os indicadores de mortalidade infantil e cobertura vacinal, juntamente com a análise dos programas/estratégias de saúde catarinenses evidenciaram esses resultados. Conclusão e implicações para a prática o estado de SC investiu, ao longo de 36 anos, em diversas ações e programas que fomentaram a melhoria da saúde da criança, com destaque para as ações de caráter municipal. Analisando e sintetizando as informações previamente pulverizadas em documentos históricos, este trabalho contribui para a visualização e compreensão acerca das práticas governamentais voltadas à criança em SC, nas últimas décadas, facilitando a replicação de boas práticas.

RESUMEN Objetivo Analizar las políticas y programas dirigidos a la salud infantil, en el estado de Santa Catarina (SC), Brasil, entre 1982 y 2018, así como sus contribuciones a la reducción de la mortalidad infantil en el estado. Método Investigación histórica, con enfoque cualitativo. Los datos fueron recolectados mediante investigación documental, con búsqueda manual y electrónica; los documentos obtenidos fueron sometidos a análisis de contenido. Resultados Las estrategias de vigilancia de la salud y la atención primaria de salud, dirigidas al público materno infantil y neonatal se señalan como las principales responsables del avance de la salud del niño en SC. Los indicadores de mortalidad infantil y cobertura de vacunación, junto con el análisis de los programas / estrategias de salud de Santa Catarina, mostraron estos resultados. Conclusión y implicaciones para la práctica El estado de SC ha invertido, durante 36 años, en diversas acciones y programas que han promovido la mejora de la salud del niño, con énfasis en acciones de carácter municipal. Analizando y sintetizando la información previamente pulverizada en documentos históricos, este trabajo contribuye a la visualización y comprensión de las prácticas gubernamentales dirigidas a los niños en SC, en las últimas décadas, facilitando la replicación de buenas prácticas.

ABSTRACT Objective To analyze policies and programs directed to child health, in the state of Santa Catarina (SC), Brazil, between 1982 and 2018, as well as their contributions to the infant mortality reduction in the state. Method Historical research, with a qualitative approach. Data were collected through documentary research, with manual and electronic search; the documents obtained were submitted to content analysis. Results Health surveillance strategies and primary health care, aimed at the maternal-infant and neonatal public are pointed out as the main responsible for the advancement of the child's health, in SC. The indicators of infant mortality and vaccination coverage, together with the analysis of Santa Catarina's health programs / strategies, pointed these results. Conclusion and implications for practice The state of SC has invested, over 36 years, in various actions and programs that have promoted the improvement of child health, with emphasis on actions of municipal scope. By analyzing and synthesizing information previously pulverized in historical documents, this work contributes to the visualization and understanding about government practices aimed at children in SC, in the last decades, facilitating the replication of good practices.

The mother's risk of premature death after child loss across two centuries.

While the rare occurrence of child loss is accompanied by reduced life expectancy of parents in contemporary affluent populations, its impact in developing societies with high child mortality rates is unclear. We identified all parents in Iceland born 1800-1996 and compared the mortality rates of 47,711 parents who lost a child to those of their siblings (N = 126,342) who did not. The proportion of parents who experienced child loss decreased from 61.1% of those born 1800-1880 to 5.2% of those born after 1930. Child loss was consistently associated with increased rate of maternal, but not paternal, death before the age of 50 across all parent birth cohorts; the relative increase in maternal mortality rate ranged from 35% among mothers born 1800-1930 to 64% among mothers born after 1930. The loss of a child poses a threat to the survival of young mothers, even during periods of high infant mortality rates.

Alexandre Frias i Roig: puericultor, médico y divulgador. Luchador incansable en favor de la lactancia materna y de la infancia / Alexandre Frias i Roig: childcare pediatrician, medical doctor and scientific disseminator. Tireless fighter in favor of breastfeeding and childhood

Alexandre Frias nació en Reus, ciudad donde desarrolló la mayor parte de su actividad profesional. Médico y puericultor, trabajó incansablemente con el fin de mejorar la salud infantil. Creó el primer Instituto de Puericultura integral de España en 1919, que se mantuvo en funcionamiento hasta su muerte. Las actividades del instituto se iniciaron con un consultorio para niños lactantes, servicio de lactario y un laboratorio de análisis, y se ampliaron posteriormente con servicios de puericultura prenatal, refectorio para embarazadas y mujeres, un consultorio de pediatría con servicio de vacunación y, como complemento, un servicio de asistencia domiciliaria de comadrona y un médico tocólogo. Convencido de que la lactancia materna y la higiene eran fundamentales para la prevención de enfermedades, realizó una ingente labor educativa entre madres, médicos, gobernantes y sociedad en general. Precursor de numerosas iniciativas con fines curativos y preventivos, instauró la educación sanitaria para madres y profesionales, las colonias escolares, la inspección médica-escolar, el servicio a domicilio de básculas para control de peso e incubadoras para niños prematuros e incluso un modelo de vestido higiénico para recién nacidos. Realizó numerosas publicaciones en forma de libros, como el titulado "Lo que deben saber las madres", opúsculos y artículos de prensa. Fundó y dirigió la revista Puericultura, editada en Reus y distribuida a todo el país, que se publicó hasta 1936. Su incesante actividad en pro de la lucha contra la mortalidad infantil redujo drásticamente las muertes en Reus e influyó en la mejora sanitaria y demográfica de toda España

Alexandre Frias was born in Reus, the city where he developed most of his professional activity. Medical doctor and childcare pediatrician, he worked tirelessly in order to improve children's health. He created the first Instituto de Puericultura Integral (Integral Institute of Childcare) in Spain in 1919, which remained in operation until his death. The Institute's activities began with a clinic for breastfeeding children, breastfeeding service and a biochemical analysis laboratory, later expanding with prenatal childcare services, a refectory for pregnant women and general women, a pediatric office with a vaccination service and, as a complement, a home health care service and medical obstetrics. Convinced that breastfeeding and hygiene were fundamental for the prevention of diseases, he carried out an enormous educational work among mothers, doctors, governors and society in general. Forerunner of numerous initiatives for curative and preventive purposes, he established health education for mothers and professionals, school colonies, medical-school inspection, home delivery of scales for weight control and incubators for premature children and even a hygienic dress model for newborns. He made numerous publications as books form, such as the one entitled "Lo que deben saber las madres", booklets and newspapers articles. He founded and directed the scientific journal Puericultura (child care), published in Reus and distributed throughout the country until 1936. Its incessant activity in favor of the fight against infant mortality drastically reduced infant/children mortality in Reus and influenced the health and demographic improvement of all of Spain

The association between cold extremes and neonatal mortality in Swedish Sápmi from 1800 to 1895.

Background: Studies in which the association between temperature and neonatal mortality (deaths during the first 28 days of life) is tracked over extended periods that cover demographic, economic and epidemiological transitions are quite limited. From previous research about the demographic transition in Swedish Sápmi, we know that infant and child mortality was generally higher among the indigenous (Sami) population compared to non-indigenous populations. Objective: The aim of this study was to analyse the association between extreme temperatures and neonatal mortality among the Sami and non-Sami population in Swedish Sápmi (Lapland) during the nineteenth century. Methods: Data from the Demographic Data Base, Umeå University, were used to identify neonatal deaths. We used monthly mean temperature in Tornedalen and identified cold and warm month (5th and 95th) percentiles. Monthly death counts from extreme temperatures were modelled using negative binomial regression. We computed relative risks (RR) with 95% confidence intervals (CI), adjusting for time trends and seasonality. Results: Overall, the neonatal mortality rate was higher among Sami compared to non-Sami infants (62/1,000 vs 35/1,000 live births), although the differences between the two populations decreased after 1860. For the Sami population prior 1860, the results revealed a higher neonatal incidence rate during cold winter months (<-15.4°C, RR = 1.60, CI 1.14-2.23) compared to infants born during months of medium temperature. No association was found between extreme cold months and neonatal mortality for non-Sami populations. Warm months (+15.1°C) had no impact on Sami or non-Sami populations. Conclusions: This study revealed the role of environmental factors (temperature extremes) on infant health during the demographic transition where cold extremes mainly affected the Sami population. Ethnicity and living conditions contributed to differential weather vulnerability.

Learning From History About Reducing Infant Mortality: Contrasting the Centrality of Structural Interventions to Early 20th-Century Successes in the United States to Their Neglect in Current Global Initiatives.

Policy Points Current efforts to reduce infant mortality and improve infant health in low- and middle-income countries (LMICs) can benefit from awareness of the history of successful early 20th-century initiatives to reduce infant mortality in high-income countries, which occurred before widespread use of vaccination and medical technologies. Improvements in sanitation, civil registration, milk purification, and institutional structures to monitor and reduce infant mortality played a crucial role in the decline in infant mortality seen in the United States in the early 1900s. The commitment to sanitation and civil registration has not been fulfilled in many LMICs. Structural investments in sanitation and water purification as well as in civil registration systems should be central, not peripheral, to the goal of infant mortality reduction in LMICs. CONTEXT: Between 1915 and 1950, the infant mortality rate (IMR) in the United States declined from 100 to fewer than 30 deaths per 1,000 live births, prior to the widespread use of medical technologies and vaccination. In 2015 the IMR in low- and middle-income countries (LMICs) was 53.2 deaths per 1,000 live births, which is comparable to the United States in 1935 when IMR was 55.7 deaths per 1,000 live births. We contrast the role of public health institutions and interventions for IMR reduction in past versus present efforts to reduce infant mortality in LMICs to critically examine the current evidence base for reducing infant mortality and to propose ways in which lessons from history can inform efforts to address the current burden of infant mortality. METHODS: We searched the peer-reviewed and gray literature on the causes and explanations behind the decline in infant mortality in the United States between 1850 and 1950 and in LMICs after 2000. We included historical analyses, empirical research, policy documents, and global strategies. For each key source, we assessed the factors considered by their authors to be salient in reducing infant mortality. FINDINGS: Public health programs that played a central role in the decline in infant mortality in the United States in the early 1900s emphasized large structural interventions like filtering and chlorinating water supplies, building sanitation systems, developing the birth and death registration area, pasteurizing milk, and also educating mothers on infant care and hygiene. The creation of new institutions and policies for infant health additionally provided technical expertise, mobilized resources, and engaged women's groups and public health professionals. In contrast, contemporary literature and global policy documents on reducing infant mortality in LMICs have primarily focused on interventions at the individual, household, and health facility level, and on the widespread adoption of cheap, ostensibly accessible, and simple technologies, often at the cost of leaving the structural conditions that determine child survival largely untouched. CONCLUSIONS: Current discourses on infant mortality are not informed by lessons from history. Although structural interventions were central to the decline in infant mortality in the United States, current interventions in LMICs that receive the most global endorsement do not address these structural determinants of infant mortality. Using a historical lens to examine the continued problem of infant mortality in LMICs suggests that structural interventions, especially regarding sanitation and civil registration, should again become core to a public health approach to addressing infant mortality.

Sun Smoke in Sweden: Perinatal Implications of the Laki Volcanic Eruptions, 1783-1784.

BACKGROUND: The Icelandic volcano Laki erupted from June 1783 through January 1784. It produced 122 megatons of sulfur dioxide, particulate matter, and acid rain and contributed to one of the coldest winters on record in Western Europe. Although uncontrollable volcanic eruptions continue, few studies have investigated their perinatal health implications. METHODS: Using the Human Mortality Database, we assessed the association between the Laki event and the secondary sex ratio, infant mortality rates, and the number of births from 1751 to 1800 with time-series models that controlled for temporal trends. RESULTS: The secondary sex ratio decreased 3% below expected levels in 1784 (95% CI = -4%, -1%). Both female and male infant mortality rates exceeded expectation in 1785, by 54% (95% CI = 25%, 83%) and 37% (-1%, 74%), respectively. We observed little change in female live births but a reduction in male live births in 1784. CONCLUSIONS: Our findings are consistent with the hypothesis that the large-scale Laki volcanic eruptions of 1783-1784 resulted in adverse perinatal health outcomes in Sweden.

Cuba's Maternity Homes, 1962-2017: History, Evolution, Challenges.

Cuba's maternity homes were founded in 1962 as part of the gen-eral movement to extend health services to the whole population in the context of the post-1959 social transformations. The over-arching goal of the homes was to improve the health of pregnant women, mothers and newborns. Hence, in the beginning when there were few hospitals in Cuba's rural areas, their initial pur-pose was to increase institutional births by providing pregnant women a homelike environment closer to hospitals. There, they lived during the final weeks before delivery, where they received medical care, room and board free of charge. Over time, and with expanded access to community and hospital health facilities across Cuba, the numbers, activities, modalities and criteria for admission also changed. In particular, in addition to geographi-cal considerations, expectant mothers with defined risk factors were prioritized. For example, during the 1990s economic crisis, the maternity homes' role in healthy nutrition became paramount. The purpose of this essay is to provide a historical perspective of this process, describe the changes and results during the 55 years examined, and take a critical look at the challenges to suc-cessful implementation of this model, a mainstay at the primary healthcare level of the public health system's Maternal-Child Health Program. KEYWORDS Maternal health, maternal-child health, obstetrics, pregnancy, Cuba.

Mortalidad infantil en Santiago: representaciones y discursos, Chile, 1860-1914 / Infant mortality in Santiago: representations and discourses, Chile, 1860-1914

Resumen Se exploran las características de la mortalidad infantil en Santiago durante una fase histórica en que los indicadores demográficos alcanzaron cifras altísimas transformándose el fenómeno en un problema médico y político. Luego de comentar algunas investigaciones historiográficas sobre la temática, se demuestra cuantitativamente el comportamiento de la población infantil, recurriendo a fuentes primarias - de la medicina, la prensa y el Registro Civil - y bibliografía. Posteriormente, se describen las causas que las elites esgrimieron para explicar las muertes infantiles: materiales, morales y culturales. Las conclusiones abordan la promulgación de la ley de la infancia desvalida, los inicios de un conocimiento sobre la salud de los niños y la inauguración del Hospital Infantil.

Abstract The article explores the characteristics of infant mortality in Santiago during a historical period in which the demographic indicators reached very high figures turning the phenomenon into a medical and political issue. After commenting on historiographic data, it demonstrates the behavior of the infant population quantitatively, taking into account primary sources - from medicine, the press and civil records - and bibliography. It also exposes the motives employed by the elite to justify the children's deaths: materially, morally and culturally. The conclusion addresses the promulgation of the defenseless child law, the beginnings of knowledge on child health and the inauguration of the Child Hospital.

Revising Infant Mortality Rates for the Early Twentieth Century United States.

Accurate vital statistics are required to understand the evolution of racial disparities in infant health and the causes of rapid secular decline in infant mortality during the early twentieth century. Unfortunately, U.S. infant mortality rates prior to 1950 suffer from an upward bias stemming from a severe underregistration of births. At one extreme, African American births in southern states went unregistered at the rate of 15 % to 25 %. In this study, we construct improved estimates of births and infant mortality in the United States for 1915-1940 using recently released complete count decennial census microdata combined with the counts of infant deaths from published sources. We check the veracity of our estimates with a major birth registration study completed in conjunction with the 1940 decennial census and find that the largest adjustments occur in states with less-complete birth registration systems. An additional advantage of our census-based estimation method is the extension backward of the birth and infant mortality series for years prior to published estimates of registered births, enabling previously impossible comparisons and estimations. Finally, we show that underregistration can bias effect estimates even in a panel setting with specifications that include location fixed effects and place-specific linear time trends.