Rapid assessment of Malawi's civil registration and vital statistics system.

In 2010, Malawi adopted a National Registration Act, making the registration of births and deaths compulsory, and efforts to improve Malawi's civil registration and vital statistics (CRVS) system are underway. During a participatory-style workshop, stakeholders completed a rapid assessment of the national civil registration and vital statistics systems. While participants discussed and scored each item in a standard tool, the workshop focused on sharing of partners' roles and challenges. The workshop has enhanced receptiveness in collaboration, and an inter-ministerial technical working group has now been formed to develop a strategic plan and conduct a comprehensive assessment to guide future improvements.

En 2010, le Malawi a adopté l'état-civil national, rendant l'enregistrement des naissances et des décès obligatoire, et des efforts d'amélioration du système d'enregistrement de l'état-civil et des autres statistiques vitales du Malawi sont en cours. Lors d'un atelier participatif, les partenaires ont complété l'outil d'évaluation rapide du système de l'état-civil national et des statistiques vitales. Tandis que les participants discutaient et donnaient un score à chaque élément de l'outil, l'atelier s'est concentré sur le partage des rôles des partenaires et des défis auxquels ils étaient confrontés. L'atelier a renforcé la réceptivité des participants à la collaboration et un groupe de travail technique interministériel a maintenant été formé pour développer un plan stratégique et réaliser une évaluation plus complète afin de guider les améliorations à venir.

En el 2010, Malawi adoptó la Ley Nacional del Registro, por la cual se hace obligatorio el registro de los nacimientos y las defunciones, y están en curso iniciativas tendentes a mejorar el sistema de registro civil y estadísticas vitales. En un taller de tipo participativo, los interesados directos completaron un instrumento de evaluación rápida de los sistemas de registro civil y estadísticas vitales. Los participantes examinaron y calificaron cada elemento del instrumento, y el centro de interés del taller consistió en poner en común de las funciones y las dificultades encontradas de los asociados. El taller reforzó la receptividad durante el trabajo en colaboración y se conformó un grupo de trabajo interministerial, con el propósito de elaborar un plan estratégico y llevar a cabo una evaluación exhaustiva que permita orientar las futuras medidas de perfeccionamiento.

The contribution of heart disease to pregnancy-related mortality according to the pregnancy mortality surveillance system.

OBJECTIVE: The objective of this study was to demonstrate the increasing importance of heart disease as a cause of pregnancy-related mortality in Hawaii and the rest of the United States. STUDY DESIGN: Hawaii's Department of Public Health identified all pregnancy-associated death certificates from 1991 to 2007. Hospital records and autopsy reports were reviewed to determine whether deaths were pregnancy-related. RESULT: From 1991 to 2007, Hawaii registered 156 deaths occurring within 1 year of pregnancy, which represented 4.2% of the total number of women who died in the same 17 to 46 years age group and 9.0% of the total number of women who died in the same 17 to 34 years age group. The pregnancy-related mortality ratio was 22.4 and the pregnancy-associated mortality ratio was 50. The leading cause of pregnancy-associated mortality was heart disease (20.5%) followed by cancer (18.6%) and suicide/homicide (12.2%). Pregnancy-related deaths (n=70) were attributed to heart disease (45.7%) followed by sepsis (14.2%) and hemorrhage (12.9%). The new Hawaii death certificate beginning in 2006 increased the detection of both pregnancy-related and -associated deaths. CONCLUSION: Heart disease is the most common cause of pregnancy-related mortality in Hawaii, and with improved ascertainment, may be determined to be the most common cause of pregnancy-related mortality in the rest of the United States.

Report on the 2003 revision of the U.S. Standard Certificate of Death.

The National Center for Health Statistics (NCHS) is responsible for publishing Standard Certificates of Birth and Death for the United States of America. The standard certificates are revised roughly every 10 years. The revision process is designed to ensure that the standard certificates meet, as nearly as possible, the use for which they are intended at all levels: individual, local, state, and federal. The authors report on the most recent revision of the U.S. Standard Certificate of Death, recording the process and the role of the National Association of Medical Examiners in the process. Changes recommended during revision include requesting known aliases of a decedent and rearrangement of the certificate to provide more room for those items requesting dates and for describing how the injury occurred. New items have been added asking for information regarding traffic fatalities, the role of tobacco use in causing death, and whether female decedents were pregnant. Once approved by the Department of Health and Human Services, the new standard certificate will be made available to the states. Each state will have 2 years to adapt the U.S. Standard Certificate of Death to its use and to implement new state death certificates on January 1, 2003.

Changes in the association of low birth weight with socioeconomic status in Hawaii: 1970-1990.

This study examines rates of low birth weight (LBW) in the state of Hawaii and changes in the association of LBW with socioeconomic status from 1970 to 1990. The analysis is based on aggregate data for census tracts. Rates of low birth weight were calculated for each census tract. Relative socioeconomic scores were calculated from average household income and years of education. The results show that (1) there was a decrease in the rate of low birth weight infants in Hawaii; and (2) that the correlation between socioeconomic status and low birth weight was substantially reduced, though a significant correlation remains. The paper suggests likely ceiling effects, but that the progressive public health policies and expansion of access to primary health care in Hawaii during this period played a major role in reducing the rate of low birth weight infants and in decreasing socioeconomic inequality on this important health indicator.

Advance directive completion rates and end-of-life preferences in Hawaii.

To estimate rates of advance directive completion, preference for in-home death and hospice services at life's end, and support for physician assistance in dying, questions were added to two statewide, random-sample telephone surveys-the 1998 Behavioral Risk Factor Surveillance System (N=2,153) and the 1999 OmniTrak health survey (N=700). Data were compared across age, ethnic, and gender groups. Overall, 29% of Hawaii residents had a living will, 22% had a healthcare power of attorney, 65% said they would prefer a home death, 60% would want hospice services, 64% believed a person had a moral right to end his or her life when faced with an incurable illness, and 63% felt doctors should be allowed by law to end a patient's life if the patient and his or her family requested it. Advance directive completion rates increased with age, desire for an in-home death varied by gender and ethnicity, and support of assisted-death options varied by ethnicity. Despite a large minority population, end-of-life preferences among the general population in Hawaii are similar to those of U.S. mainlanders. However, age, gender, and ethnic differences exist. Clinicians are encouraged to ask patients directly about their preferences as a first step toward improving end-of-life care.

[Pulmonary actinomycosis presenting as a mass lesion on chest X-ray film].

A 61-year-old man presented with fever, productive cough, and occasional blood-streaked sputum. Chest X-ray films disclosed a poorly defined mass in the right middle lung field. A transbronchial lung biopsy specimen showed epithelial changes indicative of lung cancer, and a right lower lobectomy was performed. Because the resected specimen contained a cavity filled with colonies of actinomycetes, pulmonary actinomycosis was diagnosed. The cavity was surrounded by inflammatory infiltrations and fibrosis with occasional atypical epithelial changes suggestive of benign hyperplasia. Although pulmonary actinomycosis is uncommon today, it deserves attention because of the potential difficulty in differentially diagnosing it from lung cancer.

End-of-life preferences in Hawaii.

Questions on end-of-life preferences were included in two statewide, random-sample telephone surveys. Findings suggest that Hawaii residents are similar to mainlanders on their rates of advance directive completion, their preference for dying at home, their desire for hospice care when dying, and their support for legalization of aid in dying. Physicians are encouraged to ask these questions directly of their patients as a first step to improving end-of-life care.

Prenatal care utilization in Hawaii: did it improve during the last 16 years?

This paper examines the utilization of prenatal care in Hawaii from 1979 to 1994 to determine if early and adequate utilization of prenatal care has changed during this period. Birth certificates of single live born infants of resident women were the source of data for the study. During the study period, the proportion of women receiving prenatal care in the first trimester increased by nearly 5 percent but was still below the national and state Year 2000 health objective of 90 percent. Notwithstanding this improvement, the percentage of women who did not receive the recommended number of visits in spite of starting care early significantly increased. The overall proportion of women with 'intensive' prenatal care use markedly increased (134.7%). The proportion of women with 'inadequate' care use declined (10.3%), although the proportion of women with 'no care' use doubled. Complete reporting of use of care through birth certificates markedly deteriorated. The findings of this study indicate the need for changes in the targeting and provision of counseling and education on the part of health care providers. Public health leaders, policy makers, health care providers, and advocacy groups need to collectively review programmatic directions with an aim toward the development of innovative approaches to address the emerging health needs of mothers and infants in the state.

Temporal trends in maternal characteristics and pregnancy outcomes: their relevance to the provision of health services. Hawaii, 1979-1994.

This paper examines changes in maternal sociodemographic characteristics and pregnancy outcomes in Hawaii during the period 1979-1994. The more striking changes were increases of 129% in the proportion of births to women > 35 years old and of 67% in the proportion of births to unmarried mothers. The percentage of low birth weight and small-for-gestational age infants decreased while the proportion of premature births increased. Identified changes were not limited to selected population groups, but were found in various degrees in all ethnic groups. These findings are relevant to all health practitioners and will assist in the provision of appropriate care and counseling to individual women.

Asian and Pacific Islander mortality differences in Hawaii.

In the United States, national health status data pertaining to Asian and Pacific Islander (API) Americans are rarely disaggregated. By aggregating API data, however, the poor health status of some API groups is often masked by the favorable health status of others. The purpose of this paper is two-fold: (1) to compare mortality rates of the five major ethnic groups in Hawaii (Caucasians, Chinese, Filipinos, Japanese, and Hawaiians) and (2) to explore methodological issues related to comparative studies of API health indicators. Standardized and age-specific mortality rates and 95 per cent confidence intervals for major causes of death were estimated for 1990 based on Hawaii vital records and population data. In general, death rates were highest for Hawaiians and lowest for Japanese and Chinese, illustrating the importance of API data disaggregation and suggesting that special attention be paid to improving the health of Hawaiians. Methodologically, the study demonstrated that, while some compromises in analysis are required, legitimate comparisons across API groups can be made if data sets are available.

Life and death in Hawaii: ethnic variations in life expectancy and mortality, 1980 and 1990.

Life expectancy in Hawaii is among the highest in the nation. Past research, however, found significant ethnic differences in longevity. This study presents life expectancy estimations for 1980 and 1990, along with ethnic differences in mortality rates for specific causes of death. The findings suggest that ethnic differences continue, with Chinese and Japanese having the longest life expectancy and Native Hawaiians having the shortest.

[Beneficial effect of bromocriptine in a patient with malignant syndrome and hepatic dysfunctions].

A 39 year-old male, diagnosed as meningoencephalitis, was admitted because of the development of malignant syndrome. This syndrome appeared to have resulted from anti-psychotic drugs given to relieve excitement and insomnia. As he had hepatic dysfunctions, we could not administer dantrolene further. Therefore, we gave bromocriptine to ameliorate the symptoms such as muscle rigidity or hemodynamic perturbations. Thereafter, the patient gradually became stable in hemodynamics and in other symptoms. In addition, a further deterioration in hepatic functions did not occur with administration of bromocriptine. The case suggests that in patients with malignant syndrome associated with hepatic dysfunctions, bromocriptine could be a first choice as a pharmacological treatment of the syndrome.

[A case of hyperosmolar nonketotic coma occurring during chemotherapy in lung cancer].

A 61-year-old woman was admitted to our hospital because of hoarseness and abnormal shadow on chest X-ray. We diagnosed this patient as large cell carcinoma of the right upper lobe of the lung; T3N3M1 Stage IV. She was treated with OK-432, CDDP and CQ. On the 6th day after 2nd cycle chemotherapy, she was confused, and we diagnosed her as a case of hyperosmolar nonketotic coma (HNC) on the 7th day. Unfortunately, she died on the 8th day, after 20 hours of treatment for HNC. She suffered from chronic dehydration due to trouble with left recurrent nerve palsy. Although continuous intravenous hyperalimentation was used, she had severe HNC. HNC might be one complication in chemotherapy for patients with malignancy.

[A case of immotile cilia syndrome and a review of Japanese cases].

A case of immotile cilia syndrome (ICS) is presented. A 34-year-old male, who had suffered from recurrent bronchitis, sinusitis and otitis media since early childhood, was admitted to Keio University Hospital complaining of productive cough and infertility. A saccharin test showed prolonged nasal clearance time, and semen analysis revealed immotile sperm. By electron microscopic observation of cilia of the nasal mucous epithelium and the sperm, inner and outer dynein arm defect, abnormal microtubular arrangement and compound cilia were detected and he was diagnosed as ICS. Thirty eight Japanese cases of ICS collected from the literature were analyzed concerning clinical manifestations, airway clearance, family history and ciliary ultrastructural abnormalities (Table 2, 3). Recurrent bronchitis, male infertility, chronic sinusitis, otitis and decrease in airway clearance were very common in these patients. Female infertility was more common than anticipated. The prevalence rate of situs inversus was more than 50%, probably due to more attention having been paid to Kartagener's syndrome in Japan. Recent studies show that the cilia of this syndrome is not always immotile but characterized by hypomotility or asynchrony, and have attempted to determine the relationship between each ciliary ultrastructural abnormality and motility pattern. It is necessary that more patients including incomplete and mild cases should be investigated.

[Clinical studies on patients with legal communicable diseases encountered from 1981 to 1986].

Patients with legal communicable diseases admitted to Kawasaki Municipal Hospital between 1981 and 1986 were studied. Ages of patients were over 15 year-old. During this period 115 patients were admitted. Out of these patients 84 had Shigellosis, and 9 had amebiasis. Out of 20 Salmonellosis, 18 were due to Salmonella typhi and 2 were due to Salmonella paratyphi-A, respectively. Two were admitted because of Cholera. Out of the patients with Shigellosis, 27 were domestic and 57 were foreign infections, respectively. Most of patients were infected in South Asia or India and its neighbour countries. Shigella flexneri were mainly isolated from these patients. On the contrary, Shigella sonnei was the main causative organism of patients infected in Japan. Three amebiasis patients had liver abscesses with peritonitis, and 1 patient was a bisexual person. Out of Salmonellosis, 11 were patients with typhoid fever and 9 were carrier. One Cholera patient with severe diarrhea and acute renal failure was successfully treated and already reported elsewhere.