This study considers the reproductive experiences of women in Sheffield between 1870 and 1939, encompassing the development of concepts of maternal and infant welfare, and debates over birth control and abortion. It focuses on the impact of state and voluntary enterprise, on the development of health professions and hospitals, and on the position of mothers. The study shows that high infant mortality was caused primarily by poor sanitation. Unlike other areas, Sheffield had low rates of both maternal employment and bottle feeding, suggesting that these were not significant factors. The decline in infant mortality was due to a combination of factors; the removal of privy middens and slum areas, and the development of welfare clinics and health visiting services. High maternal mortality was prevalent mainly in areas of skilled working class employment; not middle class areas as in other cities. There was no inverse correlation between infant and maternal mortality in Sheffield. Maternal mortality was caused by high rates of sepsis following illegal abortion. The reduction in mortality was due to a cyclical decline in the virulence of the causative bacteria, and the application of sulphonamide drugs to control it. The development of antenatal and birth control clinics had little impact. Despite early action to train midwives in Sheffield, midwifery remained a largely part time, low status occupation throughout the period. The hospitalisation of normal childbirth occurred early in Sheffield, and demand for beds outstripped supply, demonstrating that women were able to shape the development of services. Local authority and voluntary groups generally co-operated in the delivery of services, which were developed along pragmatic lines with little reference to debates about eugenics or national deterioration. The growth of welfare schemes was circumscribed by the available resources. Central government provided enabling legislation, but schemes were planned and implemented at the local level.

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements of the award of the Masters in Science in Epidemiology in the field of Population-based Field Epidemiology April 2012 / Objective: To determine the causes of death and associated risk factors in women of reproductive age in rural South Africa. . Methods: The study population comprised all female members aged 15-49 years of 11 000 households of a rural South African Health and Demographic Surveillance Site from 2000-2009. Deaths and person-years of observation (pyo) were determined for individuals between 01 January 2000 and 31 December 2009. Cause of death was ascertained by verbal autopsy interviews, based on ICD-10 coding; cause of death were broadly categorized as AIDS/TB causes, Non-communicable causes, Communicable/maternal/perinatal/nutrition causes, Injuries and another category of undetermined (unknown) causes of death. Overall and cause specific mortality rates (MR) with 95% confidence intervals (CI) were calculated. Cox proportional hazard regression (HR, 95% CI) was used to determine risk factors associated with overall and cause-specific mortality. Results: 42703 eligible women were included; 3098 deaths were reported for 212607 person-years (pyo) of observation. Overall MR was 14.57 deaths/1000 pyo (CI;14.07-15.09), increasing from 2000-2003 (2003: MR;18.15, CI;16.41-20.08) and subsequently decreasing (2009: MR; 9.59, CI;8.43-10.91) after introduction of antiretroviral treatment (ART) for HIV in public health system facilities in South Africa in 2004. Mortality was highest for AIDS/TB (MR;10.66, CI;10.23-11.11) and the cause of death for 73.1% of all recorded deaths. Maternal mortality was 0.07 (CI; 0.04-0.11). Women aged 30-34 years had the highest MR due to AIDS/TB (MR; 20.34/1000 pyo), women aged 45-49 years due to other causes (MR; 4.29/ 1000 pyo). v In multivariable analyses, external migration status was associated with increased hazards of all cause mortality (HR; 1.87, CI; 1.56-2.26) and other causes of mortality (HR; 1.782, CI; 1.24-2.57). Self reported poor health was significantly associated with increased hazards of all cause mortality (HR; 11.052, CI; 4.24-28.82) but not with mortality due to other causes. Positive HIV status was associated with increased hazards of all cause mortality (HR; 8.53, CI; 6.81-10.67) and other causes of mortality (HR; 2.84, CI; 1.97- 4.09). Conclusion. AIDS was the main cause of death in the current study, with mortality rates declining since introduction of ART for HIV in public health facilities in the surveillance area in 2004. Further ART roll-out, increased community awareness and sensitisation messages are still needed to reduce the spread of HIV and other sexually transmitted diseases.

Infant mortality is viewed as an important indicator of the health and social conditions of a population. However, the infant mortality rate in the United States is estimated to be much lower than those of other developed nations. This dissertation analyzes the hazard of fetal and infant death for twins and triplets in the United States between the years of 1995 and 2000. This dissertation had two main objectives: first, to examine the effects of the birthweight and gestational age on the hazards of fetal, neonatal, postneonatal, and infant death; and second, to better understand the timing of mortality among multiples during their early life. I show that after controlling for relevant characteristics of the mother and child, gestational age and birthweight significantly influence the hazard of mortality for twins and triplets. The major finding in this dissertation shows that there is a higher hazard for twins than triplets. The unexpected higher hazard of mortality for twins compared to triplets may well be due to the social and demographic characteristics of parents of twins and triplets, particularly the possible use of Assisted Reproductive Technologies.

Background: Most of the previous studies about risk factors associated with death in pediatric intensive care unit (PICU) were done in western countries and focused on physiological and laboratorial indexes. Some of them had inconsistent results. There were few studies about the epidemiologic profile of mortality and risk factors associated with death in the PICU in China. Compared with other countries, China has different health care policy, insurance system, population, culture, and socioeconomic situation that may affect disease outcomes differently. Some data showed that Chinese PICUs had higher mortality. It is important to know more about the possible factors associated with excess death in PICU in a Chinese setting. Objectives: The objectives of this study were to estimate mortality (incidence proportion of death) in pediatric intensive care unit (PICU) in a tertiary hospital and identify the main risk factors associated with death in PICU. Methods: This was a case-control study. We retrospectively investigated the clinical data of patients who were admitted to the PICU during January 2010 to December 2013 in a tertiary hospital in Guangzhou, China. All the dead cases in PICU during the studied period were chosen as cases, and the controls were randomly selected from the patients who were alive when they were discharged from the PICU during the same period. The incidence proportion of death was estimated, and then logistic regression model was carried out to explore the risk factors for death. Results: The overall mortality in this PICU was 6.5% (95% CI 5.6 % - 7.4%) during January 2010 to December 2013. The following factors were found to have significant association with higher risk for death: middle level socioeconomic status (OR 2.51, 95% 1.07 - 5.87) and low level socioeconomic status (OR 5.86, 95% CI 2.32 - 14.77) compared with the high level socioeconomic status; admission from pediatric emergency observation unit (OR 2.08, 95% CI 1.10 - 3.91) compared with admission from transfer system (i.e. other hospital); critical severity of disease (OR 2.62 , 95% CI 1.48 - 4.64), and seriously critical severity of disease (OR 8.41, 95% CI 3.26 - 21.67) compared with non-critical severity of disease ; existence of multiple organ dysfunction syndrome (OR 3.64, 95% CI 1.91- 6.91) compared with absence of multiple organ dysfunction syndrome; existence of comorbidity (OR 3.14, 95% CI 1.68 - 5.86) compared with absence of comorbidity; infectious disease (OR 2.42, 95% CI 1.07- 5.49), neoplasm (OR 4.53, 95% CI 1.63 - 12.62), neurological disease ( OR 4.21, 95% CI 1.85 - 9.59) and endocrine, immune and nutritional disease (OR 7.56, 95% CI 2.10 - 27.20 ) compared with respiratory disease . Conclusion: Our study was the first one to comprehensively investigate the risk factors for death in PICU of a tertiary hospital in China. We described profile of dead cases, estimated the mortality and investigated the risk factors associated with death in PICU. During January 2010 to December 2013 the mortality in the PICU was found to be 6.5%, and risk factors for higher mortality in PICU included lower level socioeconomic status, admission from the pediatric emergency observation unit, more severe conditions of disease, presence of comorbidity and multiple organ dysfunction syndrome, and disease categories of infectious diseases, neoplasm, neurological disease, and endocrine, immune and nutritional disease. Our study provided information for developing preventive strategy to reduce the mortality in PICU. / published_or_final_version / Public Health / Master / Master of Public Health

Thesis (M.P.H.)--University of Michigan, 1946.

Thesis (M.P.H.)--University of Michigan, 1946.

Thesis (M.Soc.Sc.)--University of Hong Kong, 1987. / Also available in print.

Thesis (M.Soc.Sc.)--University of Hong Kong, 1989. / Also available in print.

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