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Biomedical subjects

D C Ewbank

Publications and source records attributed to D C Ewbank.

15 recordsLinked to original sources
PubMed1999

Deaths attributable to Alzheimer's disease in the United States.

OBJECTIVES: This study provided 2 estimates of the number of deaths attributable to Alzheimer's disease in the United States. METHODS: One estimate was based on data from the East Boston, Mass, study. The second was based on a simulation using population-based estimates of prevalence and separate estimates of excess death by duration of disease. RESULTS: Despite different methods and very different estimates of prevalence, these 2 methods led to very similar estimates of 173,000 and 163,000 excess deaths. CONCLUSIONS: These estimates suggest that 7.1% of all deaths in the United States in 1995 are attributable to Alzheimer's disease, placing it on a par with cerebrovascular diseases as the third leading cause of death.

Adult↗
PubMed1996

Performance of the dementia severity rating scale: a caregiver questionnaire for rating severity in Alzheimer disease.

The Dementia Severity Rating Scale (DSRS) is an informant-based, multiple-choice questionnaire that assesses severity from the mildest to the most severe stages in the major functional and cognitive domains affected in Alzheimer disease (AD). The DSRS has good reliability as measured by making repeated observations over short time periods and by comparing caregiver responses to information collected by a physician or an experienced nonphysician research associate. The measure correlates favorably with the Washington University Clinical Dementia Rating scale and with standard cognitive testing measures. The DSRS provides a simple, valid, and sensitive measure of impairment associated with AD. It is ideally suited for multisite collaborative studies and can be implemented with a minimum of staff time and training.

Activities of Daily Living↗
PubMed1993

Impact of selective primary care on childhood mortality in a rural health zone of Zaire.

Following the introduction of intensified child survival activities, use of health services for children increased markedly: measles vaccination reached 74% of children aged 12-23 months, and the use of oral rehydration therapy for the treatment of diarrhoea had increased. During the same period, childhood mortality declined by 33% for children aged 1-4 years. Data on cases of measles in the local hospital reveals that the pattern of measles epidemics characteristic of the years preceding programme implementation was altered in the years following programme implementation. The mean annual number of inpatient measles cases declined from 108 before the programme to 36 after its start. The high correlation between the number of inpatient measles cases and mortality at ages 6-35 months suggests that the programme reduced mortality largely by reducing the incidence of measles. Primary health care activities, supported in part by the Combatting Childhood Communicable Diseases Project, is estimated to have reduced mortality at ages 6-35 months by at least the 18-23% associated with the change in the incidence of measles and may have been responsible for the full 28% reduction recorded between 1980-1984 and 1985-1989.

Adolescent↗
PubMed1993

Impact of health programmes on child mortality in Africa: evidence from Zaire and Liberia.

The Mortality and Use of Health Services studies were designed to measure changes in the coverage of health services and in infant and child mortality rates associated with the implementation of the Combatting Childhood Communicable Diseases programme. The papers in this supplement provide the results of research carried out in areas of Zaire and Liberia. Data from these studies provide credible evidence that these programmes actually reduced mortality. The proportion of children dying by their fifth birthday declined by 17% in Zaire and by 32% in Liberia. These estimates of programme impact are consistent with the increases in the use of health services and with data from similar studies in other countries. Results of these surveys suggest that child survival programmes in Africa can reduce mortality substantially in populations living in different environments at very different initial levels of child mortality.

Communicable Disease Control↗
PubMed1993

A strategy for evaluating the mortality impact of child survival programmes in Africa: Combatting Childhood Communicable Diseases Project.

The Mortality and Use of Health Services surveys were designed to measure the mortality impact of the Combatting Childhood Communicable Diseases programmes which are based on childhood vaccinations, prenatal immunization against tetanus, home-based use of oral rehydration therapy, and presumptive treatment of malaria. The survey design includes pretest and post-test surveys in programme and non-programme areas. The questionnaires are designed to collect information on use of health services and on pregnancy histories to provide retrospective reporting of child mortality. When combined with data from surveillance systems (particularly information on cases of measles cases seen at clinics and health centres), these data should provide reasonable estimates of programme impact.

Adolescent↗
PubMed1989

Estimating birth stopping and spacing behavior.

A decomposition of age-specific marital fertility rates into indices related to spacing and stopping is developed by using Coale and Trussell's indices and the first few parity progression ratios. This approach leads to estimates of the mean birth interval among low-parity births that can be used to address the issue of fertility control early in marriage. In this way the model addresses several of the most serious limitations of Coale and Trussell's approach. The usefulness of the proposed indices is demonstrated by applications to historical data from the United States and Europe.

Birth Intervals↗
PubMed1988

The effect of child fostering on feeding practices and access to health services in rural Sierra Leone.

In Sierra Leone, where infant and child mortality rates are quite high, a large proportion of small children from 1 to 5 yr are fostered: living away from their mothers. This paper examines the relationships between fosterage and child feeding practices and children's access to Western medical care. Ethnographic data from field studies in Sierra Leone are combined with quantitative data from Serabu Hospital, which show that fostered children are underrepresented in hospital admissions and that young fosters present more problems of malnutrition. (Fostered girls appear to be at more risk in both these categories than boys.) Unlike young fosters, however, older ones do not appear to be at more risk than children with mothers. We draw connections between these results and patterns of intra-household discrimination in food allocation and access to medical treatment for young fostered children: especially those sent to elderly rural caretakers. Finally, we examine the implications of the findings for applied issues, arguing that fostered children may slip through the cracks of maternal-child health care programs.

Child↗
PubMed1987

Demographic heterogeneity and uncertainty in population projections.

Recent developments in a class of stochastic population processes were used to study the impact of demographic heterogeneity on the uncertainty of population projections. Selected for study by computer simulation were population projections for East Africa designed to quantify opinions regarding expected fertility and mortality declines. Since both fertility and mortality declined in these projections, their laws of evolution may be described as time inhomogeneous. The computer simulation studies reported in this paper strongly suggest that randomized laws of evolution should be taken into account in further developments of population projection methodologies designed formally and computationally to accommodate uncertainty. Variability in fecundability, the kind of demographic heterogeneity studied in this paper, is only one aspect of these randomized laws.

Africa, Eastern↗
PubMed1987

History of black mortality and health before 1940.

This article documents the history of black mortality between 1850 and 1940 and begins the process of placing that history into the context of the more general history of mortality decline in the United States. One aspect of this process has been to discuss the trends in mortality among blacks and whites living in the same general geographic areas--for example, comparing southern rural blacks with southern rural whites. A second part has been to relate black mortality to many of the factors that have been discussed as determinants of general mortality trends--such as water and sanitation, the urban disadvantage in mortality, and child care and feeding practices. During the second half of the nineteenth century, black mortality declined only slightly or not at all. Between 1850 and 1880 there may have been some decline in child mortality, but the trends in adult mortality are indeterminate. Between 1880 and 1900 both child and adult mortality rates were constant. Sometime between 1900 and 1910 mortality rates among blacks began to decline at all ages, especially in urban areas. During the first four decades of this century mortality rates among American blacks declined substantially. Expectation of life at birth increased from about 35 years to about 54 years, which represents a significant improvement in health and living standards. The life expectancy among blacks in 1940, however, was still two years below the value for whites in the death registration area in 1920. (This may exaggerate the difference slightly since the mortality rates for 1919 and 1920 were artificially low following the pandemic of influenza in 1918. In addition, the mortality rates in the DRA may not have been representative of the whole white population.) Throughout the period studied, blacks had substantially higher mortality rates than whites living in the same area. Although the amount of excessive mortality among blacks differed from place to place and period to period, we did not find a single area or time when black mortality rates were close to those of whites. The examination of causes of death among whites and blacks in 1920 showed that racial differences in the amount of tuberculosis explained a substantial part of the mortality differences in New York and North Carolina, but blacks probably had excessive mortality due to all causes.(ABSTRACT TRUNCATED AT 400 WORDS)

Black or African American↗
PubMed1984

A mathematical overview of a computer simulation model of maternity histories with illustrative examples.

A mathematical overview of a stochastic computer simulation model of maternity histories is provided. Various components of human reproduction are accommodated in the model through distributions of waiting times among live births. Included in these components are distributions of age at first marriage in a cohort of women, waiting times to pregnancy for fecundable women, and the lengths of infecundable periods following live births. Probabilities that pregnancies end in either a live birth, induced abortion, or some other type of outcome are also included. Elements of renewal theory and semi-Markov processes in discrete time were the basic mathematical concepts used in the construction of the model. A brief description of an interactive software package called MATHIST, which may be used to implement the model on a computer, is also included. Four illustrative computer runs with MATHIST, pertinent to the operation of family planning programmes in Africa, are also described and discussed.

Adult↗
PubMed1981

Reduction of mortality in rural Haiti through a primary-health-care program.

Deaths and their causes in a rural Haitian population of 8820 were studied through hospital records, death registration, a disease survey, and health surveillance. The results were used in selecting eight diseases for the delivery of health services by village-level health workers. The impact of the services was measured by monitoring annual age-specific and disease-specific mortality rates and by comparing them with officially estimated national mortality rates. Mortality rates fell progressively during five years, to levels only one fourth as high as the national estimates. The fall in mortality was associated principally with services that prevented deaths due to tetanus, malnutrition, diarrhea, and tuberculosis. The total program of hospital and village health services saved 495 years of potential life per thousand population per year. Most of the saving was attributable to preventive services. The program eventually served more than 115,000 persons, and it has been replicated by other agencies for an additional 135,000 Haitians.

Adolescent↗