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Verbal autopsies could reveal how millions live and die

Since January, Kazi Mojammel Haque has had the sometimes difficult job of going door-to-door in villages in the Kaligonj region of Bangladesh to ask people for details of how their loved ones passed away. 

Haque is a field worker who has carried out 40 “verbal autopsies” so far -- a research method for determining the probable cause of death when no formal medical records of the deceased may exist — as part of the Data for Health initiative. The program, supported by Bloomberg Philanthropies and the Department of Foreign Affairs of Australia, was designed to help 15 developing countries around the world improve their public health data collection methods. Think of the verbal autopsy as an interview with a standardized set of questions aimed at filling in the blanks for a person’s symptoms to help determine the ultimate cause of death .

“I faced challenges during (an) interview with a son of a deceased woman,” Haque wrote in a note to CBS News about one of the more difficult interviews. “He asked me ‘why you didn’t come before death?’” Haque had to explain to the grieving family “that verbal autopsy is needed for determining CoD (cause of death) to improve medical treatment in the future.”

While this kind of questioning can be painful, it’s crucial. In 2014, the World Health Organization reported that two-thirds of the 56 million people who die around the world each year are “invisible.” These deaths remain unregistered, leaving glaring information gaps about their illnesses and injuries — information that could help governments make better decisions about public health policy.

Data for Health hopes to step in and help rectify this by piloting a technology initiative to improve the collection of this information. Field workers like Haque are being trained to conduct in-person interviews with family members of the deceased and use Android tablets to record their answers. After the information is entered into a free data-collection app it’s sent to a central server, where an algorithm analyzes the data to determine a probable cause of death.

A program getting off the ground

At the moment, field workers in Brazil, Rwanda, Myanmar, Bangladesh, Ghana, Tanzania and Sri Lanka have been undergoing training with the technology. Workers in other countries, like the Solomon Islands, for instance, will soon start training.

“Computer algorithms are not perfect. They’ve gotten pretty good, and that helps build up a picture of a pattern of mortality and causes of death at the community level,” said Dr. Philip Setel, who heads the Vital Strategies civil registration and vital statistics (CRVS) program under the Data for Health initiative.

In addition to benefitting the health sector, he said this data can also be used to help track the effectiveness of aid programs.

“By having this active follow-up to deaths, we can help countries that want to maintain population registers as a basis of things like electoral rolls or following up with payments on social entitlements, for instance,” he said.

Setel said that the initiative makes


Breast-feeding study sheds light on benefits for babies

Breast-feeding may not make kids sharper or better behaved than their non-nursed peers over the long-term, a new study suggests.

Breast-feeding is known to have many positive effects for babies and moms. But the notion that it makes kids smarter or better able to regulate their behavior is unproven.

“The belief that babies who are breast-fed have advantages in their cognitive development, in particular, has been a topic of debate for over a century now,” said Lisa-Christine Girard, the lead researcher on the new study.

Her team found that 3- and 5-year-olds who’d been breast-fed did, in fact, score higher on tests of vocabulary and problem-solving. The children also typically had fewer behavioral issues, based on parents’ ratings.

But most of those connections seemed to be explained by other factors — such as the mothers’ education and the family’s social class.

Breast-feeding  was  tied to one positive effect: fewer problems with hyperactivity at the age of 3. But even that link disappeared by the age of 5, the study found.

Still, the finding does suggest that breast-feeding might have a direct effect on young children’s hyperactivity, according to Girard, a research fellow at University College Dublin in Ireland.

But it’s possible that things change after kids start school, she added. At that point, other factors might “exert a larger role on children’s hyperactivity once the home environment is no longer the predominant environment in which children spend the majority of their waking hours.”

The findings, published March 27 in  Pediatrics , are not the final word on breast-feeding and child development, however.

Researchers are still trying to understand the “complete picture,” Girard said. But it’s challenging to weed out the effects of breast-feeding, per se, from all of the other factors that influence something as complex as child development.

It’s clear, Girard said, that at least in developed countries, mothers who breast-feed tend to differ from moms who don’t. On average, they are more educated and less likely to smoke or engage in other “risky behaviors” during pregnancy, for example.

Girard and her colleagues dug into the issue by reviewing data from a long-term study of roughly 8,000 Irish families.

The majority of children in the study had been breast-fed for some amount of time.

And in general, they did better on tests of “expressive” vocabulary and problem-solving, versus kids who’d never been breast-fed. Their parents also gave higher ratings to their behavior on a standard questionnaire.

In the end, though, most of those connections seemed to be explained by other factors. That was the case even for kids who’d been breast-fed for a relatively longer time — at least six months.

There was one exception: 3-year-olds who’d been exclusively breast-fed for at least six months had slightly lower hyperactivity ratings.

Dr. Lydia Furman, a pediatrician at Rainbow Babies and Children’s Hospital in Cleveland, described the study as “thoughtful.”

It does have limitations, though, according to Furman, who wrote an editorial published with the findings.

For one, she said, few


Could eating less salt reduce nighttime bathroom trips?

Lowering your salt intake could mean fewer trips to the bathroom in the middle of the night, a new study suggests.

Most people over age 60, and many even younger, wake up to pee one or more times a night. This is called nocturia. This interruption of sleep can lead to problems such as stress, irritability or tiredness, which can affect quality of life.

There are several possible causes of nocturia, including — as this study found — the amount of salt in your diet.

“This is the first study to measure how salt intake affects the frequency of going to the bathroom, so we need to confirm the work with larger studies,” said study leader Tomohiro Matsuo, from Nagasaki University in Japan.

“Nighttime urination is a real problem for many people, especially as they get older. This work holds out the possibility that a simply dietary modification might significantly improve the quality of life for many people,” he said.

The study included more than 300 Japanese adults. They all had high salt intake and sleeping problems. They were given instructions and help to reduce their salt intake and followed for 12 weeks.

The American Heart Association recommends that people consume no more than 2,300 milligrams (2.3 grams) of sodium daily. That’s about a teaspoon of salt.

Ideally, the AHA says, people shouldn’t have more than 1,500 milligrams (1.5 grams) of sodium per day. Table salt is made up of about 40 percent sodium, according to the AHA.

More than 200 people in the study reduced their salt intake. They went from an average of 11 grams per day to 8 grams a day.

With that reduction in salt, the average number of nighttime trips to the bathroom to urinate fell from 2.3 to 1.4 times per night. The number of times people needed to urinate during the day also decreased.

The drop in nighttime bathroom visits also led to an improvement in quality of life, researchers said.

In comparison, the nearly 100 participants whose average salt intake rose — from 9.6 grams per night to 11 grams nightly — had an increase in nighttime trips to the bathroom, from 2.3 to 2.7 times a night, the study revealed.

The study was to be presented Sunday at the European Society of Urology annual meeting, in London. Findings presented at meetings are typically viewed as preliminary until they’ve been published in a peer-reviewed journal.

Dr. Marcus Drake is a professor at the University of Bristol in England and leader of the working group for the ESU Guidelines Office Initiative on Nocturia. “This is an important aspect of how patients potentially can help themselves to reduce the impact of frequent urination. Research generally focuses on reducing the amount of water a patient drinks, and the salt intake is generally not considered,” he said.

“Here we have a useful study showing how we need to consider all influences to get the best chance of improving the symptom,” Drake said in an ESU news release.


Amputations and death: Docs paint gruesome picture of alleged prison woes

BOISE, Idaho --  Idaho inmates are asking a federal judge to penalize the state after saying prison officials repeatedly violated a settlement plan in a long-running lawsuit over health care, leading to amputations and other serious injuries and even some prisoners’ deaths.

In a series of documents filed in federal court, the inmates’ attorney Christopher Pooser painted a bleak and often gruesome picture of the alleged problems at the Idaho State Correctional Institution south of Boise. The prison is the state’s oldest, with more than 1,400 beds, including special units for chronically ill, elderly and disabled inmates.

Pooser and the inmates allege some prisoners were forced to undergo amputations after their blisters and bedsores went untreated and began to rot, and others with serious disabilities were left unbathed or without water for extended periods and given food only sporadically.

The prison’s death rates outpaced the national average as well as rates at other Idaho facilities, according to the documents. And despite hearing evidence to the contrary, prison officials failed to double-check the numbers when its health care contractor, Corizon, reported being 100 percent compliant with state health care requirements.

Meanwhile, prison officials were falsifying documents to make it look like all employees were trained in suicide prevention when many were not, the filings said.

The inmates are asking the judge to hold the state in contempt of court and levy more than $24 million in fines against the Idaho Department of Correction. They say the state could cover some of the fines by recovering money paid under its contract with Corizon, but they also want the state to feel the budget hit so prison leaders will be motivated to make a fix.

In a statement emailed to The Associated Press, Idaho’s corrections director, Henry Atencio, said he couldn’t address the specific claims in the motion for contempt because the allegations are now before the court. But he said his agency has been making an “all-out effort to bring the 36-year-old Balla case to a successful resolution for all parties” for the past two years.

Corizon spokeswoman Martha Harbin said in an email that patient privacy laws prevent the company from discussing specifics. But she said the existence of a lawsuit doesn’t necessarily mean there was wrongdoing.

“We strive to provide quality care that meets the needs of our patients and makes the best use of taxpayer resources,” Harbin wrote.

The case started in 1981 when so many inmates from the Idaho State Correctional Institution began filing lawsuits that they threatened to clog Idaho’s federal court. A judge noted similarities between the cases and combined them into one class-action lawsuit, which became known as the “Balla case” after the lead plaintiff, Walter Balla.

The claims ranged from overcrowding and excessive violence to limited access to medical care. Some have been settled, but the medical care complaints continue at the prison.

The lawsuit seemed close to a conclusion a couple of years ago when all sides agreed to a deal in which


Now what? Options for consumers as health bill drama fades

As the political drama over health care legislation in Washington fades, the rest of the country faces a more immediate concern: Getting insurance for next year.

The Republican health plan designed to replace the Affordable Care Act, also known as Obamacare , would not have taken full effect for a few years anyway - and now it’s dead.

“We’re going to be living with Obamacare for the foreseeable future ,” House Speaker Paul Ryan said Friday.

That means millions of Americans will have to navigate a current federal health care system that, while not “ imploding ” as President Trump has said, is at least in flux.

Mary Vavrik, a 57-year-old freelance deposition court reporter from Anchorage, Alaska said she was relieved that the current health law will remain because she’s happy with the coverage she gets through her exchange - even as she acknowledged that reforms are needed.

“It’s not a perfect plan but I’m really grateful to have what I do have,” she said.

Prices for insurance plans offered on the public insurance exchanges set up by the health care law have soared in many markets, and choices for customers have dwindled. That’s because insurers have faced sizable financial losses on the exchanges in recent years, and have responded by either hiking prices or pulling out of certain markets altogether.

Now, attention will turn to administrative changes underway in Washington designed to stabilize the exchanges by preventing more insurer defections.

The open enrollment period to sign up for insurance for 2018 is slated to start this fall, but insurers are making decisions now about whether to participate. What kinds of plans will be available and how much they will cost will depend on a few key decisions by insurers and regulators in the coming weeks.

Will I have plans to choose from?

It depends on where you live. Choices are dwindling, but chances are at least one insurer will sell in your market. That company may offer several plans.

Generally, big cities will have more choices than rural areas where there may not be enough customers to attract insurers.

As of now, there are 16 counties in a region of Tennessee around Knoxville that have no insurers committed to sell coverage on the exchange next year. About a third of the nation’s 3,100 counties are down to just one insurer.

Insurers have been pulling back, and more are expected to leave, but health care researchers are not predicting mass defections.

“For most consumers, (2018) will look a lot like ‘17,” said Dan Mendelson, president of the consulting firm Avalere.

Customers can try to find coverage outside their exchange, but then they won’t be able to use tax credits to help pay the bills, which may be particularly painful since many markets have seen prices soar.

Are there fixes in store?

Last month, the Health and Human Services Department, which runs exchanges in many states, proposed some adjustments to try to stabilize these marketplaces.

For example, insurers want greater

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