Search

Introduction Good understanding of mortality data is essential for developing and evaluating health policies. The causes of any death are usually reported on parts I and II of a death [...], Objective To investigate a new approach to calculating cause-related standardized mortality rates that involves assigning weights to each cause of death reported on death certificates. Methods We derived cause-related standardized mortality rates from death certificate data for France in 2010 using: (i) the classic method, which considered only the underlying cause of death; and (ii) three novel multiple-cause-of-death weighting methods, which assigned weights to multiple causes of death mentioned on death certificates: the first two multiple-cause-of-death methods assigned non-zero weights to all causes mentioned and the third assigned non-zero weights to only the underlying cause and other contributing causes that were not part of the main morbid process. As the sum of the weights for each death certificate was 1, each death had an equal influence on mortality estimates and the total number of deaths was unchanged. Mortality rates derived using the different methods were compared. Findings On average, 3.4 causes per death were listed on each certificate. The standardized mortality rate calculated using the third multiple-cause-of-death weighting method was more than 20% higher than that calculated using the classic method for five disease categories: skin diseases, mental disorders, endocrine and nutritional diseases, blood diseases and genitourinary diseases. Moreover, this method highlighted the mortality burden associated with certain diseases in specific age groups. Conclusion A multiple-cause-of-death weighting approach to calculating cause-related standardized mortality rates from death certificate data identified conditions that contributed more to mortality than indicated by the classic method. This new approach holds promise for identifying underrecognized contributors to mortality. Objectif Etudier une nouvelle approche permettant de calculer des taux comparatifs de mortalite due a differentes causes en ponderant chaque cause de deces declaree sur les certificats de deces. Methodes Nous avons calcule des taux comparatifs de mortalite due a differentes causes a partir des donnees de certificats de deces emis en France en 2010 suivant: (i) la methode classique, oli nous avons uniquement tenu compte de la cause sous-jacente de deces; et (ii) trois nouvelles methodes de ponderation de causes multiples de deces, qui conslstaient a appliquer une ponderation aux differentes causes de deces mentionnees sur les certificats de deces: les deux premieres methodes tenant compte de plusleurs causes de deces consistalent a appliquer une ponderation autre que zero a toutes les causes mentionnees et la troisieme consistait a appliquer une ponderation autre que zero uniquement a la cause sous-jacente et a d'autres causes aggravantes, exterieures au processus pathologlque principal. La somme des ponderations pour chaque certlficat de deces etait de 1. Ainsi, chaque deces avalt la meme influence sur les estimations de la mortalite, sans changer le nombre total de deces. Les taux de mortalite obtenus suivant ces differentes methodes ont ensulte ete compares. Resultats En moyenne, 3,4 causes etaient mentionnees sur chaque certificat de deces. Le taux comparatlf de mortalite calcule selon la troisieme methode de ponderation de causes multiples de deces etait plus de 20% superieur a celui calcule selon la methode classique pour cinq categories de maladies: maladies de la peau, troubles mentaux, maladies endocriniennes et nutritionnelles, maladies du sang et maladies uro-genitales. En outre, cette methode a mis en relief la charge de mortalite associee a certaines maladies dans des groupes d'age specifiques. Conclusion L'approche consistant a ponderer des causes multiples de deces afin de calculer des taux comparatifs de mortalite due a differentes causes a partir des donnees figurant sur des certificats de deces a permis de reperer les pathologies qui contribuaient plus a la mortalite que ce qu'indlqualt la methode classique. Cette nouvelle approche devrait permettre d'identifier les facteurs peu reconnus qui contribuem pourtant a la mortalite. Objetivo Investigar un nuevo enfoque para calcular las tasas estandarizadas de mortalidad relacionada con las causas que implique la asignacion de variables de cada causa de muerte Indicada en los certificados de defuncion. Metodos Se derivaron las tasas estandarizadas de mortalidad relacionada con las causas de certificados de defuncion en Francia en 2010 utilizando: (i) el metodo clasico, que consideraba unicamente la causa subyacente de la muerte; y (ii) tres nuevos metodos de evaluacion de multiples causas de muerte, que asignaban variables a varias causas de muerte mencionadas en los certificados de defuncion: los primeros dos metodos de multiples causas de muerte asignaron variables no nulas en todas las causas mencionadas y el tercero asigno las mismas variables solo a la causa subyacente y otras causas contribuyentes que no formaban parte del proceso morbido principal. Dado que la suma de las variables de cada certificado era 1, cada defuncion tenia la misma influencia en las estimaciones de mortalidad y el numero total de muertes permanecio Intacto. Se compararon las tasas de mortalidad derivadas utilizando los distintos metodos. Resultados De media, cada certificado enumeraba 3,4 causas por muerte. La tasa de mortalidad estandarizada calculada utilizando el tercer metodo de evaluacion de multiples causas de muerte fue mas de un 20% superior a la calculada utilizando el metodo clasico para cinco categorias de enfermedades: enfermedades cutaneas, trastornos mentales, enfermedades endocrinas y nutricionales, enfermedades sanguineas y enfermedades genitourinarias. Asimismo, este metodo destaco el umbral de mortalidad relacionado con determinadas enfermedades de grupos de edades en particular. Conclusion Un enfoque de evaluacion de multiples causas de muerte para calcular las tasas estandarizadas de mortalidad relacionada con las causas de datos recopilados de certificados de defuncion identifico las condiciones que contribuyeron mas a la mortalidad que las indicadas en el metodo clasico. Este nuevo enfoque promete identificar contribuyentes no reconocidos a la mortalidad.

Introduction: Adults living with a neurodevelopmental disorder may present episodes of aggression, which may lead to the use of seclusion or restraint. The aim of the study was to assess the effect of an intervention aimed at reducing the use of coercive measures in a long-term care unit for adults suffering from a neurodevelopmental disorder with or without psychiatric co-morbidities., Method: The single-center study used a sequential mixed-methods explanatory design. Retrospective data on periods of seclusion, with and without physical restraint, were collected for the ten-month pre-intervention and post-intervention periods. A qualitative survey was conducted at the end of the intervention period among the health professionals working in the unit to review the implementation and the efficiency of the approach., Results: A significant decrease was observed between the pre- and post-intervention period in the number of seclusion and restraint sequences, the number of patients experiencing seclusion and restraint, and the duration of seclusion and restraint sequences. The efficiency of the approach was confirmed by the health care professionals and was attributed to leadership focused on limiting coercive measures, better adherence to legal obligations, team cohesion, and the implementation of alternative tools and methods., Discussion: Reducing the use of coercive measures with adults with neurodevelopmental disorders is possible. Further studies are needed to confirm the effectiveness of alternative strategies to seclusion and restraint.