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AIMS: To audit wording and formulation inaccuracies in certifying the cause of death. METHODS: Five hundred causes of death were analysed from the counterfoils of medical death certificates (Form 66). Wording and formulation inaccuracies were defined as terms contrary to the notes given to doctors in books on death certificates. RESULTS: One or more inaccuracies were identified in 29% of cases. In 5.8% of cases, the inaccuracies were sufficiently serious to warrant further action or enquiry by the Registrar of Births and Deaths, including referral to Her Majesty's Coroner. CONCLUSIONS: Most inaccuracies could have been avoided by adhering to the notes for medical practitioners contained in books of death certificates. The wording and formulation of causes of death warrants special prominence in under-graduate and postgraduate medical education. The topic should be audited and medical practitioners should pay particular attention to cases worthy of referral to HM Coroner.

Traditional deformable image registration imposes a uniform smoothness constraint on the deformation field. This is not appropriate when registering images visualizing organs that slide relative to each other, and therefore leads to registration inaccuracies. In this paper, we present a deformation field regularization term that is based on anisotropic diffusion and accommodates the deformation field discontinuities that are expected when considering sliding motion. The registration algorithm was assessed first using artificial images of geometric objects. In a second validation, monomodal chest images depicting both respiratory and cardiac motion were generated using an anatomically-realistic software phantom and then registered. Registration accuracy was assessed based on the distances between corresponding segmented organ surfaces. Compared to an established diffusive regularization approach, the anisotropic diffusive regularization gave deformation fields that represented more plausible image correspondences, while giving rise to similar transformed moving images and comparable registration accuracy.

This paper is concerned with the distribution of birthweight of some 18,700 singleton live and still births taking place in Cornwall, Devon, Plymouth, and Exeter in 1965. Information collected as part of the statutory birth registration process was linked to the corresponding information about the birth recorded by the local authority health department. The birthweights were originally recorded in ounces, but the irregularities in the pattern of results suggest that the observations are subject to substantial observer error and are accurate at best to the nearest quarter pound.

The general form of the birthweight distribution is examined and it is shown that the overall distribution can be effectively summarized by a mixture of two normal components. Because of the inaccuracies of the basic data concerning birthweight, it is not possible to obtain reliable estimates of all the five parameters necessary to describe a mixture of two normal components. However, the distribution (which we convert to the metric scale) can be described adequately in terms of the mean and standard deviation of the primary or major component and the proportion of births weighing less than 2,000 g, the corresponding figures for all single births being 3,380 g, 500 g, and 2·0% respectively.

The population of single births was subdivided in turn on the basis of sex, social class, parity, and maternal age. The mean of the primary component was about 120 g higher in males than in females, about 130 g higher in parity 1 births than in parity 0 births, about 110 g higher in births to mothers of 30-34 years of age than in births to mothers of less than 20 years, and about 150 g higher in social classes 1 and 2 than in social class 5. When two or more attributes are considered in combination, the social class gradient is present in most of the various subpopulations formed by subdivision of the population in terms of the other attributes. However, there seem to be complex interactions in terms of sex, parity, and maternal age. For example, the estimates of the mean of the primary component for males of parity 0 increase with increasing maternal age, whereas the corresponding estimates for females of parity 0 decrease. The variability of the primary distribution is greater for males than for females and increases with decreasing social class, increasing parity, and increasing maternal age. The proportion of births weighing less than 2,000 g was similar in males and females but decreased with increasing social class. In terms of parity, the proportion was higher for parity 0 than for parity 1 but subsequently increased with increasing parity. A similar pattern exists for maternal age in male infants, the proportion decreasing with age to reach a minimum in the 25-29 years age group and subsequently increasing as maternal age increases further. Female infants, on the other hand, show a totally different pattern in the lowest maternal age groups.

The objective of this review is to discuss the available data on the prevalence and causes of global blindness, and some of the associated trends and limitations seen. A literature search was conducted using the terms “global AND blindness” and “global AND vision AND impairment”, resulting in seven appropriate articles for this review. Since 1990 the estimate of global prevalence of blindness has gradually decreased when considering the best corrected visual acuity definition: 0.71% in 1990, 0.59% in 2002, and 0.55% in 2010, corresponding to a 0.73% reduction per year over the 2002–2010 period. Significant limitations were found in the comparability between the global estimates in prevalence or causes of blindness or visual impairment. These limitations arise from various factors such as uncertainties about the true cause of the impairment, the use of different definitions and methods, and the absence of data from a number of geographical areas, leading to various extrapolation methods, which in turn seriously limit comparability. Seminal to this discussion on limitations in the comparability of studies and data, is that blindness has historically been defined using best corrected visual acuity.

Objective

To assess the burden and quality of life of caregivers of patients with sickle cell anemia taking hydroxyurea versus those of patients not taking hydroxyurea.

Methods

A cross-sectional study was performed of caregivers of outpatients with sickle cell anemia in two public hospitals in Campo Grande, MS, from January through June 2010. The World Health Organization Quality of Life-BREF Scale and the Caregiver Burden Scale were used.

Results

Of the 37 caregivers in this study, 81.1% were women, 73.0% were mothers, 59.5% were married, 54.1%were mulattos, 48.6% were housewives, 54.1% had family incomes of up to one minimum wage and 75.7% had onlycompleted elementary education. The mean duration of care provided (time after diagnosis) was 16.08 ± 9.88 yearsand 89.2% reported that they provided 24-hour care. Regarding health, 27.0% of study participants reported having physical and 13.5% emotional problems. There were no significant relationships between these variables either with the different domains or the total score of the WHOQOL-BREF comparing caregivers of patients taking hydroxyurea versusthose of patients not taking hydroxyurea. There was a moderate negative linear correlation between the WHOQOL-BREF and the Caregiver Burden Scale scores (linear correlation test of Pearson: p-value = 0.003, r = -0.477). The burden of caregivers of patients who did not take hydroxyurea was significantly higher than those of patients who took the medication in terms of general tension, disappointment, environment and total score (student t-test: p-value < 0.05).

Conclusion

In the perception of the caregiver, looking after sickle cell anemia patients represents a moderate negative burden.

Background

Self-report recall questionnaires are commonly used to measure physical activity, energy expenditure and time use in children and adolescents. However, self-report questionnaires show low to moderate validity, mainly due to inaccuracies in recalling activity in terms of duration and intensity. Aside from recall errors, inaccuracies in estimating energy expenditure from self-report questionnaires are compounded by a lack of data on the energy cost of everyday activities in children and adolescents. This article describes the development of the Multimedia Activity Recall for Children and Adolescents (MARCA), a computer-delivered use-of-time instrument designed to address both the limitations of self-report recall questionnaires in children, and the lack of energy cost data in children.

Methods

The test-retest reliability of the MARCA was assessed using a sample of 32 children (aged 11.8 ± 0.7 y) who undertook the MARCA twice within 24-h. Criterion validity was assessed by comparing self-reports with accelerometer counts collected on a sample of 66 children (aged 11.6 ± 0.8 y). Content and construct validity were assessed by establishing whether data collected using the MARCA on 1429 children (aged 11.9 ± 0.8 y) exhibited relationships and trends in children's physical activity consistent with established findings from a number of previous research studies.

Results

Test-retest reliability was high with intra-class coefficients ranging from 0.88 to 0.94. The MARCA demonstrated criterion validity comparable to other self-report instruments with Spearman coefficients ranging from rho = 0.36 to 0.45, and provided evidence of good content and construct validity.

Conclusion

The MARCA is a valid and reliable self-report questionnaire, capable of a wide variety of flexible use-of-time analyses related to both physical activity and sedentary behaviour, and offers advantages over existing pen-and-paper questionnaires.