The key features of the cold debrief should: Be held within six weeks of the outbreak cardizem 60mg overnight delivery heart attack in spanish. Public health units/agencies generic cardizem 120 mg line blood pressure levels low too low, followed by representatives contributing to a debrief of government agencies at a national level 12 discount cardizem 180 mg on-line blood pressure position. Pre-Debrief Planning The following actions should take place to prepare for debriefing: Send invitations to all those involved Confirm attendees and set the length of the debrief depending on the number attending Confirm venue and set-up (around a table (preferable if numbers permit), seats in rows (if large group)) Create an agenda Create a feedback template Email debrief feedback template to all participants prior to the debrief meeting for completion and to formulate their thoughts and to handover for collation. Debrief Ground Rules It is important to set ground rules when undertaking a debriefing session to ensure the process and environment are safe for all participants and encourage active participation from all. Key features include: Conducting the debriefing openly and honestly Don’t interrupt other people as each person is entitled to their own opinion If the issue has already been identified there is no need to return to it No one person should monopolise the debriefing Be about organisational understanding and learning Be consistent with professional responsibilities Respect the rights of individuals Value equally all those concerned Be about learning not assigning blame. Debrief Agenda A successful debrief needs to be structured to make the most of the participants’ time and experiences. It is best to start with the positives, move on to what might have been done better and conclude with positive take home messages. Recommendations and Action Points Dealing with the output from a debrief should include the following: The minute taker should compete the minutes within 24-48 hours of the debrief and forward to the Incident Controller. Further Information Further information on Organisational Debriefing is contained in the Ministry of Civil Defence and Emergency Management ‘Organisational Debriefing’ document which can be accessed at the following link: http://www. Documentation of outbreaks and investigations High quality, comprehensive documentation of all recognised outbreaks is essential for any disease surveillance system because: national collection of outbreak data facilitates the recognition of relationships between events occurring in different areas of the country, such as the identification of widely dispersed outbreaks the reports can be used to convince health professionals and the public of the need for preventive measures documentation of outbreaks may be used to evaluate and improve prevention strategies it is rarely, if ever, possible to identify risk factors for disease from single, sporadic cases. Almost all risk factors are identified from investigations of outbreaks or groups of cases understanding of emerging diseases may be improved, especially modes of transmission and risk factors reports can be used as teaching aids for diseases and outbreak investigation, including identifying how future outbreak investigations may be improved outbreak investigations are generally improved through the discipline of systematic and comprehensive documentation local and national statistics on outbreak occurrence can more readily be compiled when a uniform approach to their recording is used it may be necessary for the fulfilment of international reporting requirements, especially if the disease is one where eradication is expected. Whether both levels occur in a particular investigation will depend on the extent of the outbreak and its investigation. Routine outbreak documentation Document preliminary and final outbreak data onto the Outbreak Report Form included in EpiSurv, the national notifiable disease database. Use the outbreak number assigned by EpiSurv for all food, water and other environmental samples submitted to the laboratory for analysis. The Outbreak Report Form in EpiSurv should be updated periodically as the investigation progresses. Completed Outbreak Report Forms are also used in the production of local and national statistics on outbreak occurrence, including causal agents, modes of transmission and risk factors. Level two documentation: the Outbreak Investigation Report A higher level of detail about the investigation can be documented in a formal Outbreak Investigation Report. These reports record the full details of the methods, results, discussion and recommendations from the outbreak investigation in a form suitable for wider distribution and possible publication. Preparation and dissemination of an Outbreak Investigation Report ensures that the investigation process is open for peer review, and that the findings can have an impact beyond the local circumstances. Outbreak Investigation Reports can be circulated directly among other agencies, or disseminated using pre-existing communication networks such as FoodNet, OzFoodNet and the New Zealand equivalent, http://www. Please attach a copy of all Outbreak Investigation Reports to the EpiSurv record so that details can be included in the monthly surveillance report and considered for inclusion in the New Zealand Public Health Surveillance Report. Coordinated outbreak control plans with detailed check lists whilst ideal have not been considered as being essential in the local situation. Conclusion This guidelines document presents a unified framework for outbreak management in New Zealand. The document builds substantially on previous sets of guidelines by adding sections on environmental and laboratory aspects of outbreak investigation to the section on epidemiology, and by describing outbreak management (control, communication and documentation). As such, the document encompasses the entire range of outbreak response activities. The title of the document has been changed to reflect more closely its particular focus on food- and water- borne outbreaks. The guidelines document also shows that the interrelationships between the different components of outbreak management do not necessarily occur in a linear and progressive sequence. Outbreak management must be adapted to the circumstances of each outbreak as it emerges. It is important to adopt a flexible approach to outbreak management, and the document is therefore presented as a series of independent modules that do not necessarily have to be conducted in sequence during an outbreak investigation. Modification of this document is expected over time in response to comments by users. We expect the web-based version of this document to facilitate future revisions, updates and amendments in a timely and ordered manner. We hope that this updated document continues to contribute to improved outbreak management in New Zealand. Investigating Clusters of Non-Communicable Disease: guidelines for public health services. Consumer attitudes and behaviours - key risk factors in an outbreak of Salmonella Typhimurium phage type 12 infection sourced to chicken nuggets. An international outbreak of Salmonella enteritidis associated with lasagne; lessons on the need for cross-national co-operation in investigating food-borne outbreaks. Retrospective cohort study of an outbreak of cryptosporidiosis caused by a rare Cryptosporidium parvum subgenotype. A New Zealand outbreak of norovirus gastroenteritis linked to the consumption of imported raw Korean oysters. An outbreak of Salmonella Typhimurium phage type 1 associated with watermelon in Gisborne, January 2009 http://journal. Gastroenteritis Outbreak Caused by Waterborne Norovirus at a New Zealand Ski Resort, July 2006. Smith D; Pink R, Mitchell P, Community and Public Health: Measles outbreak in Canterbury 2009: http://www. A guide to health impact assessment: guidelines for public health services and resource management agencies and consent applications. A pseudo-outbreak of Aureobasidium species lower respiratory tract infections caused by reuse of single-use stopcocks during bronchoscopy. Salmonellosis associated with marijuana: a multistate outbreak traced by plasmid fingerprinting. The epidemiologic field investigation: science and judgement in public health practice. Outbreak of salmonellosis after a wedding party, Bavaria, Germany, summer 2010: The importance of implementing food safety concepts. Adlam B, Perera S, Lake R, Gallagher L, Bhattacharya A: Recruiting community controls. Krumkamp R, Reintjes R, Dirksen-Fischer M: Case-case study of a Salmonella outbreak: An epidemiologic method to analyse surveillance data. Case-case analysis of enteric diseases with routine surveillance data: Potential use and example results. Draft 2005 guidelines available on Guidelines for Drinking-water Quality Management for New Zealand http://www. Outbreak of Salmonella serotype Hartford infections associated with unpasteurised orange juice. A foodborne outbreak of gastroenteritis associated with Norovirus: first molecular trace-back to deli sandwiches contaminated during preparation. Review on aberrant disease detection, referral, prioritisation, investigation, reporting, and management processes in New Zealand (unpublished draft; January 2008)67 68.
Additionally purchase cardizem 120mg with mastercard arteria jugularis interna, if consultants work in groups buy cardizem 120mg amex blood pressure 160100, a greater proportion of income could be allocated to the most senior team member discount 180mg cardizem with visa arteria princeps pollicis, who is more likely to be a male. Firth-Cozens (2008a, 2008b) noted, however, that the increased incidence of discipline 58 and litigation among male doctors could offset these differences with regard to financial concerns. Although women often excel compared to men in areas related to developing strong doctor-patient relationships (Firth-Cozens, 2008b), this advantage does not necessarily translate to increased value. Nicoletti (2006) reported research indicating that, although patients claim to value strong doctor-patient relationships, they are often unwilling to pay more or drive further to visit doctors with whom they could develop such relationships. Nicoletti noted, however, that the existing research studying doctor- patient relationships from an economic perspective is insufficient. The Culture of the Medical Profession Beyond medical education and practical economic concerns, the prevailing culture of the medical profession continues to encourage the attitudes that characterize ineffective communication between physicians and their patients. Patients who refused the medical professionals’ advice were described as “difficult” and “insistent. In addition, it has been argued that the medical profession encourages a normative, gendered view of illness, which results in a perceived need for women to work harder in order to be perceived as credible patients (Werner & Malterud, 2003). The gendered view of illness is exemplified by Kempner’s (2003) discussion of the common perception of migraine as a women’s illness, which is due in part to the higher incidence of migraine among females. The author reviewed evidence suggesting that gendering migraine has a significant impact on health and doctor-patient relationships. Diagnosis rates and the perception of the legitimacy of migraine complaints among female and male patients are affected. Munch (2004) noted that many such gender biases in diagnoses were uncovered by second-wave feminist research between 1970 and 1995. The cultural marginalization of women in healthcare extends not only to female patients, but to female doctors and nurses, as well. Due to women’s history of oppression and the nature of medical training, it is not uncommon for women entering medical professions to maintain patriarchal attitudes (Carter, 1994). According to Carter, there are “unspoken rules of communication” between nurses, who are primarily female, and physicians (p. These rules require nurses to refrain from disagreeing with physicians and place a low value on nurses’ suggestions. However, it is not clear that 60 gender bias accounts for all interactions between nurses and physicians. In a survey- based study of 125 nurses, Rothstein and Hannum (2007) found that nurses had similar perceptions of female and male physicians with whom they interacted, suggesting that professional differences play a role in addition to gender differences. Kilminster, Downes, Gough, Murdoch-Eaton, and Roberts (2007) pointed out that gender bias in research may contribute to the uncertainty regarding women’s place in the medical field and the effect of changes in gender composition within the field. In an extensive review of literature related to women in medicine, the authors found little strong evidence of gender differences in practical areas of healthcare. Instead, gender expectations in education and clinical practice were found to have a larger effect. The researchers concluded that there has been very little research specifically focusing on male doctors. Research practices are already gendered, treating women as the subject to be examined. For example, Munch (2004) conducted a review of literature related to second-wave feminist approaches to diagnoses from 1970 to 1995. The review revealed that feminist perspectives were instrumental in uncovering a number of areas where gender bias problematically affects women’s healthcare. Gender awareness in research, therefore, may be important in uncovering areas in which the culture of the medical profession marginalizes women. According to Chrisler (2001), the culture of the medical profession is not supportive of chronic illness, as evidenced by the belief among physicians that, for example, women over-report pain, and that vague symptoms are unworthy of serious consideration. Instead of crediting patients’ reports about their conditions, medical professionals tend to focus on acute conditions and verifiable complaints. Martin and Peterson (2009) defined chronic illness as “a state or passage of care for long-term pain and suffering that may not be cured” (p. These authors discussed the social context of chronic illness from a constructionist perspective. Perhaps more than other medical complaints, chronic illnesses require a highly personal process of meaning construction. According to the authors, proper management of illness involves active interpretation, not “simple biomedical labeling” (p. Although doctors may provide interpretations of chronic illness, biomedical interpretations cannot help patients understand and experience the illness and long-term treatment. Additionally, the culture of the medical profession may encourage patients to withhold details of their experiences of chronic illness from physicians in order to avoid being judged as complaining. Even when medical professionals do take patients’ experiences into account, there is evidence suggesting that they interpret experiences according to rigid models. Thelford, Kralik, and Koch (2006) conducted a review of literature related to the view of patients with chronic illness as understood through the terms acceptance and denial. The 62 researchers found that medical professionals tend to place patient experiences within this framework, even when the experiences do not fit the framework. According to the authors, this tendency may affect patients’ understanding of their own experiences and cause them to internalize predefined labels in their self-understanding. This suggests that preconceptions and biases related to chronic illness may have a significant effect on learning to cope with chronic illness. The medical profession’s inability to address chronic illness in a meaningful way and to place little importance on chronic pain may interact with the marginalization of women, placing female patients with chronic illness and disability at risk of receiving inadequate treatment (Thomas, 2001). This underscores the impact that gender has in every area of the medical profession and its culture. Gender Differences in Communication With regard to conversation during medical consultations, evidence suggests that there is a significant disparity between the communication styles preferred by patients and those preferred by physicians. Platt (2008) reported some of this evidence, noting that doctors commonly complain about verbose patients who tell long stories when doctors ask questions. Additionally, Platt noted that doctors use their authority to encourage patients to communicate in the doctors’ preferred styles, resulting in patient 63 dissatisfaction. Doctor-patient relationships are affected by communication, and gender differences in communication styles could amplify these effects. Women’s communication patterns may be ill-suited to the logical structure of the diagnostic tree used by physicians. These differences in communication may present a persistent obstacle to effective communication between doctors and female patients. For example, Tannen’s (2007) study revealed that women use conversation to generate intimacy, whereas men use conversation to create or maintain their status in a group. These differences may influence how physicians and patients interact within a professional setting. For example, whereas men tend to describe their symptoms in a frank and confident manner, women often give generalized descriptions of their symptoms.
This situation might apply to common event or environmental outbreaks when people then disperse to different parts of New Zealand order cardizem canada blood pressure walmart, where they subsequently become ill purchase 60mg cardizem mastercard arrhythmia or dysrhythmia. This situation is most likely to occur with dispersed food- and water- borne outbreaks where the contaminated food or water is consumed in multiple places generic cardizem 120 mg otc arteria frontalis-. This approach is suggested as a means to assist health districts in responding to localised outbreaks with distributed cases. If a multi-district outbreak investigation is required, then the MoH will lead or coordinate this process. Once a decision had been made that a true multi-district outbreak is occurring, then the MoH may convene a national outbreak management team. The lead agency will manage the national investigation and the response, including chairing teleconferences, monitoring the situation at the national level, and developing and implementing any national response plans, including any nationally consistent communication messages that may be required. Improving the identification of disease outbreaks in New Zealand [unpublished report]. The epidemiologic field investigation: science and judgement in public health practice. Appendix 2: Questionnaire design and interview techniques Do not underestimate how long it takes to develop a good, thorough process for collecting information from subjects (cases or non-cases/controls) interviewed as part of the outbreak investigation. It is important to build the technological skill-base within the outbreak investigating agency so that the process runs smoothly. Appendix 2 gives a general overview of the principles of questionnaire design, and then presents a step-by-step process for developing tools and undertaking data collection. Questionnaire Design ‘Questionnaire’ in the context of outbreak investigation refers to any survey instrument used to collect information directly from participants, regardless of the information collection technique. It should be noted, however, that questionnaires administered by an interviewer are more correctly 1 termed interview schedules. At the outset when an outbreak is suspected, a hypothesis-generating questionnaire such as the “shotgun questionnaire” may be useful while to test a hypothesis an instrument modified from the template in Appendix 3 could be used. While it is usually possible to repeat statistical analysis if it is performed incorrectly, there is seldom a second chance to question all the subjects in an investigation. Whenever possible, investigators should save time and effort and make use of the experience of others by “borrowing”, wholly or in part, questionnaires that have been useful in previous investigations. Only structured questionnaires, where all subjects are asked exactly the same questions, are likely to be of use in outbreak investigations. Unstructured questionnaires are useful for generating hypotheses from interviews conducted at the early stages of an investigation, but the information obtained from them is generally difficult to quantify for the descriptive or analytic stages of the investigation. If it is necessary to construct a questionnaire from scratch or modify the questions in an existing document, use the following questionnaire design framework and principles. Variable components Potential exclusion criteria (these would normally be applied before the interview starts or early in the interview). Principles of questionnaire development Use questions from other outbreak questionnaires. In comparison, open questions allow any response, and it may be difficult to understand the participant’s exact meaning at a later date. For example, an open-ended question enquiring about a drinking-water source could be: From where do you obtain water for drinking? Bottled drinking-water Yes No Usual town supply Yes No Tanker truck water Yes No Private bore water Yes No Other water Yes No If other, please specify_______________________________ With the open-ended question, a response of “tap” would not allow the investigator to distinguish whether this really means town supply, private bore water or other water. Add an ‘other’ option to the list of answers, unless you are very confident that there are no other possible answers. When these instructions are necessary, they must be clear and easy to see, and the point at which questions resume must be obvious. Questionnaire formatting Questionnaire formatting is an essential step in order to avoid ambiguity and obtain accurate information. Write the number of times a week, or 99 for “don’t know” _____ times If unexpected problems arise with any questions or any aspect of the questionnaire, these should be documented fully in the outbreak report so that they can be avoided in future investigations. Questionnaire pre-testing Questionnaire pre-testing should be balanced against the need to rapidly develop an interview tool to begin the investigation. Optimally, pre-testing should include at least a detailed desk review and a limited number of practice interviews. The practice interviews should examine the questionnaire for clarity of wording and identification of ambiguities and misunderstandings. The pilot allows the questionnaire content, wording and instructions to be tested in a realistic setting using typical interviewers. Standardised interview introduction The preamble to the interview should be pre-scripted as much as possible to standardise information collection. It will be important to pre-test the interview introduction to ensure that it reads in a professional but relaxed style and builds a rapport with the participant. It is important that the introduction provides complete information about the aims and methods of the study and establishes the credibility and responsibility of the investigator. This material has been adapted from the guidelines for the preparation of information sheets, contained in the guidelines for completion 2 of the national application form for ethical approval of a research project , developed by the Health Research Council. This may duplicate the introductory statement read as part of the protocol for control recruitment (see page 48). State that the information collected will only be used for the purposes of the investigation and will be kept confidential. Include a statement with wording such as: “No material which could personally identify you will be used in any reports on this study. Appropriate wording may be: “Your participation is entirely voluntary (your choice). You do not have to take part in this study”, and, “You do not have to answer all the questions, and you may stop the interview at any time. Principles of Interviewing Outbreak investigation questionnaires are usually administered to the subject by an interviewer, either face-to-face or by telephone. English as second language) More timely Thelephone Less costly than face-to-face Lower response rates than face-to- interviews face Higher response rates than mailed Shorter questionnaires used Even more timely Unable to capture important visual Can collect more sensitive information (e. The advantages of this approach over postal or self- administered questionnaires are that the interviewer can ensure the completeness and quality of the recorded responses. Other advantages over postal or self-administered questionnaires include a superior participation rate and the opportunity for the education of subjects following completion of data collection. The style of interview required for analytic epidemiological studies is somewhat different to the more relaxed style that may be used when interviewing apparently sporadic cases. In the analytic study, all interviews are carried out in an identical, highly structured manner, using a standard questionnaire. It is, however, unethical to ignore requests for advice or to disregard proffered information about other people who may be at risk.
For countries with Pertussis cases and deaths were based on a natural history epidemics concentrated in high-risk groups cheap cardizem 60 mg otc blood pressure chart download excel, they used model using vaccine coverage and age-speciﬁc case fatality prevalence estimates derived from the estimated population rates from community based studies generic cardizem 180 mg mastercard heart attack reasons, where available size and prevalence surveillance data in each high-risk cate- (Crowcroft and others 2003) generic 120mg cardizem with visa pulse pressure 80 mmhg. The model is a revision of gory, and then employed simple models to back-calculate Galezka and Robertson’s (2004) approach. For countries with usable death reg- ﬁrmed earlier ﬁndings that the proportion of deaths attrib- istration data, deaths due to diarrheal diseases were esti- utable to acute respiratory infections diminishes as general mated directly from that data. Much of the variability across studies regression model was used to estimate proportional mor- in the proportion of child deaths attributed to acute respi- tality from diarrhea for children under ﬁve (Boschi-Pinto ratory infections was due to the use of verbal autopsies to and others forthcoming). The regression data were drawn tics from developing countries where coverage was high to from more than 60 community-based studies carried out develop regional and global estimates. The Burden of Disease and Mortality by Condition: Data, Methods, and Results for 2001 | 63 Malaria. For Sub-Saharan Africa, Abortion-related mortality occurs mainly as a result of country-speciﬁc estimates of malaria mortality were based unsafe induced abortion. Subsequent adjustments were made to the estimated country-speciﬁc malaria deaths to ensure that Perinatal Causes. Work is currently under way to reﬁne and revise these some maternal or placental causes, such as multiple preg- country-speciﬁc estimates of malaria mortality in collabo- nancy. However, acknowledging that nearly all deaths due to perinatal causes Chagas’ Disease. Chagas’ disease estimates were obtained occur during the neonatal period, we ﬁrst estimated the from recent intensive surveillance activities in the Southern envelope of neonatal mortality for every country (for details Cone American countries and community-based studies of the method see Murray and Lopez 1998). Mortality from maternal conditions was estimated following a similar approach to earlier Cancer. Depending age-period-cohort model of cancer survival was based on on the availability and quality of data on detailed causes of data from the Surveillance, Epidemiology, and End Results maternal deaths, the methods used to estimate the propor- program of the National Cancer Institute (Ries and others tion of deaths of women of reproductive age that is due to 2002). Combined with available inci- speciﬁc criteria for a regression model were used to estimate dence data from the International Agency for Research on maternal mortality. This category includes dependence maternal causes for each country was estimated by multi- on and nondependent problem use of both licit and illicit 64 | Global Burden of Disease and Risk Factors | Colin D. This report was a preferred source some regions with a substantial prevalence of illicit drug of information, because it includes war deaths by country use, available data sources do not record any deaths as due and year, a departure from the typical practice of supplying to drug dependence. The report’s data were rect estimates based on estimates of the prevalence of illicit checked against historical and current estimates by other drug use and of case fatality rates, on the assumption that research groups, such as those of the Uppsala Conﬂict Data almost all mortality directly attributable to drug use disor- Project (Gleditsch and others 2002) and the Center for ders is associated with illicit drugs. However, making even International Development and Conﬂict Management at indirect estimates is difﬁcult because the use of these drugs the University of Maryland (Marshall and Gurr 2003). Murray, King, direct mortality based on available data (Degenhardt and and others (2002) summarize the issues involved in estimat- others 2003; Ezzati and others 2002). Many of the range of sources, including a formal literature search of all available data sources on conﬂict deaths only count deaths studies that estimated the prevalence of problematic drug in conﬂicts that involve the armed forces of at least one state use, the United Nations Drug Control Program, and the or one or more armed factions seeking to gain control of all European Monitoring Centre for Drugs and Drug or part of the state, and in which more than a certain num- Addiction (2002). Some sources count only users that had estimated mortality due to individual causes battlefield deaths and deaths that occur concurrently of death (overdose, suicide, and trauma) and to all causes of with conﬂict. They data, evidence suggests that deaths due to drug use disorders also included deaths due to terrorism carried out by organ- are underrecorded (European Monitoring Centre for Drugs ized groups. For these include deaths from other causes, such as starvation, infec- countries, mortality ﬁgures were adjusted for age groups in tious disease epidemics, or lack of medical intervention for which the estimated deaths derived from the comparative chronic diseases, that may be counterfactually attributable risk assessment analysis exceeded the number of deaths to war or civil conﬂict. Country-speciﬁc estimates of war deaths and Watch 2001) and Handicap International’s annual report on corresponding uncertainty ranges were obtained from a landmine victims (Handicap International 2001). The Armed Whereas total injury deaths for most countries were Conﬂict Report (Project Ploughshares 2001, 2002), a report derived either from death registration data or from cause of The Burden of Disease and Mortality by Condition: Data, Methods, and Results for 2001 | 65 death models, war deaths were treated as “outside the enve- due to biases in the data sets available to estimate national lope,” and for countries for which life tables were estimated mortality patterns, for example, if data are derived from from data for earlier years not affected by war, war deaths urban hospital statistics. The statistical basis for cause of death models has also been enhanced by the adap- Cause of Death Modeling for Countries with Poor Data tation of models for compositional data that were pre- Although epidemiological studies and other data sources viously developed in other areas (Katz and King 1999). Preston modeled the analysis of the epidemiological transition, see Salomon and relationship between total mortality and cause-speciﬁc mor- Murray 2002a). The log of cause-speciﬁc variables that were selected based on these criteria were all- mortality was postulated to be a linear function of the log of cause mortality, as before, plus income per capita in inter- total mortality, and poorly coded deaths were redistributed national dollars. Both variables were included in logged before estimating the regression equations. The statistical model has been improved by sex, and cause than previous efforts, with substantially more adapting models for compositional data that were previously representation of middle-income countries. Increasing developed in other areas, and a substantially larger data set the range of observed cause of death patterns should of 1,613 country-years of observations was used for analysis. For the 2001, and describes its application for estimating (a) broad two youngest age groups, a smaller number of observations cause patterns for populations where no cause of death were available because some countries for some periods information is available, and (b) broad cause of death pat- reported only on the age range from birth to 11 months. This hypothesis builds on the notion income per capita (Salomon and Murray 2002a). The results from this approach were use- based only on total mortality and income because other fac- ful in estimating cause of death patterns for residual areas in tors inﬂuence the pattern. Using similar arguments, Salomon and Murray (2001a) Application of CodMod for Countries without Good suggested that it may be possible to use patterns of deviation Registration Data. They terns of deviation from the expected cause composition demonstrated an example of this for mortality data from across countries or regions based on the probability distri- Chile and Mexico for women aged 35 to 39 for 1965–94. In other They estimated the percentiles at which the observed cause words, the models permit comparison of the observed pat- fractions for the two countries fell in the probability distri- tern with the pattern that would be predicted conditional on bution of predicted fractions produced by the Monte Carlo the levels of all-cause mortality and income per capita asso- simulations conditional on the mortality and income levels ciated with that observation. Overall, this example suggested that tern of deviation over short time intervals within a country deviation patterns in groups of similar countries may be or across countries in the same mortality stratum, it is pos- similar, allowing predictions of cause of death patterns in sible to use the observed cause of death pattern in a refer- countries where registration data are not available but for ence population to estimate the cause of death pattern for which neighboring countries do have data. Some examples of applications simple spreadsheet program called CodMod (Salomon and would be Murray 2001a). Note that as described earlier, the CodMod was also used to develop regional patterns of results reported here are tabulated by underlying disease deviation from predicted cause compositions, which were cause or external cause of injury. Total attributable deaths then used to estimate mortality by broad causes for countries for some diseases that increase the risk of other diseases or for which no registration data were available. Chapter 4 estimates deaths attrib- the case of the Sub-Saharan Africa region, where good utable to 26 global risk factors. For other countries in that region, regional models were based on weighted death rates using Egyptian Worldwide, one death in every three is from a Group I cause. For the Paciﬁc islands, a regional pattern was 2 percent of Group I deaths in 1990, it accounted for 44 per- based on data available from islands reporting death regis- cent of Group I deaths in 2001. Virtually all the Group I cause of death model for 12 causes of death to estimate deaths are in low- and middle-income countries. Of these child deaths, 99 percent occurred Group I 36% in low- and middle-income countries. Those age 70 and over accounted for 70 percent of deaths in high-income countries, compared with 30 percent in other countries. In these countries, 30 percent of 54% 87% all deaths occur at ages 15 to 59, compared with 15 percent Source: Authors’ calculations. The causes of death at these ages, as well as in childhood, are thus important in assessing Figure 3. Murray Children (ages 0–14) ulations with high mortality and low incomes than in the High-income countries high-income countries.