COVID-19 and the selection problem in national cause-of-death statistics.

The World Health Organization has issued international instructions for certification and classification (coding) of the coronavirus disease (COVID-19) as cause of death. Central to these instructions is the selection of the underlying cause of death for a public health preventive purpose. This article focuses on two rules for this selection: (1) that a death due to COVID-19 should be counted independently of pre-existing conditions that are suspected of triggering a severe course of COVID-19 and (2) that COVID-19 should not be considered as due to anything else. The article argues that observance of the first rule may not always lead to an optimal selection from a preventive point of view and that in the future the ascertainment of an animal source of the coronavirus (SARS-CoV-2) would make it possible to reconceptualize 'COVID-19' and create a zoonotic classification code by means of which a factor of a greater preventive value could be selected than what is currently possible.

Evolution of the neural basis of consciousness: a bird-mammal comparison.

The main objective of this essay is to validate some of the principal, currently competing, mammalian consciousness-brain theories by comparing these theories with data on both cognitive abilities and brain organization in birds. Our argument is that, given that multiple complex cognitive functions are correlated with presumed consciousness in mammals, this correlation holds for birds as well. Thus, the neuroanatomical features of the forebrain common to both birds and mammals may be those that are crucial to the generation of both complex cognition and consciousness. The general conclusion is that most of the consciousness-brain theories appear to be valid for the avian brain. Even though some specific homologies are unresolved, most of the critical structures presumed necessary for consciousness in mammalian brains have clear homologues in avian brains. Furthermore, considering the fact that the reptile-bird brain transition shows more structural continuity than the stem amniote-mammalian transition, the line drawn at the origin of mammals for consciousness by several of the theorists seems questionable. An equally important point is that consciousness cannot be ruled out in the absence of complex cognition; it may in fact be the case that consciousness is a necessary prerequisite for complex cognition.

Health and evolution.

Darwinian medicine may shed new light on the notion of health and many current health problems. In this paper, health, as an ability to realize one's own welfare, is compared with health as an ability--either being developed or actually present--to perform a reproductive function of one's species. It is argued that knowledge about the conditions for health in the latter sense may enhance our efforts to promote health in the former sense.

Credit for discoveries: citation data as a basis for history of science analysis.

Citation data have become an increasingly significant source of information for historians, sociologists, and other researchers studying the evolution of science. In the past few decades elaborate methodologies have been developed for the use of citation data in the study of the modern history of science. This article focuses on how citation indexes make it possible to trace the background and development of discoveries as well as to assess the credit that publishing scientists assign to particular discoverers. Kuhn's notion of discovery is discussed. The priority dispute over the discovery of the AIDS virus is used as an example.

Why is prevention so difficult and slow?

The abundance of perceived 'possibilities' for prevention contrasts sharply with the difficulties that face preventive programmes. We argue that this situation has emerged from an incomplete understanding of the process of prevention, involving a mixture of biological factors, human decision making and time perspectives. Based on examples, an analysis of the factors in the prevention process is presented.

Consciousness and biological evolution.

It has been suggested that if the preservation and development of consciousness in the biological evolution is a result of natural selection, it is plausible that consciousness not only has been influenced by neural processes, but has had a survival value itself; and it could only have had this, if it had also been efficacious. This argument for mind-brain interaction is examined, both as the argument has been developed by William James and Karl Popper and as it has been discussed by C.D. Broad. The problem of identifying mental phenomena with certain neural phenomena is also addressed. The main conclusion of the analysis is that an explanation of the evolution of consciousness in Darwinian terms of natural selection does not rule out that consciousness may have evolved as a mere causally inert effect of the evolution of the nervous system, or that mental phenomena are identical with certain neural phenomena. However, the interactionistic theory still seems, more plausible and more fruitful for other reasons brought up in the discussion.

Mind as a force field: comments on a new interactionistic hypothesis.

The survival and development of consciousness in biological evolution call for an explanation. An interactionistic mind-brain theory seems to have the greatest explanatory value in this context. An interpretation of an interactionistic hypothesis, recently proposed by Karl Popper, is discussed both theoretically and based on recent experimental data. In the interpretation, the distinction between the conscious mind and the brain is seen as a division into what is subjective and what is objective, and not as an ontological distinction between something immaterial and something material. The interactionistic hypothesis is based on similarities between minds and physical forces. The conscious mind is understood to interact with randomly spontaneous spatio-temporal patterns of action potentials through an electromagnetic field. Consequences and suggestions for future studies are discussed.

Multiple cause-of-death data as a tool for detecting artificial trends in the underlying cause statistics: a methodological study.

The aims of the study were: (i) to identify trends in the underlying cause-of-death statistics that are due to changes in the coders' selection and coding of causes, and (ii) to identify changes in the coders' documented registration principles that can explain the observed trends in the statistics. 31 Basic Tabulation List categories from the Swedish national cause-of-death register for 1970-1988 were studied. The coders' tendency to register a condition as the underlying cause of death (the underlying cause ratio) was estimated by dividing the occurrence of the condition as underlying cause (the underlying cause rate) with the total registration of the condition (the multiple cause rate). When the development of the underlying cause rate series followed more closely the underlying cause ratio series than the multiple cause rate series, and a corresponding change in the registration rules could be found, the underlying cause rate trend was concluded to be due to changes in the coders' tendency to register the condition. For thirteen categories (fourteen trends), the trends could be explained by changes in the coders' interpretation practice: five upward, four insignificant, and five downward trends. In addition, for three categories the trends could be explained by new explicit ICD-9 rules.

A discussion of the mind-brain problem.

In this paper Popper formulates and discusses a new aspect of the theory of mind. This theory is partly based on his earlier developed interactionistic theory. It takes as its point of departure the observation that mind and physical forces have several properties in common, at least the following six: both are (i) located, (ii) unextended, (iii) incorporeal, (iv) capable of acting on bodies, (v) dependent upon body, (vi) capable of being influenced by bodies. Other properties such as intensity and extension in time may be added. It is argued that a fuller understanding of the nature of forces is essential for the analysis of the mind-brain problem. The relative autonomy and indeterministic nature of mind is stressed. Indeterminism is treated in relation to a theorem of Hadamard. The computer theory of mind and the Turing test are criticized. Finally the evolution of mind is discussed.

The Mediterranean Osteoporosis Study (MEDOS): theoretical and practical issues of a major international project on hip fracture epidemiology.

The Mediterranean Osteoporosis Study (MEDOS), a multicentre study on incidence, risk factors, and means of prevention of hip fracture in the Mediterranean region, started in 1986 and involved 14 centres, in Portugal, Spain, France, Italy, Greece, and Turkey. The project comprised three parts: a) a collection of existing register data on hip fracture occurrence from the 31 European ministries of health; b) a study of hip fracture incidence in the defined areas of the participating centres in the Mediterranean countries in age groups above 50 years; c) a case-control study comparing 8,185 individuals (2,816 cases and 5,369 controls; two controls per case). The structure of the project and its development is described. Methodological issues involving questions of reliability and validity are discussed. A number of measures were taken in order to obtain a high quality study, e.g., retranslations of the questionnaire of the case-control study, a separate reliability study of the interviewers' performance and uniformity, and a systematic tracing and estimation of the impact of errors in the data processing procedure. The complexity of the management process and the importance of effective communication on methodological issues are underlined.

The WHO principles for registering causes of death: suggestions for improvement.

In the ongoing 10th revision of the International Classification of Diseases, the WHO's rules for registering causes of death are revised. Previous studies have shown that deficiencies in the WHO's rules and basic concepts for registering causes of death impair the quality of cause-of-death statistics. The purpose of the present paper is to elucidate some of these shortcomings and to make suggestions for improvement. Also, the purpose of the WHO's definition of 'the underlying cause of death' is discussed, and a modification suggested. Suggestions are also made for new definitions of the four basic WHO concepts, 'causes of death', 'the underlying cause of death', 'direct cause' and 'contributory conditions'. At the end an account is given of the proposals made within the WHO for changes in the rules for registering causes of death.