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Sample records for 5-year mortality rates

  1. 5-year mortality in hemodialysis patients: a single center study in Tripoli.

    PubMed

    Buargub, Mahdia A

    2008-03-01

    To investigate the 5-year mortality of patients undergoing maintenance hemo-dialysis (HD) at Al-Shat center Tripoli, we reviewed during June 2007 the records of all the HD patients initiated on HD from Jun 2000 and Jan 2002. There were 124 patients in the study, 77 males (63.6%) and 47 (36.4%) females, with a mean age of 49 +/- 14 years. Diabetic nephropathy (DN) was the underlying kidney disease in 34 (27.4%) patients. After 5 years; 3 patients were transferred to other centers, 18 (14.9%) patients underwent kidney transplan-tation. Out of the 103 patients who continued on hemodialysis, 53 (51.4%) expired during the 5-year follow-up. Mortality was associated with older age (p 50 years) and DN (p< 0.002 and OR of 3.9). Mortality rate in diabetics was 74.1% and significantly associated with male sex (p< 0.0067 and OR of 2.4), older age (p< 0.004), presence of hypertension (p< 0.003 and OR of 3.9), type 1 diabetes (OR 1.6), and elevated mean body weight (p< 0.046). Mortality was also relatively higher in black patients (OR of 2.0) and smokers (OR of 1.39). In conclusion, the overall 5- year mortality for dialysis patients was elevated and higher in the diabetics. PMID:18310882

  2. Vitamin A deficiency and attributable mortality among under-5-year-olds.

    PubMed Central

    Humphrey, J. H.; West, K. P.; Sommer, A.

    1992-01-01

    Reported are estimates of the prevalence in developing countries of physiologically significant vitamin A deficiency and the number of attributable deaths. The WHO classification of countries by the severity and extent of xerophthalmia was used to categorize developing countries by likely risk of subclinical vitamin A deficiency. Using vital statistics compiled by UNICEF, we derived population figures and mortality rates for under-5-year-olds. The findings of vitamin A supplementation trials were applied to populations at-risk of endemic vitamin A deficiency to estimate the potential impact of improved vitamin A nutriture in reducing mortality during preschool years. Worldwide, over 124 million children are estimated to be vitamin A deficient. Improved vitamin A nutriture would be expected to prevent approximately 1-2 million deaths annually among children aged 1-4 years. An additional 0.25-0.5 million deaths may be averted if improved vitamin A nutriture can be achieved during the latter half of infancy. Improved vitamin A nutriture alone could prevent 1.3-2.5 million of the nearly 8 million late infancy and preschool-age child deaths that occur each year in the highest-risk developing countries. PMID:1600583

  3. Soil bacterial community structure remains stable over a 5-year chronosequence of insect-induced tree mortality

    PubMed Central

    Ferrenberg, Scott; Knelman, Joseph E.; Jones, Jennifer M.; Beals, Stower C.; Bowman, William D.; Nemergut, Diana R.

    2014-01-01

    Extensive tree mortality from insect epidemics has raised concern over possible effects on soil biogeochemical processes. Yet despite the importance of microbes in nutrient cycling, how soil bacterial communities respond to insect-induced tree mortality is largely unknown. We examined soil bacterial community structure (via 16S rRNA gene pyrosequencing) and community assembly processes (via null deviation analysis) along a 5-year chronosequence (substituting space for time) of bark beetle-induced tree mortality in the southern Rocky Mountains, USA. We also measured microbial biomass and soil chemistry, and used in situ experiments to assess inorganic nitrogen mineralization rates. We found that bacterial community structure and assembly—which was strongly influenced by stochastic processes—were largely unaffected by tree mortality despite increased soil ammonium (NH4+) pools and reductions in soil nitrate (NO3−) pools and net nitrogen mineralization rates after tree mortality. Linear models suggested that microbial biomass and bacterial phylogenetic diversity are significantly correlated with nitrogen mineralization rates of this forested ecosystem. However, given the overall resistance of the bacterial community to disturbance from tree mortality, soil nitrogen processes likely remained relatively stable following tree mortality when considered at larger spatial and longer temporal scales—a supposition supported by the majority of available studies regarding biogeochemical effects of bark beetle infestations in this region. Our results suggest that soil bacterial community resistance to disturbance helps to explain the relatively weak effects of insect-induced tree mortality on soil N and C pools reported across the Rocky Mountains, USA. PMID:25566204

  4. Soil bacterial community structure remains stable over a 5-year chronosequence of insect-induced tree mortality.

    PubMed

    Ferrenberg, Scott; Knelman, Joseph E; Jones, Jennifer M; Beals, Stower C; Bowman, William D; Nemergut, Diana R

    2014-01-01

    Extensive tree mortality from insect epidemics has raised concern over possible effects on soil biogeochemical processes. Yet despite the importance of microbes in nutrient cycling, how soil bacterial communities respond to insect-induced tree mortality is largely unknown. We examined soil bacterial community structure (via 16S rRNA gene pyrosequencing) and community assembly processes (via null deviation analysis) along a 5-year chronosequence (substituting space for time) of bark beetle-induced tree mortality in the southern Rocky Mountains, USA. We also measured microbial biomass and soil chemistry, and used in situ experiments to assess inorganic nitrogen mineralization rates. We found that bacterial community structure and assembly-which was strongly influenced by stochastic processes-were largely unaffected by tree mortality despite increased soil ammonium ([Formula: see text]) pools and reductions in soil nitrate ([Formula: see text]) pools and net nitrogen mineralization rates after tree mortality. Linear models suggested that microbial biomass and bacterial phylogenetic diversity are significantly correlated with nitrogen mineralization rates of this forested ecosystem. However, given the overall resistance of the bacterial community to disturbance from tree mortality, soil nitrogen processes likely remained relatively stable following tree mortality when considered at larger spatial and longer temporal scales-a supposition supported by the majority of available studies regarding biogeochemical effects of bark beetle infestations in this region. Our results suggest that soil bacterial community resistance to disturbance helps to explain the relatively weak effects of insect-induced tree mortality on soil N and C pools reported across the Rocky Mountains, USA. PMID:25566204

  5. Health transitions in sub-Saharan Africa: overview of mortality trends in children under 5 years old (1950-2000).

    PubMed Central

    Garenne, Michel; Gakusi, Enéas

    2006-01-01

    OBJECTIVE: To reconstruct and analyse mortality trends in children younger than 5 years in sub-Saharan Africa between 1950 and 2000. METHODS: We selected 66 Demographic and Health Surveys and World Fertility Surveys from 32 African countries for analysis. Death rates were calculated by yearly periods for each survey. When several surveys were available for the same country, overlapping years were combined. Country-specific time series were analysed to identify periods of monotonic trends, whether declining, steady or increasing. We tested changes in trends using a linear logistic model. FINDINGS: A quarter of the countries studied had monotonic declining mortality trends: i.e. a smooth health transition. Another quarter had long-term declines with some minor rises over short periods of time. Eight countries had periods of major increases in mortality due to political or economic crises, and in seven countries mortality stopped declining for several years. In eight other countries mortality has risen in recent years as a result of paediatric AIDS. Reconstructed levels and trends were compared with other estimates made by international organizations, usually based on indirect methods. CONCLUSION: Overall, major progress in child survival was achieved in sub-Saharan Africa during the second half of the twentieth century. However, transition has occurred more slowly than expected, with an average decline of 1.8% per year. Additionally, transition was chaotic in many countries. The main causes of mortality increase were political instability, serious economic downturns, and emerging diseases. PMID:16799731

  6. [Mortality in children under 5 years of age in families of marginal settlements in Guadalajara].

    PubMed

    Nápoles-Rodríguez, F; Vásquez-Garibay, E M; Romero-Velarde, E

    1991-09-01

    The purpose was, to determine the frequency of infant mortality in the marginal areas of Guadalajara and, find its association with sociodemographic and economical factors, which are known as determinant of the nutritional status of children. There were included 898 families in a cross sectional design among children who applied to the food supplementation program of ONI of Guadalajara. Through an interview and home visit, it was obtained information about sociodemographic and economical characteristics and food habits. The data was recorded and analyzed by the Dbase III Plus and Epi-Info program. It was also used Chi square test and Odds Ratio for the statistical analysis. Education of the mother and income per capita for feeding (as a percentage of the minimum salary) had a significantly and inverse association with infant mortality (P less than 0.0001 and P less than 0.001 respectively). There was also major mortality among children with no social security (P less than 0.05). The Odds Ratio for infant mortality was of 3.02 for education of the father, 8.42 for education of the mother and 6.8 for income per capita for feeding. Meanwhile the level of education and the economical situation of the studied population remain so low, it seems improbable to decrease the rate of infant mortality. PMID:1777094

  7. Spiritual Peace Predicts 5-Year Mortality in Congestive Heart Failure Patients

    PubMed Central

    Park, Crystal L.; George, Login; Aldwin, Carolyn M.; Choun, Soyoung; Suresh, D. P.; Bliss, Deborah

    2015-01-01

    Objective Spirituality is favorably related to depression, quality of life, hospitalizations, and other important outcomes in congestive heart failure (CHF) patients but has not been examined as a predictor of mortality risk in this population. Given the well-known difficulties in managing CHF, we hypothesized that spirituality would be associated with lower mortality risk, controlling for baseline demographics, functional status, health behaviors, and religiousness. Method Participants were 191 CHF patients (64% male; Mage = 68.6 years, SD = 10.1) who completed a baseline survey and were then followed for five years. Results Nearly one third of the sample (32%) died during the study period. Controlling for demographics and health status, smoking more than doubled the risk of mortality, while alcohol consumption was associated with slightly lower risk of mortality. Importantly, adherence to healthy lifestyle recommendations was associated with halved mortality risk. While both religion and spirituality were associated with better health behaviors at baseline in bivariate analyses, a proportional hazard model showed that only spirituality was significantly associated with reduced mortality risk (by 20%), controlling for demographics, health status, and health behaviors. Conclusions Experiencing spiritual peace, along with adherence to a healthy lifestyle, were better predictors of mortality risk in this sample of CHF patients than were physical health indicators such as functional status and comorbidity. Future research might profitably examine the efficacy of attending to spiritual issues along with standard lifestyle interventions. PMID:26414488

  8. Mortality rates decline in Malaysia.

    PubMed

    1991-11-01

    Experiencing remarkable decreases in mortality rates over the past 3 decades, Malaysia currently has one of the lowest mortality rates among developing countries, a rate that compares favorably with those of developed countries. Between 1957 and 1989, the crude death rate dropped from 12.4/1000 population to 4.6. Over the same period, Malaysia recorded even greater decreases in the infant mortality rate, from 75.5/1000 births to 15.2. The Maternal mortality rate also declined from 1.48 in 1970 to 0.24 in 1988. The data indicates that mortality rates vary from state to state, and that rural areas have a higher mortality than urban areas. According to a study by the National Population and Family Development Board, the use of maternal and child health services has played an important role in reducing neonatal, perinatal, infant, child, and maternal mortality rates. Nearly all women in Malaysia receive antenatal services. While the country has achieved great gains on mortality rates, programs focusing on specific age and socioeconomic groups could lead to even greater reductions. The Minister for National Unity and Social Development, Dato Napsiah Omar, has called for the development of programs designed to improve the population's quality of life. PMID:12284509

  9. Migration, urbanisation and mortality: 5-year longitudinal analysis of the PERU MIGRANT study

    PubMed Central

    Pena, Melissa S Burroughs; Bernabé-Ortiz, Antonio; Carrillo-Larco, Rodrigo M; Sánchez, Juan F; Quispe, Renato; Pillay, Timesh D; Málaga, Germán; Gilman, Robert H; Smeeth, Liam; Miranda, J Jaime

    2015-01-01

    Objective To compare all-cause and cause-specific mortality among 3 distinct groups: within-country, rural-to-urban migrants, and rural and urban dwellers in a longitudinal cohort in Peru. Methods The PERU MIGRANT Study, a longitudinal cohort study, used an age-stratified and sex-stratified random sample of urban dwellers in a shanty town community in the capital city of Peru, rural dwellers in the Andes, and migrants from the Andes to the shanty town community. Participants underwent a questionnaire and anthropomorphic measurements at a baseline evaluation in 2007–2008 and at a follow-up visit in 2012–2013. Mortality was determined by death certificate or family interview. Results Of the 989 participants evaluated at baseline, 928 (94%) were evaluated at follow-up (mean age 48 years; 53% female). The mean follow-up time was 5.1 years, totalling 4732.8 person-years. In a multivariable survival model, and relative to urban dwellers, rural participants had lower all-cause mortality (HR=0.27; 95% CI 0.07 to 0.98), and both the rural (HR=0.07; 95% CI 0.01 to 0.87) and migrant (HR=0.13; 95% CI 0.02 to 0.81) groups had lower cardiovascular mortality. Conclusions Cardiovascular mortality of migrants remains similar to that of the rural group, suggesting that rural-to-urban migrants do not appear to catch up with urban mortality in spite of having a more urban cardiovascular risk factor profile. PMID:25987723

  10. Child Mortality Rate in Ethiopia

    PubMed Central

    Susuman, A Sathiya

    2012-01-01

    Ethiopia’s childhood mortality has continued to decline although at a swift pace. The drop in urban childhood mortality decline, duration of breastfeeding is the principle reason for the overall decline in mortality trends in Ethiopia. Data from the Ethiopian Demographic and Health Surveys 2000 and 2005 were used. Indirect estimation of Brass and Trussell’s methods were adopted. Selected demographic and socio-economic variables were included in the analysis with statistically significant effects. Findings clearly show neonatal and post neonatal mortality decline gradually. Even though, Ethiopia’s childhood mortality rates are still high. The result shows less than 2 years birth interval have higher infant mortality rates than higher birth interval (113 deaths per 1000). The proper spacing of births allows more time for childcare to make more maternal resources available for the care of the child and mother. Therefore, further research is urgent for regional level and national level investigation. PMID:23113145

  11. Epidemiology and mortality of burns in the Lucknow Region, India--a 5 year study.

    PubMed

    Kumar, Sachil; Ali, Wahid; Verma, Anoop K; Pandey, Abhishek; Rathore, Shiuli

    2013-12-01

    Nearly 95% of global burn deaths and disabilities are estimated to occur in low and middle income countries of the world. Burns are extremely common and are a major public health problem in a developing country like India. The purpose of this study was to record and evaluate the causes and the magnitude of the fatal burns retrospectively. An analysis of autopsy records revealed 2225 (10.7%) cases of burns among the total autopsies done over 5 years period (1st January 2008-27th November 2012) in the mortuary of Forensic Medicine & Toxicology, K.G.M.U., Lucknow. The majority of deaths (88.8%) occurred between 10 and 49 years of age group with a preponderance of females (87.5%). The flame burns were seen in 60.1% of the victims. The majority of burn incidents were suicidal (38.6%) in nature followed by accidental (37.3%) and homicidal (24.1%) deaths. The percentages of burns with a total body surface area (TBSA) over 50% were observed in most of the cases (82.5%). In most of the cases deaths occurred within a week (82%) and most of the victims died from septicaemia and pneumonia (43.7%) followed by neurogenic shock (28.5%). The results of this study provide the necessary information to implement programmes for health education relating to prevention of burns focusing on the domestic setting. PMID:23663899

  12. Relapse and Late Mortality in 5-Year Survivors of Myeloablative Allogeneic Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia in First Chronic Phase

    PubMed Central

    Goldman, John M.; Majhail, Navneet S.; Klein, John P.; Wang, Zhiwei; Sobocinski, Kathleen A.; Arora, Mukta; Horowitz, Mary M.; Rizzo, J. Douglas

    2010-01-01

    Purpose Allogeneic hematopoietic cell transplantation (HCT) is curative therapy for chronic myeloid leukemia (CML), but its long-term outcomes are not well described. We studied the long-term outcomes of CML patients in first chronic phase who receive an allogeneic HCT. Patients and Methods Our study included 2,444 patients who received myeloablative HCT for CML in first chronic phase between 1978 and 1998 and survived in continuous complete remission for at least 5 years (median follow-up, 11 years; range, 5 to 25 years). Donor sources were human leukocyte antigen–matched siblings in 1,692 patients, unrelated donors in 639 patients, and other related donors in 113 patients. Results Overall survival rates at 15 years were 88% (95% CI, 86% to 90%) for sibling HCT and 87% (95% CI, 83% to 90%) for unrelated donor HCT. Corresponding cumulative incidences of relapse were 8% (95% CI, 7% to 10%) and 2% (95% CI, 1% to 4%), respectively. The latest relapse was reported 18 years post-HCT. In multivariable analyses, history of chronic graft-versus-host disease increased risks of late overall mortality and nonrelapse mortality but reduced risks of relapse. In comparison with age-, race-, and sex-adjusted normal populations, the mortality of HCT recipients was significantly higher until 14 years post-HCT; thereafter, mortality rates were similar to those of the general population (relative mortality ratio at 15 years, 2.3; 95% CI, 0 to 4.9). Conclusion Recipients of allogeneic HCT for CML in first chronic phase who remain in remission for at least 5 years have favorable subsequent long-term survival, and their mortality rates eventually approach those of the general population. PMID:20212247

  13. Mortality differences between self-employed and paid employees: a 5-year follow-up study of the working population in Sweden

    PubMed Central

    Toivanen, Susanna; Griep, Rosane Härter; Mellner, Christin; Vinberg, Stig; Eloranta, Sandra

    2016-01-01

    Objectives Analyse mortality differences between self-employed and paid employees with a focus on industrial sector, educational level and gender using Swedish register data. Methods A cohort of the total working population (4 776 135 individuals; 7.2% self-employed; 18–100 years of age at baseline 2003) in Sweden with a 5-year follow-up (2004–2008) for all-cause and cause-specific mortality (57 743 deaths). Self-employed individuals were categorised as sole proprietors or limited liability company (LLC) owners according to their enterprise's legal form. Cox proportional hazards models were applied to compare mortality rates between sole proprietors, LLC owners and paid employees, adjusted for sociodemographic confounders. Results Mortality from cardiovascular diseases was 16% lower and from suicide 26% lower among LLC owners than among paid employees, adjusted for confounders. Within the industrial category, all-cause mortality was 13–15% lower among sole proprietors and LLC owners compared with employees in manufacturing and mining (MM) as well as personal and cultural services (PCS), and 11–20% higher in sole proprietors in trade, transport and communication and the welfare industry (W). A significant three-way interaction indicated 17–23% lower all-cause mortality among male LLC owners in MM and female sole proprietors in PCS, and 50% higher mortality in female sole proprietors in W than in employees in the same industries. Conclusions Mortality differences between self-employed individuals and paid employees vary by the legal form of self-employment, across industries, and by gender. Differences in work environment exposures and working conditions, varying market competition across industries and gender segregation in the labour market are potential mechanisms underlying these findings. PMID:27443155

  14. Causes of mortality and associated modifiable health care factors for children (< 5-years) admitted at Onandjokwe Hospital, Namibia

    PubMed Central

    Mdala, Johnface F.; Mash, Robert

    2015-01-01

    Introduction: Many countries, especially those from sub-Saharan Africa, are unlikely to reach the Millennium Development Goal for under-5 mortality reduction by 2015. This study aimed to identify the causes of mortality and associated modifiable health care factors for under-5 year-old children admitted to Onandjokwe Hospital, Namibia. Method: A descriptive retrospective review of the medical records of all children under five years who died in the hospital for the period of 12 months during 2013, using two different structured questionnaires targeting perinatal deaths and post-perinatal deaths respectively. Results: The top five causes of 125 perinatal deaths were prematurity 22 (17.6%), birth asphyxia 19 (15.2%), congenital anomalies 16 (12.8%), unknown 13 (10.4%) and abruptio placenta 11 (8.8%). The top five causes of 60 post-perinatal deaths were bacterial pneumonia 21 (35%), gastroenteritis 12 (20%), severe malnutrition 6 (10%), septicaemia 6 (10%), and tuberculosis 4 (6.7%). Sixty-nine (55%) perinatal deaths and 42 (70%) post-perinatal deaths were potentially avoidable. The modifiable factors were: late presentation to a health care facility, antenatal clinics not screening for danger signs, long distance referral, district hospitals not providing emergency obstetric care, poor monitoring of labour and admitted children in the wards, lack of screening for malnutrition, failure to repeat an HIV test in pregnant women in the third trimester or during breastfeeding, and a lack of review of the urgent results of critically ill children. Conclusion: A significant number of deaths in children under 5-years of age could be avoided by paying attention to the modifiable factors identified in this study. PMID:26245607

  15. Transcatheter Aortic Valve Implantation and Morbidity and Mortality-Related Factors: a 5-Year Experience in Brazil

    PubMed Central

    Souza, André Luiz Silveira; Salgado, Constantino González; Mourilhe-Rocha, Ricardo; Mesquita, Evandro Tinoco; Lima, Luciana Cristina Lima Correia; de Mattos, Nelson Durval Ferreira Gomes; Rabischoffsky, Arnaldo; Fagundes, Francisco Eduardo Sampaio; Colafranceschi, Alexandre Siciliano; Carvalho, Luiz Antonio Ferreira

    2016-01-01

    Background Transcatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease. Objective To evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation. Methods Prospective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality. Results A total of 136 patients with a mean age of 83 years (80-87) underwent heart valve implantation; of these, 49% were women, 131 (96.3%) had aortic stenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prosthetic valve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%). The baseline orifice area was 0.67 ± 0.17 cm2 and the mean left ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with an STS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expanding in 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%; in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Blood transfusion (relative risk of 54; p = 0.0003) and pulmonary arterial hypertension (relative risk of 5.3; p = 0.036) were predictive of in-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p = 0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) were predictive of 1-year mortality. At 30 days, 97% of patients were in NYHA functional class I/II; at one year, this figure reached 96%. Conclusion Transcatheter aortic valve implantation was performed with a high success rate and low mortality. Blood transfusion was associated with higher in-hospital and one-year mortality. Peak C-reactive protein was associated with one-year mortality. PMID:27192383

  16. Survival Rate of Short, Locking Taper Implants with a Plateau Design: A 5-Year Retrospective Study

    PubMed Central

    Demiralp, Kemal Özgür; Akbulut, Nihat; Kursun, Sebnem; Argun, Didem; Bagis, Nilsun; Orhan, Kaan

    2015-01-01

    Background. Short implants have become popular in the reconstruction of jaws, especially in cases with limited bone height. Shorter implants, those with locking tapers and plateau root shapes, tend to have longer survival times. We retrospectively investigated the cumulative survival rates of Bicon short implants (<8 mm) according to patient variables over a 5-year period. Materials and Methods. This study included 111 consecutively treated patients with 371 implants supporting fixed or removable prosthetics. Data were evaluated to acquire cumulative survival rates according to gender, age, tobacco use, surgical procedure, bone quality, and restoration type. Statistics were performed using chi-square, Mann-Whitney, and Kruskal Wallis H tests. Results. The survival rate was 97.3% with, on average, 22.8 months of follow-up. Patients older than 60 years had higher failure rate than the other age groups (P < 0.05). Placed region, age, and bone quality had adverse effects on survival rate in the <8 mm implant group with statistically significant difference (P < 0.05). Conclusions. Approximately 23-month follow-up data indicate that short implants with locking tapers and plateau-type roots have comparable survival rates as other types of dental implants. However, due to limitations of study, these issues remain to be further investigated in future randomized controlled clinical trials. PMID:25961004

  17. Oral glucose retention, saliva viscosity and flow rate in 5-year-old children.

    PubMed

    Negoro, M; Nakagaki, H; Tsuboi, S; Adachi, K; Hanaki, M; Tanaka, D; Takami, Y; Nakano, T; Kuwahara, M; Thuy, T T

    2000-11-01

    There are significant differences of glucose retention in site-specificity and individuals. Sixty-two 5-year-old nursery schoolchildren participated in this study on the relation between the viscosity of saliva and flow rate and glucose retention. Each child was instructed to rinse his/her mouth with a glucose solution (0.5 M, 5 ml) and then to spit out. Three minutes after rinsing, glucose retention was determined. Resting saliva was collected by a natural outflow method, then the flow rate was determined. A rotational viscometer was used to determine the viscosity. Glucose retention and flow rate were correlated at the left maxillary primary molars, and glucose retention and viscosity were correlated at the maxillary central primary incisors. It was concluded that glucose retention after glucose mouth rinsing was site-specific, and that glucose retention and the index of decayed, missing and filled primary teeth (dmft) were slightly correlated with the salivary viscosity and flow rate. PMID:11000387

  18. Risk Factors for Long-Term Mortality after Hospitalization for Community-Acquired Pneumonia: A 5-Year Prospective Follow-Up Study

    PubMed Central

    Holter, Jan C.; Ueland, Thor; Jenum, Pål A.; Müller, Fredrik; Brunborg, Cathrine; Frøland, Stig S.; Aukrust, Pål; Husebye, Einar; Heggelund, Lars

    2016-01-01

    Background Contributors to long-term mortality in patients with community-acquired pneumonia (CAP) remain unclear, with little attention paid to pneumonia etiology. We examined long-term survival, causes of death, and risk factors for long-term mortality in adult patients who had been hospitalized for CAP, with emphasis on demographic, clinical, laboratory, and microbiological characteristics. Methods Two hundred and sixty-seven consecutive patients admitted in 2008–2011 to a general hospital with CAP were prospectively recruited and followed up. Patients who died during hospital stay were excluded. Demographic, clinical, and laboratory data were collected within 48 hours of admission. Extensive microbiological work-up was performed to establish the etiology of CAP in 63% of patients. Mortality data were obtained from the Norwegian Cause of Death Registry. Cox regression models were used to identify independent risk factors for all-cause mortality. Results Of 259 hospital survivors of CAP (median age 66 years), 79 (30.5%) died over a median of 1,804 days (range 1–2,520 days). Cumulative 5-year survival rate was 72.9% (95% CI 67.4–78.4%). Standardized mortality ratio was 2.90 for men and 2.05 for women. The main causes of death were chronic obstructive pulmonary disease (COPD), vascular diseases, and malignancy. Independent risk factors for death were the following (hazard ratio, 95% CI): age (1.83 per decade, 1.47–2.28), cardiovascular disease (2.63, 1.61–4.32), COPD (2.09, 1.27–3.45), immunocompromization (1.98, 1.17–3.37), and low serum albumin level at admission (0.75 per 5g/L higher, 0.58–0.96), whereas active smoking was protective (0.32, 0.14–0.74); active smokers were younger than non-smokers (P < 0.001). Microbial etiology did not predict mortality. Conclusions Results largely confirm substantial comorbidity-related 5-year mortality after hospitalization for CAP and the impact of several well-known risk factors for death, and extend

  19. Necrotizing soft tissue infection: analysis of the factors related to mortality in 30 cases of a single institution for 5 years

    PubMed Central

    Park, Sung Jin; Choi, Chang In; Yun, Sung Pil; Kim, Jae Hun; Seo, Hyung Il; Jo, Hong Jae; Jun, Tae Yong

    2016-01-01

    Purpose Necrotizing soft tissue infection is the infection of the soft tissue with necrotic changes. It is rare, but results in high mortality. We analyzed the characteristics of patients, prognosis, and mortality factors after reviewing 30 cases of a single hospital for 5 years. Methods From January 2009 to December 2013, 30 patients diagnosed with necrotizing fasciitis or Fournier's gangrene in Pusan National University Hospital were enrolled for this study. The following parameters were analyzed retrospectively: demographics, infection site, initial laboratory finding, initial antibiotics, isolated microorganisms, number of surgeries, time to first operation, length of intensive care unit, and total hospital stays. Results The overall mortality rate was 23.3%. Mean body mass index (BMI) of the survival group (24.7 ± 5.0 kg/m2) was significantly higher than the nonsurvival group (22.0 ± 1.4 kg/m2, P = 0.029). When BMI was less than 23 kg/m2, the mortality rate was significantly higher (P = 0.025). Two patients (6.7%) with chronic kidney disease requiring hemodialysis died (P = 0.048). Initial WBC count (>13×103/µL), CRP (>26.5 mg/dL), and platelet (PLT) count (<148×103/µL) were found to have negative impact on the prognosis of necrotizing soft tissue infection. Factors such as potassium level, blood urea nitrogen (>27.6 mg/dL), serum creatinine (>1.2 mg/dL) that reflected kidney function were significant mortality factors. Conclusion Patients with low BMI or abnormal values of WBC count, CRP, and PLT count reflecting the degree of infection or abnormal renal function will need more intensive care. PMID:27433464

  20. The Clinicopathologic Characteristics and 5-year Survival Rate of Epithelial Ovarian Cancer in Yazd, Iran

    PubMed Central

    Karimi-Zarchi, Mojgan; Mortazavizadeh, Seyed Mohammad Reza; Bashardust, Nasrollah; Zakerian, Neda; Zaidabadi, Mahbube; Yazdian-Anari, Pouria; Teimoori, Soraya

    2015-01-01

    Introduction Ovarian cancer is the second most common malignancy in women, the most common cause of gynecologic cancer deaths, and most patients have advanced stage disease at the time of diagnosis. The purpose of this study was to estimate the 5-year survival of patients with epithelial ovarian cancer based on age, tumor histology, stage of disease, and type of treatment. Methods This study was conducted on 120 patients with epithelial ovarian cancer referred to Shahid Sadoughi hospital and Shah Vali oncology clinic of Yazd from 2006 to 2012. Demographic data and patient records were studied to evaluate the treatment outcome, pathology of the tumor, and stage of disease. Finally, the overall survival rate and tumor-free survival of patients was assessed. Results The mean patient age was 53.87± 14.11 years. Most participants had stage I (36.7%) or stage II (35%) disease. Serous adenocarcinoma (57.6%) was the most common pathology found in patients with epithelial ovarian cancer. The overall survival of patients in this study was significantly associated with the histological tumor type (p = 0.000) and disease stage (p = 0.0377). Stage I (84.18%) and serous adenocarcinoma (72.81%) demonstrated the best survival. The tumor-free survival rates were not associated with histology types (p = 0.079), surgical procedure (p = 0.18), or chemotherapy (p = 0.18). Conclusion The survival of patients with epithelial ovarian cancer was significantly associated with disease stage. Serous adenocarcinoma also had the best prognosis among the pathologies studied. Therefore, early detection of ovarian cancer can substantially increase the survival rate. PMID:26516450

  1. The healthy immigrant effect and mortality rates.

    PubMed

    Ng, Edward

    2011-12-01

    According to the 2006 Census, almost the Canadian population were foreign-born, a percentage that is projected to reach at least 25% by 2031. Studies based on age-standardized mortality rates (ASMR) have found a healthy immigrant effect, with lower overall rates among immigrants. A duration effect has also been observed-immigrants' mortality advantage lessened as their time in Canada increased. ASMRs based on the 1991 to 2001 census mortality follow-up study indicate a healthy immigrant effect and a duration effect at the national level for all-cause mortality for both sexes. However, at the national level, the mortality rate among women from the United States and from Sub-Saharan Africa was similar to that of Canadian-born women. For the three largest Census Metropolitan Areas (Toronto, Montreal and Vancouver), a healthy immigrant effect was not observed among women or among most men from the United States or Sub-Saharan Africa. PMID:22352149

  2. Long Term Results (>5 Years) in Patients With Peritoneovenous Shunting for Intractable Ascites: Liver Function and Cancer Mortality

    PubMed Central

    Meakins, Jonathan L.; Wu, Andrew; Smadja, Claude; Bonnet, Patrick; Gouffier, Etienne; Campillo, Bernard

    1989-01-01

    This report is based on twenty-eight (26%) of 107 patients included in a protocol for prospective evaluation of elective peritoneo-venous shunting for intractable ascites in cirrhosis. These patients had no other procedures and survived more than 5 years after the operation. All patients were free of ascites except one in whom it was mild. One patient refused follow-up. Shunt patency was assessed in 23 patients. In 14 patients (60.9%), the shunt was obstructed and the superior vena cava was occluded in 5 of them. In 9 patients (39.1%), the shunt was still functioning. No clinical or biological parameters differentiated these two groups of patients. Of the 24 patients who were alcoholics, 2 abstained completely and 20 significantly reduced their drinking habits. In 25 patients, the Pugh's score improved and was A at the time of the study. Seven patients (25.9%) developed a malignant tumor of the oro-pharynx or digestive tract, all other patients were alive and in good health. This study suggests that patients with intractable ascites treated by a peritoneo-venous shunt may survive for a long period. In patients abstaining from heavy drinking, it may function as a therapeutic bridge permitting spontaneous improvement of liver function. The risk of supervening neoplasms suggests that a continuous follow-up of these patients is warranted. PMID:2487384

  3. Impact of cardiac involvement on the risk of mortality among patients with systemic sclerosis: a 5-year follow-up of a single-center cohort.

    PubMed

    Költő, Gyöngyvér; Faludi, Réka; Aradi, Dániel; Bartos, Barbara; Kumánovics, Gábor; Minier, Tünde; Czirják, László; Komócsi, András

    2014-02-01

    Cardiac involvement is among the leading causes of mortality in patients with systemic sclerosis (SSc). Previously, we demonstrated in a single-center, cross-sectional study the frequent coexistence of different forms of cardiac involvement in systemic sclerosis including pulmonary arterial hypertension (PAH), coronary artery disease (CAD), and microvascular dysfunction (MVD). The aim of the present study was to investigate the prognostic significance of cardiac involvement. One hundred twenty patients with SSc were enrolled. All cases underwent a non-invasive cardiovascular protocol. In 30 patients with suspected cardiac involvement, right heart catheterization and intra-coronary pressure-wire-supplemented coronary angiography were performed. Clinical follow-up was 5 years. Patients with CAD at the baseline showed a trend for higher cardiovascular mortality while in patients with MVD this difference was significant (26.7 % versus 9.5 %, p = 0.077 and 30 % versus 10.1 %, p < 0.05, respectively). Cardiovascular mortality of PAH cases was higher but, however, did not reach statistical significance 21.4 % versus 10.4 %, p = 0.261. Cardiovascular event-free survival was significantly lower among patients with combinations of two or three disorders (p < 0.05). Multivariate analysis of organ involvements and comorbidities showed that the diffuse cutaneous subset, the presence of kidney involvement, the velocity of the tricuspid regurgitation, as well as diabetes mellitus were independent predictors of overall mortality. MVD and CAD alone or in combination with PAH significantly affected the 5-year cardiovascular mortality. These findings highlight the prognostic importance of coronary disease in patients with SSc [ www.clinicaltrials.gov (Reg. Nr.: NCT00843102)]. PMID:23942767

  4. Liver cancer mortality rate model in Thailand

    NASA Astrophysics Data System (ADS)

    Sriwattanapongse, Wattanavadee; Prasitwattanaseree, Sukon

    2013-09-01

    Liver Cancer has been a leading cause of death in Thailand. The purpose of this study was to model and forecast liver cancer mortality rate in Thailand using death certificate reports. A retrospective analysis of the liver cancer mortality rate was conducted. Numbering of 123,280 liver cancer causes of death cases were obtained from the national vital registration database for the 10-year period from 2000 to 2009, provided by the Ministry of Interior and coded as cause-of-death using ICD-10 by the Ministry of Public Health. Multivariate regression model was used for modeling and forecasting age-specific liver cancer mortality rates in Thailand. Liver cancer mortality increased with increasing age for each sex and was also higher in the North East provinces. The trends of liver cancer mortality remained stable in most age groups with increases during ten-year period (2000 to 2009) in the Northern and Southern. Liver cancer mortality was higher in males and increase with increasing age. There is need of liver cancer control measures to remain on a sustained and long-term basis for the high liver cancer burden rate of Thailand.

  5. Raised Speed Limits, Speed Spillover, Case-Fatality Rates, and Road Deaths in Israel: A 5-Year Follow-Up

    PubMed Central

    Richter, Elihu D.; Barach, Paul; Friedman, Lee; Krikler, Samuel; Israeli, Abraham

    2004-01-01

    Objectives. We assessed the 5-year, nationwide impact on road deaths of the raise in the speed limit (November 1, 1993) on 3 major interurban highways in Israel from 90 to 100 kph. Methods. We compared before–after trends in deaths as well as case fatality—an outcome independent of exposure (defined as vehicle-kilometers traveled). Results. After the raise, speeds rose by 4.5%–9.1%. Over 5 years, there was a sustained increase in deaths (15%) and case fatality rates (38%) on all interurban roads. Corresponding increases in deaths (13%) and case fatality (24%) on urban roads indicated “speed spillover.” Conclusions. Immediate increases in case fatality predicted and tracked the sustained increase in deaths from increased speeds of impact. Newtonian fourth power models predicted the effects of “small” increases in speed on large rises in case fatality rates. Countermeasures and congestion reduced the impact on deaths and case-fatality rates by more than half. PMID:15054007

  6. Poorly Cited Articles in Peer-Reviewed Cardiovascular Journals from 1997–2007: Analysis of 5-Year Citation Rates

    PubMed Central

    Ranasinghe, Isuru; Shojaee, Abbas; Bikdeli, Behnood; Gupta, Aakriti; Chen, Ruijun; Ross, Joseph S.; Masoudi, Frederick; Spertus, John A.; Nallamothu, Brahmajee K.; Krumholz, Harlan M.

    2015-01-01

    Background The extent to which articles are cited is a surrogate of the impact and importance of the research conducted; poorly cited papers may identify research of limited use and potential wasted investments. We assessed trends in the rates of poorly cited articles and journals in the cardiovascular literature from 1997–2007. Methods and Results We identified original articles published in cardiovascular journals and indexed in the Scopus citation database from 1997–2007. We defined poorly cited articles as those with ≤5 citations in the 5 years following publication and poorly cited journals as those with >75% of journal content poorly cited. We identified 164,377 articles in 222 cardiovascular journals from 1997–2007. From 1997–2007, the number of cardiovascular articles and journals increased by 56.9% and 75.2% respectively. Of all the articles, 75,550 (46.0%) were poorly cited, of which 25,650 (15.6% overall) had no citations. From 1997–2007, the proportion of poorly cited articles declined slightly (52.1% to 46.2%, trend P<0.001), although the absolute number of poorly cited articles increased by 2,595 (trend P<0.001). At a journal level, 44% of cardiovascular journals had more than three quarters of the journal’s content poorly cited at 5 years. Conclusion Nearly half of all peer-reviewed articles published in cardiovascular journals are poorly cited 5 years after publication, and many are not cited at all. The cardiovascular literature, and the number of poorly cited articles, have both increased substantially from 1997–2007. The high proportion of poorly cited articles and journals suggest inefficiencies in the cardiovascular research enterprise. PMID:25812573

  7. The rs12526453 Polymorphism in an Intron of the PHACTR1 Gene and Its Association with 5-Year Mortality of Patients with Myocardial Infarction

    PubMed Central

    Szpakowicz, Anna; Kiliszek, Marek; Pepinski, Witold; Waszkiewicz, Ewa; Franaszczyk, Maria; Skawronska, Malgorzata; Ploski, Rafal; Niemcunowicz-Janica, Anna; Burzynska, Beata; Tulacz, Dorota; Maciejak, Agata; Kaminski, Marcin Jakub; Opolski, Grzegorz; Musial, Wlodzimierz Jerzy; Kaminski, Karol Adam

    2015-01-01

    Objective The rs12526453 (C/G) is a single nucleotide polymorphism in an intron of the PHACTR1 gene (phosphatase and actin regulator 1). The C allele is associated with increased risk of coronary artery disease in an unknown mechanism. We investigated its association with long-term overall mortality in patients with ST-elevation myocardial infarction (STEMI) treated invasively. Methods Two independent groups of patients with STEMI were analyzed: a derivation group (n= 638) and a validation one (n=348). Genotyping was performed with the TaqMan method. The analyzed end-point was total long term mortality. Additionally, transcriptomic analysis was performed in mononuclear blood leukocytes from rs12526453 CC monozygotes or G allele carriers. Results In the study group (mean age 62.3 ± 11.9 years; 24.9% of females, n=159), percentages of CC, CG, and GG genotypes were 45.3% (n=289), 44.7% (n=285), and 10% (n=64), respectively. In the 5-year follow-up 105 patients died (16.46%). CC homozygotes had significantly lower mortality compared to other genotypes: 13.1% (n=38) vs. 18.3% in G-allele carriers (n=67), (p=0.017, Cox`s F test). In the validation group 47 patients died within 3 years (13.5%). We confirmed lower mortality of CC homozygotes: 10.1 % (n=18) vs. 16.95% in G-allele carriers (n=29), (p=0.031, Cox`s F test). Transcriptomic analysis revealed a markedly higher expression of NLRP-2 in CC homozygotes. Conclusions The rs12526453 CC homozygotes (previously associated with increased risk of myocardial infarction) showed, in 2 independent samples, better long-term survival. The finding of such high effect size, after appropriate validation, could potentially be translated into clinical practice. PMID:26086777

  8. Performance and Abuse Testing of 5 Year Old Low Rate and Medium Rate Lithium Thionyl Chloride Cells

    NASA Technical Reports Server (NTRS)

    Frerker, Rick; Zhang, Wenlin; Jeevarajan, Judith; Bragg, Bobby J.

    2001-01-01

    Most cells survived the 3 amp (A) over-discharge at room temperature for 2 hours. The cell that failed was the LTC-114 after high rate discharge of 500 mA similar to the results of the 1 A over-discharge test. Most cells opened during 0.05 Ohm short circuit test without incident but three LTC-111 cells exploded apparently due to a lack of a thermal cutoff switch. The LTC-114 cells exposed to a hard short of 0.05 Ohms recovered but the LTC-114 cells exposed to a soft short of 1 Ohm did not. This is probably due to the activation of a resetable fuse during a hard short. Fresh cells tend to survive exposure to higher temperatures than cells previously discharged at high rate (1 Amp). LTC-111 cells tend to vent at lower temperatures than the all LTC-114 cells and the LTC-115 cells that were previously discharged at rates exceeding 1 Amp.

  9. Infant mortality rates declining, but still high.

    PubMed

    Hoffman, M

    1992-10-01

    Family planning can improve infant survival. Specifically, use of family planning methods can minimize family size, increase birth spacing, and reduce the likelihood of pregnancy for teenagers and women aged 40 or older. Immunizations and oral rehydration are responsible for the falling infant mortality rats since 1977 in developing countries, especially among 1-12 month old infants. Yet, neonatal mortality in developing countries had not changed. WHO intends to step up efforts to improve newborn survival. Accurate data are needed, however. Even in developed countries which keep good statistics, infant mortality bias exists. For example, in Japan, some infant deaths are called fetal deaths. In developing countries, much of the data come from hospitals, yet most birth do not occur in hospitals. Even in surveys, bias exists, such as problems with recall. Many researchers use traditional birth attendants (TBAs) to follow up on all births in an area which may eliminate some biases. Such a prospective and longitudinal study in Trairi county in northeastern Brazil shows the infant mortality rate to be less than half of the official rate (65 vs. 142). The major causes of infant death in developed countries, which tends to occur in the neonatal period, are low birth weight, prematurity, birth complications, and congenital defects; developing countries; they are vaccine preventable infectious diseases, diarrhea and dehydration, and respiratory illnesses, all complicated by malnutrition. To make further strides in reducing infant mortality, public health workers must concentrate on the neonatal period. Training TBAs in sterile techniques, appropriate technology, resuscitation of infants, and identification of potential problems is a positive step. Yet, unpredictable conditions (e.g., AIDS) exist and/or will arise which erode improvements. For example, in Nicaragua, within 1 year after the new government introduced health budget cuts which resulted in the poor paying for

  10. Choosing a standard for adjusted mortality rates.

    PubMed

    Seltzer, F

    1996-01-01

    For over half a century, the standard for age-adjustment in mortality studies has been based on the total population according to the 1940 census. The question periodically arises, however, whether a more recent census population might now be more appropriate. Thus, a study using the six censuses from 1940 to 1990 was conducted to see the effect each of these populations would have on the age-adjusted (standardized) death rates. While the size of the age-adjusted rates was affected by the censal standard populations from 1940 to 1990, these populations hardly changed the proportional mortality by age, sex, cause-of-death and geographic area. It appears that a shift from the 1940 standard will not be necessary, although if more detailed comparisons are needed, age-specific death rates can always be used. The 1940 standard also has the advantage of being consistent with many earlier studies. PMID:8744891

  11. Female breast cancer mortality rates in Turkey.

    PubMed

    Dogan, Nurhan; Toprak, Dilek

    2014-01-01

    The main objective of this study was to analyze the mortality trends of female breast cancer in Turkey between the years 1987-2008. The rates per 100,000 age-standardized to the European standard population were assessed and time trends presented using joinpoint regression analysis. Average annual percent change (AAPC), anual percent change (APC) and 95% confidence interval (CI) was calculated. Nearly 23,000 breast cancer deaths occurred in Turkey during the period 1987-2008, with the average annual age-standardized mortality rate (ASR) being 11.9 per 100,000 women. In the last five years, significant increases were observed in all age groups, but there was no significant change over the age of 65. In this period, the biggest significant increase was in the 45-54 age group (AAPC=4.3, 95%CI=2.6 to 6.0). PMID:25292030

  12. Size-dependent mortality rate profiles.

    PubMed

    Roa-Ureta, Ruben H

    2016-08-01

    Knowledge of mortality rates is crucial to the understanding of population dynamics in populations of free-living fish and invertebrates in marine and freshwater environments, and consequently to sustainable resource management. There is a well developed theory of population dynamics based on age distributions that allow direct estimation of mortality rates. However, for most cases the aging of individuals is difficult or age distributions are not available for other reasons. The body size distribution is a widely available alternative although the theory underlying the formation of its shape is more complicated than in the case of age distributions. A solid theory of the time evolution of a population structured by any physiological variable has been developed in 1960s and 1970s by adapting the Hamilton-Jacobi formulation of classical mechanics, and equations to estimate the body size-distributed mortality profile have been derived for simple cases. Here I extend those results with regards to the size-distributed mortality profile to complex cases of non-stationary populations, individuals growing according to a generalised growth model and seasonally patterned recruitment pulses. I apply resulting methods to two cases in the marine environment, a benthic crustacean population that was growing during the period of observation and whose individuals grow with negative acceleration, and a sea urchin coastal population that is undergoing a stable cycle of two equilibrium points in population size whose individuals grow with varying acceleration that switches sign along the size range. The extension is very general and substantially widens the applicability of the theory. PMID:27164999

  13. Urban poverty and infant mortality rate disparities.

    PubMed Central

    Sims, Mario; Sims, Tammy L.; Bruce, Marino A.

    2007-01-01

    This study examined whether the relationship between high poverty and infant mortality rates (IMRs) varied across race- and ethnic-specific populations in large urban areas. Data were drawn from 1990 Census and 1992-1994 Vital Statistics for selected U.S. metropolitan areas. High-poverty areas were defined as neighborhoods in which > or = 40% of the families had incomes below the federal poverty threshold. Bivariate models showed that high poverty was a significant predictor of IMR for each group; however, multivariate analyses demonstrate that maternal health and regional factors explained most of the variance in the group-specific models of IMR. Additional analysis revealed that high poverty was significantly associated with minority-white IMR disparities, and country of origin is an important consideration for ethnic birth outcomes. Findings from this study provide a glimpse into the complexity associated with infant mortality in metropolitan areas because they suggest that the factors associated with infant mortality in urban areas vary by race and ethnicity. PMID:17444423

  14. Periampullary adenocarcinoma: analysis of 5-year survivors.

    PubMed Central

    Yeo, C J; Sohn, T A; Cameron, J L; Hruban, R H; Lillemoe, K D; Pitt, H A

    1998-01-01

    OBJECTIVE: This single-institution experience retrospectively reviews the outcomes in a group of patients treated 5 or more years ago by pancreaticoduodenectomy for periampullary adenocarcinoma. SUMMARY BACKGROUND DATA: Controversy exists regarding the benefit of resection for periampullary adenocarcinoma, particularly for pancreatic tumors. Many series report only Kaplan-Meier actuarial 5-year survival rates. There are believed to be discrepancies between the actuarial 5-year survival data and the actual 5-year survival rates. METHODS: From April 1970 through May 1992, 242 patients underwent pancreaticoduodenal resection for periampullary adenocarcinoma at The Johns Hopkins Hospital. Follow-up was complete through May 1997. All pathology specimens were reviewed and categorized. Actual 5-year survival rates were calculated. The demographic, intraoperative, pathologic, and postoperative features of patients surviving > or =5 years were compared with those of patients who survived <5 years. RESULTS: Of the 242 patients with resected periampullary adenocarcinoma, 149 (62%) were pancreatic primaries, 46 (19%) arose in the ampulla, 30 (12%) were distal bile duct cancers, and 17 (7%) were duodenal cancers. There was a 5.3% operative mortality rate during the 22 years of the review, with a 2% operative mortality rate in the last 100 patients. There were 58 5-year survivors, 28 7-year survivors, and 7 10-year survivors. The tumor-specific 5-year actual survival rates were pancreatic 15%, ampullary 39%, distal bile duct 27%, and duodenal 59%. When compared with patients who did not survive 5 years, the 5-year survivors had a significantly higher percentage of well-differentiated tumors (14% vs. 4%; p = 0.02) and higher incidences of negative resection margins (98% vs. 73%, p < 0.0001) and negative nodal status (62% vs. 31%, p < 0.0001). The tumor-specific 10-year actuarial survival rates were pancreatic 5%, ampullary 25%, distal bile duct 21%, and duodenal 59%. CONCLUSIONS

  15. Variations of Radon Risk with Changing Mortality Rates

    SciTech Connect

    Chen Jing

    2008-08-07

    This study examines the variation of radon risks with changing mortality rates. The Canadian age-specific mortality rates averaged over five year periods from 1986 to 1990 and from 1996 to 2000 were used in the risk calculations. Because of the synergistic interaction between smoking and radon, the risk of radon induced lung cancer for Canadian men decreased with the declining lung cancer mortality rates while for Canadian women the radon risks increased with the rising lung cancer mortality rates.

  16. Variations of Radon Risk with Changing Mortality Rates

    NASA Astrophysics Data System (ADS)

    Chen, Jing

    2008-08-01

    This study examines the variation of radon risks with changing mortality rates. The Canadian age-specific mortality rates averaged over five year periods from 1986 to 1990 and from 1996 to 2000 were used in the risk calculations. Because of the synergistic interaction between smoking and radon, the risk of radon induced lung cancer for Canadian men decreased with the declining lung cancer mortality rates while for Canadian women the radon risks increased with the rising lung cancer mortality rates

  17. The influence of atorvastatin on parameters of inflammation left ventricular function, hospitalizations and mortality in patients with dilated cardiomyopathy – 5-year follow-up

    PubMed Central

    2013-01-01

    Background We assessed the influence of atorvastatin on selected indicators of an inflammatory condition, left ventricular function, hospitalizations and mortality in patients with dilated cardiomyopathy (DCM). Methods We included 68 DCM patients with left ventricular ejection fraction (LVEF) ≤40% treated optimally in a prospective, randomized study. They were observed for 5 years. Patients were divided into two groups: patients who were commenced on atorvastatin 40 mg daily for two months followed by an individually matched dose of 10 or 20 mg/day (group A), and patients who were treated according to current recommendations without statin therapy (group B). Results After 5-year follow-up we assessed 45 patients of mean age 59 ± 11 years - 22 patients in group A (77% male) and 23 patients in group B (82% male). Interleukin-6, tumor necrosis factor alpha, and uric acid concentrations were significantly lower in the statin group than in group B (14.96 ± 4.76 vs. 19.02 ± 3.94 pg/ml, p = 0.012; 19.10 ± 6.39 vs. 27.53 ± 7.39 pg/ml, p = 0.001, and 5.28 ± 0.48 vs. 6.53 ± 0.46 mg/dl, p = 0.001, respectively). In patients on statin therapy a reduction of N-terminal pro-brain natriuretic peptide concentration (from 1425.28 ± 1264.48 to 1098.01 ± 1483.86 pg/ml, p = 0.045), decrease in left ventricular diastolic (from 7.15 ± 0.90 to 6.67 ± 0.88 cm, p = 0.001) and systolic diameters (from 5.87 ± 0.92 to 5.17 ± 0.97, p = 0.001) in comparison to initial values were observed. We also showed the significant increase of LVEF in patients after statin therapy (from 32.0 ± 6.4 to 38.8 ± 8.8%, p = 0.016). Based on a comparison of curves using the log-rank test, the probability of survival to 5 years was significantly higher in patients receiving statins (p = 0.005). Conclusions Atorvastatin in a small dose significantly reduce levels of inflammatory cytokines and uric

  18. Mortality Rates in a Genetically Heterogeneous Population of Caenorhabditis elegans

    NASA Astrophysics Data System (ADS)

    Brooks, Anne; Lithgow, Gordon J.; Johnson, Thomas E.

    1994-02-01

    Age-specific mortality rates in isogenic populations of the nematode Caenorhabditis elegans increase exponentially throughout life. In genetically heterogeneous populations, age-specific mortality increases exponentially until about 17 days and then remains constant until the last death occurs at about 60 days. This period of constant age-specific mortality results from genetic heterogeneity. Subpopulations differ in mean life-span, but they all exhibit near exponential, albeit different, rates of increase in age-specific mortality. Thus, much of the observed heterogeneity in mortality rates later in life could result from genetic heterogeneity and not from an inherent effect of aging.

  19. Trends in Infectious Disease Mortality Rates, Spain, 1980–2011

    PubMed Central

    Llácer, Alicia; Palmera-Suárez, Rocio; Gómez-Barroso, Diana; Savulescu, Camelia; González-Yuste, Paloma; Fernández-Cuenca, Rafael

    2014-01-01

    Using mortality data from National Institute of Statistics in Spain, we analyzed trends of infectious disease mortality rates in Spain during 1980–2011 to provide information on surveillance and control of infectious diseases. During the study period, 628,673 infectious disease–related deaths occurred, the annual change in the mortality rate was −1.6%, and the average infectious disease mortality rate was 48.5 deaths/100,000 population. Although the beginning of HIV/AIDS epidemic led to an increased mortality rate, a decreased rate was observed by the end of the twentieth century. By codes from the International Classification of Diseases, 9th revision, the most frequent underlying cause of death was pneumonia. Emergence and reemergence of infectious diseases continue to be public health problems despite reduced mortality rates produced by various interventions. Therefore, surveillance and control systems should be reinforced with a goal of providing reliable data for useful decision making. PMID:24750997

  20. Erosion rates across a steep rainfall gradient on Kauai over 5 year to 5 million year timescales

    NASA Astrophysics Data System (ADS)

    Ferrier, K.; Perron, T.; Mukhopadhyay, S.; Rosener, M.; Stock, J. D.; Huppert, K. L.; Slosberg, M.

    2011-12-01

    Landscapes on volcanic islands display a wide range of morphologies, from the deep, serrated canyons of Kaua'i to the minimally dissected surfaces of the Galapagos, reflecting a variety of eruptive and erosional histories. Measurements of erosion rates on volcanic islands are useful for reconstructing the islands' topographic evolution, as well as for quantifying terrestrial sediment fluxes to floodplains and coasts, documenting the effects of human activity and introduced species on hillslope soils, measuring fluvial fluxes of carbon and nutrients, and for comparison with rates of island uplift or subsidence. Despite their utility, however, erosional budgets of island interiors are often poorly constrained. Here we present new measurements of erosion rates on Kaua'i across a wide range of timescales and climates. We estimated Myr-scale erosion rates in 25 Kaua'i river basins by measuring the eroded volume in each basin - calculated by subtracting the present topography from the estimated pre-incision topography, which is constrained by minimally eroded remnants of the original volcano surface - and dividing by the age of the uppermost flow surface and the basin area. For a rock density of 3.0 g/cm^3, these eroded volumes and ages imply average erosion rates of 30-330 t km^{-2} yr^{-1} over the past 4-5 Myr, with the slowest rates in small canyons draining the oldest, driest terrain on the island's west side, and the fastest rates in the deep canyons on the island's younger, wetter northern side. These Myr-year scale rates are similar to minimum bounds on millennial-scale basin-average erosion rates of 107-385 t km^{-2} yr^{-1} inferred from total ^3He concentrations in detrital olivine grains, which we extracted from river sand samples in five subcatchments of Kaua'i's Hanalei River basin. Both of these sets of long-term rates are comparable to modern physical erosion rates of 369 +/- 114 t km^{-2} yr^{-1} (mean +/- s.e.), inferred from suspended sediment fluxes

  1. Studies of the mortality rate of Culicoides imicola in Morocco.

    PubMed

    Baylis, M; Touti, J; Bouayoune, H; Moudni, L; Taoufiq, B; el Hasnaoui, H

    1998-01-01

    Daily mortality rates of female Culicoides imicola were found for eight sites in Morocco in 1994 and for six sites in 1995. The mortality rates were found by operating Pirbright-type light traps for a number of consecutive nights in late summer or autumn and finding the parous rate assuming a feeding interval of 3 to 5 days. The mortality rates were calculated according to established methods. In Morocco the daily mortality rates were found to vary from about 5% per day (Arbaoua, 1994, 1995 and Sidi Moussa 1995) up to 20-25% per day (Berkane, Marrakech, Tangier). In general, estimates of daily mortality rate were consistent between the two years of study. Among sites, daily mortality rate was significantly correlated with the average night-time minimum wind speed but not mean or maximum night-time wind speeds, or with temperature, humidity or saturation deficit. The observed mortality rates suggest that at Arbaoua, were 1,000 flies to become infected with African horse sickness virus, at least 330 would live long enough to take 3 or more infective blood meals on hosts. At Berkane, the survival rate per 1,000 is less than 10. In general, the pattern observed for daily mortality rate, combined with the relative population sizes of C. imicola in Morocco, agree well with the observed distribution of African horse sickness in the country during the 1989-1991 epizootic. PMID:9785502

  2. Estimating cause-specific mortality rates using recovered carcasses.

    PubMed

    Joly, Damien O; Heisey, Dennis M; Samuel, Michael D; Ribic, Christine A; Thomas, Nancy J; Wright, Scott D; Wright, Irene E

    2009-01-01

    Stranding networks, in which carcasses are recovered and sent to diagnostic laboratories for necropsy and determination of cause of death, have been developed to monitor the health of marine mammal and bird populations. These programs typically accumulate comprehensive, long-term datasets on causes of death that can be used to identify important sources of mortality or changes in mortality patterns that lead to management actions. However, the utility of these data in determining cause-specific mortality rates has not been explored. We present a maximum likelihood-based approach that partitions total mortality rate, estimated by independent sources, into cause-specific mortality rates. We also demonstrate how variance estimates are derived for these rates. We present examples of the method using mortality data for California sea otters (Enhydra lutris nereis) and Florida manatees (Trichechus manatus latirostris). PMID:19204341

  3. Extending supplementary feeding for children younger than 5 years with moderate acute malnutrition leads to lower relapse rates

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Children with moderate acute malnutrition (MAM) have a high rate of relapse and death in the year following recovery. In this pilot study, we evaluate the long-term benefits of an extended course of nutritional therapy for children with MAM. Rural Malawian children 6 to 59 months old with MAM, defin...

  4. [Causes of adult mortality in developing and developed countries with low mortality rates].

    PubMed

    Vallin, J

    1995-06-01

    "In a certain number of developing countries, life expectancy levels now approach those of the developed world. But, though life expectancies at birth may be similar, the infant mortality rate in developing countries remains higher, but is compensated by a lower rate of mortality for adults. Is it to be expected that as infant mortality rates continue to decline, the developing countries will maintain their advantageous adult mortality rates and that life expectancy will forge ahead of the level achieved in developed countries?... To answer this question, recent trends in adult cause-specific mortality rates in four developing countries (Chile, Hong Kong, Mexico, and Costa Rica) were compared with those in three industrialized countries (France, Germany and Japan). The results were inconclusive. Whilst life expectancies in some of these countries may be expected to forge ahead (Chile, Hong Kong), in others the margin between their life expectancies and those of developed countries have already narrowed." (SUMMARY IN ENG) PMID:12347045

  5. Retrospective 5-Year Analysis of Revision Rate and Functional Outcome of TKA With and Without Patella Implant.

    PubMed

    Albrecht, Dominique C; Ottersbach, Andreas

    2016-05-01

    The aim of this study was to compare a patient cohort after total knee arthroplasty (TKA) in terms of the revision rate and the functional outcome, with and without patella resurfacing. Sixty-six patients (71 TKAs) were implanted with the mobile-bearing knee prosthesis system e.motion UC (Aesculap AG, Tuttlingen, Germany). These patients were divided into 2 groups, 1 of which received primary patella resurfacing (PPR; 51 TKAs) and 1 of which did not (non-PPR; 20 TKAs), with an average follow-up of 65.6 months (±6.9). The cohort was recorded consecutively. The evaluation was performed using the Knee Society Score and selected questions relating to the Knee Injury and Osteoarthritis Outcome Score, as well as with radiographs. Results showed that PPR was no better than non-PPR in terms of functional outcome. Two knees (10%) were revised in the non-PPR group, and 1 knee (1.96%) in the PPR group (not significant). In this cohort, 100% of implants, including the 5 TKAs of patients who did not attend the follow-up examination, had neither explanted nor loosened at the time of follow-up examination. The authors concluded that the revision rate for PPR is slightly lower, and this avoids the need for secondary patella resurfacing. The risk for complications is low, and the functional outcome is comparable. [Orthopedics. 2016; 39(3):S31-S35.]. PMID:27219724

  6. Prediction of mortality rates in the presence of missing values

    NASA Astrophysics Data System (ADS)

    Tan, Chon Sern; Pooi, Ah Hin

    2015-12-01

    A time series model based on multivariate power-normal distribution has been applied in the past literature on the United States (US) mortality data from the years 1933 to 2000 to forecast the future age-specific mortality rates of the years 2001 to 2010. In this paper, we show that the method based on multivariate power-normal distribution can still be used for an incomplete US mortality dataset that contains some missing values. The prediction intervals based on this incomplete training data are found to still have good ability of covering the observed future mortality rates although the interval lengths may become wider for long-range prediction.

  7. Impact of coronary collaterals on in-hospital and 5-year mortality after ST-elevation myocardial infarction in the contemporary percutaneous coronary intervention era: a prospective observational study

    PubMed Central

    Hara, Masahiko; Sakata, Yasuhiko; Nakatani, Daisaku; Suna, Shinichiro; Nishino, Masami; Sato, Hiroshi; Kitamura, Tetsuhisa; Nanto, Shinsuke; Hori, Masatsugu; Komuro, Issei

    2016-01-01

    Objectives To evaluate the short-term and long-term prognostic impacts of acute phase coronary collaterals to occluded infarct-related arteries (IRA) after ST-elevation myocardial infarction (STEMI) in the percutaneous coronary intervention (PCI) era. Design A prospective observational study. Setting Osaka Acute Coronary Insufficiency Study (OACIS) in Japan. Participants 3340 patients with STEMI from the OACIS database who were admitted to hospitals within 24 hours from the onset and who had a completely occluded IRA. Interventions Patients were divided into 4 groups according to the Rentrop collateral score (RCS) by angiography on admission (RCS-0, no visible collaterals; RCS-1, collaterals without IRA filling; RCS-2, collaterals with partial IRA filling; and RCS-3, collaterals with complete IRA filling). Primary outcome measures In-hospital and 5-year mortality. Results Patients with RCS-0/3 were older than patients with RCS-1/2, and the prevalence of previous myocardial infarction was highest in patients with RCS-3. Median peak creatinine phosphokinase levels decreased as RCS increases (p<0.001), suggesting the acute cardioprotective effects of collaterals. Although RCS-1 and RCS-2 collaterals were associated with better in-hospital mortality (adjusted OR 0.48, p=0.046 and 0.38, p=0.010 for RCS-1 and RCS-2, respectively) and 5-year mortality (adjusted HR 0.53, p=0.004 and 0.46, p<0.001 for RCS-1 and RCS-2, respectively) as compared with R-0, presence of RCS-3 collaterals was not associated with improved in-hospital (adjusted OR 1.35, p=0.331) and 5-year mortality (adjusted HR 0.98, p=0.920), possibly because worse clinical profiles in patients with RCS-3 may mask mortality benefit of coronary collaterals. Conclusions Presence of acute phase coronary collaterals such as RCS-1 and RCS-2 were associated with better in-hospital and 5-year mortality after STEMI in the contemporary PCI era. PMID:27412101

  8. A Study on Mortality Profile among Fifty Plus- (50+-) Population (FPP) of India: A 5-Year Retrospective Study at New Delhi District

    PubMed Central

    Chaudhary, B. L.; Kumar, Arvind; Bajaj, Amrita V.

    2016-01-01

    Objectives. To find out the mortality profile vis-a-vis different epidemiological factors at the time of autopsy among the 50+-Population. Material and Method. A five-year retrospective evaluation of medicolegal records between 2006 and 2010 was done at Lady Hardinge Medical College, New Delhi. Results. A total of 493 (17.78%) cases belonged to 50+-Population age group out of total 2773 autopsies performed. The proportion of unidentified/unknown persons among this age group was 36.51%. The unnatural and natural causes constituted 44.62% and 55.38% cases, respectively. The unspecified pneumonitis (50.18%) was reported as the commonest cause followed by coronary artery disease and respiratory tuberculosis among natural ones and the transport accident (57.27%) followed by accidental and intentional self-poisoning and exposure to noxious substances and falls among the unnatural ones. Conclusion. The findings reveal that this age group most commonly dies of natural causes rather than the unnatural ones even in autopsy cases. They have definite cure with timely interventions. The study also points out the need to devise the road and home safety measures to reduce mortality among the study population. PMID:27042177

  9. Rates of cardiovascular events and deaths are associated with advanced stages of HIV-infection: results of the HIV HEART study 7, 5 year follow-up

    PubMed Central

    Esser, Stefan; Eisele, Lewin; Schwarz, Birte; Schulze, Christina; Holzendorf, Volker; Brockmeyer, Nobert H; Hower, Martin; Kwirant, Friedhelm; Rudolph, Roland; Neumann, Till; Reinsch, Nico

    2014-01-01

    Introduction Cardiovascular diseases are increasing in aging HIV-positive patients (HIV+). Impact of traditional cardiovascular risk factors, HIV-specific parameters and antiretroviral therapy (ART) on the incidence of cardiovascular events (CVE) and on the mortality rate are investigated in different HIV+ cohorts. Methods The HIV HEART (HIVH) study is an ongoing prospective observational cohort study in the German Ruhr area to assess the frequency and clinical course of cardiac disorders in 1481 HIV+ by standardized non-invasive cardiovascular screening. CVE were defined as diagnosed or documented myocardial infarction, coronary heart disease, arterial coronary intervention, stent implantation, bypass operation and stroke. Results 1481 HIV+ subjects (mean age: 49.3±10.7 years (y), female: 15.6%) were included. 130 CVE and 90 deaths were documented until the end of 7, 5 year follow-up of HIVH. Mean duration of the HIV-infection was 12.9±6.8 y. HIV+ were treated with ART on average for 8.6±6.8 y. According to the CDC classification of the HIV-infection, HIV+ were distributed over the clinical categories (A:34.6%; B:31.4% and C:33.9%) while more than the half had an advanced immunodeficiency (I:8.3%; II:41.1%; III:50.7%). Advanced clinical and immunological stages were significantly (p<0.001) associated with higher incidences of deaths (A:16.7%; B:26.7%; C:56.7% and I:6.7%; II:27.7%; III:65.6%) and CVE (A:17.7%; B:33.1%; C:49.2% and I:3.1%; II:32.3%; III:64.6%) but not with the duration of HIV-infection (per y: Hazard ratio (HR): 0.91 [0.88–0.94]) and ART (per y: HR: 0.81 [0.79–0.84]) adjusted for age. The proportion of deceased HIV+ with HIV-RNA ≥50 copies/mL and lower CD4-cell counts at their last visit is significantly higher compared with living HIV+ without CVE (HIV-RNA ≥50 copies/mL: 25.6% vs 14.7%). Median CD4-cells: 286.5 cells/µL (IQR: 168.8–482.8) versus 574 cells/µL (IQR: 406–786). 96.1% of the living HIV+ with CVE had HIV-RNA<50 copies

  10. Trends in under-5 mortality rates and the HIV/AIDS epidemic.

    PubMed Central

    Adetunji, J.

    2000-01-01

    INTRODUCTION: The prevalence of human immunodeficiency virus (HIV) among adults and mortality rates among under-5-year-olds have increased or stagnated in many countries. The objective of this study was to investigate whether there is a link between under-5 mortality trends and the prevalence of HIV among adults and, if so, to assess the magnitude of the effect of adult HIV prevalence on under-5 mortality rates. METHOD: Data from Demographic and Health Surveys were used to establish the trends in under-5 mortality rates for 25 countries for which there are data for at least two points in time. Countries were ranked according to the most recent adult HIV prevalence data and grouped in three categories: those with very high HIV prevalence (> or = 5%); those with moderately high prevalence (1-4.9%); and those with low prevalence (< 1%). A mathematical model was fitted to obtain an estimate of the contribution of HIV/AIDS to the level of under-5 mortality in each country. RESULTS: Under-5 mortality rates showed an increase in most countries with high adult HIV prevalence, but a decrease in almost every country with moderately high or low prevalence. The estimated contribution of adult HIV prevalence to the observed level of under-5 mortality was highest (up to 61%) in Zimbabwe (where HIV prevalence was highest) and tended to decrease with the level of HIV prevalence. DISCUSSION: The contribution of HIV/AIDS to childhood mortality therefore appears to be most noticeable in settings where the epidemic is most severe. PMID:11100615

  11. Newborn calf welfare: a review focusing on mortality rates.

    PubMed

    Uetake, Katsuji

    2013-02-01

    Calf mortality control is vitally important for farmers, not only to improve animal welfare, but also to increase productivity. High calf mortality rates can be related to larger numbers of calves in a herd, employee performance, severe weather, and the neonatal period covering the first 4 weeks of life. Although the basic premise of preventing newborn calf mortality is early detection and treatment of calves at risk for failure of passive transfer of immunoglobulins, calf mortality due to infectious diseases such as acute diarrhea increases in the presence of these physical and psychological stressors. This suggests that farmers should not ignore the effects of secondary environmental factors. For prevention rather than cure, the quality of the environment should be improved, which will improve not only animal welfare but also productivity. This paper presents a review of the literature on newborn calf mortality and discusses its productivity implications. PMID:23384350

  12. Why have ovarian cancer mortality rates declined? Part I. Incidence.

    PubMed

    Sopik, Victoria; Iqbal, Javaid; Rosen, Barry; Narod, Steven A

    2015-09-01

    The age-adjusted mortality rate from ovarian cancer in the United States has declined over the past several decades. The decline in mortality might be the consequence of a reduced number of cases (incidence) or a reduction in the proportion of patients who die from their cancer (case-fatality). In part I of this three-part series, we examine rates of ovarian cancer incidence and mortality from the Surveillance Epidemiology and End Results (SEER) registry database and we explore to what extent the observed decline in mortality can be explained by a downward shift in the stage distribution of ovarian cancer (i.e. due to early detection) or by fewer cases of ovarian cancer (i.e. due to a change in risk factors). The proportion of localized ovarian cancers did not increase, suggesting that a stage-shift did not contribute to the decline in mortality. The observed decline in mortality paralleled a decline in incidence. The trends in ovarian cancer incidence coincided with temporal changes in the exposure of women from different birth cohorts to various reproductive risk factors, in particular, to changes in the use of the oral contraceptive pill and to declining parity. Based on recent changes in risk factor propensity, we predict that the trend of the declining age-adjusted incidence rate of ovarian cancer in the United States will reverse and rates will increase in coming years. PMID:26080287

  13. Investigation of the links between water vapor field evolution and rain rate based on 5 years of measurements at a midlatitude site

    NASA Astrophysics Data System (ADS)

    Labbouz, Laurent; Van Baelen, Joël.; Duroure, Christophe

    2015-11-01

    Based on 5 years of measurements of integrated water vapor (IWV), surface mixing ratio (MR), and rain rate, we investigate the relationship between the water vapor field evolution and the precipitation lifecycle. We show that in 76% of the cases the IWV reaches a maximum before the peak of precipitation, with the precipitation peak occurring on average 20 min after the IWV maximum. This delay can be related to the fall time of the precipitation. We also show that the moister the atmosphere, the greater the precipitation rates and the longer the delay. Unlike the IWV, the MR reaches a maximum after the precipitation peak in 60% of the cases, highlighting the interest of IWV compared to surface MR only. This paper and the discussions within it open a pathway to complementary studies and applications for heavy precipitation prediction.

  14. WCPSS High School Graduation Rates: 4-Year and 5-Year Cohort Rates 2011-12. Measuring Up. D&A Report No. 13.04

    ERIC Educational Resources Information Center

    Regan, Roger

    2013-01-01

    The Wake County Public School System (WCPSS) four-year cohort graduation rate declined slightly to 80.6% in 2011-12 from 80.9% in the previous year. Disaggregated graduation rates for most racial and ethnic groups stayed nearly the same or declined slightly in 2011-12, but the rate for African-American students rose from 67.9% to 69.6%. The other…

  15. Mortality Rates during Cholera Epidemic, Haiti, 2010-2011.

    PubMed

    Luquero, Francisco J; Rondy, Marc; Boncy, Jacques; Munger, André; Mekaoui, Helmi; Rymshaw, Ellen; Page, Anne-Laure; Toure, Brahima; Degail, Marie Amelie; Nicolas, Sarala; Grandesso, Francesco; Ginsbourger, Maud; Polonsky, Jonathan; Alberti, Kathryn P; Terzian, Mego; Olson, David; Porten, Klaudia; Ciglenecki, Iza

    2016-03-01

    The 2010 cholera epidemic in Haiti was one of the largest cholera epidemics ever recorded. To estimate the magnitude of the death toll during the first wave of the epidemic, we retrospectively conducted surveys at 4 sites in the northern part of Haiti. Overall, 70,903 participants were included; at all sites, the crude mortality rates (19.1-35.4 deaths/1,000 person-years) were higher than the expected baseline mortality rate for Haiti (9 deaths/1,000 person-years). This finding represents an excess of 3,406 deaths (2.9-fold increase) for the 4.4% of the Haiti population covered by these surveys, suggesting a substantially higher cholera mortality rate than previously reported. PMID:26886511

  16. Mortality Rates during Cholera Epidemic, Haiti, 2010–2011

    PubMed Central

    Rondy, Marc; Boncy, Jacques; Munger, André; Mekaoui, Helmi; Rymshaw, Ellen; Page, Anne-Laure; Toure, Brahima; Degail, Marie Amelie; Nicolas, Sarala; Grandesso, Francesco; Ginsbourger, Maud; Polonsky, Jonathan; Alberti, Kathryn P.; Terzian, Mego; Olson, David; Porten, Klaudia; Ciglenecki, Iza

    2016-01-01

    The 2010 cholera epidemic in Haiti was one of the largest cholera epidemics ever recorded. To estimate the magnitude of the death toll during the first wave of the epidemic, we retrospectively conducted surveys at 4 sites in the northern part of Haiti. Overall, 70,903 participants were included; at all sites, the crude mortality rates (19.1–35.4 deaths/1,000 person-years) were higher than the expected baseline mortality rate for Haiti (9 deaths/1,000 person-years). This finding represents an excess of 3,406 deaths (2.9-fold increase) for the 4.4% of the Haiti population covered by these surveys, suggesting a substantially higher cholera mortality rate than previously reported. PMID:26886511

  17. Benchmarking clinical practice in surgery: looking beyond traditional mortality rates.

    PubMed

    Castro, Ricardo A S; Oliveira, Pedro N; Silva Portela, Conceição; Camanho, Ana S; Queiroz e Melo, João

    2015-12-01

    This paper proposes two new measures to assess performance of surgical practice based on observed mortality: reliability, measured as the area under the ROC curve and a living score, the sum of individual risk among surviving patients, divided by the total number of patients. A Monte Carlo simulation of surgeons' practice was used for conceptual validation and an analysis of a real-world hospital department was used for managerial validation. We modelled surgical practice as a bivariate distribution function of risk and final state. We sampled 250 distributions, varying the maximum risk each surgeon faced, the distribution of risk among dead patients, the mortality rate and the number of surgeries performed yearly. We applied the measures developed to a Portuguese cardiothoracic department. We found that the joint use of the reliability and living score measures overcomes the limitations of risk adjusted mortality rates, as it enables a different valuation of deaths, according to their risk levels. Reliability favours surgeons with casualties, predominantly, in high values of risk and penalizes surgeons with deaths in relatively low levels of risk. The living score is positively influenced by the maximum risk for which a surgeon yields surviving patients. These measures enable a deeper understanding of surgical practice and, as risk adjusted mortality rates, they rely only on mortality and risk scores data. The case study revealed that the performance of the department analysed could be improved with enhanced policies of risk management, involving the assignment of surgeries based on surgeon's reliability and living score. PMID:24633958

  18. Alcohol availability and cirrhosis mortality rates by gender and race.

    PubMed Central

    Colón, I

    1981-01-01

    This study test whether the availability of alcoholic beverages is a simple integrated dimension as implied by certain policy models and in its treatment by researchers. Factor analysis reveals two independent availability factors: on-premise and retail availability. A correlation analysis found that on-premise availability was related to cirrhosis mortality rates for the total population, White males, non-White males, and White females. It was not related to non-White female cirrhosis mortality. In contrast, retail availability was not related to any of cirrhosis mortality rates. Examination of the states with extremes of high and low on-premise availability indicates that this type of availability is not a manipulable control variable but an index of extant norms toward drinking. It is recommended that differential prevention strategies be adopted rather than a uniform policy prevention model. PMID:7315996

  19. 5-Year Budget Forecasting.

    ERIC Educational Resources Information Center

    Conyers, John G.; Lingel, George; Piekarski, Robert

    2000-01-01

    Financial planning is the key to providing a high-quality instructional plan. A 5-year financial plan is typically updated by looking at district financial history, future instructional plans, staffing requirements, and revenue projections. Planning assumptions must be clearly understood by the financial team and the community. (MLH)

  20. Squamous cell carcinoma of the lips in a northern Greek population. Evaluation of prognostic factors on 5-year survival rate--I.

    PubMed

    Antoniades, D Z; Styanidis, K; Papanayotou, P; Trigonidis, G

    1995-09-01

    The purpose of this study was to determine the clinical features of squamous cell carcinoma (SCC) of the lips, along with its prognostic factors, in order to extend and update the information related to lip cancer in northern Greece and to provide a basis for international comparison. Records of 1510 patients with SCC of the oral cavity presented at the Theagenion Anticancer Institute of Thessaloniki, Greece from 1979 and 1989 were reviewed. The most common site for oral squamous cell carcinoma (OSCC) was found to be the lips (59.4%) as compared to 40.5% of intra-oral SCC. Males were affected more frequently, presenting a ratio of 9.2:1. The peak age of incidence was found to be the 6th decade for men and the 8th for women. Rural residents and outdoor workers were affected more than urban residents (79.9% versus 28.1%). Most of the patients were diagnosed in early categories and early clinical stages of the disease. Almost all (98.5%) were classified into T1 and T2 categories, and 92.9% into stages I and II. A total of 7.59% of patients presented with clinically-positive lymph-node involvement. Most of them were classified as an advanced stage of the disease. Primary surgical excision was performed on 60.14%, radiotherapy on 35.14%, a combination of these on 2.47%, and chemotherapy alone or in combination with the above regimens in 2.22% of the cases. The outcome was adequate for surgery, radiotherapy, and the combination of the two, since 91.3, 74, and 90%, respectively, survived for more than 5 years. An overall 5-year survival rate of 83.3% was found. Our findings showed that the survival rate was significantly influenced by the main prognostic factors, such as the size of the tumour, the lymph-node involvement, the clinical stage of the disease and the histologic differentiation. SCC of the lips continues to be the most common site of oral cancer development amongst the Greek population. The aetiologic significance of actinic radiation for SCC of the lips is

  1. Are infant mortality rate declines exponential? The general pattern of 20th century infant mortality rate decline

    PubMed Central

    Bishai, David; Opuni, Marjorie

    2009-01-01

    Background Time trends in infant mortality for the 20th century show a curvilinear pattern that most demographers have assumed to be approximately exponential. Virtually all cross-country comparisons and time series analyses of infant mortality have studied the logarithm of infant mortality to account for the curvilinear time trend. However, there is no evidence that the log transform is the best fit for infant mortality time trends. Methods We use maximum likelihood methods to determine the best transformation to fit time trends in infant mortality reduction in the 20th century and to assess the importance of the proper transformation in identifying the relationship between infant mortality and gross domestic product (GDP) per capita. We apply the Box Cox transform to infant mortality rate (IMR) time series from 18 countries to identify the best fitting value of lambda for each country and for the pooled sample. For each country, we test the value of λ against the null that λ = 0 (logarithmic model) and against the null that λ = 1 (linear model). We then demonstrate the importance of selecting the proper transformation by comparing regressions of ln(IMR) on same year GDP per capita against Box Cox transformed models. Results Based on chi-squared test statistics, infant mortality decline is best described as an exponential decline only for the United States. For the remaining 17 countries we study, IMR decline is neither best modelled as logarithmic nor as a linear process. Imposing a logarithmic transform on IMR can lead to bias in fitting the relationship between IMR and GDP per capita. Conclusion The assumption that IMR declines are exponential is enshrined in the Preston curve and in nearly all cross-country as well as time series analyses of IMR data since Preston's 1975 paper, but this assumption is seldom correct. Statistical analyses of IMR trends should assess the robustness of findings to transformations other than the log transform. PMID:19698144

  2. Infectious Disease Mortality Rates, Thailand, 1958–2009

    PubMed Central

    McCarron, Margaret; Lertiendumrong, Jongkol; Olsen, Sonja J.; Bundhamcharoen, Kanitta

    2012-01-01

    To better define infectious diseases of concern in Thailand, trends in the mortality rate during 1958–2009 were analyzed by using data from public health statistics reports. From 1958 to the mid-1990s, the rate of infectious disease–associated deaths declined 5-fold (from 163.4 deaths/100,000 population in 1958 to 29.5/100,000 in 1997). This average annual reduction of 3.2 deaths/100,000 population was largely attributed to declines in deaths related to malaria, tuberculosis, pneumonia, and gastrointestinal infections. However, during 1998–2003, the mortality rate increased (peak of 70.0 deaths/100,000 population in 2003), coinciding with increases in mortality rate from AIDS, tuberculosis, and pneumonia. During 2004–2009, the rate declined to 41.0 deaths/100,000 population, coinciding with a decrease in AIDS-related deaths. The emergence of AIDS and the increase in tuberculosis- and pneumonia-related deaths in the late twentieth century emphasize the need to direct resources and efforts to the control of emerging and re-emerging infectious diseases. PMID:23092558

  3. Suicide mortality rates in Louisiana, 1999-2010.

    PubMed

    Straif-Bourgeois, Susanne; Ratard, Raoult

    2012-01-01

    This report is a descriptive study on suicide deaths in Louisiana occurring in the years 1999 to 2010. Mortality data was collected from death certificates from this 12-year period to describe suicide mortality by year, race, sex, age group, and methods of suicide. Data were also compared to national data. Rates and methods used to commit suicide vary greatly according to sex, race, and age. The highest rates were observed in white males, followed by black males, white females, and black females. Older white males had the highest suicide rates. The influence of age was modulated by the sex and race categories. Firearm was the most common method used in all four categories. Other less common methods were hanging/strangulation/suffocation (HSS) and drugs/alcohol. Although no parish-level data were systematically analyzed, a comparison of suicide rates post-Katrina versus pre-Katrina was done for Orleans Parish, the rest of the Greater New Orleans area, and a comparison group. It appears that rates observed among whites, particularly males, were higher after Katrina. Data based on mortality do not give a comprehensive picture of the burden of suicide, and their interpretation should be done with caution. PMID:23362593

  4. 29 CFR Appendix A to Part 4044 - Mortality Rate Tables

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ....500000 115 0.500000 116 0.500000 117 0.500000 118 0.500000 119 0.500000 120 1.000000 Table 4—Projection... 1994, when using Table 1 or Table 3) will not survive to attain age x + 1. The projection scales in this appendix set forth for each age x the annual reduction AAX in the mortality rate at age x. Table...

  5. 29 CFR Appendix A to Part 4044 - Mortality Rate Tables

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ....500000 115 0.500000 116 0.500000 117 0.500000 118 0.500000 119 0.500000 120 1.000000 Table 4—Projection... 1994, when using Table 1 or Table 3) will not survive to attain age x + 1. The projection scales in this appendix set forth for each age x the annual reduction AAX in the mortality rate at age x. Table...

  6. Suspended-sediment transport rates at the 1.5-year recurrence interval for ecoregions of the United States: transport conditions at the bankfull and effective discharge?

    NASA Astrophysics Data System (ADS)

    Simon, Andrew; Dickerson, Wendy; Heins, Amanda

    2004-03-01

    Historical flow and suspended-sediment transport data from more than 2900 sites across the United States have been analyzed in the context of estimating flow and suspended-sediment transport conditions at the 1.5-year recurrence interval flow ( Q1.5). This is particularly relevant with the renewed focus on stream restoration activities and the urgency in developing water-quality criteria for sediment. Data were sorted into the 84 Level III ecoregions to identify spatial trends in suspended-sediment concentrations and yields to meaningfully describe suspended-sediment transport rates across the United States. Arguments are developed that in lieu of form-based estimates of say the bankfull level, a flow of a given recurrence interval ( Q1.5) is more appropriate to integrate suspended-sediment transport ratings for the purpose of defining long-term transport conditions at a site (the "effective discharge"). The use of the Q1.5 as a measure of the effective discharge for suspended-sediment transport is justified on the basis of literature reports and analytic results from hundreds of sites in 17 ecoregions that span a diverse range of hydrologic and topographic conditions (i.e., Coast Range, Arizona/New Mexico Plateau, Mississippi Valley Loess Plains, Middle Atlantic Coastal Plain). There is sufficient data to also develop regional curves for the Q1.5 in all but eight of the ecoregions. At the Q1.5 the highest median suspended-sediment concentrations occur in semiarid environments (Southwest Tablelands, Arizona/New Mexico Plateau and the Mojave Basin and Range); the highest yields occur in humid regions with erodible soils and steep slopes or channel gradients (Mississippi Valley Loess Plains [MVLP] and the Coast Range). Suspended-sediment yields for stable streams are used to determine "background" or "reference" sediment transport conditions in eight ecoregions where there is sufficient field data. The median value for stable sites within a given ecoregion are

  7. Dietary restriction of rodents decreases aging rate without affecting initial mortality rate -- a meta-analysis.

    PubMed

    Simons, Mirre J P; Koch, Wouter; Verhulst, Simon

    2013-06-01

    Dietary restriction (DR) extends lifespan in multiple species from various taxa. This effect can arise via two distinct but not mutually exclusive ways: a change in aging rate and/or vulnerability to the aging process (i.e. initial mortality rate). When DR affects vulnerability, this lowers mortality instantly, whereas a change in aging rate will gradually lower mortality risk over time. Unraveling how DR extends lifespan is of interest because it may guide toward understanding the mechanism(s) mediating lifespan extension and also has practical implications for the application of DR. We reanalyzed published survival data from 82 pairs of survival curves from DR experiments in rats and mice by fitting Gompertz and also Gompertz-Makeham models. The addition of the Makeham parameter has been reported to improve the estimation of Gompertz parameters. Both models separate initial mortality rate (vulnerability) from an age-dependent increase in mortality (aging rate). We subjected the obtained Gompertz parameters to a meta-analysis. We find that DR reduced aging rate without affecting vulnerability. The latter contrasts with the conclusion of a recent analysis of a largely overlapping data set, and we show how the earlier finding is due to a statistical artifact. Our analysis indicates that the biology underlying the life-extending effect of DR in rodents likely involves attenuated accumulation of damage, which contrasts with the acute effect of DR on mortality reported for Drosophila. Moreover, our findings show that the often-reported correlation between aging rate and vulnerability does not constrain changing aging rate without affecting vulnerability simultaneously. PMID:23438200

  8. Disentangling Effects of Vector Birth Rate, Mortality Rate, and Abundance on Spread of Plant Pathogens.

    PubMed

    Sisterson, Mark S; Stenger, Drake C

    2016-04-01

    Models on the spread of insect-transmitted plant pathogens often fix vector population size by assuming that deaths are offset by births. Although such mathematical simplifications are often justified, deemphasizing parameters that govern vector population size is problematic, as reproductive biology and mortality schedules of vectors of plant pathogens receive little empirical attention. Here, the importance of explicitly including parameters for vector birth and death rates was evaluated by comparing results from models with fixed vector population size with models with logistic vector population growth. In fixed vector population size models, increasing vector mortality decreased percentage of inoculative vectors, but had no effect on vector population size, as deaths were offset by births. In models with logistic vector population growth, increasing vector mortality decreased percentage of inoculative vectors and decreased vector population size. Consequently, vector mortality had a greater effect on pathogen spread in models with logistic vector population growth than in models with fixed vector population size. Further, in models with logistic vector population growth, magnitude of vector birth rate determined time required for vector populations to reach large size, thereby determining when pathogen spread occurred quickly. Assumptions regarding timing of vector mortality within a time step also affected model outcome. A greater emphasis of vector entomologists on studying reproductive biology and mortality schedules of insect species that transmit plant pathogens will facilitate identification of conditions associated with rapid growth of vector populations and could lead to development of novel control strategies. PMID:26637536

  9. CORRELATIONS BETWEEN AGE-ADJUSTED MORTALITY RATES FOR WHITE MALES AND FEMALES IN THE UNITED STATES BY COUNTY, 1968-1972

    EPA Science Inventory

    Intercorrelations among county mortality rates for about 50 causes of death were investigated for white males (WM) and white females (WF) for the 5-year period between 1968 and 1972. All possible pairwise correlations (1128 for WM and 1275 for WF) were calculated; those correlati...

  10. Uneven futures of human lifespans: reckonings from Gompertz mortality rates, climate change, and air pollution.

    PubMed

    Finch, Caleb E; Beltrán-Sánchez, Hiram; Crimmins, Eileen M

    2014-01-01

    The past 200 years have enabled remarkable increases in human lifespans through improvements in the living environment that have nearly eliminated infections as a cause of death through improved hygiene, public health, medicine, and nutrition. We argue that the limit to lifespan may be approaching. Since 1997, no one has exceeded Jeanne Calment's record of 122.5 years, despite an exponential increase of centenarians. Moreover, the background mortality may be approaching a lower limit. We calculate from Gompertz coefficients that further increases in longevity to approach a life expectancy of 100 years in 21st century cohorts would require 50% slower mortality rate accelerations, which would be a fundamental change in the rate of human aging. Looking into the 21st century, we see further challenges to health and longevity from the continued burning of fossil fuels that contribute to air pollution as well as global warming. Besides increased heat waves to which elderly are vulnerable, global warming is anticipated to increase ozone levels and facilitate the spread of pathogens. We anticipate continuing socioeconomic disparities in life expectancy. PMID:24401556

  11. Uneven Futures of Human Lifespans: Reckonings from Gompertz Mortality Rates, Climate Change, and Air Pollution

    PubMed Central

    Finch, Caleb E; Beltrán-Sánchez, Hiram; Crimmins, Eileen M

    2014-01-01

    The past 200 years have enabled remarkable increases in human lifespans thru improvements of the living environment that have nearly eliminated infections as a cause of death through improved hygiene- public health, medicine, and nutrition. We argue that the limit to lifespan may be approaching. Since 1997, no one has exceeded Jean Calment's record of 122.5 years, despite an exponential increase of centenarians. Moreover, the background mortality may be approaching a lower limit. We calculate from Gompertz coefficients that further increases in longevity to approach a life expectancy of 100 years in 21st C cohorts would require 50% slower mortality rate accelerations, which would be a fundamental change in the rate of human aging. Looking into the 21st C, we see further challenges to health and longevity from the continued burning of fossil fuels that contribute to air pollution, as well as global warming. Besides increased heat waves to which elderly are vulnerable, global warming is anticipated to increase ozone levels and to favor the spread of pathogens. We anticipate continuing socio-economic disparities of life expectancy. PMID:24401556

  12. Suspended-Sediment Transport Rates at the 1.5-Year Recurrence Interval for Level III Ecoregions of the United States

    NASA Astrophysics Data System (ADS)

    Simon, A.

    2002-12-01

    Historical flow and suspended-sediment transport data from more than 2,900 sites across the United States have been analyzed in the context of estimating flow and suspended-sediment transport conditions at the 1.5-year recurrence interval (Q1.5) discharge. Using a specific flow frequency provides a means of comparing streams draining watersheds of different size, geology, physiography and climate. The Q1.5 is often associated with several controversial fluvial geomorphic concepts such as bankfull discharge, dominant discharge, effective discharge and channel-forming discharge. These concepts are particularly relevant with the renewed focus on stream restoration activities and the urgency in developing water-quality criteria for sediment. Data were sorted into the 84 Level III ecoregions to identify spatial trends in suspended-sediment concentrations and yields at the bankfull discharge. Arguments are developed that in lieu of form-based estimates of the bankfull level, a flow of a given recurrence interval (Q1.5) is appropriate to estimate channel-forming conditions if it can be shown that the greatest amount of sediment is transported at this flow frequency (effective discharge). A concurrent study is underway to determine the effective discharge in each ecoregion. There is sufficient data to develop regional curves for the Q1.5 in all but eight of the ecoregions in the continental United States. At the Q1.5 the highest median suspended-sediment concentrations occur in semi-arid environments (Southwest Tablelands, Arizona-New Mexico Plateau and the Mojave Basin and Range) owing to large quantities of availalke sediment, limited vegetative cover, and the flashy nature of runoff events. The highest suspended-sediment yields occur in humid regions with erodable soils and steep slopes or channel gradients (Mississippi Valley Loess Plains and the Coast Range). Suspended-sediment yields for stable streams are used to determine "background" or "reference" sediment

  13. Differences between Older Men and Women in the Self-Rated Health-Mortality Relationship

    ERIC Educational Resources Information Center

    Bath, Peter A.

    2003-01-01

    Purpose: The aims of this study were to examine differences between older men and women: (a) in the ability of self-rated health to predict mortality, (b) in the effect of different follow-up periods on the self-rated health mortality relationship, and (c) in the relative importance of self-rated health and self-rated change in health in…

  14. Effects of type of ownership of skilled nursing facilities on residents' mortality rates in Illinois.

    PubMed

    Bell, R; Krivich, M

    1990-01-01

    The effect of ownership on the quality and cost of care in skilled nursing facilities (SNFs) was examined using unadjusted and adjusted mortality rates for such facilities in Illinois for the 1986-87 reporting year. Results indicated that when using unadjusted mortality rates, for-profit facilities had much lower rates than either government-owned or nonprofit SNFs. When mortality rates were adjusted, using available measures of intervening variables, differences by type of ownership disappeared. The higher percentage of discharges to general hospitals exhibited by for-profit facilities, compared with other types of facility ownership, appears to have the strongest effect on SNF mortality rates. PMID:2120730

  15. Misery Loves Company? A Meta-Regression Examining Aggregate Unemployment Rates and the Unemployment-Mortality Association

    PubMed Central

    Roelfs, David J.; Shor, Eran; Blank, Aharon; Schwartz, Joseph E.

    2015-01-01

    PURPOSE Individual-level unemployment has been consistently linked to poor health and higher mortality, but some scholars have suggested that the negative effect of job loss may be lower during times and in places where aggregate unemployment rates are high. We review three logics associated with this moderation hypothesis: health selection, social isolation, and unemployment stigma. We then test whether aggregate unemployment rates moderate the individual-level association between unemployment and all-cause mortality. METHODS We use 6 meta-regression models (each utilizing a different measure of the aggregate unemployment rate) based on 62 relative all-cause mortality risk estimates from 36 studies (from 15 nations). RESULTS We find that the magnitude of the individual-level unemployment-mortality association is approximately the same during periods of high and low aggregate-level unemployment. Model coefficients (exponentiated) were 1.01 for the crude unemployment rate (p = 0.27), 0.94 for the change in unemployment rate from the previous year (p = 0.46), 1.01 for the deviation of the unemployment rate from the 5-year running average (p = 0.87), 1.01 for the deviation of the unemployment rate from the 10-year running average (p = 0.73), 1.01 for the deviation of the unemployment rate from the overall average (measured as a continuous variable; p = 0.61), and showed no variation across unemployment levels when the deviation of the unemployment rate from the overall average was measured categorically. Heterogeneity between studies was significant (p < .001), supporting the use of the random effects model. CONCLUSIONS We found no strong evidence to suggest that unemployment experiences change when macro-economic conditions change. Efforts to ameliorate the negative social and economic consequences of unemployment should continue to focus on the individual and should be maintained regardless of periodic changes in macro-economic conditions. PMID:25795225

  16. Prostate-Specific Antigen at 4 to 5 Years After Low-Dose-Rate Prostate Brachytherapy Is a Strong Predictor of Disease-Free Survival

    SciTech Connect

    Lo, Andrea C.; Morris, W. James; Lapointe, Vincent; Hamm, Jeremy; Keyes, Mira; Pickles, Tom; McKenzie, Michael; Spadinger, Ingrid

    2014-01-01

    Purpose: To determine (1) the prognostic utility of prostate-specific antigen (PSA) concentration at 45 to 60 months (48mPSA) after low-dose-rate prostate brachytherapy (LDR-PB); (2) the predictors of 48mPSA; and (3) the prognostic utility of directional trends between PSA levels at 24, 36, and 48 months after LDR-PB. Methods and Materials: Between 1998 and 2008, 2223 patients with low- and intermediate-risk prostate cancer received LDR-PB monotherapy. A cohort of 1434 of these patients was identified with a documented 48mPSA and no evidence of disease relapse prior to the 48mPSA. In addition, a subset of this cohort (n=585) was identified with ≥72 months of follow-up and documented PSA values at both 24 and 36 months after implantation. Results: Median follow-up time was 76 months. Eight-year Kaplan-Meier disease-free survival (DFS) rates were 100% vs 73.4% for patients with 48mPSA ≤0.2 vs those with >0.2 ng/mL; 99.1% versus 53.8% for a 48mPSA threshold of ≤0.4 versus >0.4 ng/mL, respectively; and 97.3% versus 0% for a threshold of ≤1.0 versus >1.0 ng/mL, respectively. On multivariate analysis, the only factor predictive of DFS was 48mPSA (P<.0001). On subset analysis (n=585), 29 patients had a PSA rise (defined as >0.2 ng/mL) between 24 and 36 months, 24 patients had a rise between 36 and 48 months, and 11 patients had rises over both intervals. Failure rates in these patients were 52%, 79%, and 100%, respectively. On multivariate analysis, initial PSA, androgen deprivation therapy, and dose to 90% of the prostate significantly correlated with 48mPSA but together accounted for only ∼5% of its total variance. Conclusions: The 48mPSA after LDR-PB is highly predictive of long-term DFS. Patients with 48mPSA ≤0.4 ng/mL had a <1% risk of disease relapse at 8 years, whereas all patients with 48mPSA >1.0 ng/mL relapsed. Consecutive PSA rises of >0.2 ng/mL from 24 to 36 months and from 36 to 48 months were also highly predictive of subsequent failure.

  17. Causes and rates of mortality of swift foxes in western Kansas

    USGS Publications Warehouse

    Sovada, M.A.; Roy, C.C.; Bright, J.B.; Gillis, J.R.

    1998-01-01

    Knowledge of mortality factors is important for developing strategies to conserve the swift fox (Vulpes velox), a species being considered for listing under the Endangered Species Act, but available information about swift fox mortality is inadequate. We used radiotelemetry techniques to examine the magnitude and causes of mortality of swift fox populations in 2 study areas in western Kansas. One study area was predominantly cropland, the other rangeland. Mortality rates, calculated using Kaplan-Meier estimation techniques in a staggered entry design, were 0.55 ?? 0.08 (5 ?? SE) for adult and 0.67 ?? 0.08 for juvenile swift foxes. We did not detect differences between study areas in mortality rates for adults or juveniles. Predation by coyotes (Canis latrans) was the major cause of mortality for adult and juvenile swift foxes in both study areas, and vehicle collision was an important mortality factor for juveniles in the cropland study area. No mortality was attributed to starvation or disease.

  18. Causes and implications of the correlation between forest productivity and tree mortality rates

    USGS Publications Warehouse

    Stephenson, Nathan L.; van Mantgem, Philip J.; Bunn, Andrew G.; Bruner, Howard; Harmon, Mark E.; O'Connell, Kari B.; Urban, Dean L.; Franklin, Jerry F.

    2011-01-01

    For only one of these four mechanisms, competition, can high mortality rates be considered to be a relatively direct consequence of high NPP. The remaining mechanisms force us to adopt a different view of causality, in which tree growth rates and probability of mortality can vary with at least a degree of independence along productivity gradients. In many cases, rather than being a direct cause of high mortality rates, NPP may remain high in spite of high mortality rates. The independent influence of plant enemies and other factors helps explain why forest biomass can show little correlation, or even negative correlation, with forest NPP.

  19. Developmental milestones record - 5 years

    MedlinePlus

    ... milestones for children - 5 years References Feigelman S. The preschool years. In: Kliegman RM, Behrman RE, Jenson HB, ... Duplication for commercial use must be authorized in writing by ADAM Health Solutions. About MedlinePlus Site Map ...

  20. Child Mortality Estimation: Consistency of Under-Five Mortality Rate Estimates Using Full Birth Histories and Summary Birth Histories

    PubMed Central

    Silva, Romesh

    2012-01-01

    Background Given the lack of complete vital registration data in most developing countries, for many countries it is not possible to accurately estimate under-five mortality rates from vital registration systems. Heavy reliance is often placed on direct and indirect methods for analyzing data collected from birth histories to estimate under-five mortality rates. Yet few systematic comparisons of these methods have been undertaken. This paper investigates whether analysts should use both direct and indirect estimates from full birth histories, and under what circumstances indirect estimates derived from summary birth histories should be used. Methods and Findings Usings Demographic and Health Surveys data from West Africa, East Africa, Latin America, and South/Southeast Asia, I quantify the differences between direct and indirect estimates of under-five mortality rates, analyze data quality issues, note the relative effects of these issues, and test whether these issues explain the observed differences. I find that indirect estimates are generally consistent with direct estimates, after adjustment for fertility change and birth transference, but don't add substantial additional insight beyond direct estimates. However, choice of direct or indirect method was found to be important in terms of both the adjustment for data errors and the assumptions made about fertility. Conclusions Although adjusted indirect estimates are generally consistent with adjusted direct estimates, some notable inconsistencies were observed for countries that had experienced either a political or economic crisis or stalled health transition in their recent past. This result suggests that when a population has experienced a smooth mortality decline or only short periods of excess mortality, both adjusted methods perform equally well. However, the observed inconsistencies identified suggest that the indirect method is particularly prone to bias resulting from violations of its strong

  1. Contribution of Climate and Air Pollution to Variation in Coronary Heart Disease Mortality Rates in England

    PubMed Central

    Scarborough, Peter; Allender, Steven; Rayner, Mike; Goldacre, Michael

    2012-01-01

    There are substantial geographic variations in coronary heart disease (CHD) mortality rates in England that may in part be due to differences in climate and air pollution. An ecological cross-sectional multi-level analysis of male and female CHD mortality rates in all wards in England (1999–2004) was conducted to estimate the relative strength of the association between CHD mortality rates and three aspects of the physical environment - temperature, hours of sunshine and air quality. Models were adjusted for deprivation, an index measuring the healthiness of the lifestyle of populations, and urbanicity. In the fully adjusted model, air quality was not significantly associated with CHD mortality rates, but temperature and sunshine were both significantly negatively associated (p<0.05), suggesting that CHD mortality rates were higher in areas with lower average temperature and hours of sunshine. After adjustment for the unhealthy lifestyle of populations and deprivation, the climate variables explained at least 15% of large scale variation in CHD mortality rates. The results suggest that the climate has a small but significant independent association with CHD mortality rates in England. PMID:22427884

  2. Trends in 30-day mortality rate and case mix for paediatric cardiac surgery in the UK between 2000 and 2010

    PubMed Central

    Brown, Katherine L; Crowe, Sonya; Franklin, Rodney; McLean, Andrew; Cunningham, David; Barron, David; Tsang, Victor; Pagel, Christina; Utley, Martin

    2015-01-01

    Objectives To explore changes over time in the 30-day mortality rate for paediatric cardiac surgery and to understand the role of attendant changes in the case mix. Methods, setting and participants Included were: all mandatory submissions to the National Institute of Cardiovascular Outcomes Research (NICOR) relating to UK cardiac surgery in patients aged <16 years. The χ2 test for trend was used to retrospectively analyse the proportion of surgical episodes ending in 30-day mortality and with various case mix indicators, in 10 consecutive time periods, from 2000 to 2010. Comparisons were made between two 5-year eras of: 30-day mortality, period prevalence and mean age for 30 groups of specific operations. Main outcome measure 30-day mortality for an episode of surgical management. Results Our analysis includes 36 641 surgical episodes with an increase from 2283 episodes in 2000 to 3939 in 2009 (p<0.01). The raw national 30-day mortality rate fell over the period of review from 4.3% (95% CI 3.5% to 5.1%) in 2000 to 2.6% (95% CI 2.2% to 3.0%) in 2009/2010 (p<0.01). The case mix became more complex in terms of the percentage of patients <2.5 kg (p=0.05), with functionally univentricular hearts (p<0.01) and higher risk diagnoses (p<0.01). In the later time era, there was significant improvement in 30-day mortality for arterial switch with ventricular septal defect (VSD) repair, patent ductus arteriosus ligation, Fontan-type operation, tetralogy of Fallot and VSD repair, and the mean age of patients fell for a range of operations performed in infancy. Conclusions The raw 30-day mortality rate for paediatric cardiac surgery fell over a decade despite a rise in the national case mix complexity, and compares well with international benchmarks. Definitive repair is now more likely at a younger age for selected infants with congenital heart defects. PMID:25893099

  3. Occupational injury mortality rates in the United States: changes from 1980 to 1989.

    PubMed

    Stout, N A; Jenkins, E L; Pizatella, T J

    1996-01-01

    Changes in occupational injury mortality rates over the 1980s were examined through analysis of the National Traumatic Occupational Fatalities surveillance system. The US occupational injury mortality rate decreased 37% over the decade, with decreases seen in nearly every demographic and employment sector. Greater declines were among men, Blacks, and younger workers, as well as among agricultural, trade, and service workers. Electrocutions, machine-related incidents, and homicides showed the greatest decreases. Changes in occupational mortality rates by demography, industry, and cause of death indicate the areas in which the most progress has been made and those that are prime targets for prevention efforts. PMID:8561247

  4. Women Chemists Mortality Study Finds High Suicide Rate.

    ERIC Educational Resources Information Center

    Chemical and Engineering News, 1984

    1984-01-01

    A study of white women members (N=347) of the American Chemical Society who died between 1925 and 1979 finds five times the expected rate of suicide, a higher risk for some forms of cancer, and a lower rate of heart disease. These and other findings are discussed. (JN)

  5. Captive Reptile Mortality Rates in the Home and Implications for the Wildlife Trade

    PubMed Central

    Robinson, Janine E.; St. John, Freya A. V.; Griffiths, Richard A.; Roberts, David L.

    2015-01-01

    The trade in wildlife and keeping of exotic pets is subject to varying levels of national and international regulation and is a topic often attracting controversy. Reptiles are popular exotic pets and comprise a substantial component of the live animal trade. High mortality of traded animals raises welfare concerns, and also has implications for conservation if collection from the wild is required to meet demand. Mortality of reptiles can occur at any stage of the trade chain from collector to consumer. However, there is limited information on mortality rates of reptiles across trade chains, particularly amongst final consumers in the home. We investigated mortality rates of reptiles amongst consumers using a specialised technique for asking sensitive questions, additive Randomised Response Technique (aRRT), as well as direct questioning (DQ). Overall, 3.6% of snakes, chelonians and lizards died within one year of acquisition. Boas and pythons had the lowest reported mortality rates of 1.9% and chameleons had the highest at 28.2%. More than 97% of snakes, 87% of lizards and 69% of chelonians acquired by respondents over five years were reported to be captive bred and results suggest that mortality rates may be lowest for captive bred individuals. Estimates of mortality from aRRT and DQ did not differ significantly which is in line with our findings that respondents did not find questions about reptile mortality to be sensitive. This research suggests that captive reptile mortality in the home is rather low, and identifies those taxa where further effort could be made to reduce mortality rates. PMID:26556237

  6. Rate of ESRD Exceeds Mortality among African Americans with Hypertensive Nephrosclerosis

    PubMed Central

    Wang, Xuelei; Wright, Jackson T.; Appel, Lawrence J.; Greene, Tom; Norris, Keith; Lewis, Julia

    2010-01-01

    In several studies, patients with CKD seemed to be at greater risk for dying from cardiovascular disease (CVD) than reaching ESRD. The purpose of this study was to compare incident ESRD rates with rates of total mortality, CVD death, and a CVD composite (CVD mortality and CVD hospitalization) among participants who had hypertensive nephrosclerosis and were enrolled in the African American Study of Kidney Disease and Hypertension (AASK). The study period included the AASK trial phase (1996 through 2001) and a subsequent cohort phase (2002 through 2007). The AASK enrolled 1094 participants. Of the 764 participants who completed the trial phase without an event, 691 (90%) enrolled in the cohort phase. During 11 years of follow-up, there were 59 CVD-related deaths and 118 non–CVD-related deaths. The rate of ESRD (3.9/100 patient-years) was significantly higher than the rates of total mortality (2.2/100 patient-years), CVD mortality (0.8/100 patient-years), and the CVD composite (3.2/100 patient-years). The incidence rate ratio of ESRD to CVD mortality was 5.0. The rate of ESRD consistently exceeded the various mortality rates across most of the subgroups defined by age, gender, income, education, previous CVD, baseline urine protein excretion, and baseline estimated GFR. In conclusion, AASK participants were more likely to reach ESRD than to die. PMID:20651163

  7. Rate and Time Trend of Perinatal, Infant, Maternal Mortality, Natality and Natural Population Growth in Kosovo

    PubMed Central

    Azemi, Mehmedali; Gashi, Sanije; Berisha, Majlinda; Kolgeci, Selim; Ismaili-Jaha, Vlora

    2012-01-01

    Aim: The aim of work has been the presentation of the rate and time trends of some indicators of the heath condition of mothers and children in Kosovo: fetal mortality, early neonatal mortality, perinatal mortality, infant mortality, natality, natural growth of population etc. The treated patients were the newborn and infants in the post neonatal period, women during their pregnancy and those 42 days before and after the delivery. Methods: The data were taken from: register of the patients treated in the Pediatric Clinic of Prishtina, World Health Organization, Mother and Child Health Care, Reproductive Health Care, Ministry of Health of the Republic of Kosovo, Statistical Department of Kosovo, the National Institute of Public Health and several academic texts in the field of pediatrics. Some indicators were analyzed in a period between year 1945-2010 and 1950-2010, whereas some others were analyzed in a time period between year 2000 and 2011. Results: The perinatal mortality rate in 2000 was 29.1‰, whereas in 2011 it was 18.7‰. The fetal mortality rate was 14.5‰ during the year 2000, whereas in 2011 it was 11.0‰, in 2000 the early neonatal mortality was 14.8‰, in 2011 it was 7.5‰. The infant mortality in Kosovo was 164‰ in 1950, whereas in 2010 it was 20.5‰. The most frequent causes of infant mortality have been: lower respiratory tract infections, acute infective diarrhea, perinatal causes, congenital malformations and unclassified conditions. Maternal death rate varied during this time period. Maternal death in 2000 was 23 whereas in 2010 only two cases were reported. Regarding the natality, in 1950 it reached 46.1 ‰, whereas in 2010 it reached 14‰, natural growth of population rate in Kosovo was 29.1‰ in 1950, whereas in 2011 it was 11.0‰. Conclusion: Perinatal mortality rate in Kosovo is still high in comparison with other European countries (Turkey and Kyrgyzstan have the highest perinatal mortality rate), even though it is in a

  8. Understanding Racial and Ethnic Disparities in U.S. Infant Mortality Rates

    MedlinePlus

    ... specific infant mortality rates, by race and Hispanic origin of mother: United States, 2007 Gestational age (weeks) ... ethnic groups is higher than in other developed countries, all U.S. racial and ethnic groups might benefit ...

  9. Comparisons of prostate cancer mortality rates with dietary practices in the United States.

    PubMed

    Colli, Janet Laura; Colli, Albert

    2005-01-01

    From 1930 to 1992, prostate cancer mortality rates in the United States doubled and then declined somewhat until 2000. The objective of this study is to determine whether variations in prostate cancer mortality rates correlate with dietary changes that occurred over that period. Simple linear regression models were applied to age-adjusted prostate cancer mortality rates and per-capita consumption rates for 18 foods from 1930 to 2000. Correlation coefficients were calculated while comparing food consumption rates to prostate cancer mortality rates for the same year. Correlation coefficients were then recalculated when the prostate cancer mortality rates were compared with food consumption rates that occurred: 1 yr; 2 yr; 3 yr; and continuing in progression for 21 yr before the occurrence of the prostate cancer mortality. The largest positive correlation coefficients were associated with the consumption of: total meat (red meat, poultry and fish) (R = 0.83, T between 0 and 1); added fats and oils (R = 0.83, T = 21); ice cream (R = 0.83, T = 20); margarine (R = 0.81, T = 4); salad/cooking oil (R = 0.82, T between 3 and 4) and; vegetable shortening (R = 0.81, T between 1 and 2) where R is the correlation coefficient and T is the time in years between consumption and mortality. In conclusion, this study found strong positive correlations between prostate cancer mortality and the consumption of: total meat; added fats and oils, ice cream, salad/cooking oils, margarine, and vegetable shortening. The connection between total meat consumption and prostate cancer risk is consistent with previous studies in the literature. The link between salad/cooking oil consumption and prostate cancer risk may be consistent with past studies which suggest that mu-linolenic acid (a component of salad/cooking oils) is a suspected risk factor for prostate cancer. PMID:16301115

  10. Exploring geographic variation in US mortality rates using a spatial Durbin approach

    PubMed Central

    Yang, Tse-Chuan; Noah, Aggie; Shoff, Carla

    2015-01-01

    Previous studies focused on identifying the determinants of mortality in US counties have examined the relationships between mortality and explanatory covariates within a county only, and have ignored the well-documented spatial dependence of mortality. We challenge earlier literature by arguing that the mortality rate of a certain county may also be associated with the features of its neighboring counties beyond its own features. Drawing from both the spillover (i.e., same direction effect) and social relativity (i.e., opposite direction effect) perspectives, our spatial Durbin modeling results indicate that both theoretical perspectives provide valuable frameworks to guide the modeling of mortality variation in US counties. Our empirical findings support that mortality rate of a certain county is associated with the features of its neighbors beyond its own features. Specifically, we found support for the spillover perspective in which the percentage of the Hispanic population, concentrated disadvantage, and the social capital of a specific county are negatively associated with the mortality rate in the specific county and also in neighboring counties. On the other hand, the following covariates fit the social relativity process: health insurance coverage, percentage of non-Hispanic other races, and income inequality. Their direction of the associations with mortality in the specific county is opposite to that of the relationships with mortality in neighboring counties. Methodologically, spatial Durbin modeling addresses the shortcomings of traditional analytic approaches used in ecological mortality research such as ordinary least squares, spatial error, and spatial lag regression. Our results produce new insights drawn from unbiased estimates. PMID:25642156

  11. [Survey of suicidal mortality rate in several districts of Sichuan province].

    PubMed

    Hu, Z; Liu, X; Huo, K; Zhang, W

    1992-09-01

    A survey of the suicidal mortality rates in two cities and six districts in Sichuan province was carried out from 1980 to 1988 by the authors. The average suicidal mortality rate (ASMR) in these districts from 1980 to 1988 was 15.5/10(5), and the population and suicidal mortality rate positively correlated, r = 0.53. The ASMR in the male was 14.9/10(5), in the female 17.1/10(5), in the urban area 9.4/10(5), in the rural area 21/10(5), and the ASMR in the urban area was higher than that in the rural area (P < 0.05). The peak age of suicidal mortality was around twenty years. PMID:1304550

  12. High-dose-rate brachytherapy and hypofractionated external beam radiotherapy combined with long-term hormonal therapy for high-risk and very high-risk prostate cancer: outcomes after 5-year follow-up

    PubMed Central

    Ishiyama, Hiromichi; Satoh, Takefumi; Kitano, Masashi; Tabata, Ken-ichi; Komori, Shouko; Ikeda, Masaomi; Soda, Itaru; Kurosaka, Shinji; Sekiguchi, Akane; Kimura, Masaki; Kawakami, Shogo; Iwamura, Masatsugu; Hayakawa, Kazushige

    2014-01-01

    The purpose of this study was to report the outcomes of high-dose-rate (HDR) brachytherapy and hypofractionated external beam radiotherapy (EBRT) combined with long-term androgen deprivation therapy (ADT) for National Comprehensive Cancer Network (NCCN) criteria-defined high-risk (HR) and very high-risk (VHR) prostate cancer. Data from 178 HR (n = 96, 54%) and VHR (n = 82, 46%) prostate cancer patients who underwent 192Ir-HDR brachytherapy and hypofractionated EBRT with long-term ADT between 2003 and 2008 were retrospectively analyzed. The mean dose to 90% of the planning target volume was 6.3 Gy/fraction of HDR brachytherapy. After five fractions of HDR treatment, EBRT with 10 fractions of 3 Gy was administered. All patients initially underwent ≥6 months of neoadjuvant ADT, and adjuvant ADT was continued for 36 months after EBRT. The median follow-up was 61 months (range, 25–94 months) from the start of radiotherapy. The 5-year biochemical non-evidence of disease, freedom from clinical failure and overall survival rates were 90.6% (HR, 97.8%; VHR, 81.9%), 95.2% (HR, 97.7%; VHR, 92.1%), and 96.9% (HR, 100%; VHR, 93.3%), respectively. The highest Radiation Therapy Oncology Group-defined late genitourinary toxicities were Grade 2 in 7.3% of patients and Grade 3 in 9.6%. The highest late gastrointestinal toxicities were Grade 2 in 2.8% of patients and Grade 3 in 0%. Although the 5-year outcome of this tri-modality approach seems favorable, further follow-up is necessary to validate clinical and survival advantages of this intensive approach compared with the standard EBRT approach. PMID:24222312

  13. Subsequent surgery rates after cervical total disc replacement using a Mobi-C Cervical Disc Prosthesis versus anterior cervical discectomy and fusion: a prospective randomized clinical trial with 5-year follow-up.

    PubMed

    Jackson, Robert J; Davis, Reginald J; Hoffman, Gregory A; Bae, Hyun W; Hisey, Michael S; Kim, Kee D; Gaede, Steven E; Nunley, Pierce Dalton

    2016-05-01

    OBJECTIVE Cervical total disc replacement (TDR) has been shown in a number of prospective clinical studies to be a viable treatment alternative to anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic degenerative disc disease. In addition to preserving motion, evidence suggests that cervical TDR may result in a lower incidence of subsequent surgical intervention than treatment with fusion. The goal of this study was to evaluate subsequent surgery rates up to 5 years in patients treated with TDR or ACDF at 1 or 2 contiguous levels between C-3 and C-7. METHODS This was a prospective, multicenter, randomized, unblinded clinical trial. Patients with symptomatic degenerative disc disease were enrolled to receive 1- or 2-level treatment with either TDR as the investigational device or ACDF as the control treatment. There were 260 patients in the 1-level study (179 TDR and 81 ACDF patients) and 339 patients in the 2-level study (234 TDR and 105 ACDF patients). RESULTS At 5 years, the occurrence of subsequent surgical intervention was significantly higher among ACDF patients for 1-level (TDR, 4.5% [8/179]; ACDF, 17.3% [14/81]; p = 0.0012) and 2-level (TDR, 7.3% [17/234]; ACDF, 21.0% [22/105], p = 0.0007) treatment. The TDR group demonstrated significantly fewer index- and adjacent-level subsequent surgeries in both the 1- and 2-level cohorts. CONCLUSIONS Five-year results showed treatment with cervical TDR to result in a significantly lower rate of subsequent surgical intervention than treatment with ACDF for both 1 and 2 levels of treatment. Clinical trial registration no.: NCT00389597 ( clinicaltrials.gov ). PMID:26799118

  14. Do intersections of mortality-rate and survival functions have significance?

    PubMed

    Hirsch, H R

    1995-01-01

    Common points of intersections have frequently been reported among members of families of linearized mortality-rate and survival functions. A general condition for the existence of such intersections is derived. It is shown that a common point of intersection between straight-line functions exists if and only if the intercepts of the functions are linearly related to their slopes. This slope-intercept condition is applied to a didactic model to illustrate its generality and to three models, the Gompertz-Makeham, the Weibull, and the logistic, which are often used in the analysis of mortality data. The slope-intercept condition for the Gompertz-Makeham mortality-rate model proves to be the well-known Strehler-Mildvan correlation. Families of mortality-rate functions or of the corresponding survival functions but not both may display common points of intersection. Differences between the ages at which survival functions intersect and those at which the associated mortality-rate functions intersect are calculated to be of the order of magnitude of 10 to 20 years. Survival function intersections lie close to the limit of human life span but often arise in consequence of unsupported extrapolations of data obtained at younger ages. These and other results lead to the conclusion that, in themselves, the intersections of survival and mortality-rate functions are not of great importance. To the extent that significance can be attributed to the intersections, it lies in the existence of linear relationships between their slopes and intercepts. PMID:8591809

  15. Mortality rates by occupation in Korea: a nationwide, 13-year follow-up study

    PubMed Central

    Lee, Hye-Eun; Kim, Hyoung-Ryoul; Chung, Yun Kyung; Kang, Seong-Kyu; Kim, Eun-A

    2016-01-01

    Objective The present study sought to identify inequalities in cause-specific mortality across different occupational groups in Korea. Methods The cohort included Korean workers enrolled in the national employment insurance programme between 1995 and 2000. Mortality was determined by matching death between 1995 and 2008 according to a nationwide registry of the Korea National Statistical Office. The cohort was divided into nine occupational groups according to the Korean Standard Occupational Classification (KSOC). Age-standardised mortality rates of each subcohort were calculated. Results The highest age-standardised mortality rate was identified in KSOC 6 (agricultural, forestry and fishery workers; male (M): 563.0 per 100 000, female (F): 206.0 per 100 000), followed by KSOC 9 (elementary occupations; M: 499.0, F: 163.4) and KSOC 8 (plant, machine operators and assemblers; M: 380.3, F: 157.8). The lowest rate occurred in KSOC 2 (professionals and related workers; M: 209.1, F: 93.3). Differences in mortality rates between KSOC 2 and KSOC 9 (M: 289.9, F: 70.1) and the rate ratio of KSCO9 to KSCO2 (M: 2.39, F: 1.75) were higher in men. The most prominent mortality rate difference was observed in external causes of death (M: 96.9, F: 21.6) and liver disease in men (38.3 per 100 000). Mental disease showed the highest rate ratio (M: 6.31, F: 13.00). Conclusions Substantial differences in mortality rates by occupation were identified. Main causes of death were injury, suicide and male liver disease. Development of policies to support occupations linked with a lower socioeconomic position should be prioritised. PMID:26920855

  16. Modelling small-area inequality in premature mortality using years of life lost rates

    NASA Astrophysics Data System (ADS)

    Congdon, Peter

    2013-04-01

    Analysis of premature mortality variations via standardized expected years of life lost (SEYLL) measures raises questions about suitable modelling for mortality data, especially when developing SEYLL profiles for areas with small populations. Existing fixed effects estimation methods take no account of correlations in mortality levels over ages, causes, socio-ethnic groups or areas. They also do not specify an underlying data generating process, or a likelihood model that can include trends or correlations, and are likely to produce unstable estimates for small-areas. An alternative strategy involves a fully specified data generation process, and a random effects model which "borrows strength" to produce stable SEYLL estimates, allowing for correlations between ages, areas and socio-ethnic groups. The resulting modelling strategy is applied to gender-specific differences in SEYLL rates in small-areas in NE London, and to cause-specific mortality for leading causes of premature mortality in these areas.

  17. Calculating the Rate of Senescence From Mortality Data: An Analysis of Data From the ERA-EDTA Registry.

    PubMed

    Koopman, Jacob J E; Rozing, Maarten P; Kramer, Anneke; Abad, José M; Finne, Patrik; Heaf, James G; Hoitsma, Andries J; De Meester, Johan M J; Palsson, Runolfur; Postorino, Maurizio; Ravani, Pietro; Wanner, Christoph; Jager, Kitty J; van Bodegom, David; Westendorp, Rudi G J

    2016-04-01

    The rate of senescence can be inferred from the acceleration by which mortality rates increase over age. Such a senescence rate is generally estimated from parameters of a mathematical model fitted to these mortality rates. However, such models have limitations and underlying assumptions. Notably, they do not fit mortality rates at young and old ages. Therefore, we developed a method to calculate senescence rates from the acceleration of mortality directly without modeling the mortality rates. We applied the different methods to age group-specific mortality data from the European Renal Association-European Dialysis and Transplant Association Registry, including patients with end-stage renal disease on dialysis, who are known to suffer from increased senescence rates (n = 302,455), and patients with a functioning kidney transplant (n = 74,490). From age 20 to 70, senescence rates were comparable when calculated with or without a model. However, when using non-modeled mortality rates, senescence rates were yielded at young and old ages that remained concealed when using modeled mortality rates. At young ages senescence rates were negative, while senescence rates declined at old ages. In conclusion, the rate of senescence can be calculated directly from non-modeled mortality rates, overcoming the disadvantages of an indirect estimation based on modeled mortality rates. PMID:25887122

  18. Growth rate predicts mortality of Abies concolor in both burned and unburned stands

    USGS Publications Warehouse

    van Mantgem, P.J.; Stephenson, N.L.; Mutch, L.S.; Johnson, V.G.; Esperanza, A.M.; Parsons, D.J.

    2003-01-01

    Tree mortality is often the result of both long-term and short-term stress. Growth rate, an indicator of long-term stress, is often used to estimate probability of death in unburned stands. In contrast, probability of death in burned stands is modeled as a function of short-term disturbance severity. We sought to narrow this conceptual gap by determining (i) whether growth rate, in addition to crown scorch, is a predictor of mortality in burned stands and (ii) whether a single, simple model could predict tree death in both burned and unburned stands. Observations of 2622 unburned and 688 burned Abies concolor (Gord. & Glend.) Lindl. (white fir) in the Sierra Nevada of California, U.S.A., indicated that growth rate was a significant predictor of mortality in the unburned stands, while both crown scorch and radial growth were significant predictors of mortality in the burned stands. Applying the burned stand model to unburned stands resulted in an overestimation of the unburned stand mortality rate. While failing to create a general model of tree death for A. concolor, our findings underscore the idea that similar processes may affect mortality in disturbed and undisturbed stands.

  19. Variable selection and regression analysis for the prediction of mortality rates associated with foodborne diseases.

    PubMed

    Amene, E; Hanson, L A; Zahn, E A; Wild, S R; Döpfer, D

    2016-07-01

    The purpose of this study was to apply a novel statistical method for variable selection and a model-based approach for filling data gaps in mortality rates associated with foodborne diseases using the WHO Vital Registration mortality dataset. Correlation analysis and elastic net regularization methods were applied to drop redundant variables and to select the most meaningful subset of predictors. Whenever predictor data were missing, multiple imputation was used to fill in plausible values. Cluster analysis was applied to identify similar groups of countries based on the values of the predictors. Finally, a Bayesian hierarchical regression model was fit to the final dataset for predicting mortality rates. From 113 potential predictors, 32 were retained after correlation analysis. Out of these 32 predictors, eight with non-zero coefficients were selected using the elastic net regularization method. Based on the values of these variables, four clusters of countries were identified. The uncertainty of predictions was large for countries within clusters lacking mortality rates, and it was low for a cluster that had mortality rate information. Our results demonstrated that, using Bayesian hierarchical regression models, a data-driven clustering of countries and a meaningful subset of predictors can be used to fill data gaps in foodborne disease mortality. PMID:26785774

  20. Slowing of mortality rates at older ages in large medfly cohorts.

    PubMed

    Carey, J R; Liedo, P; Orozco, D; Vaupel, J W

    1992-10-16

    It is generally assumed for most species that mortality rates increase monotonically at advanced ages. Mortality rates were found to level off and decrease at older ages in a population of 1.2 million medflies maintained in cages of 7,200 and in a group of approximately 48,000 adults maintained in solitary confinement. Thus, life expectancy in older individuals increased rather than decreased with age. These results cast doubt on several central concepts in gerontology and the biology of aging: (i) that senescence can be characterized by an increase in age-specific mortality, (ii) that the basic pattern of mortality in nearly all species follows the same unitary pattern at older ages, and (iii) that species have absolute life-span limits. PMID:1411540

  1. Geographic Disparity in Chronic Obstructive Pulmonary Disease (COPD) Mortality Rates among the Taiwan Population

    PubMed Central

    Chan, Ta-Chien; Chiang, Po-Huang; Su, Ming-Daw; Wang, Hsuan-Wen; Liu, Michael Shi-yung

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) causes a high disease burden among the elderly worldwide. In Taiwan, the long-term temporal trend of COPD mortality is declining, but the geographical disparity of the disease is not yet known. Nationwide COPD age-adjusted mortality at the township level during 1999–2007 is used for elucidating the geographical distribution of the disease. With an ordinary least squares (OLS) model and geographically weighted regression (GWR), the ecologic risk factors such as smoking rate, area deprivation index, tuberculosis exposure, percentage of aborigines, density of health care facilities, air pollution and altitude are all considered in both models to evaluate their effects on mortality. Global and local Moran’s I are used for examining their spatial autocorrelation and identifying clusters. During the study period, the COPD age-adjusted mortality rates in males declined from 26.83 to 19.67 per 100,000 population, and those in females declined from 8.98 to 5.70 per 100,000 population. Overall, males’ COPD mortality rate was around three times higher than females’. In the results of GWR, the median coefficients of smoking rate, the percentage of aborigines, PM10 and the altitude are positively correlated with COPD mortality in males and females. The median value of density of health care facilities is negatively correlated with COPD mortality. The overall adjusted R-squares are about 20% higher in the GWR model than in the OLS model. The local Moran’s I of the GWR’s residuals reflected the consistent high-high cluster in southern Taiwan. The findings indicate that geographical disparities in COPD mortality exist. Future epidemiological investigation is required to understand the specific risk factors within the clustering areas. PMID:24845852

  2. Blunt traumatic cardiac rupture. A 5-year experience.

    PubMed

    Brathwaite, C E; Rodriguez, A; Turney, S Z; Dunham, C M; Cowley, R

    1990-12-01

    Blunt traumatic cardiac rupture is associated with a high rate of mortality. A review of the computerized trauma registry (1983 to 1988) identified 32 patients with this injury (ages 19 to 65 years; mean age, 39.5 years; 21 men and 11 women). Twenty-one patients (65.6%) were injured in vehicular crashes, 3 (9.4%) in pedestrian accidents, 3 (9.4%) in motorcycle accidents; 3 (9.4%) sustained crush injury; 1 (3.1%) was injured by a fall; and 1 (3.1%) was kicked in the chest by a horse. Anatomic injuries included right atrial rupture (13[40.6%]), left atrial rupture (8 [25%]), right ventricular rupture (10[31.3%]), left ventricular rupture (4[12.5%]), and rupture of two cardiac chambers (3 [9.4%]). Diagnosis was made by thoracotomy in all 20 patients presenting in cardiac arrest. In the remaining 12 patients, the diagnosis was established in seven by emergency left anterolateral thoracotomy and in five by subxyphoid pericardial window. Seven of these 12 patients (58.3%) had clinical cardiac tamponade and significant upper torso cyanosis. The mean Injury Severity Score (ISS), Trauma Score (TS), and Glasgow Coma Scale (GCS) score were 33.8, 13.2, and 14.3, respectively, among survivors and 51.5, 8.3, and 7.0 for nonsurvivors. The overall mortality rate was 81.3% (26 of 32 patients), the only survivors being those presenting with vital signs (6 of 12 patients [50%]). All patients with rupture of two cardiac chambers or with ventricular rupture died. The mortality rate from myocardial rupture is very high. Rapid prehospital transportation, a high index of suspicion, and prompt surgical intervention contribute to survival in these patients. PMID:2256761

  3. Apparent climatically induced increase of tree mortality rates in a temperate forest.

    PubMed

    van Mantgem, Phillip J; Stephenson, Nathan L

    2007-10-01

    We provide a first detailed analysis of long-term, annual-resolution demographic trends in a temperate forest. After tracking the fates of 21,338 trees in a network of old-growth forest plots in the Sierra Nevada of California, we found that mortality rate, but not the recruitment rate, increased significantly over the 22 years of measurement (1983-2004). Mortality rates increased in both of two dominant taxonomic groups (Abies and Pinus) and in different forest types (different elevational zones). The increase in overall mortality rate resulted from an increase in tree deaths attributed to stress and biotic causes, and coincided with a temperature-driven increase in an index of drought. Our findings suggest that these forests (and by implication, other water-limited forests) may be sensitive to temperature-driven drought stress, and may be poised for die-back if future climates continue to feature rising temperatures without compensating increases in precipitation. PMID:17845291

  4. Fishing mortality rates of giant clams (Family Tridacnidae) from the Sulu Archipelago and Southern Palawan, Philippines

    NASA Astrophysics Data System (ADS)

    Villanoy, Cesar L.; Juinio, Antoinette R.; Meñez, Lambert Anthony

    1988-05-01

    Average size frequency distributions of Tridacna squamosa, T. gigas, Hippopus hippopus and H. porcellanus harvested from the Sulu Archipelago and Southern Palawan areas from 1978 1985 were derived from export records and a warehouse inventory of giant clam shells. Average species mortality rates ( Z) were estimated and were used to approximate average fishing mortality rates ( F) over the period 1978 1985. Crude estimates of exploitation rates ( F/Z) indicate that populations of these species are already overexploited. These findings have serious implications in view of the fact that the Sulu Archipelago and Southern Palawan are thought to be the last strongholds of giant clams in Philippine waters.

  5. Judging hospitals by severity-adjusted mortality rates: the influence of the severity-adjustment method.

    PubMed Central

    Iezzoni, L I; Ash, A S; Shwartz, M; Daley, J; Hughes, J S; Mackiernan, Y D

    1996-01-01

    OBJECTIVES: This research examined whether judgments about a hospital's risk-adjusted mortality performance are affected by the severity-adjustment method. METHODS: Data came from 100 acute care hospitals nationwide and 11880 adults admitted in 1991 for acute myocardial infarction. Ten severity measures were used in separate multivariable logistic models predicting in-hospital death. Observed-to-expected death rates and z scores were calculated with each severity measure for each hospital. RESULTS: Unadjusted mortality rates for the 100 hospitals ranged from 4.8% to 26.4%. For 32 hospitals, observed mortality rates differed significantly from expected rates for 1 or more, but not for all 10, severity measures. Agreement between pairs of severity measures on whether hospitals were flagged as statistical mortality outliers ranged from fair to good. Severity measures based on medical records frequently disagreed with measures based on discharge abstracts. CONCLUSIONS: Although the 10 severity measures agreed about relative hospital performance more often than would be expected by chance, assessments of individual hospital mortality rates varied by different severity-adjustment methods. PMID:8876505

  6. In Sickness but Not in Health: Self-Ratings, Identity, and Mortality

    ERIC Educational Resources Information Center

    Idler, Ellen; Leventhal, Howard; McLaughlin, Julie; Leventhal, Elaine

    2004-01-01

    Self-rated health as a predictor of mortality has been studied primarily in large, representative populations, with relatively little progress toward understanding the information processing that individuals use to arrive at these ratings. With subsamples of National Health and Nutrition Examination Survey (NHANES) Epidemiologic Follow-up Study…

  7. Differential Neonatal and Postneonatal Infant Mortality Rates across US Counties: The Role of Socioeconomic Conditions and Rurality

    ERIC Educational Resources Information Center

    Sparks, P. Johnelle; McLaughlin, Diane K.; Stokes, C. Shannon

    2009-01-01

    Purpose: To examine differences in correlates of neonatal and postneonatal infant mortality rates, across counties, by degree of rurality. Methods: Neonatal and postneonatal mortality rates were calculated from the 1998 to 2002 Compressed Mortality Files from the National Center for Health Statistics. Bivariate analyses assessed the relationship…

  8. Investigating the Decline of Fetal and Infant Mortality Rates in Alaska During 2010 and 2011.

    PubMed

    Prince, Cheryl B; Young, Margaret B; Sappenfield, William; Parrish, Jared W

    2016-04-01

    Introduction The U.S. infant mortality rate has been steadily declining since 2007. Although the downward trend has been notable in Alaska since 2006 when the rate was 6.9 infant deaths per 1000 live births, a dramatic drop in infant mortality occurred in 2010 and 2011 when the infant mortality rate fell to 3.8 infant deaths per 1000 live births during both years. The purpose of this study was to investigate the sudden decrease in fetal and infant mortality rates (FIMR) using the perinatal periods of risk (PPOR) method, an approach that has not been used previously in Alaska. Methods The study was conducted for 251 fetal and infant deaths in 2004-2006, 265 deaths in 2007-2009, and 129 deaths in 2010-2011. Data were stratified by Alaska Native (AN) and White maternal race and urban/rural residence. Results Among both urban and rural White women, the rate ratios (RR) for FIMRs between the earlier and later time periods were not significantly different. The postneonatal mortality rate (PNMR) among AN infants living in rural areas decreased significantly (RR 0.40; 95 % confidence interval 0.21-0.76) between 2007-2009 and 2010-2011. An unexplained increase in sudden unexplained infant death was noted in 2009, followed by a precipitous decrease in 2010-2011. No other unusual distribution of the cause specific mortality rates was observed. Discussion The decrease in the Alaska Native FIMR might have been due to focused efforts for preventing postneonatal sleep associated deaths. Education for prevention of sleep related deaths, particularly in rural communities, is necessary to maintain Alaska's low PNMR. PMID:26754348

  9. Asbestos in Belgium: an underestimated health risk. The evolution of mesothelioma mortality rates (1969–2009)

    PubMed Central

    Van den Borre, Laura; Deboosere, Patrick

    2014-01-01

    Background: Although Belgium was once a major international manufacturer of asbestos products, asbestos-related diseases in the country have remained scarcely researched. Objectives: The aim of this study is to provide a descriptive analysis of Belgian mesothelioma mortality rates in order to improve the understanding of asbestos health hazards from an international perspective. Methods: Temporal and geographical analyses were performed on cause-specific mortality data (1969–2009) using quantitative demographic measures. Results were compared to recent findings on global mesothelioma deaths. Results: Belgium has one of the highest mesothelioma mortality rates in the world, following the UK, Australia, and Italy. With a progressive increase of male mesothelioma deaths in the mid-1980s, large differences in mortality rates between sexes are apparent. Mesothelioma deaths are primarily concentrated in geographic areas with proximity to former asbestos industries. Conclusions: Asbestos mortality in Belgium has been underestimated for decades. Our findings suggest that the location of asbestos industries is correlated with rates of mesothelioma, underlining the need to avert future asbestos exposure by thorough screening of potential contaminated sites and by pursuing a global ban on asbestos. PMID:24999848

  10. Trends in corrected lung cancer mortality rates in Brazil and regions

    PubMed Central

    Malta, Deborah Carvalho; de Abreu, Daisy Maria Xavier; de Moura, Lenildo; Lana, Gustavo C; Azevedo, Gulnar; França, Elisabeth

    2016-01-01

    ABSTRACT OBJECTIVE To describe the trend in cancer mortality rates in Brazil and regions before and after correction for underreporting of deaths and redistribution of ill-defined and nonspecific causes. METHODS The study used data of deaths from lung cancer among the population aged from 30 to 69 years, notified to the Mortality Information System between 1996 and 2011, corrected for underreporting of deaths, non-registered sex and age , and causes with ill-defined or garbage codes according to sex, age, and region. Standardized rates were calculated by age for raw and corrected data. An analysis of time trend in lung cancer mortality was carried out using the regression model with autoregressive errors. RESULTS Lung cancer in Brazil presented higher rates among men compared to women, and the South region showed the highest death risk in 1996 and 2011. Mortality showed a trend of reduction for males and increase for women. CONCLUSIONS Lung cancer in Brazil presented different distribution patterns according to sex, with higher rates among men and a reduction in the mortality trend for men and increase for women. PMID:27355467

  11. Which is the best deprivation predictor of foetal and infant mortality rates?

    PubMed

    Joyce, R; Webb, R; Peacock, J L; Stirland, H

    2000-01-01

    This study investigates which, if any, population-based indicator of deprivation best predicts foetal and infant mortality rates in England. For the year 1995, the deprivation levels of 364 English Local Authorities were compared; using the three commonly used indicators, Jarman score, Townsend score and percentage unemployed. The predictive value of these for stillbirth, neonatal and infant mortality rates was then calculated. The three deprivation indicators were highly inter-correlated (r=0.866-0.924). For each mortality rate, the correlation with deprivation did not differ significantly for the three indicators of deprivation. We conclude, when comparing these outcomes in different areas of England, that any of the three deprivation indicators may be used to adjust for deprivation. PMID:10787021

  12. Canadian suicide mortality rates: first-generation immigrants versus Canadian-born.

    PubMed

    Strachan, J; Johansen, H; Nair, C; Nargundkar, M

    1990-01-01

    This article examines suicide mortality rates and trends in Canada for first-generation immigrants and the Canadian-born population. Data are analyzed by age, sex and country of birth. Since 1950, suicide rates worldwide for both men and women have been increasing. In North America and most of Europe, suicide has been one of the major causes of death for many years. In Canada, suicide rates are also rising. However, this increase is due entirely to a rise in the rate for men; the rate for women has remained relatively stable. Several differences are apparent between the rates for the Canadian-born population and those for first-generation immigrants. For example, three times as many Canadian-born men as women commit suicide. For first-generation immigrants, the ratio is two to one. Suicide mortality rates for the Canadian-born are higher than those for first-generation immigrants in every age group except for the 65 and over groups. Canadian born males have higher ASMR than first generation immigrant males. The rates for women show that first-generation immigrant women have higher suicide mortality rates than their Canadian-born counterparts, and that the highest rate for all women is for immigrants born in Asia. PMID:1713798

  13. Mortality and heart rate in the elderly: role of cognitive impairment.

    PubMed

    Cacciatore, Francesco; Mazzella, Francesca; Abete, Pasquale; Viati, Luisa; Galizia, Gianluigi; D'Ambrosio, Daniele; Gargiulo, Gaetano; Russo, Salvatore; Visconti, Claudia; Della Morte, David; Ferrara, Nicola; Rengo, Franco

    2007-01-01

    Mortality related to heart rate (HR) increase in the elderly has not yet been well established. To ascertain the relationships among cognitive impairment (CI), mortality, and HR increase, the authors prospectively studied a random sample of elderly subjects stratified according to presence or absence of CI. Elderly subjects randomly selected in 1991 (n = 1332) were followed up for 12 years. Mortality was established in 98.1% of the subjects. When HR was stratified in quartiles (< 69, 70-75, 76-80, and > 80 bpm), mortality was linearly associated with increased HR in all (from 47.7 to 57.0; r2 = .43, p = .019) and in subjects without (from 41.7 to 51.1%; r2 = .50, p = .043) but not in those with CI (from 57.5 to 66.1; r2 = .20, p = .363). Cox regression analysis, adjusted for several variables, shows that HR doesn't predict mortality in all subjects (RR 0.69; 95% CI = 0.27-1.73) or in those with CI (RR 0.91; 95% CI = 0.81-1.02). In contrast, HR predicts mortality in subjects without CI (RR 1.10; 95% CI = 1.00-1.22). Hence, HR increase is a predictor of mortality in elderly subjects without CI. However, when considering all elderly subjects and those with CI, HR increase seems to have no effect on mortality. Thus, CI should be considered when focusing on HR increase as risk factor for mortality in the elderly. PMID:17364903

  14. Mortality and implant revision rates of hip arthroplasty in patients with osteoarthritis: registry based cohort study

    PubMed Central

    McMinn, D J W; Snell, K I E; Daniel, J; Treacy, R B C; Pynsent, P B

    2012-01-01

    Objectives To examine mortality and revision rates among patients with osteoarthritis undergoing hip arthroplasty and to compare these rates between patients undergoing cemented or uncemented procedures and to compare outcomes between men undergoing stemmed total hip replacements and Birmingham hip resurfacing. Design Cohort study. Setting National Joint Registry. Population About 275 000 patient records. Main outcome measures Hip arthroplasty procedures were linked to the time to any subsequent mortality or revision (implant failure). Flexible parametric survival analysis methods were used to analyse time to mortality and also time to revision. Comparisons between procedure groups were adjusted for age, sex, American Society of Anesthesiologists (ASA) grade, and complexity. Results As there were large baseline differences in the characteristics of patients receiving cemented, uncemented, or resurfacing procedures, unadjusted comparisons are inappropriate. Multivariable survival analyses identified a higher mortality rate for patients undergoing cemented compared with uncemented total hip replacement (adjusted hazard ratio 1.11, 95% confidence interval 1.07 to 1.16); conversely, there was a lower revision rate with cemented procedures (0.53, 0.50 to 0.57). These translate to small predicted differences in population averaged absolute survival probability at all time points. For example, compared with the uncemented group, at eight years after surgery the predicted probability of death in the cemented group was 0.013 higher (0.007 to 0.019) and the predicted probability of revision was 0.015 lower (0.012 to 0.017). In multivariable analyses restricted to men, there was a higher mortality rate in the cemented group and the uncemented group compared with the Birmingham hip resurfacing group. In terms of revision, the Birmingham hip resurfacings had a similar revision rate to uncemented total hip replacements. Both uncemented total hip replacements and Birmingham hip

  15. A model study with light-dependent mortality rates of copepod stages

    NASA Astrophysics Data System (ADS)

    Neumann, Thomas; Kremp, Christine

    2005-06-01

    This paper is based on an advanced ecosystem model of the Baltic Sea (ERGOM [ J. Mar. Sys. 25 (3-4) (2005) 405]), but with an increased resolution of the zooplankton stage variable [ J. Plankton Res. 23 (2001) 1217; ICES Marine Science 219 (2003) 208]. The model copepods are represented by five stages: eggs, an aggregated variable of nauplii, two aggregated groups of copepodites and adults. The transfer among the stages, i.e., hatching, molting and reproduction, is controlled by food availability and temperature. As usual, the model food web is truncated at the level of zooplankton. The study explores the effects of different parametrization of zooplankton mortality and looks in particular on light-dependent rates. The light climate may serve a proxy for the effects of visual feeding of fish larvae and fish. Different choices of the mortality parameters can result in remarkable differences in abundances and biomass of the model zooplankton and in the timing of its development. It is found that the different choices of mortality affect the development of populations in several ways: Relative small initial differences of abundances at the beginning of the spring bloom are important for the development of the model populations. Higher mortality rates are less important at food rich conditions than at scarce resources. At low phytoplankton levels, the individual development of the copepods through the stages can be faster for elevated mortality rates because then less animals have to share the available food.

  16. Comparison of Turkish and US haemodialysis patient mortality rates: an observational cohort study

    PubMed Central

    Asci, Gulay; Marcelli, Daniele; Celtik, Aygul; Grassmann, Aileen; Gunestepe, Kutay; Yaprak, Mustafa; Tamer, Abdulkerim Furkan; Turan, Mehmet Nuri; Sever, Mehmet Sukru; Ok, Ercan

    2016-01-01

    Background There are significant differences between countries in the mortality rates of haemodialysis (HD) patients. The extent of these differences and possible contributing factors are worthy of investigation. Methods As of March 2009, all patients undergoing HD or haemodiafiltration for >3 months (n = 4041) in the Turkish clinics of the NephroCare network were enrolled. Data were prospectively collected for 2 years through the European Clinical Dialysis Database. Mean age ± standard deviation was 58.7 ± 14.7 years, 45.9% were female and 22.9% were diabetic. Comparison with US data was performed by applying an indirect standardization technique, using specific mortality rates for patients on HD by age, gender, race and primary diagnosis as provided by the 2012 US Renal Data System Annual Data Report as reference. Results The crude mortality rate in Turkey was 95.1 per 1000 patient-years. Compared with the US reference population, the annual mortality rate for Turkey was significantly lower, irrespective of gender, age and diabetes. After adjustments for age, gender and diabetes, the mortality risk in the Turkish cohort was 50% lower than US whites [95% confidence interval (CI) 0.46–0.54, P < 0.001], 44% lower than US African-Americans (95% CI 0.52–0.61, P < 0.001) and 20% lower than Asian-Americans (95% CI 0.74–0.86, P < 0.05). Conclusions The annual mortality rate of prevalent HD patients was found to be significantly lower in the studied Turkish cohort compared with that published by the US Renal Data System Annual Data Report. Differences in practice patterns may contribute to the divergence. PMID:27274836

  17. Clinical spectrum and outcome of pulmonary nocardiosis: 5-year experience

    PubMed Central

    Singh, Akashdeep; Chhina, Deepinder; Soni, RK; Kakkar, Chandan; Sidhu, US

    2016-01-01

    Background: Pulmonary nocardiosis is a rare but a life-threatening infection caused by Nocardia spp. The diagnosis is often missed and delayed resulting in delay in appropriate treatment and thus higher mortality. Aim: In this study, we aim to evaluate the clinical spectrum and outcome of patients with pulmonary nocardiosis. Methods: A retrospective, 5-year (2009–2014) review of demographic profile, risk factors, clinical manifestations, imaging findings, treatment, and outcome of patients with pulmonary nocardiosis admitted to a tertiary care hospital. Results: The median age of the study subjects was 54 years (range, 16–76) and majority of them (75%) were males. The risk factors for pulmonary nocardiosis identified in our study were long-term steroid use (55.6%), chronic lung disease (52.8%), diabetes (27.8%), and solid-organ transplantation (22.2%). All the patients were symptomatic, and the most common symptoms were cough (91.7%), fever (78%), and expectoration (72%). Almost two-third of the patients were initially misdiagnosed and the alternative diagnosis included pulmonary tuberculosis (n = 7), community-acquired pneumonia (n = 5), lung abscess (n = 4), invasive fungal infection (n = 3), lung cancer (n = 2), and Wegener's granulomatosis (n = 2). The most common radiographic features were consolidation (77.8%) and nodules (56%). The mortality rate for indoor patients was 33% despite treatment. Higher mortality rate was observed among those who had brain abscess (100.0%), HIV positivity (100%), need for mechanical ventilation (87.5%), solid-organ transplantation (50%), and elderly (age > 60 years) patients (43%). Conclusion: The diagnosis of pulmonary nocardiosis is often missed and delayed resulting in delay in appropriate treatment and thus high mortality. A lower threshold for diagnosing pulmonary nocardiosis needs to be exercised, in chest symptomatic patients with underlying chronic lung diseases or systemic immunosuppression, for the early diagnosis

  18. High Basal Metabolic Rate Is a Risk Factor for Mortality: The Baltimore Longitudinal Study of Aging

    PubMed Central

    Ruggiero, Carmelinda; Metter, E. Jeffrey; Melenovsky, Vojtech; Cherubini, Antonio; Najjar, Samer S.; Ble, Alessandro; Senin, Umberto; Longo, Dan L.; Ferrucci, Luigi

    2016-01-01

    Background Despite longstanding controversies from animal studies on the relationship between basal metabolic rate (BMR) and longevity, whether BMR is a risk factor for mortality has never been tested in humans. We evaluate the longitudinal changes in BMR and the relationship between BMR and mortality in the Baltimore Longitudinal Study of Aging (BLSA) participants. Methods BMR and medical information were collected at the study entry and approximately every 2 years in 1227 participants (972 men) over a 40-year follow-up. BMR, expressed as kcal/m2/h, was estimated from the basal O2 consumption and CO2 production measured by open-circuit method. Data on all-cause and specific-cause mortality were also obtained. Result BMR declined with age at a rate that accelerated at older ages. Independent of age, participants who died had a higher BMR compared to those who survived. BMR was a significant risk factor for mortality independent of secular trends in mortality and other well-recognized risk factors for mortality, such as age, body mass index, smoking, white blood cell count, and diabetes. BMR was nonlinearly associated with mortality. The lowest mortality rate was found in the BMR range 31.3–33.9 kcal/m2/h. Participants with BMR in the range 33.9–36.4 kcal/m2/h and above the threshold of 36.4 kcal/m2/h experienced 28% (hazard ratio: 1.28; 95% confidence interval, 1.02–1.61) and 53% (hazard ratio: 1.53; 95% confidence interval, 1.19–1.96) higher mortality risk compared to participants with BMR 31.3–33.9 kcal/m2/h. Conclusion We confirm previous findings of an age-related decline of BMR. In our study, a blunted age-related decline in BMR was associated with higher mortality, suggesting that such condition reflects poor health status. PMID:18693224

  19. Physician impact on hospital admission and on mortality rates in the Medicare population.

    PubMed Central

    Krakauer, H; Jacoby, I; Millman, M; Lukomnik, J E

    1996-01-01

    OBJECTIVE. We assess the effect of variations in the supply and specialty distribution of physicians on admission rates for ambulatory care-sensitive conditions (ACS) and for all causes, and on mortality rates among Medicare beneficiaries of various health care service areas (HCSA). DATA SOURCES. For the Medicare beneficiaries, sources were the Health Care Financing Administration's 1992 enrollment and impatient (Part A) files for a 5 percent sample of that population; for the overall populations and for the medical resources of the HCSAs, the Area Resource File. STUDY DESIGN. This observational, cross-sectional study employed multiple linear regression to assess the influence of population characteristics and of the supply of physicians on hospital admissions, and Poisson regression in the analysis of the factors that affect mortality. PRINCIPAL FINDINGS. Physician supply levels vary nearly fourfold or more when comparing the top and bottom deciles of the HCSAs, Medicare admissions for ACS conditions vary about threefold, and admission rates for all causes and mortality rates vary about 1.5-fold. Physician supply levels and distributions have very little influence on ACS admission rates, and even less on the admissions for all causes and on mortality, except in HCSAs with very low physician supply levels (one-fourth the national average or less). However, these HCSAs account for only about 1 percent of the U.S. population. CONCLUSIONS. Physician supply levels and the proportions of specialists and generalists have negligible effects on health status as measured by mortality rates and by rates of admission for all causes and for conditions presumed to be sensitive to the adequacy of ambulatory care. Reductions in admissions for such conditions are not likely to be achieved through broadening of insurance to levels that exist under Medicare, nor through increases in the supply of physicians, nor, conversely, through a reduction in any presumed oversupply of

  20. Partitioning loss rates of early juvenile blue crabs from seagrass habitats into mortality and emigration

    USGS Publications Warehouse

    Etherington, L.L.; Eggleston, D.B.; Stockhausen, W.T.

    2003-01-01

    Determining how post-settlement processes modify patterns of settlement is vital in understanding the spatial and temporal patterns of recruitment variability of species with open populations. Generally, either single components of post-settlement loss (mortality or emigration) are examined at a time, or else the total loss is examined without discrimination of mortality and emigration components. The role of mortality in the loss of early juvenile blue crabs, Callinectes sapidus, has been addressed in a few studies; however, the relative contribution of emigration has received little attention. We conducted mark-recapture experiments to examine the relative contribution of mortality and emigration to total loss rates of early juvenile blue crabs from seagrass habitats. Loss was partitioned into emigration and mortality components using a modified version of Jackson's (1939) square-within-a-square method. The field experiments assessed the effects of two size classes of early instars (J1-J2, J3-J5), two densities of juveniles (low: 16 m-2, high: 64 m-2), and time of day (day, night) on loss rates. In general, total loss rates of experimental juveniles and colonization rates by unmarked juveniles were extremely high (range = 10-57 crabs m-2/6 h and 17-51 crabs m-2/6 h, for loss and colonization, respectively). Total loss rates were higher at night than during the day, suggesting that juveniles (or potentially their predators) exhibit increased nocturnal activity. While colonization rates did not differ by time of day, J3-J5 juveniles demonstrated higher rates of colonization than J1-J2 crabs. Overall, there was high variability in both mortality and emigration, particularly for emigration. Average probabilities of mortality across all treatment combinations ranged from 0.25-0.67/6 h, while probabilities of emigration ranged from 0.29-0.72/6 h. Although mean mortality rates were greater than emigration rates in most treatments, the proportion of experimental trials

  1. A Hierarchical Distance Sampling Approach to Estimating Mortality Rates from Opportunistic Carcass Surveillance Data

    PubMed Central

    Bellan, Steve E.; Gimenez, Olivier; Choquet, Rémi; Getz, Wayne M.

    2012-01-01

    Summary Distance sampling is widely used to estimate the abundance or density of wildlife populations. Methods to estimate wildlife mortality rates have developed largely independently from distance sampling, despite the conceptual similarities between estimation of cumulative mortality and the population density of living animals. Conventional distance sampling analyses rely on the assumption that animals are distributed uniformly with respect to transects and thus require randomized placement of transects during survey design. Because mortality events are rare, however, it is often not possible to obtain precise estimates in this way without infeasible levels of effort. A great deal of wildlife data, including mortality data, is available via road-based surveys. Interpreting these data in a distance sampling framework requires accounting for the non-uniformity sampling. Additionally, analyses of opportunistic mortality data must account for the decline in carcass detectability through time. We develop several extensions to distance sampling theory to address these problems.We build mortality estimators in a hierarchical framework that integrates animal movement data, surveillance effort data, and motion-sensor camera trap data, respectively, to relax the uniformity assumption, account for spatiotemporal variation in surveillance effort, and explicitly model carcass detection and disappearance as competing ongoing processes.Analysis of simulated data showed that our estimators were unbiased and that their confidence intervals had good coverage.We also illustrate our approach on opportunistic carcass surveillance data acquired in 2010 during an anthrax outbreak in the plains zebra of Etosha National Park, Namibia.The methods developed here will allow researchers and managers to infer mortality rates from opportunistic surveillance data. PMID:24224079

  2. A Hierarchical Distance Sampling Approach to Estimating Mortality Rates from Opportunistic Carcass Surveillance Data.

    PubMed

    Bellan, Steve E; Gimenez, Olivier; Choquet, Rémi; Getz, Wayne M

    2013-04-01

    Distance sampling is widely used to estimate the abundance or density of wildlife populations. Methods to estimate wildlife mortality rates have developed largely independently from distance sampling, despite the conceptual similarities between estimation of cumulative mortality and the population density of living animals. Conventional distance sampling analyses rely on the assumption that animals are distributed uniformly with respect to transects and thus require randomized placement of transects during survey design. Because mortality events are rare, however, it is often not possible to obtain precise estimates in this way without infeasible levels of effort. A great deal of wildlife data, including mortality data, is available via road-based surveys. Interpreting these data in a distance sampling framework requires accounting for the non-uniformity sampling. Additionally, analyses of opportunistic mortality data must account for the decline in carcass detectability through time. We develop several extensions to distance sampling theory to address these problems.We build mortality estimators in a hierarchical framework that integrates animal movement data, surveillance effort data, and motion-sensor camera trap data, respectively, to relax the uniformity assumption, account for spatiotemporal variation in surveillance effort, and explicitly model carcass detection and disappearance as competing ongoing processes.Analysis of simulated data showed that our estimators were unbiased and that their confidence intervals had good coverage.We also illustrate our approach on opportunistic carcass surveillance data acquired in 2010 during an anthrax outbreak in the plains zebra of Etosha National Park, Namibia.The methods developed here will allow researchers and managers to infer mortality rates from opportunistic surveillance data. PMID:24224079

  3. End of the Spectacular Decrease in Fall-Related Mortality Rate: Men Are Catching Up

    PubMed Central

    Hartholt, Klaas A.; Polinder, Suzanne; van Beeck, Ed F.; van der Velde, Nathalie; van Lieshout, Esther M. M.; Patka, Peter

    2012-01-01

    Objectives. We determined time trends in numbers and rates of fall-related mortality in an aging population, for men and women. Methods. We performed secular trend analysis of fall-related deaths in the older Dutch population (persons aged 65 years or older) from 1969 to 2008, using the national Official-Cause-of-Death-Statistics. Results. Between 1969 and 2008, the age-adjusted fall-related mortality rate decreased from 202.1 to 66.7 per 100 000 older persons (decrease of 67%). However, the annual percentage change (change per year) in mortality rates was not constant, and could be divided into 3 phases: (1) a rapid decrease until the mid-1980s (men −4.1%; 95% confidence interval [CI] = −4.9, −3.2; women −6.5%; 95% CI, −7.1, −5.9), (2) flattening of the decrease until the mid-1990s (men −1.4%; 95% CI = −2.4, −0.4; women −2.0%; 95% CI = −3.4, −0.6), and (3) stable mortality rates for women (0.0%; 95% CI = −1.2, 1.3) and rising rates for men (1.9%; 95% CI = 0.6, 3.2) over the last decade. Conclusions. The spectacular decrease in fall-related mortality ended in the mid-1990s and is currently increasing in older men at similar rates to those seen in women. Because of the aging society, absolute numbers in fall-related deaths are increasing rapidly. PMID:22401528

  4. Factors Influencing The Six-Month Mortality Rate In Patients With A Hip Fracture

    PubMed Central

    Ristic, Branko; Rancic, Nemanja; Bukumiric, Zoran; Zeljko, Stepanovic; Ignjatovic-Ristic, Dragana

    2016-01-01

    Abstract Background There are several potential risk factors in patients with a hip fracture for a higher rate of mortality that include: comorbid disorders, poor general health, age, male gender, poor mobility prior to injury, type of fracture, poor cognitive status, place of residence. The aim of this study was to assess the influence of potential risk factors for six-month mortality in hip fracture patients. Methods The study included all patients with a hip fracture older than 65 who had been admitted to the Clinic for orthopaedic surgery during one year. One hundred and ninety-two patients were included in the study. Results Six months after admission due to a hip fracture, 48 patients had died (6-month mortality rate was 25%). The deceased were statistically older than the patients who had survived. Univariate regression analysis indicated that six variables had a significant effect on hip fracture patients’ survival: age, mobility prior to the fracture, poor cognitive status, activity of daily living, comorbidities and the place where they had fallen. Multivariate regression modelling showed that the following factors were independently associated with mortality at 6 months post fracture: poor cognitive status, poor mobility prior to the fracture, comorbid disease. Conclusion Poor cognitive status appeared to be the strongest mortality predictor. The employment of brief tests for cognitive status evaluation would enable orthopaedists to have good criteria for the choice of treatment for each patient screened. PMID:27284379

  5. Concepts of Self-Rated Health: Specifying the Gender Difference in Mortality Risk

    ERIC Educational Resources Information Center

    Deeg, Dorly J. H.; Kriegsman, Didi M. W.

    2003-01-01

    Purpose: This study addresses the question of how the relation between self-rated health (SRH) and mortality differs between genders. In addition to the general question, four specific concepts of SRH are distinguished: SRH in comparison with age peers, SRH in comparison with one's own health 10 years ago, and current and future health…

  6. Sex Ratio at Birth and Infant Mortality Rate in China: An Empirical Study

    ERIC Educational Resources Information Center

    Lai, Denjian

    2005-01-01

    In this article, we used the data from the last three population censuses of China in 1982, 1990 and 2000, to study the dynamics of the sex ratio at birth and the infant mortality rate in China. In the late 1970s, China started its economic reform and implemented many family planning programs. Since then there has been great economic development…

  7. Estimating mortality rates of adult fish from entrainment through the propellers of river towboats

    USGS Publications Warehouse

    Gutreuter, S.; Dettmers, J.M.; Wahl, David H.

    2003-01-01

    We developed a method to estimate mortality rates of adult fish caused by entrainment through the propellers of commercial towboats operating in river channels. The method combines trawling while following towboats (to recover a fraction of the kills) and application of a hydrodynamic model of diffusion (to estimate the fraction of the total kills collected in the trawls). The sampling problem is unusual and required quantifying relatively rare events. We first examined key statistical properties of the entrainment mortality rate estimators using Monte Carlo simulation, which demonstrated that a design-based estimator and a new ad hoc estimator are both unbiased and converge to the true value as the sample size becomes large. Next, we estimated the entrainment mortality rates of adult fishes in Pool 26 of the Mississippi River and the Alton Pool of the Illinois River, where we observed kills that we attributed to entrainment. Our estimates of entrainment mortality rates were 2.52 fish/km of towboat travel (80% confidence interval, 1.00-6.09 fish/km) for gizzard shad Dorosoma cepedianum, 0.13 fish/km (0.00-0.41) for skipjack herring Alosa chrysochloris, and 0.53 fish/km (0.00-1.33) for both shovelnose sturgeon Scaphirhynchus platorynchus and smallmouth buffalo Ictiobus bubalus. Our approach applies more broadly to commercial vessels operating in confined channels, including other large rivers and intracoastal waterways.

  8. Changes in U.S. Hospitalization and Mortality Rates following Smoking Bans

    ERIC Educational Resources Information Center

    Shetty, Kanaka D.; DeLeire, Thomas; White, Chapin; Bhattacharya, Jayanta

    2011-01-01

    U.S. state and local governments have increasingly adopted restrictions on smoking in public places. This paper analyzes nationally representative databases, including the Nationwide Inpatient Sample, to compare short-term changes in mortality and hospitalization rates in smoking-restricted regions with control regions. In contrast with smaller…

  9. Mortality rate acceleration and post-reproductive lifespan in matrilineal whale species.

    PubMed

    Foote, Andrew D

    2008-04-23

    The strength of selection to increase the span of a life stage is dependent upon individuals at that stage being able to contribute towards individual fitness and the probability of their surviving to that stage. Complete reproductive cessation and a long post-reproductive female lifespan as found in humans are also found in killer whale (Orcinus orca) and short-finned pilot whale (Globicephala macrorhynchus), but not in the long-finned pilot whale (Globicephala melaena). Each species forms kin-based, stable matrilineal groups and exhibits kin-directed behaviours that could increase inclusive fitness. Here, the initial mortality rate and mortality rate-doubling time of females of these three closely related whale species are compared. The initial mortality rate shows little variation among pilot whale species; however mortality rate accelerates almost twice as fast in the long-finned pilot whale as it does in killer whale and short-finned pilot whale. Selection for a long post-reproductive female lifespan in matrilineal whales may therefore be determined by the proportion of females surviving past the point of reproductive cessation. PMID:18252662

  10. Geostatistical Analysis of County-Level Lung Cancer Mortality Rates in the Southeastern United States

    PubMed Central

    Goovaerts, Pierre

    2009-01-01

    The analysis of health data and putative covariates, such as environmental, socioeconomic, demographic, behavioral, or occupational factors, is a promising application for geostatistics. Transferring methods originally developed for the analysis of earth properties to health science, however, presents several methodological and technical challenges. These arise because health data are typically aggregated over irregular spatial supports (e.g., counties) and consist of a numerator and a denominator (i.e., rates). This article provides an overview of geostatistical methods tailored specifically to the characteristics of areal health data, with an application to lung cancer mortality rates in 688 U.S. counties of the southeast (1970–1994). Factorial Poisson kriging can filter short-scale variation and noise, which can be large in sparsely populated counties, to reveal similar regional patterns for male and female cancer mortality that correlate well with proximity to shipyards. Rate uncertainty was transferred through local cluster analysis using stochastic simulation, allowing the computation of the likelihood of clusters of low or high cancer mortality. Accounting for population size and rate uncertainty led to the detection of new clusters of high mortality around Oak Ridge National Laboratory for both sexes, in counties with high concentrations of pig farms and paper mill industries for males (occupational exposure) and in the vicinity of Atlanta for females. PMID:20445829

  11. Pollution Sources and Mortality Rates across Rural-Urban Areas in the United States

    ERIC Educational Resources Information Center

    Hendryx, Michael; Fedorko, Evan; Halverson, Joel

    2010-01-01

    Purpose: To conduct an assessment of rural environmental pollution sources and associated population mortality rates. Methods: The design is a secondary analysis of county-level data from the Environmental Protection Agency (EPA), Department of Agriculture, National Land Cover Dataset, Energy Information Administration, Centers for Disease Control…

  12. Mortality rates and risk factors for asymptomatic deep vein thrombosis in medical patients.

    PubMed

    Vaitkus, Paul T; Leizorovicz, Alain; Cohen, Alexander T; Turpie, Alexander G G; Olsson, Carl-Gustav; Goldhaber, Samuel Z

    2005-01-01

    The clinical importance of asymptomatic proximal and distal deep vein thrombosis (DVT) remains uncertain and controversial. The aim of this retrospective, post-hoc analysis was to examine mortality and risk factors for development of proximal DVT in hospitalized patients with acute medical illness who were recruited into a randomized, prospective clinical trial of thromboprophylaxis with dalteparin (PREVENT). We analyzed 1738 patients who had not sustained a symptomatic venous thromboembolic event by Day 21 and who had a complete compression ultrasound of the proximal and distal leg veins on Day 21. We examined the 90-day mortality rates in patients with asymptomatic proximal DVT (Group I, N=80), asymptomatic distal DVT (Group II, N=118) or no DVT (Group III, N=1540). The 90-day mortality rates were 13.75%, 3.39%, and 1.92% for Groups I-III, respectively. The difference in mortality between Group I and Group III was significant (hazard ratio 7.63, 95% CI=3.8-15.3; p <0.0001), whereas the difference between Groups II and III did not reach significance (hazard ratio 1.36, 95% CI=0.41-4.45). The association of asymptomatic proximal DVT with increased mortality remained highly significant after adjusting for differences in baseline demographics and clinical variables. Risk factors significantly associated with the development of proximal DVT included advanced age (p=0.0005), prior DVT (p=0.001), and varicose veins (p=0.04). In conclusion, the high mortality rate in patients with asymptomatic proximal DVT underscores its clinical relevance and supports targeting of asymptomatic proximal DVT as an appropriate endpoint in clinical trials of thromboprophylaxis. PMID:15630494

  13. An Administrative Claims Model for Profiling Hospital 30-Day Mortality Rates for Pneumonia Patients

    PubMed Central

    Bratzler, Dale W.; Normand, Sharon-Lise T.; Wang, Yun; O'Donnell, Walter J.; Metersky, Mark; Han, Lein F.; Rapp, Michael T.; Krumholz, Harlan M.

    2011-01-01

    Background Outcome measures for patients hospitalized with pneumonia may complement process measures in characterizing quality of care. We sought to develop and validate a hierarchical regression model using Medicare claims data that produces hospital-level, risk-standardized 30-day mortality rates useful for public reporting for patients hospitalized with pneumonia. Methodology/Principal Findings Retrospective study of fee-for-service Medicare beneficiaries age 66 years and older with a principal discharge diagnosis of pneumonia. Candidate risk-adjustment variables included patient demographics, administrative diagnosis codes from the index hospitalization, and all inpatient and outpatient encounters from the year before admission. The model derivation cohort included 224,608 pneumonia cases admitted to 4,664 hospitals in 2000, and validation cohorts included cases from each of years 1998–2003. We compared model-derived state-level standardized mortality estimates with medical record-derived state-level standardized mortality estimates using data from the Medicare National Pneumonia Project on 50,858 patients hospitalized from 1998–2001. The final model included 31 variables and had an area under the Receiver Operating Characteristic curve of 0.72. In each administrative claims validation cohort, model fit was similar to the derivation cohort. The distribution of standardized mortality rates among hospitals ranged from 13.0% to 23.7%, with 25th, 50th, and 75th percentiles of 16.5%, 17.4%, and 18.3%, respectively. Comparing model-derived risk-standardized state mortality rates with medical record-derived estimates, the correlation coefficient was 0.86 (Standard Error = 0.032). Conclusions/Significance An administrative claims-based model for profiling hospitals for pneumonia mortality performs consistently over several years and produces hospital estimates close to those using a medical record model. PMID:21532758

  14. Disparities in Cervical Cancer Mortality Rates as Determined by the Longitudinal Hyperbolastic Mixed-Effects Type II Model

    PubMed Central

    Tabatabai, Mohammad A.; Kengwoung-Keumo, Jean-Jacques; Eby, Wayne M.; Bae, Sejong; Guemmegne, Juliette T.; Manne, Upender; Fouad, Mona; Partridge, Edward E.; Singh, Karan P.

    2014-01-01

    Background The main purpose of this study was to model and analyze the dynamics of cervical cancer mortality rates for African American (Black) and White women residing in 13 states located in the eastern half of the United States of America from 1975 through 2010. Methods The cervical cancer mortality rates of the Surveillance, Epidemiology, and End Results (SEER) were used to model and analyze the dynamics of cervical cancer mortality. A longitudinal hyperbolastic mixed-effects type II model was used to model the cervical cancer mortality data and SAS PROC NLMIXED and Mathematica were utilized to perform the computations. Results Despite decreasing trends in cervical cancer mortality rates for both races, racial disparities in mortality rates still exist. In all 13 states, Black women had higher mortality rates at all times. The degree of disparities and pace of decline in mortality rates over time differed among these states. Determining the paces of decline over 36 years showed that Tennessee had the most rapid decline in cervical cancer mortality for Black women, and Mississippi had the most rapid decline for White Women. In contrast, slow declines in cervical cancer mortality were noted for Black women in Florida and for White women in Maryland. Conclusions In all 13 states, cervical cancer mortality rates for both racial groups have fallen. Disparities in the pace of decline in mortality rates in these states may be due to differences in the rates of screening for cervical cancers. Of note, the gap in cervical cancer mortality rates between Black women and White women is narrowing. PMID:25226583

  15. Wind Speed and Mortality Rate of a Marine Fish, the Northern Anchovy (Engraulis mordax).

    PubMed

    Peterman, R M; Bradford, M J

    1987-01-16

    Large variability in recruitment of marine fishes creates challenging management problems. In northern anchovy (Engraulis mordax), there is a significant linear relation between larval mortality rate and the frequency of calm, low wind speed periods during the spawning season, possibly because calm winds permit maintenance of concentrated patches of larval food. Neither cannibalism on larvae nor offshore transport contributed significantly to interannual variation in early larval mortality. These results are consistent with the hypothesis that wind-driven turbulent mixing affects variability in survival of young fish larvae. However, abundance of recruits does not necessarily reflect abundance of larvae surviving through this early stage. PMID:17750387

  16. Cross-Temporal and Cross-National Poverty and Mortality Rates among Developed Countries

    PubMed Central

    Fritzell, Johan; Kangas, Olli; Bacchus Hertzman, Jennie; Blomgren, Jenni; Hiilamo, Heikki

    2013-01-01

    A prime objective of welfare state activities is to take action to enhance population health and to decrease mortality risks. For several centuries, poverty has been seen as a key social risk factor in these respects. Consequently, the fight against poverty has historically been at the forefront of public health and social policy. The relationship between relative poverty rates and population health indicators is less self-evident, notwithstanding the obvious similarity to the debated topic of the relationship between population health and income inequality. In this study we undertake a comparative analysis of the relationship between relative poverty and mortality across 26 countries over time, with pooled cross-sectional time series analysis. We utilize data from the Luxembourg Income Study to construct age-specific poverty rates across countries and time covering the period from around 1980 to 2005, merged with data on age- and gender-specific mortality data from the Human Mortality Database. Our results suggest not only an impact of relative poverty but also clear differences by welfare regime that partly goes beyond the well-known differences in poverty rates between welfare regimes. PMID:23840235

  17. Intersections of mortality-rate and survival functions: model-independent considerations.

    PubMed

    Hirsch, H R

    1997-01-01

    In work reported previously (Hirsch, 1995), it was shown that families of straight lines intersect at a single point if and only if the slopes of the lines are linearly related to their intercepts. This slope-intercept relation was applied to several mathematical mortality models including the Gompertz-Makeham and the Weibull. In all cases, survival functions intersected at greater ages than the corresponding mortality-rate functions. It was further demonstrated that a common point of intersection can exist for members of a family of survival functions or for members of the corresponding family of mortality-rate functions but not for both. Here the same results are obtained with respect to intersections of general model-independent survival and mortality-rate functions. The generality of the results strengthens the conclusion reached earlier that these intersections imply only the existence of a valid slope-intercept relation and have little other significance with regard to the biology of aging. PMID:9193896

  18. Health Human Capital in Sub-Saharan Africa: Conflicting Evidence from Infant Mortality Rates and Adult Heights

    PubMed Central

    Akachi, Yoko; Canning, David

    2011-01-01

    We investigate trends in cohort infant mortality rates and adult heights in 39 developing countries since 1960. In most regions of the world improved nutrition, and reduced childhood exposure to disease, have lead to improvements in both infant mortality and adult stature. In Sub-Saharan Africa, however, despite declining infant mortality rates, adult heights have not increased. We argue that in Sub-Saharan Africa the decline in infant mortality may have been due to interventions that prevent infant deaths rather than improved nutrition and childhood morbidity. Despite declining infant mortality, Sub-Saharan Africa may not be experiencing increases in health human capital. PMID:20634153

  19. Heart Rate at Hospital Discharge in Patients With Heart Failure Is Associated With Mortality and Rehospitalization

    PubMed Central

    Laskey, Warren K.; Alomari, Ihab; Cox, Margueritte; Schulte, Phillip J.; Zhao, Xin; Hernandez, Adrian F.; Heidenreich, Paul A.; Eapen, Zubin J.; Yancy, Clyde; Bhatt, Deepak L.; Fonarow, Gregg C.

    2015-01-01

    Background Whether heart rate upon discharge following hospitalization for heart failure is associated with long‐term adverse outcomes and whether this association differs between patients with sinus rhythm (SR) and atrial fibrillation (AF) have not been well studied. Methods and Results We conducted a retrospective cohort study from clinical registry data linked to Medicare claims for 46 217 patients participating in Get With The Guidelines®–Heart Failure. Cox proportional‐hazards models were used to estimate the association between discharge heart rate and all‐cause mortality, all‐cause readmission, and the composite outcome of mortality/readmission through 1 year. For SR and AF patients with heart rate ≥75, the association between heart rate and mortality (expressed as hazard ratio [HR] per 10 beats‐per‐minute increment) was significant at 0 to 30 days (SR: HR 1.30, 95% CI 1.22 to 1.39; AF: HR 1.23, 95% CI 1.16 to 1.29) and 31 to 365 days (SR: HR 1.15, 95% CI 1.12 to 1.20; AF: HR 1.05, 95% CI 1.01 to 1.08). Similar associations between heart rate and all‐cause readmission and the composite outcome were obtained for SR and AF patients from 0 to 30 days but only in the composite outcome for SR patients over the longer term. The HR from 0 to 30 days exceeded that from 31 to 365 days for both SR and AF patients. At heart rates <75, an association was significant for mortality only for both SR and AF patients. Conclusions Among older patients hospitalized with heart failure, higher discharge heart rate was associated with increased risks of death and rehospitalization, with higher risk in the first 30 days and for SR compared with AF. PMID:25904590

  20. Is Self-Rated Health an Independent Index for Mortality among Older People in Indonesia?

    PubMed Central

    Ng, Nawi; Hakimi, Mohammad; Santosa, Ailiana; Byass, Peter; Wilopo, Siswanto Agus; Wall, Stig

    2012-01-01

    Background Empirical studies on the association between self-rated health (SRH) and subsequent mortality are generally lacking in low- and middle-income countries. The evidence on whether socio-economic status and education modify this association is inconsistent. This study aims to fill these gaps using longitudinal data from a Health and Demographic Surveillance System (HDSS) site in Indonesia. Methods In 2010, we assessed the mortality status of 11,753 men and women aged 50+ who lived in Purworejo HDSS and participated in the INDEPTH WHO SAGE baseline in 2007. Information on self-rated health, socio-demographic indicators, disability and chronic disease were collected through face-to-face interview at baseline. We used Cox-proportional hazards regression for mortality and included all variables measured at baseline, including interaction terms between SRH and both education and socio-economic status (SES). Results During an average of 36 months follow-up, 11% of men and 9.5% of women died, resulting in death rates of 3.1 and 2.6 per 1,000 person-months, respectively. The age-adjusted Hazard Ratio (HR) for mortality was 17% higher in men than women (HR = 1.17; 95% CI = 1.04–1.31). After adjustment for covariates, the hazard ratios for mortality in men and women reporting bad health were 3.0 (95% CI = 2.0–4.4) and 4.9 (95% CI = 3.2–7.4), respectively. Education and SES did not modify this association for either sex. Conclusions This study supports the predictive power of bad self-rated health for subsequent mortality in rural Indonesian men and women 50 years old and over. In these analyses, education and household socio-economic status do not modify the relationship between SRH and mortality. This means that older people who rate their own health poorly should be an important target group for health service interventions. PMID:22523584

  1. An ecological analysis of PM2.5 concentrations and lung cancer mortality rates in China

    PubMed Central

    Fu, Jingying; Jiang, Dong; Lin, Gang; Liu, Kun; Wang, Qiao

    2015-01-01

    Objective To explore the association between Particulate Matter (PM)2.5 (particles with an aerodynamic diameter less than 2.5 µm) and lung cancer mortality rates and to estimate the potential risk of lung cancer mortality related to exposure to high PM2.5 concentrations. Design Geographically weighted regression was performed to evaluate the relation between PM2.5 concentrations and lung cancer mortality for males, females and for both sexes combined, in 2008, based on newly available long-term data. Lung cancer fatalities from long-term exposure to PM2.5 were calculated according to studies by Pope III et al and the WHO air quality guidelines (AQGs). Setting 31 provinces in China. Results PM2.5 was associated with the lung cancer mortality of males, females and both sexes combined, in China, although there were exceptions in several regions, for males and females. The number of lung cancer fatalities calculated by the WHO AQGs ranged from 531 036 to 532 004, whereas the number calculated by the American Cancer Society (ACS) reached 614 860 after long-term (approximately 3–4 years) exposure to PM2.5 concentrations since 2008. Conclusions There is a positive correlation between PM2.5 and lung cancer mortality rate, and the relationship between them varies across the entire country of China. The number of lung cancer fatalities estimated by ACS was closer to the actual data than those of the WHO AQGs. Therefore, the ACS estimate of increased risk of lung cancer mortality from long-term exposure to PM2.5 might be more applicable for evaluating lung cancer fatalities in China than the WHO estimate. PMID:26603253

  2. [Infant mortality in Peru].

    PubMed

    Ramos Padilla, M A

    1987-01-01

    Bolivia, Haiti, and Peru have infant mortality levels as high as those of the developed countries a century ago. The decline of general and especially infant mortality experienced in Latin America beginning in the 1940s was uneven throughout the continent. Cuba's infant mortality rate declined by 86% between 1940-80, but Peru's declined by only 48% despite its higher initial level. In 1984, 34% of all deaths in Peru were to children under 1 year and about 21% were to children 1-5 years old. Socioeconomic factors are the major explanation of Peru's poor infant mortality levels. Regional and social disparities in access to housing, food, urban infrastructure, and other vital goods and services are reflected in infant mortality statistics. Infant mortality has declined in both rural and urban areas, but the magnitude of the decline was much greater in urban areas. Between 1960-75, the infant mortality rate declined from 133 to 80/1000 live births in urban areas, but only from 180 to 150/1000 in rural areas. Investment in the infrastructure and services of the cities during the 1950s and 60s was not matched by any significant investment in rural infrastructure. Rural-urban mortality differentials are not as profound in countries which distribute public investment more evenly between rural and urban areas. Cuba's rural infant mortality rate is only 16% greater than its urban rate, while Peru's rural rate is 47% higher. The rural-urban differential in Peru hides a steep gap between the metropolitan zone of Lima-Callao, which has an infant mortality rate of 55/1000, and that of all cities, which have a rate 45% higher. Metropolitan Lima has the highest levels of living in Peru, including the highest incomes and best housing and service infrastructure. A majority of Peru's economic and industrial development has been concentrated in Lima. Peru's infant mortality differentials are also striking at the departmental level. The 5 departments with the highest infant mortality

  3. Improving size, lymph node metastatic rate, breast conservation, and mortality of invasive breast cancer in Rhode Island women, a well-screened population.

    PubMed

    Coburn, Natalie G; Cady, Blake; Fulton, John P; Law, Calvin; Chung, Maureen A

    2012-10-01

    The beneficial impact of screening mammography on breast cancer outcome continues to be debated as demonstrated by guidelines published by the United States Preventive Services Task Force. A previous report from Rhode Island, which has a very high rate of mammographic screening, demonstrated significant improvements in invasive breast cancer presentation and mortality through 2001. This report updates data through 2008 to determine whether previous favorable trends continued. Rhode Island Cancer Registry data regarding invasive breast cancer presentation and mortality in 17,522 female residents diagnosed between 1987 and 2008, inclusive, were analyzed for demographic and pathological factors. Data were analyzed by four time periods: 1987-1992, 1993-1998, 1999-2003, and 2004-2008 and overall. Statistically significant improvements occurred over the four successive time periods, in mean cancer size (23.7, 20.9, 19.6, and 19.3 mm, p < 0.0001), pathologic grade (Grade I: 12, 15, 19, and 17 %; Grade III 57, 41, 36, and 35 %, p < 0.0001), breast conserving surgery (38, 56, 67, and 71 %, p < 0.0001) and mortality (37.3, 31.4, 25.1, and 22.6 per 100,000/year, p < 0.0001). The results showed that high screening rates favorably impacted presentation of and mortality from invasive breast cancer in Rhode Island. From 1987 to 2008, there has been a 39 % decline in breast cancer mortality considering 5 year periods (37.3 vs. 22.6 deaths per 100,000) and 41 % comparing the period from 1990 to 2008, which may exceed the goal of 50 % mortality reduction by 2015 established by the American Cancer Society. PMID:22933028

  4. Data, collaboration reduce sepsis mortality rates, improve use of ICU resources.

    PubMed

    2016-01-01

    Two different hospital systems have made sizable dents in their sepsis mortality rates through a collaborative process between emergency and ICU staff. At Northwest Hospital in Randallstown, MD, success occurred, in part, by lowering the threshold for transfer of emergency patients with signs of sepsis to the ICU. Voorhees, NJ-based Kennedy Health has lowered sepsis mortality rates by taking steps to integrate the care of sepsis patients between the ED and the ICU, and slashing the time required to deliver bundle-oriented care. Research conducted at Northwest Hospital shows that sepsis mortality decreased by nearly half, going from 14.38% before intervention to 7.85% following implementation of the lower ICU thresholds. Clinical leaders at Kennedy Health report that they have lowered sepsis mortality from the mid-20% range to less than 12% through a collaborative approach involving all stakeholders. Sources from both hospitals stress the importance of using data to achieve buy-in to improvement efforts, and giving interventions enough time to take hold. PMID:26731929

  5. Growth and mortality rates of bigeye tuna Thunnus obesus (Perciformes: Scombridae) in the central Atlantic Ocean.

    PubMed

    Zhu, Guoping; Xu, Liuxiong; Zhou, Yingqi; Chen, Xinjun

    2009-01-01

    Age and growth parameters were estimated for bigeye tuna Thunnus obesus Lowe, 1839 sampled from China longline fisheries in the central Atlantic Ocean from October 2002 to July 2003 and from August 2004 to March 2005. The von Bertalanffy growth parameters were estimated at L(infinity)=217.9 cm fork length, k=0.23 year(-1), and t(0)=-0.44 year. The total mortality rate (Z) was estimated to be from 0.82 to 1.02, the fishing mortality (F) and the natural mortality were 0.54 year(-1) and 0.39 year(-1), respectively. The exploitation ratio (E) was 0.35. This study provides the detailed estimates of growth and mortality rate for bigeye tuna in the central Atlantic Ocean, which can be used as biological input parameters in further stock evaluations in this region. However, age analysis, additional validation of the size composition and stock structure are needed for future studies. PMID:19637690

  6. Apparent climatically induced increase of tree mortality rates in a temperate forest

    USGS Publications Warehouse

    van Mantgem, P.J.; Stephenson, N.L.

    2007-01-01

    We provide a first detailed analysis of long-term, annual-resolution demographic trends in a temperate forest. After tracking the fates of 21 338 trees in a network of old-growth forest plots in the Sierra Nevada of California, we found that mortality rate, but not the recruitment rate, increased significantly over the 22 years of measurement (1983-2004). Mortality rates increased in both of two dominant taxonomic groups (Abies and Pinus) and in different forest types (different elevational zones). The increase in overall mortality rate resulted from an increase in tree deaths attributed to stress and biotic causes, and coincided with a temperature-driven increase in an index of drought. Our findings suggest that these forests (and by implication, other water-limited forests) may be sensitive to temperature-driven drought stress, and may be poised for die-back if future climates continue to feature rising temperatures without compensating increases in precipitation. ?? 2007 Blackwell Publishing Ltd/CNRS.

  7. Larval mortality rates and population dynamics of Lesser Sandeel ( Ammodytes marinus) in the northwestern North Sea

    NASA Astrophysics Data System (ADS)

    Heath, Michael R.; Rasmussen, Jens; Bailey, Martin C.; Dunn, John; Fraser, John; Gallego, Alejandro; Hay, Stephen J.; Inglis, Michelle; Robinson, Susan

    2012-05-01

    Intense fishing of a stock of sandeels ( Ammodytes marinus) on the sand banks off the Firth of Forth, northeast Scotland, during the 1990s led to a decline in catch per unit effort to uneconomic levels and collateral failures of piscivorous seabird breeding success at nearby colonies. A prohibition on fishing in 1999 was followed by a short-term recovery of stock biomass, but then a sustained decline to very low levels of abundance. Demographic survey data show that despite the decline in stock, recruit abundance was maintained implying an increasing larval survival rate, and that the stock decline was not due to recruitment failure. To verify this hypothesis we analysed a 10-year long data set of weekly catches of sandeel larvae at a nearby plankton monitoring site to determine the patterns of larval mortality and dispersal. We found that the loss rate of larvae up to 20 d age decreased over time, corresponding with the trend in survival rate implied by the stock demography data. The pattern of loss rate in relation to hatchling abundance implied that mortality may have been density dependent. Our study rules out increased larval mortality as the primary cause of decline in the sandeel stock.

  8. Resting heart rate as a prognostic factor for mortality in patients with breast cancer.

    PubMed

    Lee, Dong Hoon; Park, Seho; Lim, Sung Mook; Lee, Mi Kyung; Giovannucci, Edward L; Kim, Joo Heung; Kim, Seung Il; Jeon, Justin Y

    2016-09-01

    Although elevated resting heart rate (RHR) has been shown to be associated with mortality in the general population and patients with certain diseases, no study has examined this association in patients with breast cancer. A total of 4786 patients with stage I-III breast cancer were retrospectively selected from the Severance hospital breast cancer registry in Seoul, Korea. RHR was measured at baseline and the mean follow-up time for all patients was 5.0 ± 2.5 years. Hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated using Cox regression models. After adjustment for prognostic factors, patients in the highest quintile of RHR (≥85 beat per minute (bpm)) had a significantly higher risk of all-cause mortality (HR: 1.57; 95 %CI 1.05-2.35), breast cancer-specific mortality (HR: 1.69; 95 %CI 1.07-2.68), and cancer recurrence (HR: 1.49; 95 %CI 0.99-2.25), compared to those in the lowest quintile (≤67 bpm). Moreover, every 10 bpm increase in RHR was associated with 15, 22, and 6 % increased risk of all-cause mortality, breast cancer-specific mortality, and cancer recurrence, respectively. However, the association between RHR and cancer recurrence was not statistically significant (p = 0.26). Elevated RHR was associated with an increased risk of mortality in patients with breast cancer. The findings from this study suggest that RHR may be used as a prognostic factor for patients with breast cancer in clinical settings. PMID:27544225

  9. Sex ratio at birth and mortality rates are negatively related in humans.

    PubMed

    Dama, Madhukar Shivajirao

    2011-01-01

    Evolutionary theory posits that resource availability and parental investment ability could signal offspring sex selection, in order to maximize reproductive returns. Non-human studies have provided evidence for this phenomenon, and maternal condition around the time of conception has been identified as most important factor that influence offspring sex selection. However, studies on humans have reported inconsistent results, mostly due to use of disparate measures as indicators of maternal condition. In the present study, the cross-cultural differences in human natal sex ratio were analyzed with respect to indirect measures of condition namely, life expectancy and mortality rate. Multiple regression modeling suggested that mortality rates have distinct predictive power independent of cross-cultural differences in fertility, wealth and latitude that were earlier shown to predict sex ratio at birth. These findings suggest that sex ratio variation in humans may relate to differences in parental and environmental conditions. PMID:21887320

  10. Sex Ratio at Birth and Mortality Rates Are Negatively Related in Humans

    PubMed Central

    Dama, Madhukar Shivajirao

    2011-01-01

    Evolutionary theory posits that resource availability and parental investment ability could signal offspring sex selection, in order to maximize reproductive returns. Non-human studies have provided evidence for this phenomenon, and maternal condition around the time of conception has been identified as most important factor that influence offspring sex selection. However, studies on humans have reported inconsistent results, mostly due to use of disparate measures as indicators of maternal condition. In the present study, the cross-cultural differences in human natal sex ratio were analyzed with respect to indirect measures of condition namely, life expectancy and mortality rate. Multiple regression modeling suggested that mortality rates have distinct predictive power independent of cross-cultural differences in fertility, wealth and latitude that were earlier shown to predict sex ratio at birth. These findings suggest that sex ratio variation in humans may relate to differences in parental and environmental conditions. PMID:21887320

  11. Simultaneous estimates of synechococcus spp. Growth and grazing mortality rates in the English Channel

    NASA Astrophysics Data System (ADS)

    Ning, Xiu-Ren; Vaulot, Daniel

    1996-03-01

    The marine chroococooid phycoerythrin-containing Synechococcus spp. cyanobacterium has been implicated as a substantial component of the photosynthetic picoplankton in the ocean. Although its importance as food source for heterotrophic nanoplankton is now recognized, information about the cycling of Synechococcus biomass and its diel pattern is limited and study methodology varies among authors. The selective metabolic inhibitor method was used to simultaneously estimate growth and grazing disappearance rates of Synechococcus in the English Channel where growth rates ranged from 0.25 to 0.72/d (mean ±SD=0.51±0.17/d) and grazing mortality rates ranged from 0.19 to 0.64/d (mean ±SD=0.48±0.17/d). Size-fractionated experiments demonstrated that up to 70% of Synechococcus disappearance could be attributed to grazers going through a 2 μm Nuclepore filter. Synechococcus grazing mortality rates (mean=0.74 ±0.25/d) during the day were always higher than that (mean=0.2±0.20/d) during the night, while growth rates showed no clear diel pattern. A positive correlation was observed between growth rates and in situ temperature ranging from 9 to 17°C, while in contrast grazing was independent of temperature. The close similatiry between average growth and grazing rates suggests a rapid recycling of Synechococcus biomass in English Channel coastal waters.

  12. Abnormal Heart Rate Turbulence Predicts Cardiac Mortality in Low, Intermediate and High Risk Older Adults

    PubMed Central

    Stein, Phyllis K.; Barzilay, Joshua I.

    2011-01-01

    Introduction We examined whether heart rate turbulence (HRT) adds to traditional risk factors for cardiac mortality in older adults at low, intermediate and high risk. Methods and Results N=1298, age ≥65 years, with 24-hour Holter recordings were studied. HRT, which quantifies heart rate response to ventricular premature contractions, was categorized as: both turbulence onset (TO) and turbulence slope (TS) normal; TO abnormal; TS abnormal; or both abnormal. Independent risks for cardiac mortality associated with HRT or, for comparison, elevated C-reactive protein (CRP) (>3.0 mg/L), were calculated using Cox regression analysis adjusted for traditional cardiovascular disease risk factors and stratified by the presence of no, isolated subclinical (i.e., intermediate risk) or clinical CVD. Having both TS and TO abnormal compared to both normal was associated with cardiac mortality in the low risk group [HR 7.9, 95% CI 2.8–22.5, (p<0.001)]. In the high and intermediate risk groups, abnormal TS and TO ([HR 2.2, 95% CI 1.5–4.0, p=0.016] and [HR 2.7, 95% CI 1.2–5.9, p=0.012]), respectively, were also significantly associated with cardiac mortality. In contrast, elevated CRP was associated with increased cardiac mortality risk only in low risk individuals [HR 2.5, 95% CI 1.3–5.1, p=0.009]. In the low risk group, the c-statistic was 0.706 for the base model, 0.725 for the base model with CRP, and 0.767 for the base model with HRT. Conclusions Abnormal HRT independently adds to risk stratification of low, intermediate and high risk individuals but appears to add especially to the stratification of those considered at low risk. PMID:21134026

  13. Significantly Increased Medical Expenditure on Breast Cancer Failing to Bring Down Its Mortality and Incidence Rate

    PubMed Central

    Ho, Ming-Lin; Liaw, Yung-Po; Lai, Chien-Hsu; Chen, Yen-Yu; Tsai, Horng-Der; Chou, Ming-Chih; Hsiao, Yi-Hsuan

    2013-01-01

    Background: The direct impact of medical expenses on breast cancer incidence and mortality rate has not been sufficiently addressed. The purpose of this study is to investigate the potential correlation between the incidence and mortality rate of breast cancer and the medical expenses in Taiwan. Materials and Methods: Breast cancer cases were identified from the National Health Insurance Research Database (NHIRD) with corresponding to International Classification of Diseases, and the Ninth Revision (ICD-9) code 174, 1740-1749, 175, 1750 and 1759 from January 1999 to December 2006. Age-specific incidences were estimated by population data obtained from the Department of Statistics, Ministry of the Interior. Medical expenses, including outpatient and inpatient services, were also retrieved from the NHIRD. Results: The incidence increased from 20.06 per 100,000 in 1999 to 30.34 per 100,000 in 2006; the total expenses increased from 1,449,333,521 in 1999 to 4,350,400,592 Taiwan dollars in 2006. The age-standardized mortality rate for female breast cancer remained essentially unchanged, while the age-standardized incidence increased steadily (except 2002-2003). Among the top 20 coexisting ICD-9 codes for expenses, four are directly on cancers, while 16 are on other diseases or symptoms, which are not necessarily caused by breast cancer. Conclusions: Significantly increased medical expenditure on breast cancer failed to bring down its mortality and incidence rate. The finding has implications for healthcare policy planners in proposing strategies for breast cancer control and allocating the resources. PMID:23983817

  14. Hepatic Parenchymal Preservation Surgery: Decreasing Morbidity and Mortality Rates in 4,152 Resections for Malignancy

    PubMed Central

    Kingham, T Peter; Correa-Gallego, Camilo; D'Angelica, Michael I; Gönen, Mithat; DeMatteo, Ronald P; Fong, Yuman; Allen, Peter J; Blumgart, Leslie H; Jarnagin, William R

    2015-01-01

    Background Liver resection is used to treat primary and secondary malignancies. Historically, these procedures were associated with significant complications, which may affect cancer-specific outcome. This study analyzes the changes in morbidity and mortality after hepatic resection over time. Study Design Records of all patients undergoing liver resection for a malignant diagnosis from 1993 to 2012 at Memorial Sloan Kettering were analyzed. Patients were divided into early (1993-1999), middle (2000-2006), and recent (2007-2012) eras. Major hepatectomy was defined as resection of 3 or more segments. Univariate and multivariate analyses were made with t-tests or Mann-Whitney tests. Results 3,875 patients underwent 4,152 resections for malignancy. The most common diagnosis was metastatic colorectal cancer (n=2,476, 64% of patients). Over the study period, 90-day mortality rate decreased from 5% to 1.6% (p<0.001). Perioperative morbidity decreased from 53% to 20% (p<0.001). The percentage of major hepatectomies decreased from 66% to 36% (p<0.001). The rate of perioperative transfusion decreased from 51% to 21% (p<0.001). The spectrum of perioperative morbidity changed markedly over time, with abdominal infections (43% of complications) overtaking cardiopulmonary complications (22% of complications). Peak postoperative bilirubin (OR 1.1, p<0.001), blood loss (OR 1.5, p=0.001), major hepatectomy (OR 1.3, p=0.031), and concurrent partial colectomy (OR 2.4, p<0.001) were independent predictors of perioperative morbidity. The mortality associated with trisectionectomy (6%) and right hepatectomy (3%) remained unchanged over time. Conclusions Morbidity and mortality rates after partial hepatectomy for cancer have decreased substantially as the major hepatectomy rate dropped. Encouraging parenchymal preservation and preventing abdominal infections are vital for continued improvement of liver resection outcomes. PMID:25667141

  15. Chemical characterization of indoor air of homes from communes in Xuan Wei, China, with high lung cancer mortality rates

    EPA Science Inventory

    In a rural county, Xuan Wei, China, the lung cancer mortality rate is among China's highest, especially in women. This mortality rate is more associated with indoor air burning of smoky coal, as opposed to smokeless coal or wood, for cooking and heating under unvented conditions....

  16. Changes and determinants in under-five mortality rate in Turkey since 1988.

    PubMed

    Yalçin, S Songül; Tezel, Başak; Köse, Mehmet Rifat; Tugay, Deniz; Mollahaliloğlu, Salih; Erkoç, Yasin

    2013-06-01

    Child survival is the focus of the fourth Millenium Developmental Goal (MDG4). This paper describes levels, trends, and differentials in Under-Five Mortality Rate (U5MR) and also summarizes state programmes in Turkey between 1988 and 2010. Turkey is among only a few countries that have already surpassed MDG4 and have reduced their under-five mortality rate by more than two-thirds. In 2010, 13 out of every 1,000 children died before their fifth birthday. Low birth weight, high-birth order, short birth intervals, rural residence, low level of maternal education and lowest wealth quintile have affected negatively children's chances of survival. Expanding the scope of free vaccination programmes for children, improving screening and disease prevention schemes aimed at children, encouraging breastfeeding, implementing an emergency obstetric care programme, improving the services provided to newborns (a newborn intensive care programme) have brought about a significant decrease in the rate of infant and under-five mortality. The implementation of state and region specific action plans should be necessary to increase the chance of an access to the Continuum of Care for each mother and infant and to surpass MDG4. PMID:24053063

  17. Exacerbation rate, health status and mortality in COPD – a review of potential interventions

    PubMed Central

    Seemungal, Terence AR; Hurst, John R; Wedzicha, Jadwiga A

    2009-01-01

    COPD is prevalent in Western society and its incidence is rising in the developing world. Acute exacerbations of COPD, about 50% of which are unreported, lead to deterioration in quality of life and contribute significantly to disease burden. Quality of life deteriorates with time; thus, most of the health burden occurs in more severe disease. COPD severity and frequent and more severe exacerbations are all related to an increased risk of mortality. Inhaled corticosteroids (ICS) have similar effects on quality of life but ICS/long-acting bronchodilator combinations and the long-acting antimuscarinic tiotropium all improve health status and exacerbation rates and are likely to have an effect on mortality but perhaps only with prolonged use. Erythromycin has been shown to decrease the rate of COPD exacerbations. Pulmonary rehabilitation and regular physical activity are indicated in all severities of COPD and improve quality of life. Noninvasive ventilation is associated with improved quality of life. Long-term oxygen therapy improves mortality but only in hypoxic COPD patients. The choice of an inhaler device is a key component of COPD therapy and this requires more attention from physicians than perhaps we are aware of. Disease management programs, characterized as they are by patient centeredness, improve quality of life and decrease hospitalization rates. Most outcomes in COPD can be modified by interventions and these are well tolerated and have acceptable safety profiles. PMID:19554195

  18. Geomagnetic storms link to the mortality rate in the Smolyan region for the period 1988--2009

    NASA Astrophysics Data System (ADS)

    Simeonova, Siyka G. 1; Georgieva, Radostina C. 2; Dimitrova, Boryana H. 2; Slavcheva, Radka G. 2; Kerimova, Bojena P. 2; Georgiev, Tsvetan B. 34

    We present correlations and trends of 10 parameters of annual mortality rate (1 to common mortality rate, 5 to cardiovascular reasons and 4 to "accidental" reasons (car accidents, suicides, infections)) with respect to 6 parameters of annual solar and geomagnetic activity (Wolf index, number of geomagnetic storms, duration of the storms, amplitude of the storms). During the period of observation, characterized by a 3-4-fold decrease of the mean geomagnetic activity (in terms of the number and the duration of the storms) and with a strong variations of the amplitude of the storms (about an almost constant mean values for the period), there is a 1.3-fold decrease in the urban population, a 1.5-fold increase of the common mortality rate, a 1.8-fold increase of the cardiovascular mortality rate and a 1.1-fold decrease of the "accidental" mortality rates. During the years 2003-2005 we observe about 2-fold temporary increase in the storm amplitudes. During the years 2007-2008, characterized by extremely low geomagnetic activity, we observe a surprising temporary increase of the common and the cardiovascular mortality rates 1.1 and 1.3-fold, respectively (Figures 1-4). We point out 3 main results. (1) The available data shows notable increase in the mortality rates while there is generally a decrease of the solar or geomagnetic activity during the studied period (Figures 5-9). We explain this anti-correlation with the domination of the increasing mortality rates as an effect of the advance in the mean age of the population (due to immigration of young people and decrease of new-borns), hiding an eventual display of the solar and geomagnetic influence on the mortality rates. Using this data we can not reveal influence of the long-time (10-20 years) change of the average solar and geomagnetic activity on the mortality rate. (2) Excluding the unusual years 2007 and 2008, we establish that with respect to the years with low geomagnetic activity (1993, 1995, 1996, 1999), in

  19. Reducing high maternal mortality rates in western China: a novel approach.

    PubMed

    Gyaltsen Gongque Jianzan, Kunchok; Gyal Li Xianjia, Lhusham; Gipson, Jessica D; Kyi Cai Rangji, Tsering; Pebley, Anne R

    2014-11-01

    Among the Millennium Development Goals, maternal mortality reduction has proven especially difficult to achieve. Unlike many countries, China is on track to meeting these goals on a national level, through a programme of institutionalizing deliveries. Nonetheless, in rural, disadvantaged, and ethnically diverse areas of western China, maternal mortality rates remain high. To reduce maternal mortality in western China, we developed and implemented a three-level approach as part of a collaboration between a regional university, a non-profit organization, and local health authorities. Through formative research, we identified seven barriers to hospital delivery in a rural Tibetan county of Qinghai Province: (1) difficulty in travel to hospitals; (2) hospitals lack accommodation for accompanying families; (3) the cost of hospital delivery; (4) language and cultural barriers; (5) little confidence in western medicine; (6) discrepancy in views of childbirth; and (7) few trained community birth attendants. We implemented a three-level intervention: (a) an innovative Tibetan birth centre, (b) a community midwife programme, and (c) peer education of women. The programme appears to be reaching a broad cross-section of rural women. Multilevel, locally-tailored approaches may be essential to reduce maternal mortality in rural areas of western China and other countries with substantial regional, socioeconomic, and ethnic diversity. PMID:25555773

  20. Temporal Trends in Incidence and Mortality Rates for Colorectal Cancer by Tumor Location: 1975–2007

    PubMed Central

    Scoggins, John; Rossing, Mary Anne; Li, Christopher I.; Newcomb, Polly A.

    2012-01-01

    Objectives. We evaluated changes in colorectal cancer (CRC) incidence and mortality by anatomic site to assess the possible impact of CRC screening. Methods. Using data from 9 Surveillance, Epidemiology, and End Results cancer registries, we estimated trends in 1975–2007 CRC incidence and 1985–2007 incidence-based mortality. We evaluated trends separately for proximal and distal CRC, overall and by stage, tumor site, and race. Results. Between 1975 and 2007, 323 237 adults in the study area were diagnosed with CRC. For most tumor and population subgroups, incidence rates increased between 1975 and 1985 and subsequently declined markedly. Declines were most rapid between 1999 and 2007 and were greater for distal than proximal CRC. Declines in incidence were greater for White than Black adults and greatest for regional-stage disease. There was little difference in trends across subsites within the proximal and distal colorectum. Declines in incidence-based mortality mirrored those for incidence. Conclusions. Recent declines in CRC incidence and mortality are greater for distal than proximal CRC. Differing trends across populations may reflect variations in screening prevalence; distinct trends by tumor characteristics likely reflect differences in screening efficacy. PMID:22873481

  1. Cause-specific mortality rates in sub-Saharan Africa and Bangladesh.

    PubMed Central

    Adjuik, Martin; Smith, Tom; Clark, Sam; Todd, Jim; Garrib, Anu; Kinfu, Yohannes; Kahn, Kathy; Mola, Mitiki; Ashraf, Ali; Masanja, Honorati; Adazu, Kubaje; Adazu, Ubaje; Sacarlal, Jahit; Alam, Nurul; Marra, Adama; Gbangou, Adjima; Mwageni, Eleuther; Binka, Fred

    2006-01-01

    OBJECTIVE: To provide internationally comparable data on the frequencies of different causes of death. METHODS: We analysed verbal autopsies obtained during 1999 -2002 from 12 demographic surveillance sites in sub-Saharan Africa and Bangladesh to find cause-specific and age-specific mortality rates. The cause-of-death codes used by the sites were harmonized to conform to the ICD-10 system, and summarized with the classification system of the Global Burden of Disease 2000 (Version 2). FINDINGS: Causes of death in the African sites differ strongly from those in Bangladesh, where there is some evidence of a health transition from communicable to noncommunicable diseases, and little malaria. HIV dominates in causes of mortality in the South African sites, which contrast with those in highly malaria endemic sites elsewhere in sub-Saharan Africa (even in neighbouring Mozambique). The contributions of measles and diarrhoeal diseases to mortality in sub-Saharan Africa are lower than has been previously suggested, while malaria is of relatively greater importance. CONCLUSION: The different patterns of mortality we identified may be a result of recent changes in the availability and effectiveness of health interventions against childhood cluster diseases. PMID:16583076

  2. Disentangling effects of vector birth rate, mortality rate, and abundance on spread of a plant pathogen

    Technology Transfer Automated Retrieval System (TEKTRAN)

    For insect-transmitted plant pathogens, rates of pathogen spread are a function of vector abundance. While vector abundance is recognized to be important, parameters that govern vector population size receive little attention. For example, epidemiological models often fix vector population size by a...

  3. Mortality rate estimation for eelgrass Zostera marina (Potamogetonaceae) using projections from Leslie matrices.

    PubMed

    Flores Uzeta, Olga; Solana Arellano, Elena; Echavarría Heras, Héctor

    2008-09-01

    The main goal of this study is to provide estimations of mean mortality rate of vegetative shoots of the seagrass Zostera marina in a meadow near Ensenada Baja California, using a technique that minimizes destructive sampling. Using cohorts and Leslie matrices, three life tables were constructed, each representing a season within the period of monthly sampling (April 1999 to April 2000). Ages for the cohorts were established in terms of Plastochrone Interval (PI). The matrices were projected through time to estimate the mean total number of individuals at time t, n(t) as well as mortality. We found no statistical differences between observed and predicted mean values for these variables (t = -0.11, p = 0.92 for n(t) and t = 0.69, p = 0.5 for mean rate of mortality). We found high correlation coefficient values between observed and projected values for monthly number of individuals (r = 0.70, p = 0.007) and monthly mortality rates (r = 0.81, p = 0.001). If at a certain time t a sudden environmental change occurs, and as long as the perturbation does not provoke the killing of all the individuals of a given age i for 0 < or = i < or = x - 1, there will be a prevailing number of individuals of age or stage x at a time t+1. This nondestructive technique reduces the number of field visits and samples needed for the demographic analysis of Z. marina, and therefore decreases the disturbance caused by researches to the ecosystem. PMID:19419024

  4. A Review of Morbidity and Mortality Rates and Disease Occurrence in North American Feedlot Cattle

    PubMed Central

    Kelly, Andrew P.; Janzen, Eugene D.

    1986-01-01

    A review of veterinary literature on morbidity or mortality rates in feedlot cattle was performed. Incidence (attack) rates were the only types of rates reviewed. Differences in the definition of terms made reports difficult to compare. Case-definitions were often poorly defined and most were based on chemotherapeutic treatment as a criterion. A summary was made of 14 comparable studies containing disease incidence rates in calves in the first few weeks following arrival in feedlots. The incidence of morbidity ranged from 0% to 69% with most reports between 15% and 45%. The mortality rate in the same period ranged from 0% to 15% with most reports between 1% and 5%. The peak incidence of disease was within the first three weeks after the arrival of calves in the feedlots. Few other epidemiological descriptions (season, day of the week, geographical, age, sex, or breed) had been objectively described. The most common clinical and necropsy diagnoses were respiratory infections, often described as shipping fever. PMID:17422726

  5. Mortality rates and division of labor in the leaf-cutting ant, Atta colombica

    PubMed Central

    Brown, Mark J F.; Bot, A N M.; Hart, Adam G.

    2006-01-01

    Division of labor in social groups is affected by the relative costs and benefits of conducting different tasks. However, most studies have examined the dynamics of division of labor, rather than the costs and benefits that presumably underlie the evolution of such systems. In social insects, division of labor may be simplistically described as a source-sink system, with external tasks, such as foraging, acting as sinks for the work force. The implications of two distinct sinks – foraging and waste-heap working – for division of labor were examined in the leaf-cutting ant Atta colombica. Intrinsic mortality rates were similar across external task groups. Exposure to waste (a task-related environment) led to a 60% increase in the mortality rate of waste-heap workers compared to workers not exposed to waste. Given the small number of workers present in the waste-heap task group, such increases in mortality are unlikely to affect division of labor and task allocation dramatically, except perhaps under conditions of stress. PMID:19537995

  6. Co-infection with Multiple Respiratory Pathogens Contributes to Increased Mortality Rates in Algerian Poultry Flocks.

    PubMed

    Sid, Hicham; Benachour, Karine; Rautenschlein, Silke

    2015-09-01

    Respiratory infections are a common cause for increased mortality rates in poultry worldwide. To improve intervention strategies, circulating pathogens have to be identified and further characterized. Because of the lack of diagnostic tools, it was not known what pathogens contribute to the high mortality rates in association with respiratory disease in Algeria. Our objective was to determine if primary pathogens including Mycoplasma gallisepticum (MG), Mycoplasma synoviae (MS), avian influenza virus (AIV), infectious bronchitis virus (IBV), and avian metapneumovirus (aMPV), known to be present in neighboring countries, can also be detected in Algerian chicken and turkey flocks. Results demonstrate the circulation of the investigated pathogens in Algerian poultry flocks as multi-infections. Phylogenetic characterization of the Algerian IBV strains confirmed the circulation of nephropathogenic viruses that are different from the strains isolated in neighboring countries. This could suggest the existence of a new IBV genotype in North Africa. Additionally, we detected for the first time an aMPV subtype B field strain and avian influenza virus. Interestingly, all viral pathogens were present in co-infections with MG, which could exacerbate clinical disease. Additional pathogens may be present and should be investigated in the future. Our results suggest that multiple respiratory infections may be responsible for high mortality in Algerian poultry flocks and very probably also in other regions of the world, which demonstrates the need for the establishment of more comprehensive control strategies. PMID:26478165

  7. Effect of marital status on death rates. Part 2: Transient mortality spikes

    NASA Astrophysics Data System (ADS)

    Richmond, Peter; Roehner, Bertrand M.

    2016-05-01

    We examine what happens in a population when it experiences an abrupt change in surrounding conditions. Several cases of such "abrupt transitions" for both physical and living social systems are analyzed from which it can be seen that all share a common pattern. First, a steep rising death rate followed by a much slower relaxation process during which the death rate decreases as a power law. This leads us to propose a general principle which can be summarized as follows: "Any abrupt change in living conditions generates a mortality spike which acts as a kind of selection process". This we term the Transient Shock conjecture. It provides a qualitative model which leads to testable predictions. For example, marriage certainly brings about a major change in personal and social conditions and according to our conjecture one would expect a mortality spike in the months following marriage. At first sight this may seem an unlikely proposition but we demonstrate (by three different methods) that even here the existence of mortality spikes is supported by solid empirical evidence.

  8. Rates of Complications and Mortality in Older Diabetes Patients: The Diabetes and Aging Study

    PubMed Central

    Huang, Elbert S.; Laiteerapong, Neda; Liu, Jennifer Y.; John, Priya M.; Moffet, Howard H.; Karter, Andrew J.

    2014-01-01

    Importance In the coming decades, the population of older adults with diabetes is expected to grow substantially. Understanding the clinical course of diabetes in this population is critical for establishing evidence-based clinical practice recommendations, research priorities, allocating resources, and setting health policies. Objective Contrast rates of diabetes complications and mortality across age and diabetes duration categories. Design, Setting, Participants This cohort study (2004–2010) included 72,310 older (≥60 years of age) patients with type 2 diabetes enrolled in a large, integrated healthcare delivery system. Incidence densities (events per 1000 person-years (pys)) were calculated for each age category (60s, 70s, 80+ years) and duration of diabetes (shorter: 0–9 years vs. longer: 10+ years). Main Outcome Measures Incident acute hyperglycemic events, acute hypoglycemic events (hypoglycemia), microvascular complications [end-stage renal disease (ESRD), peripheral vascular disease, lower extremity amputation, advanced eye disease], cardiovascular complications [coronary artery disease (CAD), cerebrovascular disease (CVD), congestive heart failure (CHF)], and all-cause mortality. Results Among older adults with diabetes of short duration, cardiovascular complications followed by hypoglycemia were the most common non-fatal complications. For example, among 70–79 year olds with short duration of diabetes, CAD and hypoglycemia rates were higher (11.5 and 5.0/1000 pys respectively), compared to ESRD (2.6/1000), amputation (1.3/1000), and acute hyperglycemic events (0.8/1000). We observed a similar pattern among subjects in the same age group with long diabetes duration where CAD and hypoglycemia had some of the highest incidence rates (19.0 and 15.9 /1000 pys respectively), compared to ESRD (7.6/1000), amputation (4.3/1000), and acute hyperglycemic events (1.8/1000). For a given age group, rates of each outcome, particularly hypoglycemia and

  9. Infant Stool Color Card Screening Helps Reduce the Hospitalization Rate and Mortality of Biliary Atresia

    PubMed Central

    Lee, Min; Chen, Solomon Chih-Cheng; Yang, Hsin-Yi; Huang, Jui-Hua; Yeung, Chun-Yan; Lee, Hung-Chang

    2016-01-01

    Abstract Biliary atresia (BA) is a significant liver disease in children. Since 2004, Taiwan has implemented a national screening program that uses an infant stool color card (SCC) for the early detection of BA. The purpose of this study was to examine the outcomes of BA cases before and after the launch of this screening program. The objectives of this study were to evaluate the rates of hospitalization, liver transplantation (LT), and mortality of BA cases before and after the program, and to examine the association between the hospitalization rate and survival outcomes. This was a population-based cohort study. BA cases born during 1997 to 2010 were identified from the Taiwan National Health Insurance Research Database. Sex, birth date, hospitalization date, LT, and death data were collected and analyzed. The hospitalization rate by 2 years of age (Hosp/2yr) was calculated to evaluate its association with the outcomes of LT or death. Among 513 total BA cases, 457 (89%) underwent the Kasai procedure. Of these, the Hosp/2yr was significantly reduced from 6.0 to 6.9/case in the earlier cohort (1997–2004) to 4.9 to 5.3/case in the later cohort (2005–2010). This hospitalization rate reduction was followed by a reduction in mortality from 26.2% to 15.9% after 2006. The Cox proportional hazards model showed a significant increase in the risk for both LT (hazard ratio [HR] = 1.14, 95% confidence interval [CI] = 1.10–1.18) and death (HR = 1.05, 95% CI = 1.01–1.08) for each additional hospitalization. A multivariate logistic regression model found that cases with a Hosp/2yr >6 times had a significantly higher risk for both LT (adjusted odds ratio [aOR] = 4.35, 95% CI = 2.82–6.73) and death (aOR = 1.75, 95% CI = 1.17–2.62). The hospitalization and mortality rates of BA cases in Taiwan were significantly and coincidentally reduced after the launch of the SCC screening program. There was a significant association between the

  10. Estimated Glomerular Filtration Rate and Mortality among Patients with Coronary Heart Disease

    PubMed Central

    Ding, Ding; Xia, Min; Li, Dan; Yang, Yunou; Li, Qing; Liu, Jiaxing; Chen, Xuechen; Hu, Gang; Ling, Wenhua

    2016-01-01

    Objective The association between estimated glomerular filtration rate (eGFR) and the risk of mortality among patients with coronary heart disease (CHD) is complex and still unclear. The aim of this study was to evaluate the effect of eGFR on the risk prediction of all-cause and cardiovascular disease (CVD) mortality with a long follow-up period among patients with CHD in China. Methods We conducted a prospective cohort study of 3276 Chinese patients with CHD. Cox proportional hazards regression models were used to estimate the association of different levels of eGFR with the risks of mortality. Results During a mean follow-up period of 4.9 years, 293 deaths were identified. The multivariable-adjusted hazard ratios associated with different levels of eGFR (≥90 [reference group], 60–89, 30–59, 15–29 ml/min per 1.73m2) at baseline were 1.00, 1.28 (95% confidence interval [CI], 0.87–1.88), 1.96 (95% CI, 1.31–2.94), and 3.91 (95% CI, 2.15–7.13) (P <0.001) for all-cause mortality, and 1.00, 1.26 (95% CI, 0.78–2.04), 1.94 (95% CI, 1.17–3.20), and 3.77 (95% CI, 1.80–7.89) (P <0.001) for CVD mortality, respectively. After excluding subjects who died during the first 2 years of follow-up (n = 113), the graded associations of eGFR with the risks of all-cause and CVD morality were still present. The addition of eGFR to a model including traditional cardiovascular risk factors resulted in significant improvement in the prediction of all-cause and CVD mortality. Conclusions Reduced eGFR (< 60 ml/min per 1.73 m2) at baseline is associated with increased risks of all-cause and CVD mortality among Chinese patients with CHD. PMID:27537335

  11. Observational Study of 1-Year Mortality Rates Before and After a Major Earthquake Among Chinese Nonagenarians

    PubMed Central

    Dong, Birong; Wu, Hongmei; Zhang, Yanling; Guralnik, Jack M.; Malmstrom, Theodore K.; Morley, John E.

    2011-01-01

    Background. Little is known about mortality among nonagenarians after an earthquake. Methods. Using secondary data analyses from the 2005 study called the Project of Longevity and Aging in Dujiangyan(n = 870), 1-year mortality rates were compared among a pre-earthquake group and a post-earthquake group of nonagenarians. All participants were from Dujiangyan, 50 km from the epicenter of the May 12, 2008 earthquake, in China. The pre-earthquake group was a subset of the 870 Project of Longevity and Aging in Dujiangyan participants, ages 93–95 years at the beginning of “Time Frame 1” (July 2005 through June 2006; n = 228). The post-earthquake group was a different subset of the 870 Project of Longevity and Aging in Dujiangyan participants, ages 93–95 years and alive at the beginning of Time Frame 2 (July 2008 through June 2009; n = 235). Time Frame 2 excluded a 7-week period following the earthquake in order to account for deaths due to trauma. Pre-earthquake health assessment data from the 2005 Project of Longevity and Aging in Dujiangyan study were used to calculate unadjusted/adjusted hazard ratios (HRs) for mortality. Results. One-year mortality rates were 8.3% (19/228) and 16.2% (38/235) in the pre-earthquake group and the post-earthquake group, respectively (p =.01). In unadjusted analyses, only “being in the post-earthquake group” was associated with death (HR = 2.04; 95% confidence interval [CI], 1.17–3.53; p = .011). In the multivariable Cox regression model, being in the post-earthquake group continued to be the strongest risk factor associated with mortality (HR = 2.47; 95% CI, 1.39–4.40; p = .002). Other significant risk factors included impaired cognition (HR = 1.97; 95% CI, 1.10–3.53; p = .024), serum albumin (HR = 0.90; 95% CI, 0.82–0.98; p < .015), and serum triglycerides (HR = 1.51; 95% CI, 1.15–1.99; p = .003). Conclusion. The May 12, 2008 earthquake in Wenchuan, China, was associated with a twofold increase in the 1-year

  12. Concordance of effects of medical interventions on hospital admission and readmission rates with effects on mortality

    PubMed Central

    Hemkens, Lars G.; Contopoulos-Ioannidis, Despina G.; Ioannidis, John P.A.

    2013-01-01

    Background: Many clinical trials examine a composite outcome of admission to hospital and death, or infer a relationship between hospital admission and survival benefit. This assumes concordance of the outcomes “hospital admission” and “death.” However, whether the effects of a treatment on hospital admissions and readmissions correlate to its effect on serious outcomes such as death is unknown. We aimed to assess the correlation and concordance of effects of medical interventions on admission rates and mortality. Methods: We searched the Cochrane Database of Systematic Reviews from its inception to January 2012 (issue 1, 2012) for systematic reviews of treatment comparisons that included meta-analyses for both admission and mortality outcomes. For each meta-analysis, we synthesized treatment effects on admissions and death, from respective randomized trials reporting those outcomes, using random-effects models. We then measured the concordance of directions of effect sizes and the correlation of summary estimates for the 2 outcomes. Results: We identified 61 meta-analyses including 398 trials reporting mortality and 182 trials reporting admission rates; 125 trials reported both outcomes. In 27.9% of comparisons, the point estimates of treatment effects for the 2 outcomes were in opposite directions; in 8.2% of trials, the 95% confidence intervals did not overlap. We found no significant correlation between effect sizes for admission and death (Pearson r = 0.07, p = 0.6). Our results were similar when we limited our analysis to trials reporting both outcomes. Interpretation: In this metaepidemiological study, admission and mortality outcomes did not correlate, and discordances occurred in about one-third of the treatment comparisons included in our analyses. Both outcomes convey useful information and should be reported separately, but extrapolating the benefits of admission to survival is unreliable and should be avoided. PMID:24144601

  13. Impact of acquired comorbidities on all-cause mortality rates among older breast cancer survivors

    PubMed Central

    Ahern, Thomas P.; Lash, Timothy L.; Thwin, Soe Soe; Silliman, Rebecca A.

    2010-01-01

    Background Breast cancer survivors with higher numbers of comorbidities at the time of primary treatment suffer higher rates of all-cause mortality than comparatively healthier survivors. The effect of time-varying comorbidity status on mortality in breast cancer survivors, however, has not been well investigated. Objective We examined longitudinal comorbidity in a cohort of women treated for primary breast cancer to determine whether accounting for comorbidities acquired after baseline assessment influenced the hazard ratio of all-cause mortality compared with an analysis using only baseline comorbidity. Methods Cox proportional hazards adjusted for age, race/ethnicity, and exercise habits were modeled using (1) only a baseline Charlson index; (2) four Charlson index values collected longitudinally and entered as time-varying covariates, with missing values addressed by carrying forward the prior observation; and (3) the four longitudinal Charlson scores entered as time-varying covariates, with missing values multiply imputed. Results The three modeling strategies yielded similar results; Model 1 HR: 1.4 per unit increase in Charlson index, 95% CI: 1.2, 1.7; Model 2 HR: 1.3, 95% CI: 1.1, 1.5 and Model 3 HR: 1.4, 95% CI: 1.2, 1.6. Conclusions Our findings indicate that a unit increase in the Charlson comorbidity index raises the hazard rate for all-cause mortality by approximately 1.4-fold in older women treated for primary breast cancer. The conclusion is essentially the same whether accounting only for baseline comorbidity or accounting for acquired comorbidity over a median follow-up period of 85 months. PMID:19106734

  14. [The relationship between provider volume and mortality rate: volume data of German centres of excellence].

    PubMed

    Gandjour, A; Lauterbach, K W

    2001-09-01

    The purpose of this study was to determine the percentage of centres of excellence (COEs) in Germany that achieved, for selected diagnoses and interventions, annual hospital or surgeon threshold volumes associated with a lower mortality rate. A systematic review and evaluation of the literature identified the most relevant study for each diagnosis and intervention selected. Each diagnosis and intervention was only considered if the most relevant source yielded a threshold volume associated with a reduced mortality rate. COEs received questionnaires on the annual volume of such diagnoses and interventions for each department, providing physician (median), and senior consultant in 1999. For most of the diagnoses and interventions considered, the percentage of COEs meeting their respective threshold volumes exceeded 50%. Exceptions were carotid endarterectomy (performed in departments of general cardiac surgery) and liver transplantation. The percentage of providing physicians and senior consultants performing to the desired standard remained above 75% for most of the diagnoses and interventions. Exceptions were surgeons dealing with carotid endarterectomy, correcting congenital heart disease (both performed in departments of general cardiac surgery), and correcting primary hyperparathyroidism. That a smaller percentage of centres for general cardiac surgery, liver transplantation, and primary hyperparathyroidism operates at their threshold volumes may be due to a relative oversupply of centres specialising in these treatments as well as a the lack of regional centres with a high referral rate. Due to the country-specificity of studies performed on the relationship between volume and mortality rate, it is highly recommended that Germany-specific volume-outcome studies be performed particularly in specialties with relatively low case volumes. PMID:11677797

  15. An ecological study of cancer mortality rates in California, 1950–64, with respect to solar UVB and smoking indices

    PubMed Central

    2012-01-01

    Purpose: This paper addresses whether nonmelanoma skin cancer (NMSC) mortality rates can serve as a useful index of population ultraviolet-B (UVB) irradiance and vitamin D production in a manner that affects the risk of internal cancers Methods: This analysis uses the ecological study approach with cancer mortality rate data from 19 state economic areas in California. This paper uses age-adjusted data for those aged 40 y or older. Two additional indices for solar UVB doses were also used: latitude and surface UVB doses for July 1992 from the total ozone mapping spectrometer. Lung cancer mortality rates served as the index of the health effects of smoking Results: Significant inverse correlations with NMSC mortality rate in multiple linear regression analyses were found during the period 1950–64 for eight types of cancer for males: bladder, brain, colon, gastric, prostate, and rectal cancer; multiple myeloma; and non-Hodgkin lymphoma. No similar results emerged for females with respect to all three UVB indices. Their NMSC mortality rates averaged 60% lower than those for males. Lung cancer mortality rates were directly correlated with three types of cancer for males: laryngeal, oral, and renal. No significant correlations with NMSC mortality rates appeared for later periods Conclusions: NMSC mortality rates were found inversely correlated with internal cancers for males in the period 1950–64. After that period, no further such correlations were found. The reasons may hypothetically include reduced NMSC mortality rates, high immigration rates, movement from rural to urban locations and reduced solar UVB irradiance. PMID:22928074

  16. Patterns and trends of pancreatic cancer mortality rates in Arkansas, 1969-2002: a comparison with the US population.

    PubMed

    Zhang, Jianjun; Dhakal, Ishwori; Ning, Baitang; Kesteloot, Hugo

    2008-02-01

    Little is known about trends in pancreatic cancer mortality in individual states of the US and its whole population. This study aimed to describe the patterns and trends of pancreatic cancer mortality in Arkansas, 1969-2002, using the US national rates as a reference. Joinpoint regression analyses were performed to evaluate trends in age-standardized mortality rates of pancreatic cancer by age group, sex, and race, using data obtained from the National Center for Health Statistics. Throughout the period examined, mortality decreased in young and middle-aged people (<60 years) and men but increased in old people (>/=60 years) and women. A continuous fall in mortality occurred among whites except for a transient rise in the late 1970s. For blacks, mortality rates did not cease to increase until 1995. Unlike in Arkansas, a monotonic upward or downward trend in mortality by age group and sex was not observed in the US. A decline of mortality stopped in 1997 for US whites. Recent decreasing trends were more pronounced in Arkansas blacks than in US blacks. Changes of pancreatic cancer mortality in the last three decades in Arkansas remarkably differed by age, sex, and race and were different in patterns from those of the US population. PMID:18090906

  17. Mortality, Rehospitalisation and Violent Crime in Forensic Psychiatric Patients Discharged from Hospital: Rates and Risk Factors

    PubMed Central

    Fazel, Seena; Wolf, Achim; Fimińska, Zuzanna; Larsson, Henrik

    2016-01-01

    Objectives To determine rates and risk factors for adverse outcomes in patients discharged from forensic psychiatric services. Method We conducted a historical cohort study of all 6,520 psychiatric patients discharged from forensic psychiatric hospitals between 1973 and 2009 in Sweden. We calculated hazard ratios for mortality, rehospitalisation, and violent crime using Cox regression to investigate the effect of different psychiatric diagnoses and two comorbidities (personality or substance use disorder) on outcomes. Results Over mean follow-up of 15.6 years, 30% of patients died (n = 1,949) after discharge with an average age at death of 52 years. Over two-thirds were rehospitalised (n = 4,472, 69%), and 40% violently offended after discharge (n = 2,613) with a mean time to violent crime of 4.2 years. The association between psychiatric diagnosis and outcome varied—substance use disorder as a primary diagnosis was associated with highest risk of mortality and rehospitalisation, and personality disorder was linked with the highest risk of violent offending. Furthermore comorbid substance use disorder typically increased risk of adverse outcomes. Conclusion Violent offending, premature mortality and rehospitalisation are prevalent in patients discharged from forensic psychiatric hospitals. Individualised treatment plans for such patients should take into account primary and comorbid psychiatric diagnoses. PMID:27196309

  18. Trends in amenable mortality rate in the Mongolian population, 2007-2014.

    PubMed

    Surenjav, Enkhjin; Sovd, Tugsdelger; Yoshida, Yoshitoku; Yamamoto, Eiko; Reyer, Joshua A; Hamajima, Nobuyuki

    2016-02-01

    Amenable mortality (AM) is an indicator of medical care quality. This study aimed to assess the trend and magnitude of AM in Mongolia, with the purpose of providing evidence for decisions on resource allocation. This is the first study on AM trends in Mongolia. Retrospective analysis was done on mortality statistics for the period 2007-2014. Causes of death were coded according to the 10th revision of the International Classification of Diseases (ICD-10). Nolte & McKee's classification of AM was used for the estimation of amenable mortality rates (AMRs) in Mongolia. During the study period, a total of 130,402 deaths were registered in Mongolia, of which 44,800 (34.4%) deaths were classified as being amenable. The age-standardized AMR per 100,000 population was highest in 2007 (226.6), and declined continuously until the level of 169.2 in 2014. The rate remained consistently higher in males than in females. Cerebrovascular diseases, ischemic heart diseases, perinatal deaths, influenza/pneumonia/asthma and tuberculosis were the leading causes of AM in the past eight years in Mongolia. The AMR was higher in remote western provinces with harsh weather conditions, high poverty rates, lack of human resources for health, and poor infrastructure. In addition, the provinces where Mongolia's ethnic minorities live tended to have a higher AMR. The government of Mongolia needs to critically look at the regional differences in AM in order to allocate health resources, including human resources, effectively. Further studies are needed to look into the causes of regional disparities in AM, individual-level risk factors to amenable deaths, and validity of death coding in health sector. PMID:27019528

  19. Trends in amenable mortality rate in the Mongolian population, 2007–2014

    PubMed Central

    Surenjav, Enkhjin; Sovd, Tugsdelger; Yoshida, Yoshitoku; Yamamoto, Eiko; Reyer, Joshua A.; Hamajima, Nobuyuki

    2016-01-01

    ABSTRACT Amenable mortality (AM) is an indicator of medical care quality. This study aimed to assess the trend and magnitude of AM in Mongolia, with the purpose of providing evidence for decisions on resource allocation. This is the first study on AM trends in Mongolia. Retrospective analysis was done on mortality statistics for the period 2007–2014. Causes of death were coded according to the 10th revision of the International Classification of Diseases (ICD-10). Nolte & McKee’s classification of AM was used for the estimation of amenable mortality rates (AMRs) in Mongolia. During the study period, a total of 130,402 deaths were registered in Mongolia, of which 44,800 (34.4%) deaths were classified as being amenable. The age-standardized AMR per 100,000 population was highest in 2007 (226.6), and declined continuously until the level of 169.2 in 2014. The rate remained consistently higher in males than in females. Cerebrovascular diseases, ischemic heart diseases, perinatal deaths, influenza/pneumonia/asthma and tuberculosis were the leading causes of AM in the past eight years in Mongolia. The AMR was higher in remote western provinces with harsh weather conditions, high poverty rates, lack of human resources for health, and poor infrastructure. In addition, the provinces where Mongolia’s ethnic minorities live tended to have a higher AMR. The government of Mongolia needs to critically look at the regional differences in AM in order to allocate health resources, including human resources, effectively. Further studies are needed to look into the causes of regional disparities in AM, individual-level risk factors to amenable deaths, and validity of death coding in health sector. PMID:27019528

  20. The Impact of Data Suppression on Local Mortality Rates: The Case of CDC WONDER

    PubMed Central

    Beyer, Kirsten; Rushton, Gerard

    2014-01-01

    CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) is the nation’s primary data repository for health statistics. Before WONDER data are released to the public, data cells with fewer than 10 case counts are suppressed. We showed that maps produced from suppressed data have predictable geographic biases that can be removed by applying population data in the system and an algorithm that uses regional rates to estimate missing data. By using CDC WONDER heart disease mortality data, we demonstrated that effects of suppression could be largely overcome. PMID:24922161

  1. Morbidity and mortality rates in major blunt trauma to the upper chest.

    PubMed Central

    Poole, G V; Myers, R T

    1981-01-01

    It is widely believed that fractures of the first rib are associated with more severe injuries than fractures of other ribs. To confirm or refute that belief, we conducted a retrospective review of 168 patients with major blunt trauma resulting in fractures of the upper ribs treated at the North Carolina Baptist Hospital. A comparison of morbidity and mortality rates in relation to highest rib fractured showed essentially no correlation. We concluded that all patients with deceleration or crushing injuries involving upper-rib fractures must be suspected of having significant multiple organ system trauma and evaluated accordingly. PMID:7458452

  2. Postnatal growth rates covary weakly with embryonic development rates and do not explain adult mortality probability among songbirds on four continents.

    PubMed

    Martin, Thomas E; Oteyza, Juan C; Mitchell, Adam E; Potticary, Ahva L; Lloyd, Penn

    2015-03-01

    Growth and development rates may result from genetic programming of intrinsic processes that yield correlated rates between life stages. These intrinsic rates are thought to affect adult mortality probability and longevity. However, if proximate extrinsic factors (e.g., temperature, food) influence development rates differently between stages and yield low covariance between stages, then development rates may not explain adult mortality probability. We examined these issues based on study of 90 songbird species on four continents to capture the diverse life-history strategies observed across geographic space. The length of the embryonic period explained little variation (ca. 13%) in nestling periods and growth rates among species. This low covariance suggests that the relative importance of intrinsic and extrinsic influences on growth and development rates differs between stages. Consequently, nestling period durations and nestling growth rates were not related to annual adult mortality probability among diverse songbird species within or among sites. The absence of a clear effect of faster growth on adult mortality when examined in an evolutionary framework across species may indicate that species that evolve faster growth also evolve physiological mechanisms for ameliorating costs on adult mortality. Instead, adult mortality rates of species in the wild may be determined more strongly by extrinsic environmental causes. PMID:25674692

  3. Postnatal growth rates covary weakly with embryonic development rates and do not explain adult mortality probability among songbirds on four continents

    USGS Publications Warehouse

    Martin, Thomas E.; Oteyza, Juan C.; Mitchell, Adam E.; Potticary, Ahva L.; Lloyd, P.

    2016-01-01

    Growth and development rates may result from genetic programming of intrinsic processes that yield correlated rates between life stages. These intrinsic rates are thought to affect adult mortality probability and longevity. However, if proximate extrinsic factors (e.g., temperature, food) influence development rates differently between stages and yield low covariance between stages, then development rates may not explain adult mortality probability. We examined these issues based on study of 90 songbird species on four continents to capture the diverse life-history strategies observed across geographic space. The length of the embryonic period explained little variation (ca. 13%) in nestling periods and growth rates among species. This low covariance suggests that the relative importance of intrinsic and extrinsic influences on growth and development rates differs between stages. Consequently, nestling period durations and nestling growth rates were not related to annual adult mortality probability among diverse songbird species within or among sites. The absence of a clear effect of faster growth on adult mortality when examined in an evolutionary framework across species may indicate that species that evolve faster growth also evolve physiological mechanisms for ameliorating costs on adult mortality. Instead, adult mortality rates of species in the wild may be determined more strongly by extrinsic environmental causes.

  4. Modeling Atmospheric Emissions and Calculating Mortality Rates Associated with High Volume Hydraulic Fracturing Transportation

    NASA Astrophysics Data System (ADS)

    Mathews, Alyssa

    Emissions from the combustion of fossil fuels are a growing pollution concern throughout the global community, as they have been linked to numerous health issues. The freight transportation sector is a large source of these emissions and is expected to continue growing as globalization persists. Within the US, the expanding development of the natural gas industry is helping to support many industries and leading to increased transportation. The process of High Volume Hydraulic Fracturing (HVHF) is one of the newer advanced extraction techniques that is increasing natural gas and oil reserves dramatically within the US, however the technique is very resource intensive. HVHF requires large volumes of water and sand per well, which is primarily transported by trucks in rural areas. Trucks are also used to transport waste away from HVHF well sites. This study focused on the emissions generated from the transportation of HVHF materials to remote well sites, dispersion, and subsequent health impacts. The Geospatial Intermodal Freight Transport (GIFT) model was used in this analysis within ArcGIS to identify roadways with high volume traffic and emissions. High traffic road segments were used as emissions sources to determine the atmospheric dispersion of particulate matter using AERMOD, an EPA model that calculates geographic dispersion and concentrations of pollutants. Output from AERMOD was overlaid with census data to determine which communities may be impacted by increased emissions from HVHF transport. The anticipated number of mortalities within the impacted communities was calculated, and mortality rates from these additional emissions were computed to be 1 in 10 million people for a simulated truck fleet meeting stricter 2007 emission standards, representing a best case scenario. Mortality rates due to increased truck emissions from average, in-use vehicles, which represent a mixed age truck fleet, are expected to be higher (1 death per 341,000 people annually).

  5. Mortality rates of pathogen indicator microorganisms discharged from point and non-point sources in an urban area.

    PubMed

    Kim, Geonha; Hur, Jin

    2010-01-01

    This research measured the mortality rates of pathogen indicator microorganisms discharged from various point and non-point sources in an urban area. Water samples were collected from a domestic sewer, a combined sewer overflow, the effluent of a wastewater treatment plant, and an urban river. Mortality rates of indicator microorganisms in sediment of an urban river were also measured. Mortality rates of indicator microorganisms in domestic sewage, estimated by assuming first order kinetics at 20 degrees C were 0.197 day(-1), 0.234 day(-1), 0.258 day(-1) and 0.276 day(-1) for total coliform, fecal coliform, Escherichia coli, and fecal streptococci, respectively. Effects of temperature, sunlight irradiation and settlement on the mortality rate were measured. Results of this research can be used as input data for water quality modeling or can be used as design factors for treatment facilities. PMID:20923108

  6. Brain cancer mortality rates increase with Toxoplasma gondii seroprevalence in France

    USGS Publications Warehouse

    Vittecoq, Marion; Elguero, Eric; Lafferty, Kevin D.; Roche, Benjamin; Brodeur, Jacques; Gauthier-Clerc, Michel; Missé, Dorothée; Thomas, Frédéric

    2012-01-01

    The incidence of adult brain cancer was previously shown to be higher in countries where the parasite Toxoplasma gondii is common, suggesting that this brain protozoan could potentially increase the risk of tumor formation. Using countries as replicates has, however, several potential confounding factors, particularly because detection rates vary with country wealth. Using an independent dataset entirely within France, we further establish the significance of the association between T. gondii and brain cancer and find additional demographic resolution. In adult age classes 55 years and older, regional mortality rates due to brain cancer correlated positively with the local seroprevalence of T. gondii. This effect was particularly strong for men. While this novel evidence of a significant statistical association between T. gondii infection and brain cancer does not demonstrate causation, these results suggest that investigations at the scale of the individual are merited.

  7. Why has under-5 mortality decreased at such different rates in different countries?

    PubMed

    Jamison, Dean T; Murphy, Shane M; Sandbu, Martin E

    2016-07-01

    Controlling for socioeconomic and geographic factors, under-5 mortality (5q0) in developing countries has been declining at about 2.7% per year, a high rate of 'technical progress'. This paper adduces theoretical and empirical reasons for rejecting the usual specification of homogeneous technical progress across countries and uses a panel of 95 developing countries for the period 1970-2000 to explore the consequences of heterogeneity. Allowing country-specific rates of technical progress sharply reduces the estimated income elasticity of 5q0 and points to country variation in technical progress as the principal source of the (large) cross-country variation in 5q0 decline. Education levels and physician coverage also contribute and are less affected than income of allowing country variation in technical progress. The paper concludes by decomposing 1970-2000 5q0 decline into its different sources for each country. PMID:27046447

  8. Problem of small numbers in reporting of cancer incidence and mortality rates in Indian cancer registries.

    PubMed

    Takiar, Ramnath; Nadayil, Deenu; Nandakumar, A

    2009-01-01

    The present paper examines the problem of small numbers (<20 cases) associated with many sites of cancers in Indian cancer registries. The cancer incidence data of 14 Population Based Cancer Registries for the periods of 2001-03 and 2004-05 were utilized for the analysis. Nine out of 14 registries had more than 50% of their sites being associated with small numbers while seven registries had 50% of their sites having as low as 5 cases. Sites associated with small numbers showed a lot of variation and significant differences in their incidence rates within two years duration which are not feasible. The percentage age distribution was also found to vary with different periods. The paper has effectively shown the effect of population size on incidence rates. For a registry of population size 300,000, the incidence rate of 6 can very well be unstable. There are many registries in the world with their population size less than 200,000. Even in the case of registries with high population (>or= 500,000) the practice is to report the cancer incidence by different ethnic groups with populations less than 200,000 and thereby introduce the problem of small numbers in reporting the incidences of various cancer sites. To overcome this problem, pooling of data over broad age groups or ten years age groups or 3 to 5 years periods is one immediate solution. PMID:19827889

  9. Testosterone Deficiency Increases Hospital Readmission and Mortality Rates in Male Patients with Heart Failure

    PubMed Central

    dos Santos, Marcelo Rodrigues; Sayegh, Ana Luiza Carrari; Groehs, Raphaela Vilar Ramalho; Fonseca, Guilherme; Trombetta, Ivani Credidio; Barretto, Antônio Carlos Pereira; Arap, Marco Antônio; Negrão, Carlos Eduardo; Middlekauff, Holly R.; Alves, Maria-Janieire de Nazaré Nunes

    2015-01-01

    Background Testosterone deficiency in patients with heart failure (HF) is associated with decreased exercise capacity and mortality; however, its impact on hospital readmission rate is uncertain. Furthermore, the relationship between testosterone deficiency and sympathetic activation is unknown. Objective We investigated the role of testosterone level on hospital readmission and mortality rates as well as sympathetic nerve activity in patients with HF. Methods Total testosterone (TT) and free testosterone (FT) were measured in 110 hospitalized male patients with a left ventricular ejection fraction < 45% and New York Heart Association classification IV. The patients were placed into low testosterone (LT; n = 66) and normal testosterone (NT; n = 44) groups. Hypogonadism was defined as TT < 300 ng/dL and FT < 131 pmol/L. Muscle sympathetic nerve activity (MSNA) was recorded by microneurography in a subpopulation of 27 patients. Results Length of hospital stay was longer in the LT group compared to in the NT group (37 ± 4 vs. 25 ± 4 days; p = 0.008). Similarly, the cumulative hazard of readmission within 1 year was greater in the LT group compared to in the NT group (44% vs. 22%, p = 0.001). In the single-predictor analysis, TT (hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.58–4.85; p = 0.02) predicted hospital readmission within 90 days. In addition, TT (HR, 4.65; 95% CI, 2.67–8.10; p = 0.009) and readmission within 90 days (HR, 3.27; 95% CI, 1.23–8.69; p = 0.02) predicted increased mortality. Neurohumoral activation, as estimated by MSNA, was significantly higher in the LT group compared to in the NT group (65 ± 3 vs. 51 ± 4 bursts/100 heart beats; p < 0.001). Conclusion These results support the concept that LT is an independent risk factor for hospital readmission within 90 days and increased mortality in patients with HF. Furthermore, increased MSNA was observed in patients with LT. PMID:26200897

  10. Declines in stillbirth and neonatal mortality rates in Europe between 2004 and 2010: results from the Euro-Peristat project

    PubMed Central

    Zeitlin, Jennifer; Mortensen, Laust; Cuttini, Marina; Lack, Nicholas; Nijhuis, Jan; Haidinger, Gerald; Blondel, Béatrice; Hindori-Mohangoo, Ashna D

    2016-01-01

    Background Stillbirth and neonatal mortality rates declined in Europe between 2004 and 2010. We hypothesised that declines might be greater for countries with higher mortality in 2004 and disproportionally affect very preterm infants at highest risk. Methods Data about live births, stillbirths and neonatal deaths by gestational age (GA) were collected using a common protocol by the Euro-Peristat project in 2004 and 2010. We analysed stillbirths at ≥28 weeks GA in 22 countries and live births ≥24 weeks GA for neonatal mortality in 18 countries. Per cent changes over time were assessed by calculating risk ratios (RR) for stillbirth, neonatal mortality and preterm birth rates in 2010 vs 2004. We used meta-analysis techniques to derive pooled RR using random-effects models overall, by GA subgroups and by mortality level in 2004. Results Between 2004 and 2010, stillbirths declined by 17% (95% CI 10% to 23%), with a range from 1% to 39% by country. Neonatal mortality declined by 29% (95% CI 23% to 35%) with a range from 9% to 67%. Preterm birth rates did not change: 0% (95% CI −3% to 3%). Mortality declines were of a similar magnitude at all GA; mortality levels in 2004 were not associated with RRs. Conclusions Stillbirths and neonatal deaths declined at all gestational ages in countries with both high and low levels of mortality in 2004. These results raise questions about how low-mortality countries achieve continued declines and highlight the importance of improving care across the GA spectrum. PMID:26719590

  11. Effects of local extrinsic mortality rate, crime and sex ratio on preventable death in Northern Ireland

    PubMed Central

    Uggla, Caroline; Mace, Ruth

    2015-01-01

    Background and objectives: Individual investment in health varies greatly within populations and results in significant differences in the risk of preventable death. Life history theory predicts that individuals should alter their investment in health (somatic maintenance) in response to ecological cues that shift the perceived fitness payoffs to such investments. However, previous research has failed to isolate the effects of different ecological factors on preventable death, and has often relied on macro-level data without individual controls. Here, we test some key predictions concerning the local ecology—that higher extrinsic mortality rate (EMR), crime rate and mate-scarcity (male/female-biased sex ratio) at the ward-level—will be associated with a higher risk of preventable death. Methodology: We use census-based data from Northern Ireland (n = 927 150) on preventable death during an 8.7-year period from the 2001 Census and run Cox regressions for (i) accident/suicide or alcohol-related death and (ii) deaths from preventable diseases, for men and women separately, controlling for a wide range of individual variables. Results: We find evidence of ward-level EMR and crime rate being positively associated with preventable death among men, particularly men with low socioeconomic position. There was a tentative relationship between male-biased sex ratio and preventable death among women, but not among men. Conclusion and implications: Both behaviours that might lead to ‘risky’ death and health neglect might be adaptive responses to local ecologies. Efforts to reduce crime might be as effective as those to reduce extrinsic mortality, and both could have positive effects on various health behaviours. PMID:26338679

  12. Is the United States Maternal Mortality Rate Increasing? Disentangling trends from measurement issues Short title: U.S. Maternal Mortality Trends

    PubMed Central

    Declercq, Eugene; Cabral, Howard; Morton, Christine

    2016-01-01

    Background A pregnancy question was added to the U.S. standard death certificate in 2003 to improve ascertainment of maternal deaths. The delayed adoption of this question among states led to data incompatibilities, and impeded accurate trend analysis. Our objectives were to develop methods for trend analysis, and to provide an overview of U.S. maternal mortality trends from 2000–2014. Methods This observational study analyzed vital statistics maternal mortality data from all U.S. states in relation to the format and year-of-adoption of the pregnancy question. Correction factors were developed to adjust data from before the standard pregnancy question was adopted, to promote accurate trend analysis. Joinpoint regression was used to analyze trends for groups of states with similar pregnancy questions. Results The estimated maternal mortality rate (per 100,000 live births) for 48 states and Washington D.C. (excluding California and Texas, analyzed separately) increased by 26.6%, from 18.8 in 2000 to 23.8 in 2014. California showed a declining trend, while Texas had a sudden increase in 2011–2012. Analysis of the measurement change suggests that U.S. rates in the early 2000s were higher than previously reported. Discussion Despite the United Nations Millennium Development Goal for a 75% reduction in maternal mortality by 2015, the estimated maternal mortality rate for 48 states and Washington D.C. increased from 2000–2014, while the international trend was in the opposite direction. There is a need to redouble efforts to prevent maternal deaths and improve maternity care for the 4 million U.S. women giving birth each year. PMID:27500333

  13. Determining the Independent Risk Factors and Mortality Rate of Nosocomial Infections in Pediatric Patients.

    PubMed

    Aktar, Fesih; Tekin, Recep; Güneş, Ali; Ülgen, Cevat; Tan, İlhan; Ertuğrul, Sabahattin; Köşker, Muhammet; Balık, Hasan; Karabel, Duran; Yolbaş, Ilyas

    2016-01-01

    The objective of this study was to determine the rate, independent risk factors, and outcomes of healthcare-associated infections in pediatric patients. This study was performed between 2011 and 2014 in pediatric clinic and intensive care unit. 86 patients and 86 control subjects were included in the study. Of 86 patients with nosocomial infections (NIs), there were 100 NIs episodes and 90 culture growths. The median age was 32.0 months. The median duration of hospital stay of the patients was 30.0 days. The most frequent pathogens were Coagulase-negative Staphylococcus, Acinetobacter spp., Klebsiella spp., and Candida spp. Unconsciousness, prolonged hospitalization, transfusion, mechanical ventilation, use of central venous catheter, enteral feeding via a nasogastric tube, urinary catheter, and receiving carbapenems and glycopeptides were found to be significantly higher in NIs patients. Multivariate logistic regression analysis showed prolonged hospitalization, neutropenia, and use of central venous catheter and carbapenems as the independent risk factors for NIs. In the univariate analysis, unconsciousness, mechanical ventilation, enteral feeding, use of enteral feeding via a nasogastric tube, H2 receptor blockers, and port and urinary catheter were significantly associated with mortality. In the multiple logistic regression analysis, only mechanical ventilation was found as an independent predictor of mortality in patients with NIs. PMID:26981536

  14. Determining the Independent Risk Factors and Mortality Rate of Nosocomial Infections in Pediatric Patients

    PubMed Central

    Aktar, Fesih; Tekin, Recep; Güneş, Ali; Ülgen, Cevat; Tan, İlhan; Ertuğrul, Sabahattin; Köşker, Muhammet; Balık, Hasan; Karabel, Duran; Yolbaş, Ilyas

    2016-01-01

    The objective of this study was to determine the rate, independent risk factors, and outcomes of healthcare-associated infections in pediatric patients. This study was performed between 2011 and 2014 in pediatric clinic and intensive care unit. 86 patients and 86 control subjects were included in the study. Of 86 patients with nosocomial infections (NIs), there were 100 NIs episodes and 90 culture growths. The median age was 32.0 months. The median duration of hospital stay of the patients was 30.0 days. The most frequent pathogens were Coagulase-negative Staphylococcus, Acinetobacter spp., Klebsiella spp., and Candida spp. Unconsciousness, prolonged hospitalization, transfusion, mechanical ventilation, use of central venous catheter, enteral feeding via a nasogastric tube, urinary catheter, and receiving carbapenems and glycopeptides were found to be significantly higher in NIs patients. Multivariate logistic regression analysis showed prolonged hospitalization, neutropenia, and use of central venous catheter and carbapenems as the independent risk factors for NIs. In the univariate analysis, unconsciousness, mechanical ventilation, enteral feeding, use of enteral feeding via a nasogastric tube, H2 receptor blockers, and port and urinary catheter were significantly associated with mortality. In the multiple logistic regression analysis, only mechanical ventilation was found as an independent predictor of mortality in patients with NIs. PMID:26981536

  15. Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis

    PubMed Central

    Nitsch, Dorothea; Grams, Morgan; Sang, Yingying; Black, Corri; Cirillo, Massimo; Djurdjev, Ognjenka; Iseki, Kunitoshi; Jassal, Simerjot K; Kimm, Heejin; Kronenberg, Florian; Øien, Cecilia M; Levin, Adeera; Woodward, Mark; Hemmelgarn, Brenda R

    2013-01-01

    Objective To assess for the presence of a sex interaction in the associations of estimated glomerular filtration rate and albuminuria with all-cause mortality, cardiovascular mortality, and end stage renal disease. Design Random effects meta-analysis using pooled individual participant data. Setting 46 cohorts from Europe, North and South America, Asia, and Australasia. Participants 2 051 158 participants (54% women) from general population cohorts (n=1 861 052), high risk cohorts (n=151 494), and chronic kidney disease cohorts (n=38 612). Eligible cohorts (except chronic kidney disease cohorts) had at least 1000 participants, outcomes of either mortality or end stage renal disease of ≥50 events, and baseline measurements of estimated glomerular filtration rate according to the Chronic Kidney Disease Epidemiology Collaboration equation (mL/min/1.73 m2) and urinary albumin-creatinine ratio (mg/g). Results Risks of all-cause mortality and cardiovascular mortality were higher in men at all levels of estimated glomerular filtration rate and albumin-creatinine ratio. While higher risk was associated with lower estimated glomerular filtration rate and higher albumin-creatinine ratio in both sexes, the slope of the risk relationship for all-cause mortality and for cardiovascular mortality were steeper in women than in men. Compared with an estimated glomerular filtration rate of 95, the adjusted hazard ratio for all-cause mortality at estimated glomerular filtration rate 45 was 1.32 (95% CI 1.08 to 1.61) in women and 1.22 (1.00 to 1.48) in men (Pinteraction<0.01). Compared with a urinary albumin-creatinine ratio of 5, the adjusted hazard ratio for all-cause mortality at urinary albumin-creatinine ratio 30 was 1.69 (1.54 to 1.84) in women and 1.43 (1.31 to 1.57) in men (Pinteraction<0.01). Conversely, there was no evidence of a sex difference in associations of estimated glomerular filtration rate and urinary albumin-creatinine ratio with end stage renal

  16. When heart goes “BOOM” to fast. Heart rate greater than 80 as mortality predictor in acute myocardial infarction

    PubMed Central

    Davidovic, Goran; Iric-Cupic, Violeta; Milanov, Srdjan; Dimitijevic, Aleksandra; Petrovic-Janicijevic, Mirjana

    2013-01-01

    Many prospective studies established association between high heart rate and increased cardiovascular morbidity and mortality, independently of other risk factors. Heart rate over 80 beats per minute more often leads to atherosclerotic plaque disruption, the main step in developing acute coronary syndrome. Purpose was to investigate the incidence of higher heart rate levels in patients with anterior wall acute myocardial infarction with ST-segment elevation and the influence of heart rate on mortality. Research included 140 patients with anterior wall acute myocardial infarction with ST-segment elevation treated in Coronary Unit, Clinical Center Kragujevac in the period from January 2001-June 2006. Heart rate was calculated as the mean value of baseline and heart rate in the first 30 minutes after admission. Other risk factors were also followed to determine their connection with elevated heart rate. Results showed that the majority of patients survived (over 70%). In a total number of patients, more than 75% had a heart rate levels greater than 80 beats per minute. There was a significant difference in heart rate on addmision between survivors and patients who died, with a greater levels in patients with fatal outcome. Both, univariate and multivariate regression analysis singled out heart rate greater than 80 beats per minute as independent mortality predictor in these patients. Heart rate greater than 80 beats per minute is a major, independent risk factor for morbidity and important predictor of mortality in patients with acute myocardial infarction. PMID:23991346

  17. The Effectiveness of a Geriatric Hip Fracture Clinical Pathway in Reducing Hospital and Rehabilitation Length of Stay and Improving Short-Term Mortality Rates

    PubMed Central

    Lau, Tak-Wing; Fang, Christian; Leung, Frankie

    2013-01-01

    Background: A geriatric hip fracture clinical pathway, led by an orthopedic surgeon, was developed in 2007. This clinical pathway team is multidisciplinary and consists of surgeons, physicians, anesthetists, nurses, physiotherapists, occupational therapists, medical social workers, dieticians as well as voluntary support groups. Methods: From early 2007 onward, all patients older than 65 years with acute isolated hip fractures were included. During the whole inpatient treatment, all relevant data were captured prospectively. The data in 2006, before the implementation of the clinical pathway, were collected retrospectively through computer record system. A study of the length of stay in acute and rehabilitation hospital and also the short-term mortality rate was carried out to compare the difference before and after the implementation of the pathway. Results: From 2007 onward, more than 1300 hip fractures were treated. After the implementation of the pathway, the preoperative length of stay was markedly shortened by 4 days, from an average of 6.1 days in 2006 to 1.5 days in 2011 (P < .05). The postoperative length of stay and the overall acute hospital length of stay also improved significantly. The length of stay in rehabilitation hospital was also significantly shorter in the 4-year period. Although the number of hip fractures increased annually with increased age and number of comorbidities each year, the inpatient mortality rate showed a gradual decrease from 2.7% in 2006 to 1.25% in 2010. The 30 days mortality rate also showed a decrease from 3.65% in 2006 to 2.75% in 2010. Conclusion: Geriatric hip fracture clinical pathway is an excellent approach to the geriatric hip fracture service. The most significant improvement is the dramatic shortening of the length of hospital stay. Our success in the past 5 years has proven its value and sustainability. PMID:23936733

  18. The first 5 years after the dissertation.

    PubMed

    Hodges, L C; Poteet, G W

    1992-01-01

    To succeed in academia, nursing faculty members must devote the first 5 years following the dissertation to achieving a standard to tenure characteristic of the profession. Most institutions in the country adhere to the American Association of University Professors' guidelines for tenure. These guidelines mandate excellence in teaching, scholarship, and service. A fourth characteristic, leadership, is increasingly considered in tenure decisions. The expectations of an academic career in nursing serve as the foundation for a framework to evaluate the likelihood of success in a particular setting. A detailed 5-year plan for achieving tenure is proposed. PMID:1634654

  19. Short-Term Effect of Coarse Particles on Daily Mortality Rate in A Tropical City, Kaohsiung, Taiwan.

    PubMed

    Tsai, Shang-Shyue; Weng, Yi-Hao; Chiu, Ya-Wen; Yang, Chun-Yuh

    2015-01-01

    Many studies examined the short-term effects of air pollution on frequency of daily mortality over the past two decades. However, information on the relationship between exposure to levels of coarse particles (PM(2.5-10)) and daily mortality rate is relatively sparse due to limited availability of monitoring data and findings are inconsistent. This study was undertaken to determine whether an association exists between PM(2.5-10) levels and rate of daily mortality in Kaohsiung, Taiwan, a large industrial city with a tropical climate. Daily mortality rate, air pollution parameters, and weather data for Kaohsiung were obtained for the period 2006-2008. The relative risk (RR) of daily mortality occurrence was estimated using a time-stratified case-crossover approach, controlling for (1) weather variables, (2) day of the week, (3) seasonality, and (4) long-term time trends. For the single-pollutant model without adjustment for other pollutants, PM(2.5-10) exposure levels showed significant correlation with total mortality rate both on warm and cool days, with an interquartile range increase associated with a 14% (95% CI = 5-23%) and 12% (95% CI = 5-20%) rise in number of total deaths, respectively. In two-pollutant models, PM(2.5-10) exerted significant influence on total mortality frequency after inclusion of sulfur dioxide (SO(2)) on warm days. On cool days, PM(2.5-10) induced significant elevation in total mortality rate when SO(2) or ozone (O(3)) was added in the regression model. There was no apparent indication of an association between PM(2.5-10) exposure and deaths attributed to respiratory and circulatory diseases. This study provided evidence of correlation between short-term exposure to PM(2.5-10) and increased risk of death for all causes. PMID:26580668

  20. Longitudinal Changes in Vascular Risk Markers and Mortality Rates among a Latino Population with Hypertension

    PubMed Central

    Pflederer, Matthew C.; Long, Carlin S.; Beaty, Brenda; Havranek, Edward P.; Mehler, Philip S.; Keniston, Angela

    2016-01-01

    Vascular markers such as pulse-wave velocity and carotid intima-media thickness (CIMT) might improve the prediction of incident cardiovascular disease beyond traditional risk factors. These vascular markers have not been well characterized in minority populations and might be more useful than inflammatory biomarkers. We conducted a prospective, longitudinal cohort study among hypertensive patients in an urban safety-net hospital. We evaluated inflammatory biomarkers, arterial pulse-wave velocity, and carotid intima-media thickness at baseline, 1 year, and 2 years. The primary outcome variable was CIMT. Generalized linear mixed-effects models were used to evaluate associations between CIMT and predictive variables accounting for the correlation of multiple measurements within subjects over time. For our secondary outcome, we used administrative and National Death Index data to determine all-cause death, and univariate relationships were evaluated. Among 175 subjects, 117 were Latino (67%) and 117 were female (67%). Pulse-wave velocity and CIMT regressed over time (both P <0.001) and were highly correlated (P <0.001). Only pulse-wave velocity (P=0.002) and total cholesterol (P=0.03) were associated with CIMT in time-varying covariate analysis. At a median follow-up period of 80 months, 17 of 175 subjects had died (10%). Higher baseline CIMT and pulse-wave velocity were associated with increased mortality rates (both P <0.01). No serum inflammatory marker was significantly correlated with longitudinal changes in CIMT or death. In conclusion, both arterial stiffness and preclinical carotid atherosclerosis were associated with increased mortality rates and might be useful risk-stratification markers among this minority population. PMID:27127427

  1. Longitudinal Changes in Vascular Risk Markers and Mortality Rates among a Latino Population with Hypertension.

    PubMed

    Pflederer, Matthew C; Long, Carlin S; Beaty, Brenda; Havranek, Edward P; Mehler, Philip S; Keniston, Angela; Krantz, Mori J

    2016-04-01

    Vascular markers such as pulse-wave velocity and carotid intima-media thickness (CIMT) might improve the prediction of incident cardiovascular disease beyond traditional risk factors. These vascular markers have not been well characterized in minority populations and might be more useful than inflammatory biomarkers. We conducted a prospective, longitudinal cohort study among hypertensive patients in an urban safety-net hospital. We evaluated inflammatory biomarkers, arterial pulse-wave velocity, and carotid intima-media thickness at baseline, 1 year, and 2 years. The primary outcome variable was CIMT. Generalized linear mixed-effects models were used to evaluate associations between CIMT and predictive variables accounting for the correlation of multiple measurements within subjects over time. For our secondary outcome, we used administrative and National Death Index data to determine all-cause death, and univariate relationships were evaluated. Among 175 subjects, 117 were Latino (67%) and 117 were female (67%). Pulse-wave velocity and CIMT regressed over time (both P <0.001) and were highly correlated (P <0.001). Only pulse-wave velocity (P=0.002) and total cholesterol (P=0.03) were associated with CIMT in time-varying covariate analysis. At a median follow-up period of 80 months, 17 of 175 subjects had died (10%). Higher baseline CIMT and pulse-wave velocity were associated with increased mortality rates (both P <0.01). No serum inflammatory marker was significantly correlated with longitudinal changes in CIMT or death. In conclusion, both arterial stiffness and preclinical carotid atherosclerosis were associated with increased mortality rates and might be useful risk-stratification markers among this minority population. PMID:27127427

  2. Post-Exercise Heart Rate Recovery Independently Predicts Mortality Risk in Patients with Chronic Heart Failure

    PubMed Central

    Tang, Yi-Da; Dewland, Thomas A.; Wencker, Detlef; Katz, Stuart D.

    2009-01-01

    Background Post-exercise heart rate recovery (HRR) is an index of parasympathetic function associated with clinical outcomes in populations with and without documented coronary heart disease. Decreased parasympathetic activity is thought to be associated with disease progression in chronic heart failure (HF), but an independent association between post-exercise HRR and clinical outcomes among such patients has not been established. Methods and Results We measured HRR (calculated as the difference between heart rate at peak exercise and after 1 minute of recovery) in 202 HF subjects and recorded 17 mortality and 15 urgent transplantation outcome events over 624 days of follow-up. Reduced post-exercise HRR was independently associated with increased event risk after adjusting for other exercise-derived variables (peak oxygen uptake and VE/VCO2 slope), for the Heart Failure Survival Score (adjusted HR 1.09 for one beat/min reduction, 95% CI 1.05-1.13, p<0.0001) and the Seattle Heart Failure Model score (adjusted HR 1.08 for one beat/min reduction, 95% CI 1.05-1.12, p<0.0001). Subjects in the lowest risk tertile based on post-exercise HRR (≥30 beats/min) had low risk of events irrespective of the risk predicted by the survival scores. In a subgroup of 15 subjects, reduced post-exercise HRR was associated with increased serum markers of inflammation (interleukin-6 r=0.58, p=0.024, high sensitivity C-reactive protein r=0.66, p=0.007). Conclusions Post-exercise HRR predicts mortality risk in patients with HF and provides prognostic information independent of previously described survival models. Pathophysiologic links between autonomic function and inflammation may be mediators of this association. PMID:19944361

  3. Digoxin Use to Control Ventricular Rate in Patients with Atrial Fibrillation and Heart Failure Is Not Associated with Increased Mortality

    PubMed Central

    Dominic, Paari

    2015-01-01

    Introduction. Digoxin is used to control ventricular rate in atrial fibrillation (AF). There is conflicting evidence regarding safety of digoxin. We aimed to evaluate the risk of mortality with digoxin use in patients with AF using meta-analyses. Methods. PubMed was searched for studies comparing outcomes of patients with AF taking digoxin versus no digoxin, with or without heart failure (HF). Studies were excluded if they reported only a point estimate of mortality, duplicated patient populations, and/or did not report adjusted hazard ratios (HR). The primary endpoint was all-cause mortality. Adjusted HRs were combined using generic inverse variance and log hazard ratios. A multivariate metaregression model was used to explore heterogeneity in studies. Results. Twelve studies with 321,944 patients were included in the meta-analysis. In all AF patients, irrespective of heart failure status, digoxin is associated with increased all-cause mortality (HR [1.23], 95% confidence interval [CI] 1.16–1.31). However, digoxin is not associated with increased mortality in patients with AF and HF (HR [1.08], 95% CI 0.99–1.18). In AF patients without HF digoxin is associated with increased all-cause mortality (HR [1.38], 95% CI 1.12–1.71). Conclusion. In patients with AF and HF, digoxin use is not associated with an increased risk of all-cause mortality when used for rate control. PMID:26788401

  4. EVALUATION OF THE MORTALITY RATE ONE YEAR AFTER HIP FRACTURE AND FACTORS RELATING TO DIMINISHED SURVIVAL AMONG ELDERLY PEOPLE

    PubMed Central

    Ricci, Guilherme; Longaray, Maurício Portal; Gonçalves, Ramiro Zilles; Neto, Ary da Silva Ungaretti; Manente, Marislei; Barbosa, Luíza Barbosa Horta

    2015-01-01

    Objective: To evaluate the mortality rate after one year and correlated preoperative factors, among patients with hip fractures. Methods: We prospectively studied 202 out of a total of 376 patients with a diagnosis of hip fracture who were admitted to the Hospital Cristo Redentor, between October 2007 and March 2009. The database with the epidemiological analysis was set up during their hospitalization, and follow–up data were obtained preferentially by phone. Results: The overall mortality rate after one year of follow-up was 28.7% or 58 deaths, among which 11 (5.45%) occurred during hospitalization. Fractures were more prevalent among women (71.3%) and rare among blacks (5%). Among the comorbidities, dementia and depression showed a statistically significant reduction in survival (p = 0.018 and 0.007, respectively). Conclusion: The mortality rate after one year of follow-up was 28.7%. Dementia and depression increased this rate. PMID:27042638

  5. Quality Indicators but Not Admission Volumes of Neonatal Intensive Care Units Are Effective in Reducing Mortality Rates of Preterm Infants

    PubMed Central

    Rochow, Niels; Lee, Sauyoung; Schünemann, Holger; Fusch, Christoph

    2016-01-01

    Aim To investigate how two different strategies to form larger neonatal intensive care units (NICU) impact neonatal mortality rates. Methods Cross-sectional study modeling admission volumes and mortality rates of 177,086 VLBW infants aggregated into 862 NICUs. Cumulative 3-year data was abstracted from Vermont Oxford Network. The model simulated a reduction in number of NICUs by stepwise exclusion using either admission volume (VOL) or quality (QUAL) cut-offs. After randomly redirecting infants of excluded to remaining NICUs resulting system mortality rates were calculated with and without adjusting for effects of experience levels (EL) using published data to reflect effects of different team-to-patient exposure. Results The quality-based strategy is more effective in reducing mortality; while VOL alone was not able to reduce system mortality, QUAL already achieved a 5% improvement after reducing 8% of NICUs and redirecting 6% of infants. Including “EL”, a 5% improvement of mortality was achieved by reducing 77% (VOL) vs. 7% (QUAL) of NICUs and redirecting 54% (VOL) vs. 5% (QUAL) of VLBW infants, respectively. Conclusion While a critical number of admissions is needed to maintain skills this study emphasizes the importance of including quality parameters to restructure neonatal care. The findings can be generalized to other medical fields. PMID:27508499

  6. Mortality Prediction in the Oldest Old with Five Different Equations to Estimate Glomerular Filtration Rate: The Health and Anemia Population-based Study

    PubMed Central

    Mandelli, Sara; Riva, Emma; Tettamanti, Mauro; Detoma, Paolo; Giacomin, Adriano; Lucca, Ugo

    2015-01-01

    Background Kidney function declines considerably with age, but little is known about its clinical significance in the oldest-old. Objectives To study the association between reduced glomerular filtration rate (GFR) estimated according to five equations with mortality in the oldest-old. Design Prospective population-based study. Setting Municipality of Biella, Piedmont, Italy. Participants 700 subjects aged 85 and older participating in the “Health and Anemia” Study in 2007–2008. Measurements GFR was estimated using five creatinine-based equations: the Cockcroft-Gault (C-G), Modification of Diet in Renal Disease (MDRD), MAYO Clinic, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Berlin Initiative Study-1 (BIS-1). Survival analysis was used to study mortality in subjects with reduced eGFR (<60 mL/min/1.73m2) compared to subjects with eGFR ≥60 mL/min/1.73m2. Results Prevalence of reduced GFR was 90.7% with the C-G, 48.1% with MDRD, 23.3% with MAYO, 53.6% with CKD-EPI and 84.4% with BIS-1. After adjustment for confounders, two-year mortality was significantly increased in subjects with reduced eGFR using BIS-1 and C-G equations (adjusted HRs: 2.88 and 3.30, respectively). Five-year mortality was significantly increased in subjects with eGFR <60 mL/min/1.73m2 using MAYO, CKD-EPI and, in a graduated fashion in reduced eGFR categories, MDRD. After 5 years, oldest old with an eGFR <30 mL/min/1.73m2 showed a significantly higher risk of death whichever equation was used (adjusted HRs between 2.04 and 2.70). Conclusion In the oldest old, prevalence of reduced eGFR varies noticeably depending on the equation used. In this population, risk of mortality was significantly higher for reduced GFR estimated with the BIS-1 and C-G equations over the short term. Though after five years the MDRD appeared on the whole a more consistent predictor, differences in mortality prediction among equations over the long term were less apparent. Noteworthy, subjects with

  7. Salivary Immunoglobulin A Secretion Rate Is Negatively Associated with Cancer Mortality: The West of Scotland Twenty-07 Study.

    PubMed

    Phillips, Anna C; Carroll, Douglas; Drayson, Mark T; Der, Geoff

    2015-01-01

    Immunoglobulins are essential for combating infectious disease although very high levels can indicate underlying pathology. The present study examined associations between secretory immunoglobulin A (sIgA) in saliva and mortality rates in the general population. Participants were 639 adults from the eldest cohort of the West of Scotland Twenty-07 Study aged 63 years at the time of saliva sampling in 1995. From unstimulated 2-minute saliva samples, saliva volume and S-IgA concentration were measured, and S-IgA secretion rate determined as their product. Mortality data were tracked for 19 years. Cox proportional hazard models were applied to compute hazard ratios (HR) for all-cause mortality from sIgA secretion rate. Associations were adjusted for gender, assay batch, household occupational group, smoking, medication usage, and self-reported health. There was a negative association between log sIgA secretion rate and all-cause mortality, HR = 0.81, 95%CI = 0.73-0.91, p < .001. Further analysis of specific causes of mortality revealed that the all-cause association was due to an underlying association with cancer mortality and in particular with cancers other than lung cancer. The HR for non-lung cancer was 0.68 (95%CI = 0.54 to 0.85) implying a 32% reduction in mortality risk per standard deviation rise in log sIgA secretion rate. Effects were stronger for men than women. For deaths from respiratory diseases, sIgA secretion had a non-linear relationship with mortality risk whereby only the very lowest levels of secretion were associated with elevated risk. SIgA concentration revealed a similar but weaker pattern of association. In the present study, higher secretion rates of sIgA were associated with a decreased risk of death from cancer, specifically non-lung cancer, as well as from respiratory disease. Thus, it appears that sIgA plays a protective role among older adults, and could serve as a marker of mortality risk, specifically cancer mortality. PMID:26699127

  8. Salivary Immunoglobulin A Secretion Rate Is Negatively Associated with Cancer Mortality: The West of Scotland Twenty-07 Study

    PubMed Central

    Carroll, Douglas; Drayson, Mark T.

    2015-01-01

    Immunoglobulins are essential for combating infectious disease although very high levels can indicate underlying pathology. The present study examined associations between secretory immunoglobulin A (sIgA) in saliva and mortality rates in the general population. Participants were 639 adults from the eldest cohort of the West of Scotland Twenty-07 Study aged 63 years at the time of saliva sampling in 1995. From unstimulated 2-minute saliva samples, saliva volume and S-IgA concentration were measured, and S-IgA secretion rate determined as their product. Mortality data were tracked for 19 years. Cox proportional hazard models were applied to compute hazard ratios (HR) for all-cause mortality from sIgA secretion rate. Associations were adjusted for gender, assay batch, household occupational group, smoking, medication usage, and self-reported health. There was a negative association between log sIgA secretion rate and all-cause mortality, HR = 0.81, 95%CI = 0.73–0.91, p < .001. Further analysis of specific causes of mortality revealed that the all-cause association was due to an underlying association with cancer mortality and in particular with cancers other than lung cancer. The HR for non-lung cancer was 0.68 (95%CI = 0.54 to 0.85) implying a 32% reduction in mortality risk per standard deviation rise in log sIgA secretion rate. Effects were stronger for men than women. For deaths from respiratory diseases, sIgA secretion had a non-linear relationship with mortality risk whereby only the very lowest levels of secretion were associated with elevated risk. SIgA concentration revealed a similar but weaker pattern of association. In the present study, higher secretion rates of sIgA were associated with a decreased risk of death from cancer, specifically non-lung cancer, as well as from respiratory disease. Thus, it appears that sIgA plays a protective role among older adults, and could serve as a marker of mortality risk, specifically cancer mortality. PMID:26699127

  9. Agricultural adjuvants: acute mortality and effects on population growth rate of Daphnia pulex after chronic exposure.

    PubMed

    Stark, John D; Walthall, William K

    2003-12-01

    Acute and chronic toxicity of eight agricultural adjuvants (Bond, Kinetic, Plyac, R-11, Silwet L-77, Sylgard 309, X-77, and WaterMaxx) to Daphnia pulex were evaluated with 48-h acute lethal concentration estimates (LC50) and a 10-d population growth-rate measurement, the instantaneous rate of increase (r1). Based on LC50, the order of toxicity was R-11 > X-77 = Sylgard 309 = Silwet L-77 > Kinetic > Bond > Plyac > WaterMaxx; all LC50 estimates were higher than the expected environmental concentration (EEC) of 0.79 mg/L, indicating that none of these adjuvants should cause high levels of mortality in wild D. pulex populations. Extinction, defined as negative population growth rate, occurred after exposure to 0.9 mg/L R-11, 13 mg/L X-77, 25 mg/L Kinetic, 28 mg/L Silwet, 18 mg/L Sylgard, 450 mg/L Bond, 610 mg/L Plyac, and 1,600 mg/L WaterMaxx. Concentrations that caused extinction were substantially below the acute LC50 for R-11, Kinetic, Plyac, X-77, and Bond. The no-observable-effects concentration (NOEC) and lowest-observable-effects concentration (LOEC) for the number of offspring per surviving female after exposure to R-11 were 0.5 and 0.75 mg/L, respectively. The NOEC and LOEC for population size after exposure to R-11 were (1.25 and 0.5 mg/L, respectively. Both of these values were lower than the EEC, indicating that R-11 does have the potential to cause damage to D. pulex populations after application at recommended field rates. The wide range of concentrations causing extinction makes it difficult to generalize about the potential impacts that agricultural adjuvants might have on aquatic ecosystems. Therefore, additional studies that examine effects on other nontarget organisms and determine residues in aquatic ecosystems may be warranted. PMID:14713050

  10. Differences in Age-Standardized Mortality Rates for Avoidable Deaths Based on Urbanization Levels in Taiwan, 1971–2008

    PubMed Central

    Chen, Brian K.; Yang, Chun-Yuh

    2014-01-01

    The World is undergoing rapid urbanization, with 70% of the World population expected to live in urban areas by 2050. Nevertheless, nationally representative analysis of the health differences in the leading causes of avoidable mortality disaggregated by urbanization level is lacking. We undertake a study of temporal trends in mortality rates for deaths considered avoidable by the Concerted Action of the European Community on Avoidable Mortality for four different levels of urbanization in Taiwan between 1971 and 2008. We find that for virtually all causes of death, age-standardized mortality rates (ASMRs) were lower in more urbanized than less urbanized areas, either throughout the study period, or by the end of the period despite higher rates in urbanized areas initially. Only breast cancer had consistently higher AMSRs in more urbanized areas throughout the 38-year period. Further, only breast cancer, lung cancer, and ischemic heart disease witnessed an increase in ASMRs in one or more urbanization categories. More urbanized areas in Taiwan appear to enjoy better indicators of health outcomes in terms of mortality rates than less urbanized areas. Access to and the availability of rich healthcare resources in urban areas may have contributed to this positive result. PMID:24503974

  11. [Growth, mortality and exploitation rate of Priacanthus arenatus (Perciformes: Priacanthidae), in the trawl fisheries of northeast Venezuela].

    PubMed

    Toledo, J; Mendoza, J; Marcano, L

    2000-12-01

    We analyzed growth, mortality and exploitation rate of Priacanhus arenatus, captured by the shrimp trawling fishery (1989-1996), in northeastern Venezuela. The growth coefficient (K) and the asymptotic length (L8) were estimated by length-frequency data using the Battacharya method and other routines of the FISAT program. Total mortality (Z) and exploitation (E) rates were obtained by length-converted catch curve analysis, based on length-frequency data, and the Berverton and Holt's yield per recruit model, respectively. The mean growth parameters L and K were estimated as 474.7 mm and 0.69 year(-1), respectively. Mean total mortality was 4.03 and the exploitation rate range was 0.70-0.80. Results indicated that the population is overexploited. PMID:15272462

  12. Endoscopic removal of foreign bodies from the upper gastrointestinal tract: 5-year experience

    PubMed Central

    Emara, Mohamed H; Darwiesh, Ehab M; Refaey, Mohamed M; Galal, Sherif M

    2014-01-01

    Background Foreign bodies (FBs) in the upper gastrointestinal tract are produced chiefly by accidental swallowing but rarely produce symptoms. Removal of FBs is not an infrequent challenge for upper gastrointestinal endoscopy. The aim of this study is to elicit our experience in a 5-year period in dealing with FBs in the upper gastrointestinal tract using upper endoscopy. Methods This retrospective study was conducted at Zagazig University Hospitals, Egypt, over a 5-year period. We reviewed all patients’ files with full notations on age, sex, type of FB and its anatomical location, treatments, and outcomes (complications, success rates, and mortalities). Patients with incomplete files and those with FBs not identified at the endoscopic examination were excluded. Results A total of 45 patients were identified. Their ages ranged from 6 months to 102 years. Slight male predominance was noticed (53.3%). The most frequent presentation was a history of FB ingestion without any associated manifestations (44.4%). Coins were the most commonly encountered FBs (14/45). Esophagus was the most common site of trapping (27/45). The overall success rate was 95.6% (43/45). Upper endoscopy successfully resolved the problem by either FB removal (41/43) or dislodgment of the impacted fleshy meat to the stomach (2/43). Two cases were referred for surgical removal. The rate of complications was 6.7%. Furthermore, no mortalities due to FB ingestion or removal had been reported throughout the study. Conclusion Our experience with FB removal emphasizes its importance and ease when performed by experienced hands, at well-equipped endoscopy units, and under conscious sedation in most cases, with high success rates and minor complications. PMID:25053889

  13. Variation in bird-window collision mortality and scavenging rates within an urban landscape

    EPA Science Inventory

    Annual avian mortality from collisions with windows and buildings is estimated to range from a million to a billion birds in the United States alone. However, estimates of mortality based on carcass counts suffer from bias due to imperfect detection and carcass scavenging. We stu...

  14. An Ecological Study of the Determinants of Differences in 2009 Pandemic Influenza Mortality Rates between Countries in Europe

    PubMed Central

    Nikolopoulos, Georgios; Bagos, Pantelis; Lytras, Theodoros; Bonovas, Stefanos

    2011-01-01

    Background Pandemic A (H1N1) 2009 mortality rates varied widely from one country to another. Our aim was to identify potential socioeconomic determinants of pandemic mortality and explain between-country variation. Methodology Based on data from a total of 30 European countries, we applied random-effects Poisson regression models to study the relationship between pandemic mortality rates (May 2009 to May 2010) and a set of representative environmental, health care-associated, economic and demographic country-level parameters. The study was completed by June 2010. Principal Findings Most regression approaches indicated a consistent, statistically significant inverse association between pandemic influenza-related mortality and per capita government expenditure on health. The findings were similar in univariable [coefficient: –0.00028, 95% Confidence Interval (CI): –0.00046, –0.00010, p = 0.002] and multivariable analyses (including all covariates, coefficient: –0.00107, 95% CI: –0.00196, –0.00018, p = 0.018). The estimate was barely insignificant when the multivariable model included only significant covariates from the univariate step (coefficient: –0.00046, 95% CI: –0.00095, 0.00003, p = 0.063). Conclusions Our findings imply a significant inverse association between public spending on health and pandemic influenza mortality. In an attempt to interpret the estimated coefficient (–0.00028) for the per capita government expenditure on health, we observed that a rise of 100 international dollars was associated with a reduction in the pandemic influenza mortality rate by approximately 2.8%. However, further work needs to be done to unravel the mechanisms by which reduced government spending on health may have affected the 2009 pandemic influenza mortality. PMID:21589928

  15. High Neonatal Mortality Rates in Rural India: What Options to Explore?

    PubMed Central

    Upadhyay, Ravi Prakash; Chinnakali, Palanivel; Odukoya, Oluwakemi; Yadav, Kapil; Sinha, Smita; Rizwan, S. A.; Daral, Shailaja; Chellaiyan, Vinoth G.; Silan, Vijay

    2012-01-01

    The neonatal mortality rate in India is amongst the highest in the world and skewed towards rural areas. Nonavailability of trained manpower along with poor healthcare infrastructure is one of the major hurdles in ensuring quality neonatal care. We reviewed case studies and relevant literature from low and middle income countries and documented alternative strategies that have proved to be favourable in improving neonatal health. The authors reiterate the fact that recruiting and retaining trained manpower in rural areas by all means is essential to improve the quality of neonatal care services. Besides this, other strategies such as training of local rural healthcare providers and traditional midwives, promoting home-based newborn care, and creating community awareness and mobilization also hold enough potential to influence the neonatal health positively and efforts should be made to implement them on a larger scale. More research is demanded for innovations such as “m-health” and public-private partnerships as they have been shown to offer potential in terms of improving the standards of care. The above proposed strategy is likely to reduce morbidity among neonatal survivors as well. PMID:23213561

  16. Hospital Strategies for Reducing Risk-Standardized Mortality Rates in Acute Myocardial Infarction

    PubMed Central

    Bradley, Elizabeth H.; Curry, Leslie A.; Spatz, Erica S.; Herrin, Jeph; Cherlin, Emily J.; Curtis, Jeptha P.; Thompson, Jennifer W.; Ting, Henry H.; Wang, Yongfei; Krumholz, Harlan M.

    2012-01-01

    Background Despite recent improvements in survival after acute myocardial infarction (AMI), U.S. hospitals vary 2-fold in their 30-day risk-standardized mortality rates (RSMRs). Nevertheless, information is limited on hospital-level factors that may be associated with RSMRs. Objective To identify hospital strategies that were associated with lower RSMRs. Design Cross-sectional survey of 537 hospitals (91% response rate) and weighted multivariate regression by using data from the Centers for Medicare & Medicaid Services to determine the associations between hospital strategies and hospital RSMRs. Setting Acute care hospitals with an annualized AMI volume of at least 25 patients. Participants Patients hospitalized with AMI between 1 January 2008 and 31 December 2009. Measurements Hospital performance improvement strategies, characteristics, and 30-day RSMRs. Results In multivariate analysis, several hospital strategies were significantly associated with lower RSMRs and in aggregate were associated with clinically important differences in RSMRs. These strategies included holding monthly meetings to review AMI cases between hospital clinicians and staff who transported patients to the hospital (RSMR lower by 0.70 percentage points), having cardiologists always on site (lower by 0.54 percentage points), fostering an organizational environment in which clinicians are encouraged to solve problems creatively (lower by 0.84 percentage points), not cross-training nurses from intensive care units for the cardiac catheterization laboratory (lower by 0.44 percentage points), and having physician and nurse champions rather than nurse champions alone (lower by 0.88 percentage points). Fewer than 10% of hospitals reported using at least 4 of these 5 strategies. Limitation The cross-sectional design demonstrates statistical associations but cannot establish causal relationships. Conclusion Several strategies, which are currently implemented by relatively few hospitals, are

  17. Heart rate multiscale entropy at three hours predicts hospital mortality in 3,154 trauma patients.

    PubMed

    Norris, Patrick R; Anderson, Steven M; Jenkins, Judith M; Williams, Anna E; Morris, John A

    2008-07-01

    Complexity is a measure of variation and randomness potentially indicating improvement or deterioration in critically ill patients. Previously, we have shown integer heart rate (HR) multiscale entropy (MSE), an indicator of complexity, predicts death based on long duration (12 h) and dense (>or=0.4 Hz) windows of HR data. However, such restrictions reduce the use of MSE in the clinical setting. We hypothesized MSE predicts death using HR data of shorter duration and lower density. During the initial 24 h of intensive care unit stay, 3,154 patients had at least 3 h of continuous integer HR sampled. The first continuous window of 3, 6, 9, and 12 h was selected for each patient regardless of density, and an open-source MSE algorithm was applied (M. Costa, www.physionet.org; m = 2; r = 0.15). Risk of death based on MSE, alone and with covariates (age, sex, injury severity score), was assessed using randomly selected logistic regression in half of the cases. Area under the receiver operator curve (AUC) was computed in the other half in subgroups having various durations and densities of HR data. At days 2.3 (median) and 4.9 (mean), 441 patients (14%) died. Multiscale entropy stratified patients by mortality and was an independent predictor of death using 3 h or more of data. Multiscale entropy alone (AUC = 0.66 - 0.71) predicted death comparably to covariates alone (AUC = 0.72). We conclude: (1) Heart rate MSE within hours of admission predicts death occurring days later. (2) Multiscale entropy is robust to variation in bedside data duration and density occurring in a working intensive care unit. (3) Complexity may be a new clinical biomarker of outcome. PMID:18323736

  18. Interactions between hatch dates, growth rates, and mortality of Age-0 native Rainbow Smelt and nonnative Alewife in Lake Champlain

    USGS Publications Warehouse

    Parrish, Donna; Simonin, Paul W.; Rudstam, Lars G.; Pientka, Bernard; Sullivan, Patrick J.

    2016-01-01

    Timing of hatch in fish populations can be critical for first-year survival and, therefore, year-class strength and subsequent species interactions. We compared hatch timing, growth rates, and subsequent mortality of age-0 Rainbow Smelt Osmerus mordax and Alewife Alosa pseudoharengus, two common open-water fish species of northern North America. In our study site, Lake Champlain, Rainbow Smelt hatched (beginning May 26) almost a month earlier than Alewives (June 20). Abundance in the sampling area was highest in July for age-0 Rainbow Smelt and August for age-0 Alewives. Late-hatching individuals of both species grew faster than those hatching earlier (0.6 mm/d versus 0.4 for Rainbow Smelt; 0.7 mm/d versus 0.6 for Alewives). Mean mortality rate during the first 45 d of life was 3.4%/d for age-0 Rainbow Smelt and was 5.5%/d for age-0 Alewives. Alewife mortality rates did not differ with hatch timing but daily mortality rates of Rainbow Smelt were highest for early-hatching fish. Cannibalism is probably the primary mortality source for age-0 Rainbow Smelt in this lake. Therefore, hatching earlier may not be advantageous because the overlap of adult and age-0 Rainbow Smelt is highest earlier in the season. However, Alewives, first documented in Lake Champlain in 2003, may increase the mortality of age-0 Rainbow Smelt in the summer, which should favor selection for earlier hatching.

  19. Trends in Mortality Rate from Cardiovascular Disease in Brazil, 1980-2012

    PubMed Central

    Mansur, Antonio de Padua; Favarato, Desidério

    2016-01-01

    Background Studies have questioned the downward trend in mortality from cardiovascular diseases (CVD) in Brazil in recent years. Objective to analyze recent trends in mortality from ischemic heart disease (IHD) and stroke in the Brazilian population. Methods Mortality and population data were obtained from the Brazilian Institute of Geography and Statistics and the Ministry of Health. Risk of death was adjusted by the direct method, using as reference the world population of 2000. We analyzed trends in mortality from CVD, IHD and stroke in women and men in the periods of 1980-2006 and 2007-2012. Results there was a decrease in CVD mortality and stroke in women and men for both periods (p < 0.001). Annual mortality variations for periods 1980-2006 and 2007-2012 were, respectively: CVD (total): -1.5% and -0.8%; CVD men: -1.4% and -0.6%; CVD women: -1.7% and -1.0%; DIC (men): -1.1% and 0.1%; stroke (men): -1.7% and -1.4%; DIC (women): -1.5% and 0.4%; stroke (women): -2.0% and -1.9%. From 1980 to 2006, there was a decrease in IHD mortality in men and women (p < 0.001), but from 2007 to 2012, changes in IHD mortality were not significant in men [y = 151 + 0.04 (R2 = 0.02; p = 0.779)] and women [y = 88-0.54 (R2 = 0.24; p = 0.320). Conclusion Trend in mortality from IHD stopped falling in Brazil from 2007 to 2012. PMID:27223642

  20. The Relationship between Toxics Release Inventory Discharges and Mortality Rates in Rural and Urban Areas of the United States

    ERIC Educational Resources Information Center

    Hendryx, Michael; Fedorko, Evan

    2011-01-01

    Background: Potential environmental exposures from chemical manufacturing or industrial sites have not been well studied for rural populations. The current study examines whether chemical releases from facilities monitored through the Toxics Release Inventory (TRI) program are associated with population mortality rates for both rural and urban…

  1. Association of soil arsenic and nickel exposure with cancer mortality rates, a town-scale ecological study in Suzhou, China.

    PubMed

    Chen, Kai; Liao, Qi Lin; Ma, Zong Wei; Jin, Yang; Hua, Ming; Bi, Jun; Huang, Lei

    2015-04-01

    Heavy metals and arsenic are well-known carcinogens. However, few studies have examined whether soil heavy metals and arsenic concentrations associate with cancer in the general population. In this ecological study, we aimed to evaluate the association of heavy metals and arsenic in soil with cancer mortality rates during 2005-2010 in Suzhou, China, after controlling for education and smoking prevalence. In 2005, a total of 1683 soil samples with a sampling density of one sample every 4 km(2) were analyzed. Generalized linear model with a quasi-Poisson regression was applied to evaluate the association between town-scale cancer mortality rates and soil heavy metal concentrations. Results showed that soil arsenic exposure had a significant relationship with colon, gastric, kidney, lung, and nasopharyngeal cancer mortality rates and soil nickel exposure was significantly associated with liver and lung cancer. The associations of soil arsenic and nickel exposure with colon, gastric, kidney, and liver cancer in male were higher than those in female. The observed associations of soil arsenic and nickel with cancer mortality rates were less sensitive to alternative exposure metrics. Our findings would contribute to the understanding of the carcinogenic effect of soil arsenic and nickel exposure in general population. PMID:25410308

  2. An ecologic study of cancer mortality rates in Spain with respect to indices of solar UVB irradiance and smoking.

    PubMed

    Grant, William B

    2007-03-01

    There is increasing evidence that vitamin D reduces the risk of many types of cancer. Geographic variations in cancer mortality rates in Spain are apparently linked to variations in solar ultraviolet (UV) irradiances and other factors. Cancer mortality rates for 48 continental Spanish provinces for 1978-1992 were used in linear regression analyses with respect to mortality rates for latitude (an index of solar UVB levels), skin cancer (an index of high cumulative UVB irradiance), melanoma (an index related to solar UV irradiance and several other factors) and lung cancer (an index of cumulative effects of smoking). The 9 cancers with mortality rates significantly correlated with latitude for 1 or both sexes were brain, gastric, melanoma, nonmelanoma skin cancer (NMSC), non-Hodgkin's lymphoma (NHL), pancreatic, pleural, rectal and thyroid cancer. Inverse correlations with latitude were found for laryngeal, lung and uterine corpus cancer. The 17 cancers inversely correlated with NMSC are bladder, brain, breast, colon, esophageal, gallbladder, Hodgkin's lymphoma, lung, melanoma, multiple myeloma, NHL, ovarian, pancreatic, pleural, rectal, thyroid and uterine corpus cancer. The 16 correlated with melanoma are bladder, brain, breast, colon, gallbladder, leukemia, lung, multiple myeloma, NHL, ovarian, pancreatic, pleural, prostate, rectal, renal and uterine corpus cancer. The results for lung cancer were in accordance with the literature. These results provide more support for the UVB/vitamin D/cancer hypothesis and indicate a new way to investigate the role of solar UV irradiance on cancer risk. They also provide more evidence that melanoma and NMSC have different etiologies. PMID:17149699

  3. A Study of the Gender-Specific Mortality Rates in Korea and Japan for the Formation of Health Promotion Policy

    ERIC Educational Resources Information Center

    Nam, Eun-Woo; Song, Yea-Li-A

    2007-01-01

    Objective: This study attempts to provide fundamental information to help with the development of health policy and health services by looking at the trends of the gender-specific mortality rates in Korea and Japan. Design: The death statistics of Korea and Japan over the 21-year period from 1983 to 2003 are analyzed. Setting: We used the death…

  4. Melanoma incidence mortality rates and clinico-pathological types in the Siberian area of the Russian Federation.

    PubMed

    Gyrylova, Svetlana Nikolaevna; Aksenenko, Mariya Borisovna; Gavrilyuk, Dmitriy Vladimirovich; Palkina, Nadezda Vladimirovna; Dyhno, Yuriy Alexandrovich; Ruksha, Tatiana Gennadievna; Artyukhov, Ivan Pavlovich

    2014-01-01

    Russian rates for melanoma incidence and mortality are relatively low as compared to some other white populations but the tumor is of increasing importance. In this paper, data are based on a retrospective descriptive analysis of melanoma epidemiology and clinicopathological characteristics in Krasnoyarsk Territory belonging to the Siberian Federal District of the Russian Federation. The age-adjusted incidence and mortality rates for the period 1996-2009 were determined with subsequent retrospective analysis of clinicopathological data of 103 primary melanoma cases. Our results showed that incidence and mortality rates in the region under consideration match the Russian national trends and correspond to epidemiological data of the countries of Eastern Europe. Stratification of melanoma cases by age, sex, clinicopathological state and localization revealed a prevalence of lesions on the trunk and lower extremities. Most melanomas diagnosed were of superficial spreading type and the third Clark's level of tumor invasion and stage II according to AJCC. In spite of comparatively low rates of incidence and mortality the trend to increase of melanoma cases in the region under consideration obviously calls for more attention and further investigation. PMID:24716957

  5. Spontaneous Pneumothorax: A 5-Year Experience

    PubMed Central

    Sousa, Cristiana; Neves, Joao; Sa, Nuno; Goncalves, Fabienne; Oliveira, Julio; Reis, Ernestina

    2011-01-01

    Background Spontaneous pneumothorax (SP) is defined by the presence of air in the pleural space without history of trauma. It is classified as secondary if coexisting with underlying pulmonary disease. Its an entity with considerable incidence and treatment particularities which give reason for a reflection on the subject. We present a 5-year casuistry, characterizing the SP epidemiology, clinical presentation, investigation and therapeutic choices. Methods Sixty-six patients were included in the study, corresponding to 93 episodes of SP. Results We have found male predominance and the mean age was 34.5 years old. In 60.6% of cases there was history of tobacco use; 36.4% of cases were classified as secondary; 30.1% of patients with secondary SP and 21.7% with primary SP recurred; 89.2% had an acute presentation. The most frequent initial symptom was chest pain (90.3%) and 81.7% had diminished breath sounds. In 17.3% it was documented a physical strain associated. We did not identify statistically significant association between the SP occurrence and the variation of the atmospheric pressure, on the first day of symptoms. In 12.9% of episodes the initial treatment option was observation. In most of the episodes the lung totally expanded. However, in 29.1% of the episodes surgical treatment was needed. Conclusions Our results are similar to the literature. Some clinical records are incomplete, demanding the implementation of rules to improve knowledge about this matter. Keywords Spontaneous pneumothorax; Primary spontaneous pneumothorax; Secondary spontaneous pneumothorax; Epidemiology PMID:21811541

  6. Microbiological monitoring of endoscopes: 5-year review.

    PubMed

    Gillespie, Elizabeth E; Kotsanas, Despina; Stuart, Rhonda L

    2008-07-01

    Periodic microbiological monitoring of endoscopes is a recommendation of the Gastroenterological Society of Australia (GENSA). The aim of monitoring has been to provide quality assurance of the cleaning and disinfection of endoscopes; however, there is controversy regarding its frequency. This lack of consensus stimulated a review of the experience within our health service. At Southern Health, routine microbiological sampling has involved 4-weekly monitoring of bronchoscopes, duodenoscopes and automated flexible endoscope reprocessors (AFER), and 3-monthly monitoring of all other gastrointestinal endoscopes. Records of testing were reviewed from 1 January 2002 until 31 December 2006. A literature review was conducted, cost analysis performed and positive cultures investigated. There were 2374 screening tests performed during the 5-year period, including 287 AFER, 631 bronchoscopes for mycobacteria and 1456 endoscope bacterial screens. There were no positive results of the AFER or bronchoscopes for mycobacteria. Of the 1456 endoscopic bacterial samples, six were positive; however, retesting resulted in no growth. The overall cost of tests performed and cost in time for nursing staff to collect the samples was estimated at $AUD 100,400. Periodic monitoring of endoscopes is both time-consuming and costly. Our review demonstrates that AFER (Soluscope) perform well in cleaning endoscopes. Based on our 5-year experience, assurance of quality for endoscopic use could be achieved through process control as opposed to product control. Maintenance of endoscopes and AFER should be in accordance with the manufacturer's instructions and microbiological testing performed on commissioning, annually and following repair. Initial prompt manual leak testing and manual cleaning followed by mechanical leak testing, cleaning and disinfection should be the minimum standard in reprocessing of endoscopes. PMID:18086113

  7. Incidence and mortality rate of esophageal cancer has decreased during past 40 years in Hebei Province, China

    PubMed Central

    He, Yutong; Wu, Yan; Song, Guohui; Li, Yongwei; Liang, Di; Jin, Jing; Wen, Denggui

    2015-01-01

    Background Hebei province is located in North of China with of approximately 6% of whole national population. It is known as a high-risk area for esophageal cancer in China and worldwide. The aim of our study was to estimate the esophageal cancer burden and trend in Hebei Province. Methods Eight cancer registries in Hebei Province submitted cancer registry data to the Hebei Provincial Cancer Registry Center. All data were qualified and compiled for cancer statistics in 2011. The pooled data were stratified by gender and age group (0, 1-4, 5-9, 10-14…80+). Incidence and mortality rates were age-standardized to World Segi’s population standard and expressed per 100,000 persons. In addition, proportions and cumulative incidence/mortality rates for esophageal cancer were calculated. Esophageal cancer mortality data during the periods 1973-1975, 1990-1992, and 2004-2005 were extracted from the national death surveys. Mortality and incidence rate data from Cixian and Shexian were obtained from population-based cancer registries in each county. Results The estimated number of newly diagnosed esophageal cancer cases and deaths in 2011 in Hebei Province was 24,318 and 18,226, respectively. The crude incidence rate of esophageal cancer was 33.37/100,000 (males, 42.18/100,000 and females, 24.31/100,000). The age-standardized rate by world standard population (ASRW) was 28.09/100,000, ranking third among all cancers. The esophageal cancer mortality rate was 25.01/100,000 (males, 31.40/100,000 and females, 18.45/100,000), ranking third in deaths among all cancers. The mortality rates of esophageal cancer displayed a significant decreasing trend in Hebei Province from 1973-1975 (ASRW =48.69/100,000) to 2004-2005 (ASRW =28.02/100,000), with a decreased rate of 42.45%. In Cixian, the incidence of esophageal cancer decreased from 250.76/100,000 to 106.74/100,000 in males and from 153.86/100,000 to 75.41/100,000 in females, with annual percentage changes (APC) of 2.13 and 2

  8. Worldwide variation in life-span sexual dimorphism and sex-specific environmental mortality rates.

    PubMed

    Teriokhin, Anatoly T; Budilova, Elena V; Thomas, Frederic; Guegan, Jean-Francois

    2004-08-01

    In all human populations mean life span of women generally exceeds that of men, but the extent of this sexual dimorphism varies across different regions of the world. Our purpose here is to study, using global demographic and environmental data, the general tendency of this variation and local deviations from it. We used data on male and female life history traits and environmental conditions for 227 countries and autonomous territories; for each country or territory the life-span dimorphism was defined as the difference between mean life spans of women and men. The general tendency is an increase of life-span dimorphism with increasing average male-female life span; this tendency can be explained using a demographic model based on the Makeham-Gompertz equation. Roughly, the life-span dimorphism increases with the average life span because of an increase in the duration of expressing sex- and age-dependent mortality described by the second (exponential) term of the Makeham-Gompertz equation. Thus we investigated the differences in male and female environmental mortality described by the first term of the Makeham-Gompertz equation fitted to the data. The general pattern that resulted was an increase in male mortality at the highest and lowest latitudes. One plausible explanation is that specific factors tied to extreme latitudes influence males more strongly than females. In particular, alcohol consumption increases with increasing latitude and, on the contrary, infection pressures increase with decreasing latitude. This finding agrees with other observations, such as an increase in male mortality excess in Europe and Christian countries and an increase in female mortality excess in Asia and Muslim countries. An increase in the excess of female mortality may also be due to increased maternal mortality caused by an increase in fertility. However, this relation is not linear: In regions with the highest fertility (e.g., in Africa) the excess of female mortality is

  9. Experimental warming and precipitation interactively modulate the mortality rate and timing of spring emergence of a gallmaking Tephritid fly

    PubMed Central

    Xi, Xinqiang; Li, Dongbo; Peng, Youhong; Eisenhauer, Nico; Sun, Shucun

    2016-01-01

    Global climate change is mostly characterized by temperature increase and fluctuating precipitation events, which may affect the spring phenology and mortality rate of insects. However, the interaction effect of temperature and precipitation on species performance has rarely been examined. Here we studied the response of the gall-making Tephritid fly Urophora stylata (Diptera: Tephritidae) to artificial warming, changes in precipitation, and the presence of galls. Our results revealed a significant interaction effect of warming, precipitation, and galls on the life-history traits of the focal species. Specifically, when the galls were intact, warming had no effect on the phenology and increased the mortality of the fly under decreased precipitation, but it significantly advanced the timing of adult emergence and had no effect on the mortality under increased precipitation. When galls were removed, warming significantly advanced the timing of emergence and increased fly mortality, but precipitation showed no effect on the phenology and mortality. In addition, gall removal significantly increased adult fresh mass for both females and males. Our results indicate that the effect of elevated temperature on the performance of species may depend on other environmental conditions, such as variations in precipitation, and species traits like the formation of galls. PMID:27578601

  10. Experimental warming and precipitation interactively modulate the mortality rate and timing of spring emergence of a gallmaking Tephritid fly.

    PubMed

    Xi, Xinqiang; Li, Dongbo; Peng, Youhong; Eisenhauer, Nico; Sun, Shucun

    2016-01-01

    Global climate change is mostly characterized by temperature increase and fluctuating precipitation events, which may affect the spring phenology and mortality rate of insects. However, the interaction effect of temperature and precipitation on species performance has rarely been examined. Here we studied the response of the gall-making Tephritid fly Urophora stylata (Diptera: Tephritidae) to artificial warming, changes in precipitation, and the presence of galls. Our results revealed a significant interaction effect of warming, precipitation, and galls on the life-history traits of the focal species. Specifically, when the galls were intact, warming had no effect on the phenology and increased the mortality of the fly under decreased precipitation, but it significantly advanced the timing of adult emergence and had no effect on the mortality under increased precipitation. When galls were removed, warming significantly advanced the timing of emergence and increased fly mortality, but precipitation showed no effect on the phenology and mortality. In addition, gall removal significantly increased adult fresh mass for both females and males. Our results indicate that the effect of elevated temperature on the performance of species may depend on other environmental conditions, such as variations in precipitation, and species traits like the formation of galls. PMID:27578601

  11. Associated influence of hypertension and heart rate greater than 80 beats per minute on mortality rate in patients with anterior wall STEMI

    PubMed Central

    Davidovic, Goran; Iric-Cupic, Violeta; Milanov, Srdjan

    2013-01-01

    Acute myocardial infarction as a form of coronary heart disease is characterized by permanent damage/loss of anatomical and functional cardiac tissue. Diagnosis of STEMI includes data on anginal pain and persistent ST-segment elavation. According to the numerous epidemiological studies, arterial blood pressure and heart rate are offten increased especially during the first hours of pain due to domination of sympathetic response. We wanted to investigate the associated influence of heart rate greater than 80 beats per minute and hypertension on the mortality in patients with anterior wall STEMI. Research included 140 patients treated in Coronary Unit, Clinical Center Kragujevac form January 2001 to June 2006. Heart rate was calculated as the mean value of baseline and heart rate in the first 30 minutes after admission, recorded on monitor and electrocardiogram. Data for history of hypertension were collected and blood pressure levels were measured in a lying position after 5 minutes of rest, and classified according to the VII JNC recommendations as confirmation of hypertension. Collected data were analyzed in SPSS 13.0 for Windows. Heart rate greater than 80 bpm influences the hospital mortality. Systolic blood pressure levels were higher in the survivors, while for the diastolic there was no difference. History of hypertension was singled out as a significant predictor of mortality without difference between the respondents with heart rate greater and lower than 80 bpm in the survivors and fatal. Increased heart rate and hypertension at admission are significant predictors of mortality in patients with anterior wall STEMI. PMID:23724155

  12. Neonatal and Infant Mortality in Korea, Japan, and the U.S.: Effect of Birth Weight Distribution and Birth Weight-Specific Mortality Rates.

    PubMed

    Kim, Do Hyun; Jeon, Jihyun; Park, Chang Gi; Sriram, Sudhir; Lee, Kwang Sun

    2016-09-01

    Difference in crude neonatal and infant mortality rates (NMR and IMR) among different countries is due to the differences in its two determinants: birth weight distribution (BWD) and birth weight-specific mortality rates (BW-SMRs). We aimed to determine impact of BWD and BW-SMRs on differences in crude NMR and IMR among Korea, Japan, and the U.S. Our study used the live birth data of the period 2009 through 2010. Crude NMR/IMR are the lowest in Japan, 1.1/2.1, compared to 1.8/3.2, in Korea, and 4.1/6.2, in the U.S., respectively. Japanese had the best BW-SMRs of all birth weight groups compared to the Koreans and the U.S. The U.S. BWD was unfavorable with very low birth weight (< 1,500 g) rate of 1.4%, compared to 0.6% in Korea, and 0.8% in Japan. If Koreans and Japanese had the same BWD as in the U.S., their crude NMR/IMR would be 3.9/6.1 for the Koreans and 1.5/2.5 for the Japanese. If both Koreans and Japanese had the same BW-SMRs as in the U.S., the crude NMR/IMR would be 2.0/3.8 for the Koreans and 2.7/5.0 for the Japanese. In conclusion, compared to the U.S., lower crude NMR or IMR in Japan is mainly attributable to its better BW-SMRs. Koreans had lower crude NMR and IMR, primarily from its favorable BWD. Comparing crude NMR or IMR among different countries should include further exploration of its two determinants, BW-SMRs reflecting medical care, and BWD reflecting socio-demographic conditions. PMID:27510390

  13. A combined telemetry - tag return approach to estimate fishing and natural mortality rates of an estuarine fish

    USGS Publications Warehouse

    Bacheler, N.M.; Buckel, J.A.; Hightower, J.E.; Paramore, L.M.; Pollock, K.H.

    2009-01-01

    A joint analysis of tag return and telemetry data should improve estimates of mortality rates for exploited fishes; however, the combined approach has thus far only been tested in terrestrial systems. We tagged subadult red drum (Sciaenops ocellatus) with conventional tags and ultrasonic transmitters over 3 years in coastal North Carolina, USA, to test the efficacy of the combined telemetry - tag return approach. There was a strong seasonal pattern to monthly fishing mortality rate (F) estimates from both conventional and telemetry tags; highest F values occurred in fall months and lowest levels occurred during winter. Although monthly F values were similar in pattern and magnitude between conventional tagging and telemetry, information on F in the combined model came primarily from conventional tags. The estimated natural mortality rate (M) in the combined model was low (estimated annual rate ?? standard error: 0.04 ?? 0.04) and was based primarily upon the telemetry approach. Using high-reward tagging, we estimated different tag reporting rates for state agency and university tagging programs. The combined telemetry - tag return approach can be an effective approach for estimating F and M as long as several key assumptions of the model are met.

  14. Circumcision: a refined technique and 5 year review.

    PubMed Central

    Tucker, S. C.; Cerqueiro, J.; Sterne, G. D.; Bracka, A.

    2001-01-01

    The vast majority of circumcisions currently performed in the UK are for phimosis or balanitis and the patients are not looking for the denuded glans appearance of a ritual circumcision. We present a refinement of the sleeve technique of circumcision, which involves Horton's test to define the proximal incision margin, and bipolar electro-dissection. A review of all patients undergoing circumcision at the Wordsley Plastic Surgery Unit, in a 5-year period, has shown this technique to be safe with a haematoma rate of only 1.4%, and an overall complication rate of 3%. Images Figure 1 Figure 1 (G,H) Figure 2 PMID:11320921

  15. Thirty-day in-hospital revascularization and mortality rates after acute myocardial infarction in seven Canadian provinces

    PubMed Central

    Johansen, Helen; Brien, Susan E; Finès, Philippe; Bernier, Julie; Humphries, Karin; Stukel, Therese A; Ghali, William A

    2010-01-01

    BACKGROUND: Recent clinical trials have demonstrated benefit with early revascularization following acute myocardial infarction (AMI). Trends in and the association between early revascularization after (ie, 30 days or fewer) AMI and early death were determined. METHODS AND RESULTS: The Statistics Canada Health Person-Oriented Information Database, consisting of hospital discharge records for seven provinces from the Canadian Institute for Health Information Hospital Morbidity Database, was used. If there was no AMI in the preceding year, the first AMI visit within a fiscal year for a patient 20 years of age or older was included. Times to death in hospital and to revascularization procedures were counted from the admission date of the first AMI visit. Mixed model regression analyses with random slopes were used to assess the relationship between early revascularization and mortality. The overall rate of revascularization within 30 days of AMI increased significantly from 12.5% in 1995 to 37.4% in 2003, while the 30-day mortality rate decreased significantly from 13.5% to 10.6%. There was a linearly decreasing relationship – higher regional use of revascularization was associated with lower mortality in both men and women. CONCLUSIONS: These population-based utilization and outcome findings are consistent with clinical trial evidence of improved 30-day in-hospital mortality with increased early revascularization after AMI. PMID:20847971

  16. Forced migration and mortality in the very long term: did perestroika affect death rates also in Finland?

    PubMed

    Saarela, Jan; Finnäs, Fjalar

    2009-08-01

    In this article, we analyze mortality rates of Finns born in areas that were ceded to the Soviet Union after World War II and from which the entire population was evacuated. These internally displaced persons are observed during the period 1971-2004 and compared with people born in the same region but on the adjacent side of the new border. We find that in the 1970s and 1980s, the forced migrants had mortality rates that were on par with those of people in the comparison group. In the late 1980s, the mortality risk of internally displaced men increased by 20% in relation to the expected time trend. This deviation, which manifests particularly in cardiovascular mortality, coincides with perestroika and the demise of the Soviet Union, which were events that resulted in an intense debate in civil society about restitution of the ceded areas. Because state actors were reluctant to engage, the debate declined after some few years, and after the mid-1990s, the death risk again approached the long-term trend. Our findings indicate that when internally displaced persons must adjust to situations for which appropriate coping behaviors are unknown, psychosocial stress might arise several decades after their evacuation. PMID:19771945

  17. Forced Migration and Mortality in the Very Long Term: Did Perestroika Affect Death Rates Also in Finland?

    PubMed Central

    SAARELA, JAN; FINNÄS, FJALAR

    2009-01-01

    In this article, we analyze mortality rates of Finns born in areas that were ceded to the Soviet Union after World War II and from which the entire population was evacuated. These internally displaced persons are observed during the period 1971–2004 and compared with people born in the same region but on the adjacent side of the new border. We find that in the 1970s and 1980s, the forced migrants had mortality rates that were on par with those of people in the comparison group. In the late 1980s, the mortality risk of internally displaced men increased by 20% in relation to the expected time trend. This deviation, which manifests particularly in cardiovascular mortality, coincides with perestroika and the demise of the Soviet Union, which were events that resulted in an intense debate in civil society about restitution of the ceded areas. Because state actors were reluctant to engage, the debate declined after some few years, and after the mid-1990s, the death risk again approached the long-term trend. Our findings indicate that when internally displaced persons must adjust to situations for which appropriate coping behaviors are unknown, psychosocial stress might arise several decades after their evacuation. PMID:19771945

  18. Transfer of cattle embryos produced with sex-sorted semen results in impaired pregnancy rate and increased male calf mortality.

    PubMed

    Mikkola, M; Andersson, M; Taponen, J

    2015-10-15

    This study investigated the pregnancy rate and calf mortality after transfer of embryos produced using sex-sorted semen. Data for 12,438 embryo transfers performed on dairy farms were analyzed. Of these, 10,697 embryos were produced using conventional semen (CONV embryos) and 1741 using sex-sorted semen from 97 bulls (SEX embryos), predominantly of Ayrshire and Holstein breeds. Of the CONV embryos, 27.4% were transferred fresh, whereas of the SEX embryos, 55.7% were fresh. Recipient attributes (breed, parity, number of previous breeding attempts, and interval from calving to transfer) were comparable for both embryo types, heifers representing 57.8% of recipients in the CONV group and 54.8% in the SEX group. Recipients that were not artificially inseminated or did not undergo a new embryo transfer after the initial embryo transfer and had registered calving in fewer than 290 days after the transfer were considered pregnant. Pregnancy rate for recipients receiving CONV embryos was 44.1%, and for those receiving SEX embryos, it was 38.8%. The odds ratio for pregnancy in recipients receiving CONV embryos was 1.34 compared with SEX embryos (P < 0.001). The proportion of female calves was 49.6% and 92.3% in CONV and SEX groups, respectively. Overall, calf mortality was comparable in both groups. Mortality was similar in CONV and SEX groups (6.6% and 7.7%, respectively) for female calves. For male calves, mortality was 9.2% in the CONV group but significantly higher, 16.0% (P < 0.05), in the SEX group. This study showed that transfer of embryos produced with sex-sorted semen decreased the pregnancy rate by about 12% compared with embryos produced using conventional semen. Mortality of male calves born from SEX embryos was higher than for those born from CONV embryos. PMID:26174034

  19. HbA1c measured in stored erythrocytes and mortality rate among middle-aged and older women

    PubMed Central

    Liu, S.; Stampfer, M. J.; Cook, N. R.; Rexrode, K. M.; Ridker, P. M.; Buring, J. E.; Manson, J. E.

    2009-01-01

    Aims/hypothesis Diabetes is known to increase mortality rate, but the degree to which mild hyperglycaemia may be associated with the risk of death is uncertain. We examined the association between HbA1c measured in stored erythrocytes and mortality rate in women with and without diabetes. Methods We conducted a cohort study of 27,210 women ≥45 years old with no history of cardiovascular disease or cancer who participated in the Women’s Health Study, a randomised trial of vitamin E and aspirin. Results Over a median of 10 years of follow-up, 706 women died. Proportional hazards models adjusted for age, smoking, hypertension, blood lipids, exercise, postmenopausal hormone use, multivitamin use and C-reactive protein were used to estimate the relative risk of mortality. Among women without a diagnosis of diabetes and HbA1c <5.60%, those in the top quintile (HbA1c 5.19–5.59%) had a relative risk of mortality of 1.28 (95% CI 0.98–1.69, p value for linear trend=0.14) compared with those with HbA1c 2.27–4.79%. Women with HbA1c 5.60–5.99% and no diagnosis of diabetes had a 54% increased risk of mortality (95% CI 1–136%) compared with those with HbA1c 2.27–4.79%. HbA1c was significantly associated with mortality across the range 4.50–7.00% (p value for linear trend=0.02); a test of deviation from linearity was not statistically significant (p=0.67). Diabetic women had more than twice the mortality risk of non-diabetic women. Conclusions/interpretation This study provides further evidence that chronic mild hyperglycaemia, even in the absence of diagnosed diabetes, is associated with increased risk of mortality. PMID:18043905

  20. Indirectly estimated absolute lung cancer mortality rates by smoking status and histological type based on a systematic review

    PubMed Central

    2013-01-01

    Background National smoking-specific lung cancer mortality rates are unavailable, and studies presenting estimates are limited, particularly by histology. This hinders interpretation. We attempted to rectify this by deriving estimates indirectly, combining data from national rates and epidemiological studies. Methods We estimated study-specific absolute mortality rates and variances by histology and smoking habit (never/ever/current/former) based on relative risk estimates derived from studies published in the 20th century, coupled with WHO mortality data for age 70–74 for the relevant country and period. Studies with populations grossly unrepresentative nationally were excluded. 70–74 was chosen based on analyses of large cohort studies presenting rates by smoking and age. Variations by sex, period and region were assessed by meta-analysis and meta-regression. Results 148 studies provided estimates (Europe 59, America 54, China 22, other Asia 13), 54 providing estimates by histology (squamous cell carcinoma, adenocarcinoma). For all smoking habits and lung cancer types, mortality rates were higher in males, the excess less evident for never smokers. Never smoker rates were clearly highest in China, and showed some increasing time trend, particularly for adenocarcinoma. Ever smoker rates were higher in parts of Europe and America than in China, with the time trend very clear, especially for adenocarcinoma. Variations by time trend and continent were clear for current smokers (rates being higher in Europe and America than Asia), but less clear for former smokers. Models involving continent and trend explained much variability, but non-linearity was sometimes seen (with rates lower in 1991–99 than 1981–90), and there was regional variation within continent (with rates in Europe often high in UK and low in Scandinavia, and higher in North than South America). Conclusions The indirect method may be questioned, because of variations in definition of smoking and

  1. Esophageal cancer epidemiology in blacks and whites: racial and gender disparities in incidence, mortality, survival rates and histology.

    PubMed Central

    Baquet, Claudia R.; Commiskey, Patricia; Mack, Kelly; Meltzer, Stephen; Mishra, Shiraz I.

    2005-01-01

    BACKGROUND: Esophageal cancer rate disparities are pronounced for blacks and whites. This study presents black-white esophageal cancer incidence, mortality, relative survival rates, histology and trends for two five-year time periods--1991-1995 and 1996-2000--and for the time period 1991-2000. METHODS: The study used data from the National Cancer Institute's population-based Surveillance Epidemiology End Results (SEER) program with submission dates 1991-2000. Age-adjusted incidence, mortality, relative survival rates and histology for esophageal carcinoma were calculated for nine SEER cancer registries for 1991-2000. Rates were analyzed by race and gender for changes over specified time periods. RESULTS: Esophageal cancer age-adjusted incidence of blacks was about twice that of whites (8.63 vs. 4.39/100,000, p < 0.05). Age-adjusted mortality for blacks, although showing a declining trend, was nearly twice that of whites (7.79 vs. 3.96, p < 0.05). Although survival was poor for all groups, it was significantly poorer in blacks than in whites. Squamous cell carcinoma was more commonly diagnosed in blacks and white females, whereas adenocarcinoma was more common among white males (p < 0.001). CONCLUSIONS: Racial disparities in esophageal cancer incidence, mortality, survival and histology exist. Survival rates from this disease have not significantly improved over the decade. These data support the need for advances in prevention, early detection biomarker research and research on new, more effective treatment modalities for this disease. Images Figure 1 PMID:16334494

  2. Medicaid prenatal program reducing rates of low birth weight, infant mortality.

    PubMed

    1997-11-01

    Medicaid prenatal program reduces low birth weight and infant mortality: Christiana Care Health System in Wilmington, DE, rejects the free baby stroller and gift certificate approach to motivating members and instead employs peer moms in the community to mentor pregnant Medicaid members and help them make life-long health improvements. PMID:10175564

  3. Why do child mortality rates fall? An analysis of the Nicaraguan experience.

    PubMed Central

    Sandiford, P; Morales, P; Gorter, A; Coyle, E; Smith, G D

    1991-01-01

    A comprehensive review of available sources of mortality data was undertaken to document the changes that have occurred in infant mortality in Nicaragua over the last three decades. It was found that a rapid fall in infant mortality commenced in the early 1970s and has continued steadily since. Trends in several different factors which might have led to this breakthrough were examined including: income, nutrition, breastfeeding practices, maternal education, immunizations, access to health services, provision of water supplies and sanitation, and anti-malarial programs. Of these, improved access to health services appears to have been the most important factor. At a time when the number of hospital beds per capita was dropping, increasing numbers of health care professionals, particularly nurses, were becoming available to staff primary health care facilities built in the 1960s. These were provided at least partly in response to the growing political turmoil enveloping the nation at that time. Certain Nicaraguan cultural attributes may have added to the impact of the reforms. Efforts in the field of public health made since the 1979 insurrection appear to have maintained the decline in child mortality. PMID:1983913

  4. Self-Rated Health and Mortality: Does the Relationship Extend to a Low Income Setting?

    ERIC Educational Resources Information Center

    Frankenberg, Elizabeth; Jones, Nathan R.

    2004-01-01

    Although a relationship between poor self-reported health status and excess mortality risk has been well-established for industrialized countries, almost no research considers developing countries. We use data from Indonesia to show that in a low-income setting, as in more advantaged parts of the world, individuals who perceive their health to be…

  5. Effect of ambient air pollution on daily mortality rates in Guangzhou, China

    NASA Astrophysics Data System (ADS)

    Yu, Ignatius Tak Sun; Zhang, Yong hui; San Tam, Wilson Wai; Yan, Qing Hua; Xu, Yan jun; Xun, Xiao jun; Wu, Wei; Ma, Wen Jun; Tian, Lin Wei; Tse, Lap Ah; Lao, Xiang Qian

    2012-01-01

    We aimed to investigate the effects of ambient air pollutants on daily mortality in a relatively stable and homogeneous population in Guangzhou, China. Daily mortality, air pollution, and weather data between 2006 and 2009 were collected. The generalized additive model with poison regression was used to estimate the excessive risks (ERs) of air pollutants (PM 10, SO 2, and NO 2) on total, cardiovascular and respiratory mortality. The effects of lag0-1 were the greatest for total non-accidental and cardiovascular deaths. The increments of 10 μg m -3 in SO 2, NO 2, and PM 10 were associated with ERs of 1.54% (95%CI: 1.03-2.06%), 1.42% (95%CI: 1.06-1.78%), and 1.26% (95%CI: 0.86-1.66%) respectively for total non-accidental deaths, and 2.28% (95%CI: 1.40-3.16%), 1.81% (95%CI: 1.20-2.41%), and 1.79% (95%CI: 1.11-2.47%) respectively for cardiovascular deaths. For persons who died from respiratory disease, however, the maximum effects occurred at lag0. The ERs for SO 2, NO 2, and PM 10 were 1.36% (95%CI: 0.23-2.50%), 1.47% (95%CI: 0.66-2.29%) and 0.93% (95%CI: 0.03-1.83%), respectively. The effects of the three air pollutants on mortality were stronger in elderly and in women. The ERs in the present study were higher than those reported in Europe, the U.S., and most other Asian cities. Our findings show relatively higher ERs of daily mortality by ambient air pollutants in the center of Guangzhou, China, compared with estimates in other cities. Further studies with accurate exposure measurement among homogeneous population are needed to evaluate the precise magnitudes of the effects of the air pollutants.

  6. Baseline Residual Kidney Function and Its Ensuing Rate of Decline Interact to Predict Mortality of Peritoneal Dialysis Patients

    PubMed Central

    Pérez Fontán, Miguel; Remón Rodríguez, César; da Cunha Naveira, Marta; Borràs Sans, Mercè; Rodríguez Suárez, Carmen; Quirós Ganga, Pedro; Sánchez Alvarez, Emilio; Rodríguez-Carmona, Ana

    2016-01-01

    Background Baseline residual kidney function (RKF) and its rate of decline during follow-up are purported to be reliable outcome predictors of patients undergoing Peritoneal Dialysis (PD). The independent contribution of each of these factors has not been elucidated. Method We report a multicenter, longitudinal study of 493 patients incident on PD and satisfying two conditions: a glomerular filtration rate (GFR) ≥1 mL/minute and a daily diuresis ≥300 mL. The main variables were the GFR (mean of urea and creatinine clearances) at PD inception and the GFR rate of decline during follow-up. The main outcome variable was patient mortality. The secondary outcome variables were: PD technique failure and risk of peritoneal infection. The statistical analysis was based on a multivariate approach, placing an emphasis on the interactions between the two main study variables. Main Results Baseline GFR and its rate of decline performed well as independent predictors of both patient mortality and risk of peritoneal infection. These two main study variables maintained a moderate correlation with each other (r2 = 0.12, p<0.0005), and interacted clearly, as predictors of patient mortality. A low baseline GFR followed by a fast decline portended the worst survival outcome (adjusted HR 3.84, 95%CI 1.81–8.14, p<0.0005)(Ref. baseline GFR above median plus rate of decline below median). In general, the rate of decline of RKF had a greater effect on mortality than baseline GFR, which had no detectable effect on survival when the decline of RKF was slow (HR 1.17, 95% CI 0.81–2.22, p = 0.22). Conversely, a relatively high GFR at the start of PD still carried a significant risk of mortality, when RKF declined rapidly (HR 1.89, 95% CI 1.05–3.72, p = 0.028). Conclusion The risk-benefit balance of an early versus late start of PD cannot be evaluated without taking into consideration the rate of decline of RKF. This circumstance may contribute to explain the controversial results

  7. Examining mortality risk and rate of ageing among Polish Olympic athletes: a survival follow-up from 1924 to 2012

    PubMed Central

    Lin, Yuhui; Gajewski, Antoni; Poznańska, Anna

    2016-01-01

    Objectives Population-based studies have shown that an active lifestyle reduces mortality risk. Therefore, it has been a longstanding belief that individuals who engage in frequent exercise will experience a slower rate of ageing. It is uncertain whether this widely-accepted assumption holds for intense wear-and-tear. Here, using the 88 years survival follow-up data of Polish Olympic athletes, we report for the first time on whether frequent exercise alters the rate of ageing. Design Longitudinal survival data of male elite Polish athletes who participated in the Olympic Games from year 1924 to 2010 were used. Deaths occurring before the end of World War II were excluded for reliable estimates. Setting and participants Recruited male elite athletes N=1273 were preassigned to two categorical birth cohorts—Cohort I 1890–1919; Cohort II 1920–1959—and a parametric frailty survival analysis was conducted. An event-history analysis was also conducted to adjust for medical improvements from year 1920 onwards: Cohort II. Results Our findings suggest (1) in Cohort I, for every threefold reduction in mortality risk, the rate of ageing decelerates by 1%; (2) socioeconomic transitions and interventions contribute to a reduction in mortality risk of 29% for the general population and 50% for Olympic athletes; (3) an optimum benefit gained for reducing the rate of ageing from competitive sports (Cohort I 0.086 (95% CI 0.047 to 0.157) and Cohort II 0.085 (95% CI 0.050 to 0.144)). Conclusions This study further suggests that intensive physical training during youth should be considered as a factor to improve ageing and mortality risk parameters. PMID:27091824

  8. Decadal-scale rates of reef erosion following El Niño-related mass coral mortality.

    PubMed

    Roff, George; Zhao, Jian-Xin; Mumby, Peter J

    2015-12-01

    As the frequency and intensity of coral mortality events increase under climate change, understanding how declines in coral cover may affect the bioerosion of reef frameworks is of increasing importance. Here, we explore decadal-scale rates of bioerosion of the framework building coral Orbicella annularis by grazing parrotfish following the 1997/1998 El Niño-related mass mortality event at Long Cay, Belize. Using high-precision U-Th dating and CT scan analysis, we quantified in situ rates of external bioerosion over a 13-year period (1998-2011). Based upon the error-weighted average U-Th age of dead O. annularis skeletons, we estimate the average external bioerosion between 1998 and 2011 as 0.92 ± 0.55 cm depth. Empirical observations of herbivore foraging, and a nonlinear numerical response of parrotfish to an increase in food availability, were used to create a model of external bioerosion at Long Cay. Model estimates of external bioerosion were in close agreement with U-Th estimates (0.85 ± 0.09 cm). The model was then used to quantify how rates of external bioerosion changed across a gradient of coral mortality (i.e., from few corals experiencing mortality following coral bleaching to complete mortality). Our results indicate that external bioerosion is remarkably robust to declines in coral cover, with no significant relationship predicted between the rate of external bioerosion and the proportion of O. annularis that died in the 1998 bleaching event. The outcome was robust because the reduction in grazing intensity that follows coral mortality was compensated for by a positive numerical response of parrotfish to an increase in food availability. Our model estimates further indicate that for an O. annularis-dominated reef to maintain a positive state of reef accretion, a necessity for sustained ecosystem function, live cover of O. annularis must not drop below a ~5-10% threshold of cover. PMID:26113199

  9. Chemical characterization of indoor air of homes from communes in Xuan Wei, China, with high lung cancer mortality rate

    SciTech Connect

    Chuang, J.; Cao, S.; Xian, Y.; Harris, B.; Mumford, J.

    1992-01-01

    In a rural county, Xuan Wei, China, the lung cancer mortality rate is among China's highest, especially in women. This mortality rate is more associated with indoor air burning of smoky coal, as opposed to smokeless coal or wood, for cooking and heating under unvented conditions. Homes using different fuels from communes with high and low lung cancer mortality rates were sampled for particulate matter (<10 micrometers) and semivolatile organics. The fine particles obtained from homes using smoky coal contained highest concentrations of organic matter (> 70%), including PAH, followed by homes using wood and smokeless coal. The major components present in the smoky coal filter samples were PAH and alkylated PAH. The smokeless coal filter samples exhibited profiles which were similar to the smoky coal samples except that some sulfur compounds were found. The estimated concentration levels of PAH in the smokeless coal samples were about one to two orders of magnitude lower than those of the smoky coal samples. In addition to PAH, aliphatic compounds and fatty acids were the major components found in the wood samples. Selected sample extracts from homes using smoky coal were fractionated into four fractions, and the results showed that the PAH and polar fractions have high mutagenic activity. Chemical characterization of the PAH fraction indicated that concentrations of some alkylated PAH were higher than those of their parent compounds. Chemical characterization of the polar fractions showed that nitrogen heterocyclic compounds are present.

  10. Chemical characterization of indoor air of homes from communes in Xuan Wei, China, with high lung cancer mortality rate

    NASA Astrophysics Data System (ADS)

    Chuang, J. C.; Cao, S. R.; Xian, Y. L.; Harris, D. B.; Mumford, J. L.

    In a rural county, Xuan Wei, China, the lung cancer mortality rate is among China's highest, especially in women. This mortality rate is more associated with indoor air burning of smoky coal, as opposed to smokeless coal or wood, for cooking and heating under unvented conditions. Homes using different fuels from communes with high and low lung cancer mortality rates were sampled for particulate matter (< 10 μm) and semivolatile organics. The fine particles obtained from homes using smoky coal contained highest concentrations of organic matter (> 70%), including PAH, followed by homes using wood and smokeless coal. The major components present in the smoky coal filter samples were PAH and alkylated PAH. The smokeless coal filter samples exhibited profiles which were similar to the smoky coal samples except that some sulfur compounds were found. The estimated concentration levels of PAH in the smokeless coal samples were about one to two orders of magnitude lower than those of the smoky coal samples. In addition to PAH, aliphatic compounds and fatty acids were the major components found in the wood samples. Selected sample extracts from homes using smoky coal were fractionated into four fractions, and the results showed that the PAH and polar fractions have high mutagenic activity. Chemical characterization of the PAH fraction indicated that concentrations of some alkylated PAH were higher than those of their parent compounds. Chemical characterization of the polar fractions showed that nitrogen heterocyclic compounds are present.

  11. The impact of fiscal decentralization on infant mortality rates: evidence from OECD countries.

    PubMed

    Jiménez-Rubio, Dolores

    2011-11-01

    This study re-examines the hypothesis that shifts towards more decentralization would be accompanied by improvements in population health on a panel of 20 OECD countries over a thirty year period (1970-2001). Decentralization is proxied using a conventional indicator of revenue decentralization and a new measure of fiscal decentralization that reflects better than previous measures the existence of autonomy in the decision-making authority of lower tiers of government, a crucial issue in the decentralization process. The results show a considerable and positive effect of fiscal decentralization on infant mortality only if a substantial degree of autonomy in the sources of revenue is devolved to local governments. The proportion of health care expenditure on GDP and, in particular, education, were found to have a larger contribution to the reduction of infant mortality in the sample of OECD countries analysed over the period of study. PMID:21920653

  12. Heart Rate Variability Change Before and After Hemodialysis is Associated with Overall and Cardiovascular Mortality in Hemodialysis

    PubMed Central

    Chen, Szu-Chia; Huang, Jiun-Chi; Tsai, Yi-Chun; Hsiu-Chin Mai, R. N.; Jui-Hsin Chen, R. N.; Kuo, Po-Lin; Chang, Jer-Ming; Hwang, Shang-Jyh; Chen, Hung-Chun

    2016-01-01

    Low heart rate variability (HRV) has been recognized to correlate with adverse cardiovascular (CV) outcomes in hemodialysis (HD) patients. It has been reported that HRV might be improved after HD, but whether the improved HRV after HD predicts a better CV prognosis remains to be determined. This study examined the ability of the change in HRV before and after HD in predicting overall and CV mortality in HD patients. This study enrolled 182 patients under maintenance HD. HRV was examined to assess changes before and after HD. The change in HRV (ΔHRV) was defined as post-HD HRV minus pre-HD HRV. During a median follow-up period of 35.2 months, 29 deaths (15.9%) were recorded. Multivariate analysis showed that decreased ΔLF% was associated with increased overall (hazard ratios [HR], 0.978; 95% confidence interval [CI], 0.961–0.996; p = 0.019) and CV mortality (HR, 0.941; 95% CI, 0.914–0.970; p < 0.001), respectively. Moreover, adding ΔLF% to a clinical model provided an additional benefit in the prediction of overall (p = 0.002) and CV mortality (p < 0.001). HRV change before and after HD (ΔHRV) is an useful clinical marker, and it is stronger than HRV before HD in predicting overall and CV mortality. PMID:26854202

  13. Mortality rates associated with crown health for eastern forest tree species.

    PubMed

    Morin, Randall S; Randolph, KaDonna C; Steinman, Jim

    2015-03-01

    The condition of tree crowns is an important indicator of tree and forest health. Crown conditions have been evaluated during inventories of the US Forest Service Forest Inventory and Analysis (FIA) program since 1999. In this study, remeasured data from 55,013 trees on 2616 FIA plots in the eastern USA were used to assess the probability of survival among various tree species using the suite of FIA crown condition variables. Logistic regression procedures were employed to develop models for predicting tree survival. Results of the regression analyses indicated that crown dieback was the most important crown condition variable for predicting tree survival for all species combined and for many of the 15 individual species in the study. The logistic models were generally successful in representing recent tree mortality responses to multiyear infestations of beech bark disease and hemlock woolly adelgid. Although our models are only applicable to trees growing in a forest setting, the utility of models that predict impending tree mortality goes beyond forest inventory or traditional forestry growth and yield models and includes any application where managers need to assess tree health or predict tree mortality including urban forest, recreation, wildlife, and pest management. PMID:25655130

  14. Respiratory Syncytial Virus Bronchiolitis in Children up to 5 Years of Age in Spain: Epidemiology and Comorbidities

    PubMed Central

    Gil-Prieto, Ruth; Gonzalez-Escalada, Alba; Marín-García, Patricia; Gallardo-Pino, Carmen; Gil-de-Miguel, Angel

    2015-01-01

    Abstract This epidemiological survey in Spain estimates the burden of respiratory syncytial virus (RSV) infection in children up to 5 year of age during a 15-year period (1997–2011). Observational retrospective survey was conducted by reviewing data of the National Surveillance System for Hospital Data, including >98% of Spanish hospitals. All hospitalizations related to RSV infection for children up to 5 years, reported during 1997–2011 period, were analyzed. Codes were selected by using the International Classification of Diseases 9th Clinical Modification 466.0–466.19, 480.1, and 079.6. A total of 326,175 and 286,007 hospital discharges for children up to 5 and 2 years of age were reported during the study period. The annual incidence was 1072 and 2413 patients per 100,000, respectively. The average length of hospital stay was 5.7 (standard deviation 8.2) days. Four hundred forty-six deaths were reported; of those, 403 occurred in children <2 years and 355 (80%) occurred in children <12 months of age. Hospitalization and mortality rates were significantly higher in boys and decrease significantly with age. The higher rate of hospitalization and mortality rates were found in the first year of life. Annual average cost for National Health Care System was € 47 M with a mean hospitalization cost of €2162. The average length of hospitalization and costs were significantly higher in high-risk children. RSV infections in children up to 5 year of age still pose a significant health threat in Spain, especially in the infants. The development of preventive, diagnostic, and therapeutic guidelines focused in children with comorbidities may help reduce the hospital and economic burden of the disease. PMID:26020386

  15. Elevated Erythrocyte Sedimentation Rate Is Predictive of Interstitial Lung Disease and Mortality in Dermatomyositis: a Korean Retrospective Cohort Study.

    PubMed

    Go, Dong Jin; Lee, Eun Young; Lee, Eun Bong; Song, Yeong Wook; Konig, Maximilian Ferdinand; Park, Jin Kyun

    2016-03-01

    Interstitial lung disease (ILD) is a major cause of death in patients with dermatomyositis (DM). This study was aimed to examine the utility of the erythrocyte sedimentation rate (ESR) as a predictor of ILD and prognostic marker of mortality in patients with DM. One hundred-and-fourteen patients with DM were examined, including 28 with clinically amyopathic DM (CADM). A diagnosis of ILD was made based on high resolution computed tomography (HRCT) scans. The association between elevated ESR and pulmonary impairment and mortality was then examined. ILD was diagnosed in 53 (46.5%) of 114 DM patients. Cancer was diagnosed in 2 (3.8%) of 53 DM patients with ILD and in 24 (92.3%) of those without ILD (P < 0.001). The median ESR (50.0 mm/hour) in patients with ILD was significantly higher than that in patients without ILD (29.0 mm/hour; P < 0.001). ESR was inversely correlated with forced vital capacity (Spearman ρ = - 0.303; P = 0.007) and carbon monoxide diffusing capacity (ρ = - 0.319; P = 0.006). DM patients with baseline ESR ≥ 30 mm/hour had significantly higher mortality than those with ESR < 30 mm/hour (P = 0.002, log-rank test). Patients with a persistently high ESR despite immunosuppressive therapy was associated with higher mortality than those with a normalized ESR (P = 0.039, log-rank test). Elevated ESR is associated with increased mortality in patients with DM due to respiratory failure. Thus, monitoring ESR should be an integral part of the clinical care of DM patients. PMID:26955239

  16. Elevated Erythrocyte Sedimentation Rate Is Predictive of Interstitial Lung Disease and Mortality in Dermatomyositis: a Korean Retrospective Cohort Study

    PubMed Central

    2016-01-01

    Interstitial lung disease (ILD) is a major cause of death in patients with dermatomyositis (DM). This study was aimed to examine the utility of the erythrocyte sedimentation rate (ESR) as a predictor of ILD and prognostic marker of mortality in patients with DM. One hundred-and-fourteen patients with DM were examined, including 28 with clinically amyopathic DM (CADM). A diagnosis of ILD was made based on high resolution computed tomography (HRCT) scans. The association between elevated ESR and pulmonary impairment and mortality was then examined. ILD was diagnosed in 53 (46.5%) of 114 DM patients. Cancer was diagnosed in 2 (3.8%) of 53 DM patients with ILD and in 24 (92.3%) of those without ILD (P < 0.001). The median ESR (50.0 mm/hour) in patients with ILD was significantly higher than that in patients without ILD (29.0 mm/hour; P < 0.001). ESR was inversely correlated with forced vital capacity (Spearman ρ = - 0.303; P = 0.007) and carbon monoxide diffusing capacity (ρ = - 0.319; P = 0.006). DM patients with baseline ESR ≥ 30 mm/hour had significantly higher mortality than those with ESR < 30 mm/hour (P = 0.002, log-rank test). Patients with a persistently high ESR despite immunosuppressive therapy was associated with higher mortality than those with a normalized ESR (P = 0.039, log-rank test). Elevated ESR is associated with increased mortality in patients with DM due to respiratory failure. Thus, monitoring ESR should be an integral part of the clinical care of DM patients. PMID:26955239

  17. Multi-scale heart rate dynamics detected by phase-rectified signal averaging predicts mortality after acute myocardial infarction

    PubMed Central

    Kisohara, Masaya; Stein, Phyllis K.; Yoshida, Yutaka; Suzuki, Mari; Iizuka, Narushi; Carney, Robert M.; Watkins, Lana L.; Freedland, Kenneth E.; Blumenthal, James A.; Hayano, Junichiro

    2013-01-01

    Aims Acceleration and deceleration capacity (AC and DC) for beat-to-beat short-term heart rate dynamics are powerful predictors of mortality after acute myocardial infarction (AMI). We examined if AC and DC for minute-order long-term heart rate dynamics also have independent predictive value. Methods and results We studied 24-hr Holter electrcardiograms in 708 post-AMI patients who were followed up for up to 30 months thereafter. Acceleration capacity and DC was calculated with the time scales of T (window size defining heart rate) and s (wavelet scale) from 1 to 500 s and compared their prognostic values with conventional measures (ACconv and DCconv) that were calculated with (T,s) = [1,2 (beat)]. During the follow-up, 47 patients died. Both increased ACconv and decreased DCconv predicted mortality (C statistic, 0.792 and 0.797). Concordantly, sharp peaks of C statistics were observed at (T,s) = [2,7 (sec)] for both increased AC and decreased DC (0.762 and 0.768), but there were larger peaks of C statistics at around [30,60 (sec)] for both (0.783 and 0.796). The C statistic was greater for DC than AC at (30,60) (P = 0.0012). Deceleration capacity at (30,60) was a significant predictor even after adjusted for ACconv (P = 0.020) and DCconv (P = 0.028), but the predictive power of AC at (30,60) was no longer significant. Conclusion A decrease in DC for minute-order long-term heart rate dynamics is a strong predictor for post-AMI mortality and the predictive power is independent of ACconv and DCconv for beat-to-beat short-term heart rate dynamics. PMID:23248218

  18. Fine Root Mortality Rates in a Temperate Forest: Estimates using Radiocarbon Data and Numerical Modeling

    SciTech Connect

    Riley, William J.; Gaudinski, Julia B.; Torn, Margaret S.; JoslinJr., John D.; Hanson, Paul J

    2009-01-01

    Carbon (C) fluxes through roots are the most uncertain of all C exchanges between the atmosphere, plants, and soil. Yet the three dominant methods to characterize root C fluxes (minirhizotron, sequential coring, and isotopes) yield significantly different estimates of temperate forest root mortality turnover times. We contend that these discrepancies result from limitations in interpreting these very distinct types of observations. In this study we used a whole-ecosystem 14C label to develop, parameterize, and test a model (Radix1.0) of fine-root mortality and decomposition. Radix simulates two live roots pools (one with structural and non-structural C components), two dead root pools, non-normally distributed root mortality turnover times, a stored C pool, seasonal growth and respiration patterns, a best-fit to measurements approach to estimate model parameters, and Monte Carlo uncertainty analysis. We applied Radix at a temperate forest in Oak Ridge Tennessee using 14C measurements from two root size classes (<0.5 mm and 0.5−2.0 mm) and three soil depth increments (O horizon, 0−15, and 30−60 cm). Predicted root lifetimes were 0.1-0.9 y and 11-14 y for fast and slow live root pools respectively, and 0.1-4 y and 11-14 y for fast and slow dead root pool decomposition turnover times, respectively. We estimated that C fluxes through fine roots <2 mm diameter are ~40, 220, and 90 g C m-2 y 1 in the O horizon, 0−15 cm, and 30−60 cm depth intervals, respectively. We conclude that accurate characterization of C flows through fine roots required a model with two live fine-root pools, two dead fine-root pools, and root respiration. Further, root turnover times on the order of a decade imply different response times in biomass and growth than are currently predicted by models with a single annual turnover pool.

  19. Prone Breast Intensity Modulated Radiation Therapy: 5-Year Results

    SciTech Connect

    Osa, Etin-Osa O.; DeWyngaert, Keith; Roses, Daniel; Speyer, James; Guth, Amber; Axelrod, Deborah; Fenton Kerimian, Maria; Goldberg, Judith D.; Formenti, Silvia C.

    2014-07-15

    Purpose: To report the 5-year results of a technique of prone breast radiation therapy delivered by a regimen of accelerated intensity modulated radiation therapy with a concurrent boost to the tumor bed. Methods and Materials: Between 2003 and 2006, 404 patients with stage I-II breast cancer were prospectively enrolled into 2 consecutive protocols, institutional trials 03-30 and 05-181, that used the same regimen of 40.5 Gy/15 fractions delivered to the index breast over 3 weeks, with a concomitant daily boost to the tumor bed of 0.5 Gy (total dose 48 Gy). All patients were treated after segmental mastectomy and had negative margins and nodal assessment. Patients were set up prone: only if lung or heart volumes were in the field was a supine setup attempted and chosen if found to better spare these organs. Results: Ninety-two percent of patients were treated prone, 8% supine. Seventy-two percent had stage I, 28% stage II invasive breast cancer. In-field lung volume ranged from 0 to 228.27 cm{sup 3}, mean 19.65 cm{sup 3}. In-field heart volume for left breast cancer patients ranged from 0 to 21.24 cm{sup 3}, mean 1.59 cm{sup 3}. There was no heart in the field for right breast cancer patients. At a median follow-up of 5 years, the 5-year cumulative incidence of isolated ipsilateral breast tumor recurrence was 0.82% (95% confidence interval [CI] 0.65%-1.04%). The 5-year cumulative incidence of regional recurrence was 0.53% (95% CI 0.41%-0.69%), and the 5-year overall cumulative death rate was 1.28% (95% CI 0.48%-3.38%). Eighty-two percent (95% CI 77%-85%) of patients judged their final cosmetic result as excellent/good. Conclusions: Prone accelerated intensity modulated radiation therapy with a concomitant boost results in excellent local control and optimal sparing of heart and lung, with good cosmesis. Radiation Therapy Oncology Group protocol 1005, a phase 3, multi-institutional, randomized trial is ongoing and is evaluating the equivalence of a similar dose and

  20. Effects of vaccination against viral haemorrhagic disease and myxomatosis on long-term mortality rates of European wild rabbits.

    PubMed

    Calvete, C; Estrada, R; Lucientes, J; Osacar, J J; Villafuerte, R

    2004-09-25

    The effects of vaccination against myxomatosis and viral haemorrhagic disease (VHD) on long-term mortality rates in European rabbits (Oryctolagus cuniculus) were studied from 1993 to 1996 by radiotracking a free-living population of wild rabbits. During the three months after immunisation, unvaccinated young rabbits weighing between 180 and 600 g were 13.6 times more likely to die than vaccinated young rabbits. In adult rabbits, vaccination did not significantly decrease mortality, mainly owing to the high proportion of rabbits which had previously been exposed to the antigens of both diseases. Compared with adult rabbits with natural antibodies to VHD, rabbits without these antibodies were 5.2 times more likely to die of VHD during annual outbreaks. PMID:15499810

  1. A 5-year retrospective clinical study of the Dentium implants

    PubMed Central

    Lee, Jeong-Yol; Park, Hyo-Jin; Kim, Jong-Eun; Choi, Yong-Geun; Kim, Young-Soo; Huh, Jung-Bo

    2011-01-01

    PURPOSE The aim of this retrospective study was to evaluate cumulative survival rate (CSR) of Implantium implants followed for 5 years and association between risk factors and the CSR. MATERIALS AND METHODS A total of two hundred forty-nine Implantium Implants System (Dentium, Seoul, Korea) placed in ninety-five patients from 2004 to 2009 were investigated with several identified risk factors (sex, systemic disease, smoking, alchohol, reason of tooth loss, length, arch (maxilla or mandible), replace tooth type (incisor, canine, premolar or molar) Kennedy classification, prosthodontic type, prosthodontic design, opposite dentition, abutment type, occlusal material, occlusal unit, splint to tooth, cantilever, other surgery). Clinical examination (mobility, percussion, screw loosening, discomfort, etc.) and radiographic examination data were collected from patient records including all problems during follow-up period according to protocols described earlier. Life table analysis was undertaken to examine the CSR. Cox regression method was conducted to assess the association between potential risk factors and overall CSR. RESULTS Five of 249 implants were failed. Four of these were lost before loading. The 5-year implant cumulative survival rate was 97.37%. Cox regression analysis demonstrated a significant predictive association between overall CSR and systemic disease, smoking, reason of tooth loss, arch, Kennedy classification and prosthodontic design (P<.05). The screw related complication was rare. Two abutment screw fractures were found. Another complications of prosthetic components were porcelain fracture, resin facing fracture and denture fracture (n=19). CONCLUSION The 5-year CSR of Implantium implants was 97.37%. Implant survival may be dependent upon systemic disease, smoking reason of tooth loss, arch, Kennedy classification and prosthodontic design (P<.05). The presence of systemic diseases and combination of other surgical procedures may be associated

  2. Assessing and Mapping Spatial Associations among Oral Cancer Mortality Rates, Concentrations of Heavy Metals in Soil, and Land Use Types Based on Multiple Scale Data

    PubMed Central

    Lin, Wei-Chih; Lin, Yu-Pin; Wang, Yung-Chieh; Chang, Tsun-Kuo; Chiang, Li-Chi

    2014-01-01

    In this study, a deconvolution procedure was used to create a variogram of oral cancer (OC) rates. Based on the variogram, area-to-point (ATP) Poisson kriging and p-field simulation were used to downscale and simulate, respectively, the OC rate data for Taiwan from the district scale to a 1 km × 1 km grid scale. Local cluster analysis (LCA) of OC mortality rates was then performed to identify OC mortality rate hot spots based on the downscaled and the p-field-simulated OC mortality maps. The relationship between OC mortality and land use was studied by overlapping the maps of the downscaled OC mortality, the LCA results, and the land uses. One thousand simulations were performed to quantify local and spatial uncertainties in the LCA to identify OC mortality hot spots. The scatter plots and Spearman’s rank correlation yielded the relationship between OC mortality and concentrations of the seven metals in the 1 km cell grid. The correlation analysis results for the 1 km scale revealed a weak correlation between OC mortality rate and concentrations of the seven studied heavy metals in soil. Accordingly, the heavy metal concentrations in soil are not major determinants of OC mortality rates at the 1 km scale at which soils were sampled. The LCA statistical results for local indicator of spatial association (LISA) revealed that the sites with high probability of high-high (high value surrounded by high values) OC mortality at the 1 km grid scale were clustered in southern, eastern, and mid-western Taiwan. The number of such sites was also significantly higher on agricultural land and in urban regions than on land with other uses. The proposed approach can be used to downscale and evaluate uncertainty in mortality data from a coarse scale to a fine scale at which useful additional information can be obtained for assessing and managing land use and risk. PMID:24566045

  3. Restructuring fundamental predator-prey models by recognising prey-dependent conversion efficiency and mortality rates.

    PubMed

    Li, Jiqiu; Montagnes, David J S

    2015-05-01

    Incorporating protozoa into population models (from simple predator-prey explorations to complex food web simulations) is of conceptual, ecological, and economic importance. From theoretical and empirical perspectives, we expose unappreciated complexity in the traditional predator-prey model structure and provide a parsimonious solution, especially for protistologists. We focus on how prey abundance alters two key components of models: predator conversion efficiency (e, the proportion of prey converted to predator, before mortality loss) and predator mortality (δ, the portion of the population lost though death). Using a well-established model system (Paramecium and Didinium), we collect data to parameterize a range of existing and novel population models that differ in the functional forms of e and δ. We then compare model simulations to an empirically obtained time-series of predator-prey population dynamics. The analysis indicates that prey-dependent e and δ should be considered when structuring population models and that both prey and predator biomass also vary with prey abundance. Both of these impact the ability of the model to predict population dynamics and, therefore, should be included in theoretical model evaluations and assessment of ecosystem dynamics associated with biomass flux. PMID:25819465

  4. Insertion of Balloon Retained Gastrostomy Buttons: A 5-Year Retrospective Review of 260 Patients

    SciTech Connect

    Power, Sarah Kavanagh, Liam N.; Shields, Mary C.; Given, Mark F.; Keeling, Aoife N.; McGrath, Frank P.; Lee, Michael J.

    2013-04-15

    Radiologically inserted gastrostomy (RIG) is an established way of maintaining enteral nutrition in patients who cannot maintain nutrition orally. The purpose of this study was to evaluate the safety and efficacy of primary placement of a wide bore button gastrostomy in a large, varied patient population through retrospective review. All patients who underwent gastrostomy placement from January 1, 2004 to January 1, 2009 were identified. 18-Fr gastrostomy buttons (MIC-Key G) were inserted in the majority. Follow-up ranged from 6 months to 4.5 years. A total of 260 patients (M:F 140:120, average age 59.2 years) underwent gastrostomy during the study period. Overall success rate for RIG placement was 99.6 %, with success rate of 95.3 % for primary button insertion. Indications included neurological disorders (70 %), esophageal/head and neck malignancy (21 %), and other indications (9 %). Major and minor complication rates were 1.2 and 12.8 %, respectively. Thirty-day mortality rate was 6.8 %. One third of patients underwent gastrostomy reinsertion during the study period, the main indication for which was inadvertent catheter removal. Patency rate was high at 99.5 %. The maximum number of procedures in any patient was 8 (n = 2), and the average tube dwell time was 125 days. Primary radiological insertion of a wide bore button gastrostomy is a safe technique, with high success rate, high patency rate, and low major complication rate. We believe that it is feasible to attempt button gastrostomy placement in all patients, once tract length is within limits of tube length. If difficulty is encountered, then a standard tube may simply be placed instead.

  5. Mortality, Recurrence, and Dependency Rates Are Higher after Acute Ischemic Stroke in Elderly Patients with Diabetes Compared to Younger Patients

    PubMed Central

    Long, Xue; Lou, Yongzhong; Gu, Hongfei; Guo, Xiaofei; Wang, Tao; Zhu, Yanxia; Zhao, Wenjuan; Ning, Xianjia; Li, Bin; Wang, Jinghua; An, Zhongping

    2016-01-01

    Stroke has a greater effect on the elderly than on younger patients. However, the long-term outcomes associated with stroke among elderly patients with diabetes are unknown. We aimed to assess the differences in long-term outcomes between young and elderly stroke patients with diabetes. A total of 3,615 acute ischemic stroke patients with diabetes were recruited for this study between 2006 and 2014. Outcomes at 12 and 36 months after stroke (including mortality, recurrence, and dependency) were compared between younger (age <75 years) and elderly (age ≥75 years) patients. The elderly group included 692 patients (19.1%) overall. Elderly patients were more likely than younger patients to have a Trial of Org 10172 in Acute Stroke Treatment classification of stroke due to cardioembolism, moderate and severe stroke, and atrial fibrillation, but less likely to have hypertension and dyslipidemia, current smokers, and alcohol consumers. Mortality, dependency, and recurrence rates at 12 months after stroke were 19.0, 48.5, and 20.9% in the elderly group and 7.4, 30.9, and 15.4% in the younger group, respectively (all P < 0.05). Corresponding rates at 36 months after stroke were 35.4, 78.7, and 53.8% in the elderly group and 13.7, 61.7, and 43.0% in the younger group, respectively (all P < 0.001). The mortality, dependency, and recurrence rates at 12 and 36 months after stroke were significantly higher in the elderly group than in the younger group after adjusting for stroke subtypes, stroke severity, and risk factors. Odds ratios (95% confidence interval) at 12 and 36 months after stroke were 2.18 (1.64–2.89) and 3.10 (2.35–4.08), respectively, for mortality, all P < 0.001; 1.81 (1.49–2.20) and 2.04 (1.57–2.34), respectively, for dependency, all P < 0.001; and 1.37 (1.06–1.76) and 1.40 (1.07–1.85), respectively, for recurrence, P = 0.016. The findings from this study suggest that management and secondary prevention should be emphasized in elderly patients with

  6. Mortality, Recurrence, and Dependency Rates Are Higher after Acute Ischemic Stroke in Elderly Patients with Diabetes Compared to Younger Patients.

    PubMed

    Long, Xue; Lou, Yongzhong; Gu, Hongfei; Guo, Xiaofei; Wang, Tao; Zhu, Yanxia; Zhao, Wenjuan; Ning, Xianjia; Li, Bin; Wang, Jinghua; An, Zhongping

    2016-01-01

    Stroke has a greater effect on the elderly than on younger patients. However, the long-term outcomes associated with stroke among elderly patients with diabetes are unknown. We aimed to assess the differences in long-term outcomes between young and elderly stroke patients with diabetes. A total of 3,615 acute ischemic stroke patients with diabetes were recruited for this study between 2006 and 2014. Outcomes at 12 and 36 months after stroke (including mortality, recurrence, and dependency) were compared between younger (age <75 years) and elderly (age ≥75 years) patients. The elderly group included 692 patients (19.1%) overall. Elderly patients were more likely than younger patients to have a Trial of Org 10172 in Acute Stroke Treatment classification of stroke due to cardioembolism, moderate and severe stroke, and atrial fibrillation, but less likely to have hypertension and dyslipidemia, current smokers, and alcohol consumers. Mortality, dependency, and recurrence rates at 12 months after stroke were 19.0, 48.5, and 20.9% in the elderly group and 7.4, 30.9, and 15.4% in the younger group, respectively (all P < 0.05). Corresponding rates at 36 months after stroke were 35.4, 78.7, and 53.8% in the elderly group and 13.7, 61.7, and 43.0% in the younger group, respectively (all P < 0.001). The mortality, dependency, and recurrence rates at 12 and 36 months after stroke were significantly higher in the elderly group than in the younger group after adjusting for stroke subtypes, stroke severity, and risk factors. Odds ratios (95% confidence interval) at 12 and 36 months after stroke were 2.18 (1.64-2.89) and 3.10 (2.35-4.08), respectively, for mortality, all P < 0.001; 1.81 (1.49-2.20) and 2.04 (1.57-2.34), respectively, for dependency, all P < 0.001; and 1.37 (1.06-1.76) and 1.40 (1.07-1.85), respectively, for recurrence, P = 0.016. The findings from this study suggest that management and secondary prevention should be emphasized in elderly patients with diabetes in

  7. Changes in bacterial community composition and dynamics and viral mortality rates associated with enhanced flagellate grazing in a mesoeutrophic reservoir.

    PubMed

    Simek, K; Pernthaler, J; Weinbauer, M G; Hornák, K; Dolan, J R; Nedoma, J; Masín, M; Amann, R

    2001-06-01

    Bacterioplankton from a meso-eutrophic dam reservoir was size fractionated to reduce (<0.8-microm treatment) or enhance (<5-microm treatment) protistan grazing and then incubated in situ for 96 h in dialysis bags. Time course samples were taken from the bags and the reservoir to estimate bacterial abundance, mean cell volume, production, protistan grazing, viral abundance, and frequency of visibly infected cells. Shifts in bacterial community composition (BCC) were examined by denaturing gradient gel electrophoresis (DGGE), cloning and sequencing of 16S rDNA genes from the different treatments, and fluorescence in situ hybridization (FISH) with previously employed and newly designed oligonucleotide probes. Changes in bacterioplankton characteristics were clearly linked to changes in mortality rates. In the reservoir, where bacterial production about equaled protist grazing and viral mortality, community characteristics were nearly invariant. In the "grazer-free" (0.8-microm-filtered) treatment, subject only to a relatively low mortality rate (approximately 17% day(-1)) from viral lysis, bacteria increased markedly in concentration. While the mean bacterial cell volume was invariant, DGGE indicated a shift in BCC and FISH revealed an increase in the proportion of one lineage within the beta proteobacteria. In the grazing-enhanced treatment (5-microm filtrate), grazing mortality was approximately 200% and viral lysis resulted in mortality of 30% of daily production. Cell concentrations declined, and grazing-resistant flocs and filaments eventually dominated the biomass, together accounting for >80% of the total bacteria by the end of the experiment. Once again, BCC changed strongly and a significant fraction of the large filaments was detected using a FISH probe targeted to members of the Flectobacillus lineage. Shifts of BCC were also reflected in DGGE patterns and in the increases in the relative importance of both beta proteobacteria and members of the Cytophaga

  8. Mortality rate and overweight: Overblown or underestimated? A commentary on a recent meta-analysis of the associations of BMI and mortality

    PubMed Central

    Keith, Scott W.; Fontaine, Kevin R.; Allison, David B.

    2013-01-01

    In this review, we discuss strengths and limitations of a recent rigorous systematic review and meta-analysis of the literature on associations of all-cause mortality with overweight and obesity. A perspective on its meaning and potential implications are provided. To move this field forward, we suggest modeling BMI as a continuous variable, switching to modeling longevity instead of mortality, and generating large publicly available datasets in broad and diverse populations for discerning the extent to which the BMI–mortality relationship differs between groups and over time. Randomized studies of obesity-related interventions that provide assessments of their actual effects on lifespan or mortality would have great value for helping to establish valid clinical and public health recommendations around weight loss and mortality. PMID:24199152

  9. [Estimates and trends of obesity prevalence through mortality rates associated of chronic diseases in Mexico].

    PubMed

    Villa, Antonio R; Escobedo, Michelle H; Méndez-Sánchez, Nahum

    2004-01-01

    The pandemy of obesity is affecting more than 300 millions of adults in the world. The trend is increasing. Diabetes, coronary hearth disease, hypertension, cerebrovascular disease and dyslipidemia are chronic diseases associated with obesity. The methodology of this paper is proposed as an alternative resource based in mortality data to quantify the magnitude of chronic diseases in developing countries. Deaths for Mexico registered in 2000, according to selected causes, were taken to derive indirectly the prevalence of obesity in years 2000, 2005, and 2010, both males and females > or = 35 years-old. In 2010, an estimation of 8 million of Mexican with obesity is made. This methodology is referred to be probed in the quantification and projection of chronic diseases. According with our estimation, we hope in Mexico at 2010 to have between 8 and 14 millions of people > or = 35 years-old with obesity. PMID:15641468

  10. Child Mortality Estimation: A Comparison of UN IGME and IHME Estimates of Levels and Trends in Under-Five Mortality Rates and Deaths

    PubMed Central

    Alkema, Leontine; You, Danzhen

    2012-01-01

    Background Millennium Development Goal 4 calls for a reduction in the under-five mortality rate (U5MR) by two-thirds between 1990 and 2015. In 2011, estimates were published by the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) and the Institute for Health Metrics and Evaluation (IHME). The difference in the U5MR estimates produced by the two research groups was more than 10% and corresponded to more than ten deaths per 1,000 live births for 10% of all countries in 1990 and 20% of all countries in 2010, which can lead to conflicting conclusions with respect to countries' progress. To understand what caused the differences in estimates, we summarised differences in underlying data and modelling approaches used by the two groups, and analysed their effects. Methods and Findings UN IGME and IHME estimation approaches differ with respect to the construction of databases and the pre-processing of data, trend fitting procedures, inclusion and exclusion of data series, and additional adjustment procedures. Large differences in U5MR estimates between the UN IGME and the IHME exist in countries with conflicts or civil unrest, countries with high HIV prevalence, and countries where the underlying data used to derive the estimates were different, especially if the exclusion of data series differed between the two research groups. A decomposition of the differences showed that differences in estimates due to using different data (inclusion of data series and pre-processing of data) are on average larger than the differences due to using different trend fitting methods. Conclusions Substantial country-specific differences between UN IGME and IHME estimates for U5MR and the number of under-five deaths exist because of various differences in data and modelling assumptions used. Often differences are illustrative of the lack of reliable data and likely to decrease as more data become available. Improved transparency on methods and data used will help to

  11. Impact of resuscitation and thrombolysis on mortality rate from acute myocardial infarction.

    PubMed

    Trent, R; Adams, J; Jennings, K; Rawles, J

    1995-03-24

    Our objective was to estimate the saving of life by thrombolysis and resuscitation in acute myocardial infarction (AMI) before and after hospital admission. We studied all 1516 patients admitted to a Scottish teaching hospital in 1990 and 1992 who had a final diagnosis of AMI, and 311 patients enrolled in the Grampian region early anistreplase trial (GREAT). Cardiac arrest occurred in 250/1516 (16%) hospital patients. Of these, 77 (31%) were discharged alive--a saving of 51 lives per thousand cases. 797 (53%) patients received thrombolysis, of whom 114 (14%) died. Assuming the same relative reduction in mortality as in the second international study of infarct survival (ISIS-2; 23%), 34 lives were saved by thrombolytic therapy, representing 22 lives per thousand cases. Of 311 patients in GREAT, 15 (5%) had prehospital cardiac arrest, with 7 patients surviving to discharge (48%)--a saving of 23 lives per thousand cases. Those patients given domiciliary thrombolysis had a one month mortality of 6.7% (11/163) compared with 12.2% (18/148) for those receiving hospital thrombolysis--a saving of 55 lives per thousand cases for prehospital thrombolysis. This is additional to 28 lives per thousand estimated for thrombolytic therapy in hospital, totalling 83 lives saved per thousand cases of AMI receiving thrombolytic therapy prehospital. In hospital, more lives were saved by resuscitation than by thrombolytic therapy, but this ratio was reversed in the period before hospital admission. These results emphasise the paramount importance of resuscitation in hospital, and the enhanced efficacy of thrombolysis when given at the earliest opportunity. PMID:7607764

  12. Desiccation as a mitigation tool to manage biofouling risks: trials on temperate taxa to elucidate factors influencing mortality rates.

    PubMed

    Hopkins, Grant A; Prince, Madeleine; Cahill, Patrick L; Fletcher, Lauren M; Atalah, Javier

    2016-01-01

    The desiccation tolerance of biofouling taxa (adults and early life-stages) was determined under both controlled and 'realistic' field conditions. Adults of the ascidian Ciona spp. died within 24 h. Mortality in the adult blue mussel Mytilus galloprovincialis occurred within 11 d under controlled conditions, compared with 7 d when held outside. The Pacific oyster Crassostrea gigas was the most desiccation-tolerant taxon tested (up to 34 d under controlled conditions). Biofouling orientated to direct sunlight showed faster mortality rates for all the taxa tested. Mortality in Mytilus juveniles took up to 24 h, compared with 8 h for Ciona, with greater survival at the higher temperature (18.5°C) and humidity (~95% RH) treatment combination. This study demonstrated that desiccation can be an effective mitigation method for a broad range of fouling taxa, especially their early life-stages. Further work is necessary to assess risks from other high-risk species such as algae and cyst forming species. PMID:26691450

  13. Disparities in Rates of Inpatient Mortality and Adverse Events: Race/Ethnicity and Language as Independent Contributors

    PubMed Central

    Hines, Anika L.; Andrews, Roxanne M.; Moy, Ernest; Barrett, Marguerite L.; Coffey, Rosanna M.

    2014-01-01

    Patients with limited English proficiency have known limitations accessing health care, but differences in hospital outcomes once access is obtained are unknown. We investigate inpatient mortality rates and obstetric trauma for self-reported speakers of English, Spanish, and languages of Asia and the Pacific Islands (API) and compare quality of care by language with patterns by race/ethnicity. Data were from the United States Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, 2009 State Inpatient Databases for California. There were 3,757,218 records. Speaking a non-English principal language and having a non-White race/ethnicity did not place patients at higher risk for inpatient mortality; the exception was significantly higher stroke mortality for Japanese-speaking patients. Patients who spoke API languages or had API race/ethnicity had higher risk for obstetric trauma than English-speaking White patients. Spanish-speaking Hispanic patients had more obstetric trauma than English-speaking Hispanic patients. The influence of language on obstetric trauma and the potential effects of interpretation services on inpatient care are discussed. The broader context of policy implications for collection and reporting of language data is also presented. Results from other countries with and without English as a primary language are needed for the broadest interpretation and generalization of outcomes. PMID:25514153

  14. Association between risk factors for coronary heart disease in schoolboys and adult mortality rates in the same localities.

    PubMed Central

    Freeman, W; Weir, D C; Whitehead, J E; Rogers, D I; Sapiano, S B; Floyd, C A; Kirk, P M; Stalker, C R; Field, N J; Cayton, R M

    1990-01-01

    Risk factors for coronary heart disease were compared in fifth year boys (15-16 years old) from two schools that were chosen from localities with a fourfold difference in adult mortality from coronary heart disease. One school was in an underprivileged urban locality in the area of increased incidence of heart disease ('high risk') and the other in a semi-rural affluent locality with an incidence of heart disease similar to the national average ('low risk'). Smoking, hypertension, hypercholesterolaemia, obesity, physical fitness, and inactivity were evaluated as risk factors for coronary heart disease. Smoking, increased body fat, poor diet, and physical inactivity were found increased among pupils from the school in the high risk area compared with those in the low risk area. Lipids, maximum oxygen uptake, and hypertension were similar in both schools. The risk of coronary heart disease seems to reflect the adult mortality rates in the area. To reduce the overall incidence of coronary heart disease, health education should be directed towards prevention of smoking, improving diets, and increasing amounts of activity among school children, with special attention directed toward children in regions where there is a high mortality from coronary heart disease among adults. PMID:2301987

  15. Prostate Cancer in South Africa: Pathology Based National Cancer Registry Data (1986–2006) and Mortality Rates (1997–2009)

    PubMed Central

    Babb, Chantal; Urban, Margaret; Kielkowski, Danuta; Kellett, Patricia

    2014-01-01

    Prostate cancer is one of the most common male cancers globally; however little is known about prostate cancer in Africa. Incidence data for prostate cancer in South Africa (SA) from the pathology based National Cancer Registry (1986–2006) and data on mortality (1997–2009) from Statistics SA were analysed. World standard population denominators were used to calculate age specific incidence and mortality rates (ASIR and ASMR) using the direct method. Prostate cancer was the most common male cancer in all SA population groups (excluding basal cell carcinoma). There are large disparities in the ASIR between black, white, coloured, and Asian/Indian populations: 19, 65, 46, and 19 per 100 000, respectively, and ASMR was 11, 7, 52, and 6 per 100 000, respectively. Prostate cancer was the second leading cause of cancer death, accounting for around 13% of male deaths from a cancer. The average age at diagnosis was 68 years and 74 years at death. For SA the ASIR increased from 16.8 in 1986 to 30.8 in 2006, while the ASMR increased from 12.3 in 1997 to 16.7 in 2009. There has been a steady increase of incidence and mortality from prostate cancer in SA. PMID:24955252

  16. Prostate cancer in South Africa: pathology based national cancer registry data (1986-2006) and mortality rates (1997-2009).

    PubMed

    Babb, Chantal; Urban, Margaret; Kielkowski, Danuta; Kellett, Patricia

    2014-01-01

    Prostate cancer is one of the most common male cancers globally; however little is known about prostate cancer in Africa. Incidence data for prostate cancer in South Africa (SA) from the pathology based National Cancer Registry (1986-2006) and data on mortality (1997-2009) from Statistics SA were analysed. World standard population denominators were used to calculate age specific incidence and mortality rates (ASIR and ASMR) using the direct method. Prostate cancer was the most common male cancer in all SA population groups (excluding basal cell carcinoma). There are large disparities in the ASIR between black, white, coloured, and Asian/Indian populations: 19, 65, 46, and 19 per 100 000, respectively, and ASMR was 11, 7, 52, and 6 per 100 000, respectively. Prostate cancer was the second leading cause of cancer death, accounting for around 13% of male deaths from a cancer. The average age at diagnosis was 68 years and 74 years at death. For SA the ASIR increased from 16.8 in 1986 to 30.8 in 2006, while the ASMR increased from 12.3 in 1997 to 16.7 in 2009. There has been a steady increase of incidence and mortality from prostate cancer in SA. PMID:24955252

  17. Trends in the Attack Rates, Incidence, and Mortality of Stroke during 1986–2012: Data of Kaunas (Lithuania) Stroke Registry

    PubMed Central

    Radisauskas, Ricardas; Malinauskiene, Vilija; Milinaviciene, Egle; Kranciukaite-Butylkiniene, Daina; Tamosiunas, Abdonas; Bernotiene, Gailute; Luksiene, Dalia; Milasauskiene, Zemyna; Sopagiene, Diana; Rastenyte, Daiva

    2016-01-01

    Background There is a lack of reliable epidemiological data on longitudinal trends in stroke attack rates, incidence, and mortality in the countries of the Baltic region. Aims The aim of the present study was to explore the longitudinal trends of stroke in middle-aged urban population of Lithuania during the period of 1986 through 2012. Methods All stroke events in the studied population were ascertained and validated according to the standardized criteria outlined by the WHO MONICA Project. The study included all patients in Kaunas (Lithuania) city aged 25 to 64 years who experienced a stroke between 1986 and 2012. Estimates of time-trends of the annual percentage change in stroke attack rates, incidence of stroke, and mortality from this condition were made by applying the Joinpoint regression analysis. Results During the study period, 9,992 stroke events were registered. The overall proportion of recurrent events was 25.7%. Overall, 18.9% of the events (20.0% in men, and 17.4% in women) were fatal within 28 days. During the period of 1986 to 2012, a flat trend in the incidence of stroke was observed among both male and female middle-aged inhabitants of Kaunas city, while attack rates were increasing due to the increase in recurrent strokes. Both mortality and 28-day case fatality of stroke declined significantly over the study period in both sexes. Conclusions An increase both in the incidence and recurrence of stroke among middle-aged men residing in Kaunas city and in the recurrence of stroke among women denotes the inefficiency of measures applied both for primary and secondary prevention of stroke in Lithuania. The revision of current prevention strategies and the introduction of new ones are of paramount importance in order to fight the epidemic of stroke. PMID:27124412

  18. A Propensity Score Analysis Shows that Empirical Treatment with Linezolid Does Not Increase the Thirty-Day Mortality Rate in Patients with Gram-Negative Bacteremia

    PubMed Central

    Ternavasio-de la Vega, Hugo-Guillermo; Mateos-Díaz, Ana-María; Martinez, Jose-Antonio; Almela, Manel; Cobos-Trigueros, Nazaret; Morata, Laura; De-la-Calle, Cristina; Sala, Marta; Mensa, Josep; Soriano, Alex

    2014-01-01

    The role of linezolid in empirical therapy of suspected bacteremia remains unclear. The aim of this study was to evaluate the influence of empirical use of linezolid or glycopeptides in addition to other antibiotics on the 30-day mortality rates in patients with Gram-negative bacteremia. For this purpose, 1,126 patients with Gram-negative bacteremia in the Hospital Clinic of Barcelona from 2000 to 2012 were included in this study. In order to compare the mortality rates between patients who received linezolid or glycopeptides, the propensity scores on baseline variables were used to balance the treatment groups, and both propensity score matching and propensity-adjusted logistic regression were used to compare the 30-day mortality rates between the groups. The overall 30-day mortality rate was 16.0% during the study period. Sixty-eight patients received empirical treatment with linezolid, and 1,058 received glycopeptides. The propensity score matching included 64 patients in each treatment group. After matching, the mortality rates were 14.1% (9/64) in patients who received glycopeptides and 21.9% (14/64) in those who received linezolid, and a nonsignificant association between empirical linezolid treatment and mortality rate (odds ratio [OR], 1.63; 95% confidence interval [CI], 0.69 to 3.82; P = 0.275, McNemar's test) was found. This association remained nonsignificant when variables that remained unbalanced after matching were included in a conditional logistic regression model. Further, the stratified propensity score analysis did not show any significant relationship between empirical linezolid treatment and the mortality rate after adjustment by propensity score quintiles or other variables potentially associated with mortality. In conclusion, the propensity score analysis showed that empirical treatment with linezolid compared with that with glycopeptides was not associated with 30-day mortality rates in patients with Gram-negative bacteremia. PMID:25199780

  19. Association of resting heart rate and hypertension stages on all-cause and cardiovascular mortality among elderly Koreans: the Kangwha Cohort Study

    PubMed Central

    Ryu, Mikyung; Bayasgalan, Gombojav; Kimm, Heejin; Nam, Chung Mo; Ohrr, Heechoul

    2016-01-01

    Background Elevated resting heart rate and hypertension independently increase the risk of mortality. However, their combined effect on mortality in stages of hypertension according to updated clinical guidelines among elderly population is unclear. Methods We followed a cohort of 6100 residents (2600 males and 3500 females) of Kangwha County, Korea, ranging from 55 to 99 year-olds as of March 1985, for all-cause and cardiovascular mortality for 20.8 years until December 31, 2005. Mortality data were collected through telephone calls and visits (to 1991), and were confirmed by death record matching with the National Statistical Office (1992−2005). Hazard ratios were calculated for all-cause and cardiovascular mortality by resting heart rate and hypertension defined by Eighth Joint National Committee criteria using the Cox proportional hazard model after controlling for confounding factors. Results The hazard ratios associated with resting heart rate > 80 beats/min were higher in hypertensive men compared with normotensives with heart rate of 61–79 beats/min, with hazard ratios values of 1.43 (95% CI: 1.00−1.92) on all-cause mortality for prehypertension, 3.01 (95% CI: 1.07–8.28) on cardiovascular mortality for prehypertension, and 8.34 (95% CI: 2.52−28.19) for stage 2 hypertension. Increased risk (HR: 3.54, 95% CI: 1.16–9.21) was observed among those with both a resting heart rate ≥ 80 beats/min and prehypertension on cardiovascular mortality in women. Conclusions Individuals with coexisting elevated resting heart rate and hypertension, even in prehypertension, have a greater risk for all-cause and cardiovascular mortality compared to those with elevated resting heart rate or hypertension alone. These findings suggest that elevated resting heart rate should not be regarded as a less serious risk factor in elderly hypertensive patients. PMID:27605937

  20. Trends in Pneumonia Mortality Rates and Hospitalizations by Organism, United States, 2002–20111

    PubMed Central

    Wuerth, Brandon A.; Bonnewell, John P.; Wiemken, Timothy L.

    2016-01-01

    Because the epidemiology of pneumonia is changing, we performed an updated, population-based analysis of hospitalization and case-fatality rates for pneumonia patients in the United States. From 2002 to 2011, hospitalization rates decreased significantly for pneumonia caused by pneumococcus and Haemophilus influenzae but increased significantly for Pseudomonas spp., Staphylococcus aureus, and influenza virus. PMID:27532154

  1. Trends in Pneumonia Mortality Rates and Hospitalizations by Organism, United States, 2002-2011(1).

    PubMed

    Wuerth, Brandon A; Bonnewell, John P; Wiemken, Timothy L; Arnold, Forest W

    2016-09-01

    Because the epidemiology of pneumonia is changing, we performed an updated, population-based analysis of hospitalization and case-fatality rates for pneumonia patients in the United States. From 2002 to 2011, hospitalization rates decreased significantly for pneumonia caused by pneumococcus and Haemophilus influenzae but increased significantly for Pseudomonas spp., Staphylococcus aureus, and influenza virus. PMID:27532154

  2. The Alcohol Warning and Adolescents: 5-Year Effects.

    ERIC Educational Resources Information Center

    MacKinnon, David P.; Nohre, Liva; Pentz, Mary Ann; Stacy, Alan W.

    2000-01-01

    Examined the effect of alcohol warning labels on adolescents during the first 5 years that the warning was required. Surveys of 10th and 12th grade students over 5 years indicated that the initial positive effects of the labels on adolescents leveled off after 3.5 years. The labels have not affected adolescents' beliefs about alcohol or…

  3. Migration of the Duraloc cup after 5 years.

    PubMed

    Stihsen, Christoph; Pabinger, Christof; Radl, Roman; Rehak, Peter; Windhager, Reinhard

    2008-12-01

    The Duraloc cup is a frequently used metal-backed, porous-coated, hemispherical, press-fit acetabular component. Published data on loosening rates are contradictory. In this study we investigated migration patterns with computer-assisted Einzel-Bild-Roentgen-Analyse (EBRA) of 67 Duraloc 100 cups. Cup migration and clinical scores were analysed over a 5-year follow-up period. Median total migration of the Duraloc 100 cup was 1.21 mm at 5 years. Seventy-five percent of implants were radiologically stable at 2 years and 90% at 4 years. One cup loosened aseptically at 60 months, requiring revision. Cup diameters > or = 54 mm migrated significantly more than cups < 54 mm in diameter (p = 0.029 at 4 years). There was a significant correlation between high polyethylene wear and further migrating cups within the first post-operative year (p = 0.035 at 12 months). Our analysis revealed significantly higher wear in males (p = 0.029 at 4 years). Radiological loosening at two years could be calculated using receiver-operating characteristic curve analysis, and 1.2 mm as an adequate threshold value (sensitivity = 100%, specificity = 89%). PMID:17609953

  4. Measures of racial/ethnic health disparities in cancer mortality rates and the influence of socioeconomic status.

    PubMed Central

    Chu, Kenneth C.; Miller, Barry A.; Springfield, Sanya A.

    2007-01-01

    OBJECTIVES: In the 1990s, U.S. cancer mortality rates declined due to reductions in tobacco use among men and beneficial cancer interventions, such as mammography and Pap smears. We examined the cancer rates by racial/ethnic group, socioeconomic status and time period to identify disparities underlying the overall mortality trend. METHODS: We examined racial/ethnic disparities by measuring excess cancer burden [rate ratio (RR) and ratio differences (RD)] and trends in their cancer rates for nine cancer sites. The trend (T) is calculated as a ratio of the average annual cancer mortality rate for 1995-2000 relative to the rate for 1990-1994 for three levels of poverty (counties with <10% living below the poverty level, 10% - <20% and > or =20%) for the major racial/ethnic populations. We also compared the trend for each racial/ethnic SES group to the trend for lowest SES white group (TD). RESULTS: Blacks have RR disparities relative to whites for each cancer site examined, except for female lung cancer, while the other minorities had RR disparities for cervical cancer (RR>1). There are increases in RR disparities from 1990-1994 to 1995-2000 (RD>0) for colorectal cancer, prostate cancer and breast cancer for each racial/ethnic minority. Whites and blacks had declining trends for every SES group (T<1) and positive high SES gradients (the highest SES group had the best trend and the lowest SES group had the worst trend) at each cancer site, except female lung cancer (T>1). In contrast, American Indians/Alaska natives, Hispanics and Asians/ Pacific Islanders had increasing trends for some of their cancer sites, and their trends did not have the SES gradients. CONCLUSIONS: Increases in racial/ethnic disparities (RD>0) for colorectal, breast and prostate cancer were largest in the lowest SES groups. At some cancer sites, the highest SES group for minorities had worse trend results than the trends for the lowest SES white group (TD>0). PMID:17987912

  5. A trait-based trade-off between growth and mortality: evidence from 15 tropical tree species using size-specific relative growth rates

    PubMed Central

    Philipson, Christopher D; Dent, Daisy H; O’Brien, Michael J; Chamagne, Juliette; Dzulkifli, Dzaeman; Nilus, Reuben; Philips, Sam; Reynolds, Glen; Saner, Philippe; Hector, Andy

    2014-01-01

    A life-history trade-off between low mortality in the dark and rapid growth in the light is one of the most widely accepted mechanisms underlying plant ecological strategies in tropical forests. Differences in plant functional traits are thought to underlie these distinct ecological strategies; however, very few studies have shown relationships between functional traits and demographic rates within a functional group. We present 8 years of growth and mortality data from saplings of 15 species of Dipterocarpaceae planted into logged-over forest in Malaysian Borneo, and the relationships between these demographic rates and four key functional traits: wood density, specific leaf area (SLA), seed mass, and leaf C:N ratio. Species-specific differences in growth rates were separated from seedling size effects by fitting nonlinear mixed-effects models, to repeated measurements taken on individuals at multiple time points. Mortality data were analyzed using binary logistic regressions in a mixed-effects models framework. Growth increased and mortality decreased with increasing light availability. Species differed in both their growth and mortality rates, yet there was little evidence for a statistical interaction between species and light for either response. There was a positive relationship between growth rate and the predicted probability of mortality regardless of light environment, suggesting that this relationship may be driven by a general trade-off between traits that maximize growth and traits that minimize mortality, rather than through differential species responses to light. Our results indicate that wood density is an important trait that indicates both the ability of species to grow and resistance to mortality, but no other trait was correlated with either growth or mortality. Therefore, the growth mortality trade-off among species of dipterocarp appears to be general in being independent of species crossovers in performance in different light environments

  6. Brugada syndrome in a family with a high mortality rate: a case report

    PubMed Central

    2013-01-01

    Introduction Brugada syndrome is a hereditary arrhythmia characterized by a specific electrocardiographic pattern and an increased risk of sudden cardiac death, with an apparent absence of structural abnormalities or ischemic heart disease. To date, mutations in the sodium channel, voltage-gated, type V, alpha subunit gene and glycerol-3-phosphate dehydrogenase 1-like gene are estimated to account for approximately 28% of Brugada syndrome probands. Case presentation We report the case of a 32-year-old mixed-race Brazilian man who is sodium channel, voltage-gated, type V, alpha subunit gene and glycerol-3-phosphate dehydrogenase 1-like gene mutation-negative with a type 1 Brugada electrocardiographic pattern and a history of high family mortality, including five sudden deaths among relatives of whom four were first-degree relatives. Conclusion To the best of our knowledge, this is the first case of a patient who has Brugada syndrome and a history of sudden death in four first-degree family members. This case report reinforces the evidence that genetic studies are of limited use while determining risk but remain helpful for diagnosis, and that diagnosis via electrocardiography is of great importance in preventing adverse events and stratifying risk. Although there are several technologically advanced diagnostic tools, they might not be accessible in small towns and hospitals; however, a basic diagnostic tool like electrocardiography is easily accessible. PMID:23506330

  7. Fine-root mortality rates in a temperate forest: Estimates using radiocarbon data and numerical modeling

    SciTech Connect

    Riley, W.J.; Gaudinski, J.B.; Torn, M.S.; Joslin, J.D.; Hanson, P.J.

    2009-09-01

    We used an inadvertent whole-ecosystem {sup 14}C label at a temperate forest in Oak Ridge, Tennessee, USA to develop a model (Radix1.0) of fine-root dynamics. Radix simulates two live-root pools, two dead-root pools, non-normally distributed root mortality turnover times, a stored carbon (C) pool, and seasonal growth and respiration patterns. We applied Radix to analyze measurements from two root size classes (< 0.5 and 0.5-2.0 mm diameter) and three soil-depth increments (O horizon, 0-15 cm and 30-60 cm). Predicted live-root turnover times were < 1 yr and 10 yr for short- and long-lived pools, respectively. Dead-root pools had decomposition turnover times of 2 yr and 10 yr. Realistic characterization of C flows through fine roots requires a model with two live fine-root populations, two dead fine-root pools, and root respiration. These are the first fine-root turnover time estimates that take into account respiration, storage, seasonal growth patterns, and non-normal turnover time distributions. The presence of a root population with decadal turnover times implies a lower amount of belowground net primary production used to grow fine-root tissue than is currently predicted by models with a single annual turnover pool.

  8. The Effect of Application Rate of GF-120 (Spinosad) and Malathion on the Mortality of Apis mellifera (Hymenoptera: Apidae) Foragers.

    PubMed

    Cabrera-Marín, Nina Vanessa; Liedo, Pablo; Sánchez, Daniel

    2016-04-01

    Beneficial organisms like the honey bee, Apis mellifera L. (Hymenoptera: Apidae), are heavily affected by pest control practices that incorporate insecticides. Safer alternatives as the spinosad-based formulation GF-120 have been developed to overcome this issue. Though both the low concentration of spinosad and the ultra-low-volume application rate of GF-120 are supposed to have a low acute toxicity in honey bee foragers, to our knowledge such claims have not been explicitly proven. We thus carried out a series of experiments to assess the effect of GF-120, malathion, and Spintor (spinosad) on honey bee foragers when applied at two concentrations (80 and 1,500 ppm) and two application rates (low density rate [LDR]—80 drops of 5 mm diameter per square meter; high density rate [HDR]—thousands of 200 -µm-diameter droplets per square meter). Interestingly, the three pesticides caused low mortality on foragers when applied at LDR-80, LDR-1,500, or HDR-80. However, HDR-1,500 caused a very high mortality. Based upon these results, we developed a computer program to estimate the average number of foragers that are exposed at LDR and HDR. We found that more foragers receive a lethal dose when exposed at HDR than at the other rates. Our results support the hypothesis that the impact of GF-120 and malathion upon honey bees is minimal when applied at LDR and that computer simulation can help greatly in understanding the effects of pesticides upon nontarget species. PMID:26739308

  9. Mortality among Navajo uranium miners.

    PubMed Central

    Roscoe, R J; Deddens, J A; Salvan, A; Schnorr, T M

    1995-01-01

    OBJECTIVES. To update mortality risks for Navajo uranium miners, a retrospective cohort mortality study was conducted of 757 Navajos from the cohort of Colorado Plateau uranium miners. METHODS. Vital status was followed from 1960 to 1990. Standardized mortality ratios were estimated, with combined New Mexico and Arizona non-White mortality rates used for comparison. Cox regression models were used to evaluate exposure-response relationships. RESULTS. Elevated standardized mortality ratios were found for lung cancer (3.3), tuberculosis (2.6), and pneumoconioses and other respiratory diseases (2.6). Lowered ratios were found for heart disease (0.6), circulatory disease (0.4), and liver cirrhosis (0.5). The estimated relative risk for a 5-year duration of exposure vs none was 3.7 for lung cancer, 2.1 for pneumoconioses and other respiratory diseases, and 2.0 for tuberculosis. The relative risk for lung cancer was 6.9 for the midrange of cumulative exposure to radon progeny compared with the least exposed. CONCLUSIONS. Findings were consistent with those from previous studies. Twenty-three years after their last exposure to radon progeny, these light-smoking Navajo miners continue to face excess mortality risks from lung cancer and pneumoconioses and other respiratory diseases. PMID:7702118

  10. LOW PRETERM BIRTH RATE WITH DECREASING EARLY NEONATAL MORTALITY IN BOSNIA AND HERZEGOVINA DURING 2007-2014

    PubMed Central

    Hudic, Igor; Stray-Pedersen, Babill; Skokic, Fahrija; Fatusic, Zlatan; Zildzic-Moralic, Aida; Skokic, Maida; Fatusic, Jasenko

    2016-01-01

    The aim: of the study was to determine the situation of preterm births and early neonatal mortality during 2007-2014 in Tuzla Canton, Bosnia and Herzegovina. Methods: The study covers a 8-year period and is based on the protocols at the Tuzla Clinic for Gynecology and Obstetrics that covers all birth in Tuzla Canton area. We analyzed the gestational age of all newborns and recorded the number of neonatal deaths in the first week after birth. Demographics, pregnancy and birth characteristics were collected from the maternal records. Results: The total number of births in the period was 32738. Preterm birth was identified in 2401 (7.3%) cases with 12,5% occurring before 32 gestational weeks and 64% in 35-36 gestational weeks. The mothers of the 24-31 gws preterm group were significantly younger that those in the 32-36 group. In the 32-36 group there were significantly greater proportions of mothers with assisted reproductive technology and pre-eclampsia and 16.7% was medical induced preterm births versus 11.4 % in the 24-31 PTB group, p<0.05. The incidence of PTB did no vary significantly during the period, the lowest rate was found in 2010 (6.4%). A total of 221 children died giving a early mortality rate of 6.8 per 1000 live born over the 8 years. The majority 156 dying infants (70.6%) were preterm, only 5.7% died being born in the 35-36 gestational week (5.9 per 1000). Overall the preterm early mortality (7.3 per 1000) has shown a decreasing tendency during the latter years. Conclusion: During the last 8 years there have been no significant decline in preterm birth in the Tuzla region while a decline in early neonatal death has been registered. PMID:27047264

  11. Do deficits in cardiac care influence high mortality rates in schizophrenia? A systematic review and pooled analysis

    PubMed Central

    Mitchell, Alex J; Lord, Oliver

    2010-01-01

    We have previously documented inequalities in the quality of medical care provided to those with mental ill health but the implications for mortality are unclear. We aimed to test whether disparities in medical treatment of cardiovascular conditions, specifically receipt of medical procedures and receipt of prescribed medication, are linked with elevated rates of mortality in people with schizophrenia and severe mental illness. We undertook a systematic review of studies that examined medical procedures and a pooled analysis of prescribed medication in those with and without comorbid mental illness, focusing on those which recruited individuals with schizophrenia and measured mortality as an outcome. From 17 studies of treatment adequacy in cardiovascular conditions, eight examined cardiac procedures and nine examined adequacy of prescribed cardiac medication. Six of eight studies examining the adequacy of cardiac procedures found lower than average provision of medical care and two studies found no difference. Meta-analytic pooling of nine medication studies showed lower than average rates of prescribing evident for the following individual classes of medication; angiotensin converting enzyme inhibitors (n = 6, aOR = 0.779, 95% CI = 0.638–0.950, p = 0.0137), beta-blockers (n = 9, aOR = 0.844, 95% CI = 0.690–1.03, p = 0.1036) and statins (n = 5, aOR = 0.604, 95% CI = 0.408–0.89, p = 0.0117). No inequality was evident for aspirin (n = 7, aOR = 0.986, 95% CI = 0.7955–1.02, p = 0.382). Interestingly higher than expected prescribing was found for older non-statin cholesterol-lowering agents (n = 4, aOR = 1.55, 95% CI = 1.04–2.32, p = 0.0312). A search for outcomes in this sample revealed ten studies linking poor quality of care and possible effects on mortality in specialist settings. In half of the studies there was significantly higher mortality in those with mental ill health

  12. Trends in mortality rates from coronary heart disease in Belgrade (Serbia) during the period 1990–2010: a joinpoint regression analysis

    PubMed Central

    2013-01-01

    Background Coronary heart disease (CHD) causes an estimated 7 million deaths worldwide each year. In the last few decades, mortality from CHD has been decreasing in many countries. The aim of this study was to analyze the trends of mortality from CHD and myocardial infarction (MI) in the population of Belgrade during the period 1990–2010. Methods Mortality data for CHD and MI were obtained from the Municipal Institute of Statistics in Belgrade and used to calculate age- and sex-specific and age-adjusted mortality rates. Joinpoint regression analysis was used to estimate annual percent changes (APCs) in mortality and to identify points in time where significant changes in trend occur. Results Trends in CHD mortality rates showed significant decline in men during the period studied (APC -0.5%, no joinpoints detected), but no significant change among women (APC +0.4%, no joinpoints detected). While we observed significant declines in CHD mortality in men aged 35–44, 55–64 and 65–74 and women aged 55–64, there was a significant increase in mortality in men aged ≥85 and women aged 75–84 and ≥85. Trends in MI mortality rates showed similar patterns in both genders, with a significant decline from the mid-1990s. Significant decline in MI mortality was observed in almost all age groups, except the two oldest (75–84 and ≥85) in women population. Conclusions Given that CHD and MI mortality trends showed different patterns during the period studied, especially in women, our results imply that further observation of trend is needed. PMID:24320937

  13. Exploring scale-dependent correlations between cancer mortality rates using factorial kriging and population-weighted semivariograms.

    PubMed

    Goovaerts, Pierre; Jacquez, Geoffrey M; Greiling, Dunrie

    2005-04-01

    This paper presents a geostatistical methodology which accounts for spatially varying population size in the processing of cancer mortality data. The approach proceeds in two steps: (1) spatial patterns are first described and modeled using population-weighted semivariogram estimators, (2) spatial components corresponding to nested structures identified on semivariograms are then estimated and mapped using a variant of factorial kriging. The main benefit over traditional spatial smoothers is that the pattern of spatial variability (i.e. direction-dependent variability, range of correlation, presence of nested scales of variability) is directly incorporated into the computation of weights assigned to surrounding observations. Moreover, besides filtering the noise in the data the procedure allows the decomposition of the structured component into several spatial components (i.e. local versus regional variability) on the basis of semivariogram models. A simulation study demonstrates that maps of spatial components are closer to the underlying risk maps in terms of prediction errors and provide a better visualization of regional patterns than the original maps of mortality rates or the maps smoothed using weighted linear averages. The proposed approach also attenuates the underestimation of the magnitude of the correlation between various cancer rates resulting from noise attached to the data. This methodology has great potential to explore scale-dependent correlation between risks of developing cancers and to detect clusters at various spatial scales, which should lead to a more accurate representation of geographic variation in cancer risk, and ultimately to a better understanding of causative relationships. PMID:16915345

  14. Exploring scale-dependent correlations between cancer mortality rates using factorial kriging and population-weighted semivariograms

    PubMed Central

    Goovaerts, Pierre; Jacquez, Geoffrey M.; Greiling, Dunrie

    2006-01-01

    This paper presents a geostatistical methodology which accounts for spatially varying population size in the processing of cancer mortality data. The approach proceeds in two steps: (1) spatial patterns are first described and modeled using population-weighted semivariogram estimators, (2) spatial components corresponding to nested structures identified on semivariograms are then estimated and mapped using a variant of factorial kriging. The main benefit over traditional spatial smoothers is that the pattern of spatial variability (i.e. direction-dependent variability, range of correlation, presence of nested scales of variability) is directly incorporated into the computation of weights assigned to surrounding observations. Moreover, besides filtering the noise in the data the procedure allows the decomposition of the structured component into several spatial components (i.e. local versus regional variability) on the basis of semivariogram models. A simulation study demonstrates that maps of spatial components are closer to the underlying risk maps in terms of prediction errors and provide a better visualization of regional patterns than the original maps of mortality rates or the maps smoothed using weighted linear averages. The proposed approach also attenuates the underestimation of the magnitude of the correlation between various cancer rates resulting from noise attached to the data. This methodology has great potential to explore scale-dependent correlation between risks of developing cancers and to detect clusters at various spatial scales, which should lead to a more accurate representation of geographic variation in cancer risk, and ultimately to a better understanding of causative relationships. PMID:16915345

  15. An integrated surveillance system of road traffic injuries in the Lazio region of Italy: results of a 5-year study (2001-2005).

    PubMed

    Chini, Francesco; Farchi, Sara; Giorgi Rossi, Paolo; Camilloni, Laura; Borgia, Piero

    2010-09-01

    Road traffic injuries represent a relevant public-health problem. In the Lazio region of Italy, a surveillance system was activated. The aim of this work is to describe the surveillance system and report the health information in terms of temporal trends for the 5-year period 2001-2005. We identified all emergency department (ED) visits in the emergency database and then linked them with hospital discharges and mortality registry. From the integrated database, we calculated the rates of emergency room visits, of hospital admissions, and of mortality, reporting the temporal trends. Between 2001 and 2005 the rate of ED visits was 3151 per 100,000 inhabitants. Hospitalisation rates showed a significant decreasing trend. The surveillance identified 22% more deaths in the study period than reported by the official statistics. The surveillance revealed a decreasing trend for hospital admissions and a decline in deaths in 2003 concurrent to the introduction of the driver's licence point system. PMID:20352552

  16. Factors associated with declining under-five mortality rates from 2000 to 2013: an ecological analysis of 46 African countries

    PubMed Central

    Kipp, Aaron M; Blevins, Meridith; Haley, Connie A; Mwinga, Kasonde; Habimana, Phanuel; Shepherd, Bryan E; Aliyu, Muktar H; Ketsela, Tigest; Vermund, Sten H

    2016-01-01

    Objective Inadequate overall progress has been made towards the 4th Millennium Development Goal of reducing under-five mortality rates by two-thirds between 1990 and 2015. Progress has been variable across African countries. We examined health, economic and social factors potentially associated with reductions in under-five mortality (U5M) from 2000 to 2013. Setting Ecological analysis using publicly available data from the 46 nations within the WHO African Region. Outcome measures We assessed the annual rate of change (ARC) of 70 different factors and their association with the annual rate of reduction (ARR) of U5M rates using robust linear regression models. Results Most factors improved over the study period for most countries, with the largest increases seen for economic or technological development and external financing factors. The median (IQR) U5M ARR was 3.6% (2.8 to 5.1%). Only 4 of 70 factors demonstrated a strong and significant association with U5M ARRs, adjusting for potential confounders. Higher ARRs were associated with more rapidly increasing coverage of seeking treatment for acute respiratory infection (β=0.22 (ie, a 1% increase in the ARC was associated with a 0.22% increase in ARR); 90% CI 0.09 to 0.35; p=0.01), increasing health expenditure relative to gross domestic product (β=0.26; 95% CI 0.11 to 0.41; p=0.02), increasing fertility rate (β=0.54; 95% CI 0.07 to 1.02; p=0.07) and decreasing maternal mortality ratio (β=−0.47; 95% CI −0.69 to −0.24; p<0.01). The majority of factors showed no association or raised validity concerns due to missing data from a large number of countries. Conclusions Improvements in sociodemographic, maternal health and governance and financing factors were more likely associated with U5M ARR. These underscore the essential role of contextual factors facilitating child health interventions and services. Surveillance of these factors could help monitor which countries need additional support in reducing U5M

  17. Mortality rates among 5321 patients with burns admitted to a burn unit in China: 1980-1998.

    PubMed

    Jie, Xiao; Baoren, Cai

    2003-05-01

    A retrospective study was conducted on 5321 burn patients hospitalized in a burn center in Jinzhou, China during the period 1980-1998. Of the 5321 patients, 57.8% were between 15 and 44 years old and 3.4% were > or =60 years old. Ninety-six percent had burns covering less than half of body surface area and 31.7% had only full thickness skin burn. The number of patients in the 1990s was three times that of the 1980s. Overall mortality rate was 0.86%. LA(50) for total body burn area (TBSA) and only full thickness skin burn (FTSB) was 94 and 87%, respectively. The high survival rate, may relate primarily to the low percentages of older patients and of patients with severe burns. Inhalation injuries, infection and MOD are the main causes of deaths in our patients and would be key targets to improve clinical care and in future study. PMID:12706617

  18. Bias From Using Occupational Smoking Prevalence to Adjust Occupational Incidence Cohort Lung Cancer Mortality Rates

    PubMed Central

    Roth, H. Daniel

    2015-01-01

    Objective: To describe how smoking correction factors based on comparing worker smoking prevalence with population smoking prevalence are biased if applied to an occupational incidence cohort. Methods: Relative rates of smoking for shorter-tenure workers derived from occupational cohort lung cancer studies were applied to incidence and prevalence population tenure distributions to calculate relative smoking estimates. Results: High smoking rates in short-tenure workers have little effect on prevalent worker rates (relative smoking estimates, 1.04 and 1.02) and much larger effect in occupational incidence populations (relative smoking estimates, 1.58 and 1.21), which have a much higher proportion of short tenure-workers. Conclusions: Smoking correction estimates derived from surveys of smoking habits in prevalent workers may introduce bias when applied to incidence workers because of very different proportions of short-tenure workers (length-time biased sampling). PMID:25427172

  19. Adolescent Inpatient Psychiatric Admission Rates and Subsequent One-Year Mortality in England: 1998-2004

    ERIC Educational Resources Information Center

    James, Anthony; Clacey, Joe; Seagroatt, Valerie; Goldacre, Michael

    2010-01-01

    Background: Adolescence is a time of very rapid change not only in physical but also psychological development. During the teenage years there is a reported rise in the prevalence of psychiatric disorders. The aim of this study was to investigate age- and sex-specific National Health Service (NHS) hospital inpatient admission rates for psychiatric…

  20. Understanding the effects of age, period, and cohort on incidence and mortality rates.

    PubMed

    Holford, T R

    1991-01-01

    Time trends for population-based disease rates often are summarized by using direct adjustment by period of diagnosis or death. Similarly, the effect of age often is presented graphically as age-specific rates for a given period of diagnosis. These approaches may be necessary if there is an absence of long-term data, as they provide a natural way for annually updating information when monitoring trends, or they may be a convenient way of summarizing a large amount of data (7, 10, 11, 39, 45). However, these summaries only can adjust for the effect of age in a given period; they implicitly ignore the cohort effect. The effect of cohort is an important factor in understanding time trends for many diseases. Thus, it is not advisable to use data analytic strategies that routinely ignore it. Another alternative to modeling is to give a graphical presentation of the age-specific rates themselves. As I noted in the introduction, some of the first analyses to identify the effect of cohort on diseases, such as tuberculosis and lung cancer, relied entirely on a graphical analysis. Although graphs certainly are an important part of the interpretation of time trends, it would be a mistake to limit your analysis to impressions of points on a graph. For example, such a perusal would not give an objective indication of the statistical significance of a particular pattern. Regression analysis forces us to recognize a fundamental problem with interpreting time trends in disease rates--a problem that you should remember, even when trying to understand a graphical display of time trends in age-specific rates. PMID:2049144

  1. Measurement of a drowning incidence rate combining direct observation of an exposed population with mortality statistics.

    PubMed

    Morgan, Damian; Ozanne-Smith, Joan

    2015-01-01

    Drowning risk factors may be identified by comparing drowning incidence rates for comparable at-risk populations but precise methods are lacking. To address this knowledge gap, an ecological study extrapolated crude time-duration exposure to water for a specified at-risk sample of surf bathers to estimate the bather population for all wave-dominated beaches in Victoria, Australia, over a four-year summer season period. An incidence rate was calculated using surf bather drowning deaths frequencies matched for time and location. For the sample, 47,341 hours of surf bathing were estimated from 177,528 bathing episodes. Generalising these results to Victoria, the crude drowning deaths incidence rate in the summer season was 0.41 per 1,000,000 person-hours of surf bathing (95% CI 0.37-0.45). Further application of the method, particularly in open water settings, may be used to identify candidate drowning risk factors to advance drowning prevention strategies. PMID:24758173

  2. The choice of self-rated health measures matter when predicting mortality: evidence from 10 years follow-up of the Australian longitudinal study of ageing

    PubMed Central

    2010-01-01

    Background Self-rated health (SRH) measures with different wording and reference points are often used as equivalent health indicators in public health surveys estimating health outcomes such as healthy life expectancies and mortality for older adults. Whilst the robust relationship between SRH and mortality is well established, it is not known how comparable different SRH items are in their relationship to mortality over time. We used a dynamic evaluation model to investigate the sensitivity of time-varying SRH measures with different reference points to predict mortality in older adults over time. Methods We used seven waves of data from the Australian Longitudinal Study of Ageing (1992 to 2004; N = 1733, 52.6% males). Cox regression analysis was used to evaluate the relationship between three time-varying SRH measures (global, age-comparative and self-comparative reference point) with mortality in older adults (65+ years). Results After accounting for other mortality risk factors, poor global SRH ratings increased mortality risk by 2.83 times compared to excellent ratings. In contrast, the mortality relationship with age-comparative and self-comparative SRH was moderated by age, revealing that these comparative SRH measures did not independently predict mortality for adults over 75 years of age in adjusted models. Conclusions We found that a global measure of SRH not referenced to age or self is the best predictor of mortality, and is the most reliable measure of self-perceived health for longitudinal research and population health estimates of healthy life expectancy in older adults. Findings emphasize that the SRH measures are not equivalent measures of health status. PMID:20403203

  3. A 6-year comparative economic evaluation of healthcare costs and mortality rates of Dutch patients from conventional and CAM GPs

    PubMed Central

    Baars, Erik W; Kooreman, Peter

    2014-01-01

    Objectives To compare healthcare costs and mortality rates of Dutch patients with a conventional (CON) general practitioner (GP) and patients with a GP who has additionally completed training in complementary and alternative medicine (CAM). Design Comparative economic evaluation. Setting Database from the Dutch insurance company Agis. Participants 1 521 773 patients (98.8%) from a CON practice and 18 862 patients (1.2%) from a CAM practice. Main outcome measures Annual information on five types of healthcare costs for the years 2006–2011: care by GP, hospital care, pharmaceutical care, paramedic care and care covered by supplementary insurance. Healthcare costs in the last year of life. Mortality rates. Results The mean annual compulsory and supplementary healthcare costs of CON patients are respectively €1821 (95% CI 1813 to 1828) and €75.3 (95% CI 75.1 to 75.5). Compulsory healthcare costs of CAM patients are €225 (95% CI 169 to 281; p<0.001; 12.4%) lower and result mainly from lower hospital care costs (€165; 95% CI 118 to 212; p<0.001) and lower pharmaceutical care costs (€58; 95% CI 41 to 75; p<0.001), especially in the age categories 25–49 and 50–74 years. The costs in the last year of life of patients with CAM, GPs are €1161 (95% CI −138 to 2461; p<0.1) lower. This difference is entirely due to lower hospital costs (€1250; 95% CI 19 to 2481; p<0.05). The mean annual supplementary costs of CAM patients are €33 (95% CI 30 to 37; p<0.001; 44%) higher. CAM patients do not have lower or higher mortality rates than CON patients. Conclusions Dutch patients whose GP additionally completed training in CAM on average have €192 (10.1%) lower annual total compulsory and supplementary healthcare costs and do not live longer or shorter than CON patients. PMID:25164536

  4. Age, differential growth and mortality rates in unexploited populations of Florida gar, an apex predator in the Florida Everglades

    USGS Publications Warehouse

    Murie, D.J.; Parkyn, D.C.; Nico, L.G.; Herod, J.J.; Loftus, W.F.

    2009-01-01

    Florida gar, Lepisosteus platyrhincus DeKay, were sampled in two canal systems in south Florida during 2000-2001 to estimate age, growth and mortality as part of the Everglades ecosystem-restoration effort. Tamiami (C-4) and L-31W canal systems had direct connections to natural wetlands of the Everglades and harboured large Florida gar populations. Of 476 fish aged, maximum ages were 19 and 10years for females and males, respectively. Maximum sizes were also larger for females compared with males (817 vs 602 mm total length). Overall, female Florida gar from both Tamiami and L-31W were larger at age than males from L-31W that, in turn, were larger at any given age than males from Tamiami. Females also had lower rates of annual mortality (Z = 0.21) than males from L-31W (Z = 0.31) or males from Tamiami (Z = 0.54). As a large and long-lived apex predator in the Everglades, Florida gar may structure lower trophic levels. Regional- and sex-specific population parameters for Florida gar will contribute to the simulation models designed to evaluate Everglades restoration alternatives. ?? 2009 Blackwell Publishing Ltd.

  5. Equine-associated maxillofacial injuries: retrospective 5-year analysis.

    PubMed

    Islam, Shofiq; Gupta, Benjamin; Taylor, Christopher J; Chow, Jeffrey; Hoffman, Gary R

    2014-02-01

    We explored the relation between the causes of facial injuries in equestrians and the presence or absence of associated injuries. Over a 5-year period we retrospectively reviewed all patients who presented to the John Hunter Hospital, New South Wales, with facial injuries that had resulted from activity with horses. We analysed the rates of hard and soft tissue injuries, and of associated injuries by sex and mechanism. A total of 85 patients were included (50 female and 35 male) with an age range of 2-88 years. There was a significant difference in the rate of maxillofacial and associated injuries when groups were analysed for sex and mechanism of injury. Facial injuries caused by falling from a horse were more often associated with other injuries in men than in women (p<0.05), and men were 4 times more likely to present with associated injuries than women (OR 3.9; 95% CI 1.1 to 14) We also found significant differences in the rates of facial fracture. Women who had been kicked by a horse were more likely to sustain bony injuries than men (p<0.05). Our data confirm the association between kicks and facial fracture, and this may provide an impetus for the development of appropriate protective equipment. Patients who sustain facial injuries when falling from a horse often present with associated injuries and this has practical implications for clinicians involved in their management. PMID:24168759

  6. Impact of Starting an Emergency Medicine Residency Program on Overall Mortality Rate in a Regional Trauma Center

    PubMed Central

    McLaughlin, Thomas; Blow, Osbert; Herrick, John; Richman, Peter

    2016-01-01

    Background CHRISTUS Spohn Hospital Corpus Christi - Memorial began an Emergency Medicine Residency Program in March 2007. During each of the three years of their residency, residents are required to complete a trauma surgery rotation. These emergency medicine residents are the only residents participating on this rotation as there is no surgical residency. The Department of Acute Care Surgery, Trauma and Surgical Critical Care analyzed the impact of the residents on trauma patient care outcomes with the hypothesis that there were no differences. Methods Data including length of stay in the hospital, length of stay in the intensive care unit, time spent in the emergency department (ED), morbidities and mortalities were compiled from the trauma registry for patients from the year before the residents began (March 1, 2006 to February 28, 2007) and compared with patients from the first year the residents began their trauma rotations (March 1, 2007 to February 29, 2008). T-tests and Mann-Whitney U tests were used to compare continuous variables and a Chi-square test was used to analyze the categorical variable (mortality). Linear and logistic regression analyses were also performed in order to adjust for potential confounding factors. Results Trauma patient admission rates were 1,316 before and 1,391 after the residents began. No statistically significant differences were found among all of the outcome variables during the two time periods except for time spent in the ED (P = 0.00), which increased during the year the residents began (236.83 ± 4.53 minutes in 2006 compared to 297.40 ± 5.55 minutes in 2007). Linear and logistic regression analyses confirmed these results with the exception of a statistically significant decrease in mortality with the residents on the trauma service (2.8% in 2006 and 2.1% in 2007, P = 0.00) after adjustment for multiple confounding factors. Conclusion The addition of emergency medicine residents to the trauma care service did increase

  7. Age effects in monetary valuation of reduced mortality risks: the relevance of age-specific hazard rates.

    PubMed

    Leiter, Andrea M

    2011-08-01

    This paper highlights the relevance of age-specific hazard rates in explaining the age variation in "value of statistical life" (VSL) figures. The analysis-which refers to a stated preference framework-contributes to the ongoing discussion of whether benefits resulting from reduced mortality risk should be valued differently depending on the age of the beneficiaries. By focussing on a life-threatening environmental phenomenon I show that the consideration of the individual's age-specific hazard rate is important. If a particular risk affects all individuals regardless of their age so that their hazard rate is age-independent, VSL is rather constant for people at different age; if hazard rate varies with age, VSL estimates are sensitive to age. The results provide an explanation for the mixed outcomes in empirical studies and illustrate in which cases an adjustment to age may or may not be justified. Efficient provision of live-saving measures requires that such differences to be taken into account. PMID:20376521

  8. Estrous length, pregnancy rate, gestation and parturition lengths, litter size, and juvenile mortality in the domestic cat.

    PubMed

    Root, M V; Johnston, S D; Olson, P N

    1995-01-01

    Reproductive performance in a feline research colony of 14 queens is reported. Average estrous length in 38 cycles was 5.8 +/- 3.3 days, with a range of two to 19 days. Estrous length in 23 bred cycles was not shorter (p greater than 0.05) than in 15 nonbred cycles, suggesting that induction of ovulation does not decrease estrous length. Pregnancy rate in 23 bred cycles was 73.9%. Gestation length averaged 66.9 +/- 2.9 days with a range of 62 to 71 days (n = 15). Average parturition length was 16.1 +/- 14.3 hours (n = 7), with a range of four to 42 hours. Litter size ranged from one to five kittens, with an average of 3.7 kittens per litter (n = 15). Percent mortality by eight weeks of age was 29.1%, with 4.7% stillbirths. PMID:8542362

  9. [Differences between neonatal mortality and stillbirth rates in Brazil: a study based on the Unified Health System (SIH/SUS) Hospital Information System].

    PubMed

    de Andrade Schramm, J M; Szwarcwald, C L

    2000-01-01

    The main objective of this article is to estimate stillbirth and neonatal mortality rates in Brazilian States based upon the country's Hospital Information System. Analysis of 1995 data reveals contrasting rates between the various regions of the country. In order to elucidate the States' different rates, we focused on the association between indicators of coverage, utilization, and access to the Unified Health System (SUS). The results for the neonatal period mostly showed higher early neonatal mortality rates when compared to late neonatal mortality rates, higher neonatal mortality rates in the States comprising the South and Southeast regions, less variable rates between those States, and extremely low rates in some States of the North, Central-West, and Northeast regions. The limited supply of SUS services and low access to same are relevant constraints on health care for the population in the North and Northeast. Aspects related to quality of childbirth and neonatal care are also reflected in the rates studied. The findings suggest that spatial and temporal monitoring of these rates could provide analytical support for organizing the Maternal and Child Health Program. PMID:11175526

  10. Phycocyanobilin accelerates liver regeneration and reduces mortality rate in carbon tetrachloride-induced liver injury mice

    PubMed Central

    Liu, Jie; Zhang, Qing-Yu; Yu, Li-Ming; Liu, Bin; Li, Ming-Yi; Zhu, Run-Zhi

    2015-01-01

    AIM: To investigate the hepatoprotective effects of phycocyanobilin (PCB) in reducing hepatic injury and accelerating hepatocyte proliferation following carbon tetrachloride (CCl4) treatment. METHODS: C57BL/6 mice were orally administered PCB 100 mg/kg for 4 d after CCl4 injection, and then the serum and liver tissue of the mice were collected at days 1, 2, 3, 5 and 7 after CCl4 treatment. A series of evaluations were performed to identify the curative effects on liver injury and recovery. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin and superoxide dismutase (SOD) were detected to indirectly assess the anti-inflammatory effects of PCB. Meanwhile, we detected the expressions of hepatocyte growth factor, transforming growth factor alpha (TGF-α), TGF-β, tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), the factors which are associated with inflammation and liver regeneration. The protein expressions of proliferating cell nuclear antigen (PCNA), TNF-α and cytochrome C were detected by western blot. Furthermore, the survival rates were analyzed of mice which were administered a lethal dose of CCl4 (2.6 mg/kg) with or without PCB. RESULTS: In our research, PCB showed a strongly anti-inflammatory effect on CCl4-induced liver injury in mice. The ALT was significantly decreased after CCl4 treatment from day 1 (P < 0.01) and the AST was significantly decreased from day 2 (P < 0.001). Both albumin and liver SOD were increased from day 2 (P < 0.001 and P < 0.01), but serum SOD levels did not show a significant increase (P > 0.05). PCB protected the structure of liver from the injury by CCl4. TUNEL assay showed that PCB dramatically reduced the number of apoptotic cells after CCl4 treatment compared to the control (101.0 ± 25.4 vs 25.7 ± 6.4, P < 0.01). The result of western blotting showed that PCB could increase PCNA expression, decrease TNF-α and cytochrome C expression. Furthermore, data shows that PCB could improve the

  11. Estimating natural mortality rates and simulating fishing scenarios for Gulf of Mexico red grouper (Epinephelus morio) using the ecosystem model OSMOSE-WFS

    NASA Astrophysics Data System (ADS)

    Grüss, Arnaud; Schirripa, Michael J.; Chagaris, David; Velez, Laure; Shin, Yunne-Jai; Verley, Philippe; Oliveros-Ramos, Ricardo; Ainsworth, Cameron H.

    2016-02-01

    The ecosystem model OSMOSE-WFS was employed to evaluate natural mortality rates and fishing scenarios for Gulf of Mexico (GOM) red grouper (Epinephelus morio). OSMOSE-WFS represents major high trophic level (HTL) groups of species of the West Florida Shelf, is forced by the biomass of plankton and benthos groups, and has a monthly time step. The present application of the model uses a recently developed 'stochastic mortality algorithm' to resolve the mortality processes of HTL groups. OSMOSE-WFS predictions suggest that the natural mortality rate of juveniles of GOM red grouper is high and essentially due to predation, while the bulk of the natural mortality of adult red grouper results from causes not represented in OSMOSE-WFS such as, presumably, red tides. These results were communicated to GOM red grouper stock assessments. Moreover, OSMOSE-WFS indicate that altering the fishing mortality of GOM red grouper may have no global impact on the biomass of the major prey of red grouper, due to the high complexity and high redundancy of the modeled system. By contrast, altering the fishing mortality of GOM red grouper may have a large impact on the biomass of its major competitors. Increasing the fishing mortality of red grouper would increase the biomass of major competitors, due to reduced competition for food. Conversely, decreasing the fishing mortality of red grouper would diminish the biomass of major competitors, due to increased predation pressure on the juveniles of the major competitors by red grouper. The fishing scenarios that we evaluated may have slightly different impacts in the real world, due to some discrepancies between the diets of red grouper and its major competitors predicted by OSMOSE-WFS and the observed ones. Modifications in OSMOSE-WFS are suggested to reduce these discrepancies.

  12. Lower mortality rates at cardiac specialty hospitals traceable to healthier patients and to doctors' performing more procedures.

    PubMed

    O'Neill, Liam; Hartz, Arthur J

    2012-04-01

    Physician-owned cardiac specialty hospitals advertise that they have outstanding physicians and results. To test this assertion, we examined who gets referred to these hospitals, as well as whether different results occur when specialty physicians split their caseloads among specialty and general hospitals in the same markets. Using data on 210,135 patients who underwent percutaneous coronary interventions in Texas during 2004-07, we found that the risk-adjusted in-hospital mortality rate for patients treated at specialty hospitals was significantly below the rate for all hospitals in the state (0.68 percent versus 1.50 percent). However, the rate was significantly higher when physicians who owned cardiac specialty hospitals treated patients in general hospitals (2.27 percent versus 1.50 percent). In addition, several patient characteristics were associated with a lower likelihood of being admitted to a cardiac hospital for cardiac care, such as being African American or Hispanic and having Medicaid or no health insurance. After adjustment for patient severity and number of procedures performed, the overall outcomes for cardiologists who owned specialty hospitals were not significantly different from the "average outcomes" obtained at noncardiac hospitals. In contrast to previous studies, patient outcomes were found to be highly dependent on the type of hospital where the procedure was performed. To remove a potential source of bias and achieve a more balanced comparison, the quality statistics reported by physician-owned cardiac hospitals should be adjusted to incorporate the high rates of poor outcomes for the many procedures done by their cardiologists at nearby noncardiac hospitals. PMID:22492898

  13. Mortality in over 350,000 Insured Swedish dogs from 1995–2000: I. Breed-, Gender-, Age- and Cause-specific Rates

    PubMed Central

    Bonnett, BN; Egenvall, A; Hedhammar, Å; Olson, P

    2005-01-01

    This study presents data on over 350,000 insured Swedish dogs up to 10 years of age contributing to over one million dog-years at risk (DYAR) during 1995–2000. A total of 43,172 dogs died or were euthanised and of these 72% had a claim with a diagnosis for the cause of death. The overall total mortality was 393 deaths per 10,000 DYAR. Mortality rates are calculated for the 10 most common breeds, 10 breeds with high mortality and a group including all other breeds, crudely and for general causes of death. Proportional mortality is presented for several classifications. Five general causes accounted for 62% of the deaths with a diagnosis (i.e. tumour (18%), trauma (17%), locomotor (13%), heart (8%) and neurological (6%)). Mortality rates for the five most common diagnoses within the general causes of death are presented. These detailed statistics on mortality can be used in breed-specific strategies as well as for general health promotion programs. Further details on survival and relative risk by breed and age are presented in the companion paper [14]. PMID:16261924

  14. Inclusion of non-viable neonates in the birth record and its impact on infant mortality rates in Shelby County, Tennessee, USA

    PubMed Central

    Williams, Bryan L.; Magsumbol, Melina S.

    2010-01-01

    Rates of infant death are one of the most common indicators of a population's overall health status. Infant mortality rates (IMRs) are used to make broad inferences about the quality of health care, effects of health policies and even environmental quality. The purpose of our study was threefold: i) to examine the characteristics of births in the area in relation to gestational age and birthweight; ii) to estimate infant mortality using variable gestational age and/or birthweight criteria for live birth, and iii) to calculate proportional mortality ratios for each cause of death using variable gestational age and/or birthweight criteria for live birth. We conducted a retrospective analysis of all Shelby County resident-linked birth and infant death certificates during the years 1999 to 2004. Descriptive test statistics were used to examine infant mortality rates in relation to specific maternal and infant risk factors. Through careful examination of 1999–2004 resident-linked birth and infant death data sets, we observed a disproportionate number of non-viable live births (≤20 weeks gestation or ≤350 grams) in Shelby County. Issuance of birth certificates to these non-viable neonates is a factor that contributes to an inflated IMR. Our study demonstrates the complexity and the appropriateness of comparing infant mortality rates in smaller geographic units, given the unique characteristics of live births in Shelby County. The disproportionate number of pre-viable infants born in Shelby County greatly obfuscates neonatal mortality and de-emphasizes the importance of post-neonatal mortality. PMID:21589834

  15. Recanalization and Mortality Rates of Thrombectomy With Stent-Retrievers in Octogenarian Patients with Acute Ischemic Stroke

    SciTech Connect

    Parrilla, G.; Carreón, E.; Zamarro, J.; Espinosa de Rueda, M.; García-Villalba, B.; Marín, F.; Hernández-Fernández, F.; Morales, A.; Fernández-Vivas, M.; Núñez, R.; Moreno, A.

    2015-04-15

    BackgroundOur objective was to evaluate the effect of treatment with stent-retrievers in octogenarians suffering an acute ischemic stroke.MethodsA total of 150 consecutive patients with acute stroke who were treated with stent-retrievers between April 2010 and June 2012 were retrospectively reviewed. Patients were divided into those <80 years old (n = 116) and those ≥80 (n = 34). Baseline characteristics, procedure data, and endpoints (postprocedural NIHSS, death, and mRS at 3 months) were compared.ResultsHigh blood pressure, atrial fibrillation, and anticoagulation were more frequent in octogenarians (p = 0.01, 0.003, and 0.04 respectively). There were no differences between both groups regarding previous intravenous thrombolysis (32.4 vs. 48.3 %, p = 0.1), preprocedural NIHSS (18.1 vs. 16.8, p = 0.3), procedure time (74.5 (40–114) min vs. 63 (38–92) min, p = 0.2), revascularization time (380.5 (298–526.3) min vs. 350 (296.3–452.8), p = 0.3), TICI ≥ 2B (88.2 vs. 93.9 %, p = 0.1), and symptomatic haemorrhage (5.9 vs. 2.6 %, p = 0.3). Discharge NIHSS was higher in octogenarians (9.7 vs. 6.5, p = 0.03). Death and 3-month mRS ≥3 were more frequent in octogenarians (35.3 vs. 17.2 %, p = 0.02 and 73.5 vs. 37.1 %, p = 0.02). ICA-involvement and prolonged revascularization involved higher mortality (66.7 vs. 27.6 %, p = 0.03) and worse mRS (50 vs. 24.4 %, p = 0.06) in octogenarians.ConclusionsIn our series, treatment with stent-retrievers in octogenarians with acute ischemic stroke achieved good rates of recanalization but with a high mortality rate. ICA involvement and revascularization times beyond 6 hours associated to a worse prognosis. These data might be of value in the design of prospective studies evaluating the clinical efficacy of the endovascular treatments in octogenarians.

  16. Evidence of functional declining and global comorbidity measured at baseline proved to be the strongest predictors for long-term death in elderly community residents aged 85 years: a 5-year follow-up evaluation, the OCTABAIX study

    PubMed Central

    Formiga, Francesc; Ferrer, Assumpta; Padros, Gloria; Montero, Abelardo; Gimenez-Argente, Carme; Corbella, Xavier

    2016-01-01

    Objective To investigate the predictive value of functional impairment, chronic conditions, and laboratory biomarkers of aging for predicting 5-year mortality in the elderly aged 85 years. Methods Predictive value for mortality of different geriatric assessments carried out during the OCTABAIX study was evaluated after 5 years of follow-up in 328 subjects aged 85 years. Measurements included assessment of functional status comorbidity, along with laboratory tests on vitamin D, cholesterol, CD4/CD8 ratio, hemoglobin, and serum thyrotropin. Results Overall, the mortality rate after 5 years of follow-up was 42.07%. Bivariate analysis showed that patients who survived were predominantly female (P=0.02), and they showed a significantly better baseline functional status for both basic (P<0.001) and instrumental (P<0.001) activities of daily living (Barthel and Lawton index), better cognitive performance (Spanish version of the Mini-Mental State Examination) (P<0.001), lower comorbidity conditions (Charlson) (P<0.001), lower nutritional risk (Mini Nutritional Assessment) (P<0.001), lower risk of falls (Tinetti gait scale) (P<0.001), less percentage of heart failure (P=0.03) and chronic obstructive pulmonary disease (P=0.03), and took less chronic prescription drugs (P=0.002) than nonsurvivors. Multivariate Cox regression analysis identified a decreased score in the Lawton index (hazard ratio 0.86, 95% confidence interval: 0.78–0.91) and higher comorbidity conditions (hazard ratio 1.20, 95% confidence interval: 1.08–1.33) as independent predictors of mortality at 5 years in the studied population. Conclusion The ability to perform instrumental activities of daily living and the global comorbidity assessed at baseline were the predictors of death, identified in our 85-year-old community-dwelling subjects after 5 years of follow-up. PMID:27143867

  17. Evaluation of annual survival and mortality rates and longevity of bottlenose dolphins (Tursiops truncatus) at the United States Navy Marine Mammal Program from 2004 through 2013.

    PubMed

    Venn-Watson, Stephanie K; Jensen, Eric D; Smith, Cynthia R; Xitco, Mark; Ridgway, Sam H

    2015-04-15

    Objective-To evaluate annual survival and mortality rates and the longevity of a managed population of bottlenose dolphins (Tursiops truncatus). Design-Retrospective cohort study. Animals-103 bottlenose dolphins at the US Navy Marine Mammal Program (MMP). Procedures-Population age structures, annual survival and crude mortality rates, and median age at death for dolphins > 30 days old were determined from 2004 through 2013. Results-During 2004 through 2013, the annual survival rates for MMP dolphins ranged from 0.98 to 1.0, and the annual crude mortality rates ranged from 0% to 5%, with a mean of 2.7%. The median age at death was 30.1 years from 2004 through 2008 and increased to 32 years from 2009 through 2013. The maximum age for a dolphin in the study was 52 years. Conclusions and Clinical Relevance-Results indicated that the annual mortality rates were low and survival rates were high for dolphins in the MMP from 2004 through 2013 and that the median age at death for MMP dolphins during that time was over 10 years greater than that reported in free-ranging dolphins. These findings were likely attributable to the continually improving care and husbandry of managed dolphin populations. PMID:25835174

  18. Morbidity and mortality in motor neuron disease: comparison with multiple sclerosis and Parkinson's disease: age and sex specific rates and cohort analyses.

    PubMed Central

    Li, T M; Swash, M; Alberman, E

    1985-01-01

    The cause of motor neuron disease (MND) remains unknown although recent reports have suggested a possible rise in mortality rate. The present account describes age-specific patterns in morbidity rate and cross-sectional and cohort analyses of mortality rate, and compares these with those in multiple sclerosis and Parkinson's disease. First hospital admission rate for motor neuron disease (a proxy for incidence rates) rose steadily with age in males and females until the age of 75 years or more, but then fell, but only in females. This irregular pattern suggested the possibility of an environmental effect on certain older birth cohorts. The validity of the results was supported by a similar pattern in the two hospital regional authorities studied and the difference between this pattern and that found in multiple sclerosis and Parkinson's disease. Age-specific mortality rates of motor neuron disease between 15 and 64 years for males and females in England and Wales from 1940 to 1982 rose steadily with age. Mortality rates after the age of 65 fell in all female cohorts studied, but only in the earlier male cohorts. Unlike Parkinson's disease there was no strong birth cohort effect. However an analysis of Office of Population Censuses and Surveys (Registrar General) reports has revealed a slight increase in the age-specific mortality rate in both males and females aged 65 and over for successive birth cohorts born since 1900. Neither changes in ICD coding or in diagnostic habits could account for this pattern, which differed from that seen in Parkinson's disease. No such effect was seen in multiple sclerosis. PMID:3873517

  19. Does absorption of ultraviolet B by stratospheric ozone and urban aerosols influence colon and breast cancer mortality rates? Contributions from NASA and NOAA data

    NASA Astrophysics Data System (ADS)

    Gorham, Edward D.; Garland, Frank C.; Mohr, Sharif B.; Grant, William B.; Garland, Cedric F.

    2005-08-01

    Although most ultraviolet B (UVB) radiation is absorbed by stratospheric ozone, dense anthropogenic sulfate aerosols in the troposphere may further attenuate UVB in some regions. Mortality rates from colon and breast cancer tend to be much higher in areas with low levels of UVB radiation. These high rates may be due in part to inadequate cutaneous photosynthesis of vitamin D. Satellite data on atmospheric aerosols, stratospheric ozone, and cloud cover were obtained from the National Aeronautics and Space Administration (NASA) and the National Oceanic and Atmospheric Administration (NOAA). These data were combined with age-adjusted mortality rates from 175 countries reporting to the World Health Organization. Regression was used to assess the relationship of stratospheric ozone thickness, aerosol optical depth, cloud cover, solar UVB irradiance at the top of the atmosphere, average skin exposure, and a dietary factor with colon and breast cancer mortality rates. Solar UVB irradiance at the top of the atmosphere, total cloud cover, and atmospheric aerosols had the strongest associations with mortality rates, apart from a strong influence of diet. Since 95% of circulating vitamin D is derived from current or stored products of photosynthesis, which may be nonexistent or minimal much of the year above 37°N or below 37°S, attenuation of UVB by atmospheric aerosols and clouds may have a greater than expected adverse effect on human health.

  20. The logic of comparative life history studies for estimating key parameters, with a focus on natural mortality rate

    USGS Publications Warehouse

    Hoenig, John M; Then, Amy Y.-H.; Babcock, Elizabeth A.; Hall, Norman G.; Hewitt, David A.; Hesp, Sybrand A.

    2016-01-01

    There are a number of key parameters in population dynamics that are difficult to estimate, such as natural mortality rate, intrinsic rate of population growth, and stock-recruitment relationships. Often, these parameters of a stock are, or can be, estimated indirectly on the basis of comparative life history studies. That is, the relationship between a difficult to estimate parameter and life history correlates is examined over a wide variety of species in order to develop predictive equations. The form of these equations may be derived from life history theory or simply be suggested by exploratory data analysis. Similarly, population characteristics such as potential yield can be estimated by making use of a relationship between the population parameter and bio-chemico–physical characteristics of the ecosystem. Surprisingly, little work has been done to evaluate how well these indirect estimators work and, in fact, there is little guidance on how to conduct comparative life history studies and how to evaluate them. We consider five issues arising in such studies: (i) the parameters of interest may be ill-defined idealizations of the real world, (ii) true values of the parameters are not known for any species, (iii) selecting data based on the quality of the estimates can introduce a host of problems, (iv) the estimates that are available for comparison constitute a non-random sample of species from an ill-defined population of species of interest, and (v) the hierarchical nature of the data (e.g. stocks within species within genera within families, etc., with multiple observations at each level) warrants consideration. We discuss how these issues can be handled and how they shape the kinds of questions that can be asked of a database of life history studies.

  1. Association of Carcinogenic Polycyclic Aromatic Hydrocarbon Emissions and Smoking with Lung Cancer Mortality Rates on a Global Scale

    PubMed Central

    Motorykin, Oleksii; Matzke, Melissa M.; Waters, Katrina M.; Massey Simonich, Staci L.

    2013-01-01

    The objective of this research was to investigate the relationship between lung cancer mortality rates, carcinogenic polycyclic aromatic hydrocarbons (PAHs) emissions, and smoking on a global scale, as well as for different socioeconomic country groups. The estimated lung cancer deaths per 100,000 people (ED100000) and age standardized lung cancer death rate per 100,000 people (ASDR100000) in 2004 were regressed on PAH emissions in benzo[a]pyrene equivalence (BaPeq), smoking prevalence, cigarette price, gross domestic product per capita, percentage of people with diabetes, and average body mass index using simple and multiple linear regression for 136 countries. Using stepwise multiple linear regression, a statistically significant positive linear relationship was found between loge(ED100000) and loge(BaPeq) emissions for high (p-value<0.01) and for the combination of upper middle and high (p-value<0.05) socioeconomic country groups. A similar relationship was found between loge(ASDR100000) and loge(BaPeq) emissions for the combination of upper middle and high (p-value<0.01) socioeconomic country groups. Conversely, for loge(ED100000) and loge(ASDR100000), smoking prevalence was the only significant independent variable in the low socioeconomic country group (p-value<0.001). These results suggest that reducing BaPeq emissions in the U.S., Canada, Australia, France, Germany, Brazil, South Africa, Poland, Mexico, and Malaysia could reduce ED100000, while reducing smoking prevalence in Democratic People’s Republic of Korea, Nepal, Mongolia, Cambodia, and Bangladesh could significantly reduce the ED100000 and ASDR100000. PMID:23472838

  2. The effect of excess fluid balance on the mortality rate of surgical patients: a multicenter prospective study

    PubMed Central

    2013-01-01

    Introduction In some studies including small populations of patients undergoing specific surgery, an intraoperative liberal infusion of fluids was associated with increasing morbidity when compared to restrictive strategies. Therefore, to evaluate the role of excessive fluid infusion in a general population with high-risk surgery is very important. The aim of this study was to evaluate the impact of intraoperative fluid balance on the postoperative organ dysfunction, infection and mortality rate. Methods We conducted a prospective cohort study during one year in four ICUs from three tertiary hospitals, which included patients aged 18 years or more who required postoperative ICU after undergoing major surgery. Patients who underwent palliative surgery and whose fluid balance could change in outcome were excluded. The calculation of fluid balance was based on preoperative fasting, insensible losses from surgeries and urine output minus fluid replacement intraoperatively. Results The study included 479 patients. Mean age was 61.2 ± 17.0 years and 8.8% of patients died at the hospital during the study. The median duration of surgery was 4.0 (3.2 to 5.5) h and the value of the Simplified Acute Physiology Score (SAPS) 3 score was 41.8 ± 14.5. Comparing survivors and non-survivors, the intraoperative fluid balance from non-survivors was higher (1,950 (1,400 to 3,400) mL vs. 1,400 (1,000 to 1,600) mL, P <0.001). Patients with fluid balance above 2,000 mL intraoperatively had a longer ICU stay (4.0 (3.0 to 8.0) vs. 3.0 (2.0 to 6.0), P <0.001) and higher incidence of infectious (41.9% vs. 25.9%, P = 0.001), neurological (46.2% vs. 13.2%, P <0.001), cardiovascular (63.2% vs. 39.6%, P <0.001) and respiratory complications (34.3% vs. 11.6%, P <0.001). In multivariate analysis, the fluid balance was an independent factor for death (OR per 100 mL = 1.024; P = 0.006; 95% CI 1.007 to 1.041). Conclusions Patients with excessive intraoperative fluid balance have more ICU

  3. Surgical treatment of cardiac tumors: a 5-year experience from a single cardiac center

    PubMed Central

    Yin, Liang; He, Dengke; Shen, Hua; Ling, Xinyu; Li, Wei; Xue, Qian

    2016-01-01

    Background Cardiac tumors are rare but manifested with various clinical presentations and often cause unexpected symptoms or sudden death. The objective is to review the clinical presentation, histopathological spectrum, mortality and follow-up data of patients with cardiac tumors following surgery treatment over a period of 5 years. Methods We retrospectively collected the medical records of all patients diagnosed of cardiac tumors in the period between January 2008 and December 2013 at the cardiac center of our university. Clinical histories, perioperative data, surgical findings, efficacy and follow-up data were reviewed in our study. Patients were divided into two groups according to site distribution of the tumors in the heart. Results A total of 131 patients underwent surgical treatment of cardiac tumors were enrolled in this study, with a mean age of 51.39±16.37. The result of analysis showed that 79.47% (n=104) of the primary intracardiac tumors were benign, while primary malignant neoplasms accounted for 16.03% (n=21) of all patients, with the remainder (n=6, 4.6%) metastatic tumors transferred from other organs. Among all patients there were 2 in-hospital deaths and the survival rate in all patients at 1-year, 3-year and 5-year follow up was 83.20%, 78.62% and 66.41% respectively. Both patients with tumors in the left and right heart had similar basic characteristics except sex gender (P=0.002), BSA (P=0.045) and weight (P=0.033). Compared with patients with tumors in the right heart, patients with tumors in the left heart had significant higher CPB time (P<0.001), cross clamp time (P<0.001) and time of mechanical ventilation (P<0.001), and they also had longer ICU stay (P<0.001) but not total hospital stay (P=0.434). Conclusions Surgical resection represents an effective protocol in treating cardiac tumors. Data in our study of cardiac tumors on frequency and allocation were consistent with previous reports which may provide useful clinical evidence on

  4. Incidence and Mortality Rates of Disasters and Mass Casualty Incidents in Korea: A Population-Based Cross-Sectional Study, 2000-2009

    PubMed Central

    Kim, Soo Jin; Shin, Sang Do; Lee, Seung Chul; Park, Ju Ok; Sung, Joohon

    2013-01-01

    The objective of study was to evaluate the incidence and mortality rates of disasters and mass casualty incidents (MCIs) over the past 10 yr in the administrative system of Korea administrative system and to examine their relationship with population characteristics. This was a population-based cross-sectional study. We calculated the nationwide incidence, as well as the crude mortality and injury incidence rates, of disasters and MCIs. The data were collected from the administrative database of the National Emergency Management Agency (NEMA) and from provincial fire departments from January 2000 to December 2009. A total of 47,169 events were collected from the NEMA administrative database. Of these events, 115 and 3,079 cases were defined as disasters and MCIs that occurred in Korea, respectively. The incidence of technical disasters/MCIs was approximately 12.7 times greater than that of natural disasters/MCIs. Over the past 10 yr, the crude mortality rates for disasters and MCIs were 2.36 deaths per 100,000 persons and 6.78 deaths per 100,000 persons, respectively. The crude injury incidence rates for disasters and MCIs were 25.47 injuries per 100,000 persons and 152 injuries per 100,000 persons, respectively. The incidence and mortality of disasters/MCIs in Korea seem to be low compared to that of trend around the world. PMID:23678255

  5. Are Gender Differences in the Relationship between Self-Rated Health and Mortality Enduring? Results from Three Birth Cohorts in Melton Mowbray, United Kingdom

    ERIC Educational Resources Information Center

    Spiers, Nicola; Jagger, Carol; Clarke, Michael; Arthur, Antony

    2003-01-01

    Purpose: The purpose of this study was to assess whether there is an enduring gender difference in the ability of self-rated health to predict mortality and investigate whether self-reported physical health problems account for this difference. Design and Methods: Cox models for 4-year survival were fitted to data from successive cohorts aged…

  6. The effects of strong shock waves on mortality rates and percentages of pulmonary lesions in rats as a function of the number of exposures

    NASA Technical Reports Server (NTRS)

    Vassout, P.; Parmentier, G.

    1978-01-01

    The results of the study reveal that with regard to the pulmonary lesions, twice the number of exposures is compensated for by quartering the overpressure of the wave crest. With regard to the mortality rates, it reveals that halving the overpressure of the wave crest is offset by a 20-fold increase in the number of exposures.

  7. Trends and Variations in the Rates of Hospital Complications, Failure-to-Rescue and 30-Day Mortality in Surgical Patients in New South Wales, Australia, 2002-2009

    PubMed Central

    Ou, Lixin; Chen, Jack; Assareh, Hassan; Hollis, Stephanie J.; Hillman, Ken; Flabouris, Arthas

    2014-01-01

    Background Despite the increased acceptance of failure-to-rescue (FTR) as an important patient safety indicator (defined as the percentage of deaths among surgical patients with treatable complications), there has not been any large epidemiological study reporting FTR in an Australian setting nor any evaluation on its suitability as a performance indicator. Methods We conducted a population-based study on elective surgical patients from 82 public acute hospitals in New South Wales, Australia between 2002 and 2009, exploring the trends and variations in rates of hospital complications, FTR and 30-day mortality. We used Poisson regression models to derive relative risk ratios (RRs) after adjusting for a range of patient and hospital characteristics. Results The average rates of complications, FTR and 30-day mortality were 13.8 per 1000 admissions, 14.1% and 6.1 per 1000 admission, respectively. The rates of complications and 30-day mortality were stable throughout the study period however there was a significant decrease in FTR rate after 2006, coinciding with the establishment of national and state-level peak patient safety agencies. There were marked variations in the three rates within the top 20% of hospitals (best) and bottom 20% of hospitals (worst) for each of the four peer-hospital groups. The group comprising the largest volume hospitals (principal referral/teaching hospitals) had a significantly higher rate of FTR in comparison to the other three groups of smaller-sized peer hospital groups (RR = 0.78, 0.57, and 0.61, respectively). Adjusted rates of complications, FTR and 30-day mortality varied widely for individual surgical procedures between the best and worst quintile hospitals within the principal referral hospital group. Conclusions The decrease in FTR rate over the study period appears to be associated with a wide range of patient safety programs. The marked variations in the three rates between- and within- peer hospital groups highlight the

  8. Predicting 1-Year Mortality Rate for Patients Admitted With an Acute Exacerbation of Chronic Obstructive Pulmonary Disease to an Intensive Care Unit: An Opportunity for Palliative Care

    PubMed Central

    Batzlaff, Cassandra M.; Karpman, Craig; Afessa, Bekele; Benzo, Roberto P.

    2015-01-01

    The objective of this study was to develop a model to aid clinicians in better predicting 1-year mortality rate for patients with an acute exacerbation of chronic obstructive pulmonary disease admitted to the medical intensive care unit (ICU) with the goal of earlier initiation of palliative care and end-of-life communications in this patient population. This retrospective cohort study included patients from a medical ICU from April 1, 1995, to November 30, 2009. Data collected from the Acute Physiology and Chronic Health Evaluation III database included demographic characteristics; severity of illness scores; noninvasive and invasive mechanical ventilation time; ICU and hospital length of stay; and ICU, hospital, and 1-year mortality. Statistically significant univariate variables for 1-year mortality were entered into a multivariate model, and the independent variables were used to generate a scoring system to predict 1-year mortality rate. At 1-year follow-up, 295 of 591 patients died (50%). Age and hospital length of stay were identified as independent determinants of mortality at 1 year by using multivariate analysis, and the predictive model developed had an area under the operating curve of 0.68. Bootstrap analysis with 1000 iterations validated the model, age, and hospital length of stay, entered the model 100% of the time (area under the operating curve=0.687; 95% CI, 0.686–0.688). A simple model using age and hospital length of stay may be informative for providers willing to identify patients with chronic obstructive pulmonary disease with high 1-year mortality rate who may benefit from end-of-life communications and from palliative care. PMID:24656805

  9. Evaluating the predictive performance of empirical estimators of natural mortality rate using information on over 200 fish species

    USGS Publications Warehouse

    Then, Amy Y.; Hoenig, John M; Hall, Norman G.; Hewitt, David A.

    2015-01-01

    Many methods have been developed in the last 70 years to predict the natural mortality rate, M, of a stock based on empirical evidence from comparative life history studies. These indirect or empirical methods are used in most stock assessments to (i) obtain estimates of M in the absence of direct information, (ii) check on the reasonableness of a direct estimate of M, (iii) examine the range of plausible M estimates for the stock under consideration, and (iv) define prior distributions for Bayesian analyses. The two most cited empirical methods have appeared in the literature over 2500 times to date. Despite the importance of these methods, there is no consensus in the literature on how well these methods work in terms of prediction error or how their performance may be ranked. We evaluate estimators based on various combinations of maximum age (tmax), growth parameters, and water temperature by seeing how well they reproduce >200 independent, direct estimates of M. We use tenfold cross-validation to estimate the prediction error of the estimators and to rank their performance. With updated and carefully reviewed data, we conclude that a tmax-based estimator performs the best among all estimators evaluated. The tmax-based estimators in turn perform better than the Alverson–Carney method based on tmax and the von Bertalanffy K coefficient, Pauly's method based on growth parameters and water temperature and methods based just on K. It is possible to combine two independent methods by computing a weighted mean but the improvement over the tmax-based methods is slight. Based on cross-validation prediction error, model residual patterns, model parsimony, and biological considerations, we recommend the use of a tmax-based estimator (M=4.899t−0.916max, prediction error = 0.32) when possible and a growth-based method (M=4.118K0.73L−0.33∞ , prediction error = 0.6) otherwise.

  10. Does transport time help explain the high trauma mortality rates in rural areas? New and traditional predictors assessed by new and traditional statistical methods

    PubMed Central

    Røislien, Jo; Lossius, Hans Morten; Kristiansen, Thomas

    2015-01-01

    Background Trauma is a leading global cause of death. Trauma mortality rates are higher in rural areas, constituting a challenge for quality and equality in trauma care. The aim of the study was to explore population density and transport time to hospital care as possible predictors of geographical differences in mortality rates, and to what extent choice of statistical method might affect the analytical results and accompanying clinical conclusions. Methods Using data from the Norwegian Cause of Death registry, deaths from external causes 1998–2007 were analysed. Norway consists of 434 municipalities, and municipality population density and travel time to hospital care were entered as predictors of municipality mortality rates in univariate and multiple regression models of increasing model complexity. We fitted linear regression models with continuous and categorised predictors, as well as piecewise linear and generalised additive models (GAMs). Models were compared using Akaike's information criterion (AIC). Results Population density was an independent predictor of trauma mortality rates, while the contribution of transport time to hospital care was highly dependent on choice of statistical model. A multiple GAM or piecewise linear model was superior, and similar, in terms of AIC. However, while transport time was statistically significant in multiple models with piecewise linear or categorised predictors, it was not in GAM or standard linear regression. Conclusions Population density is an independent predictor of trauma mortality rates. The added explanatory value of transport time to hospital care is marginal and model-dependent, highlighting the importance of exploring several statistical models when studying complex associations in observational data. PMID:25972600

  11. A Model of Racial Residential History and Its Association with Self-Rated Health and Mortality Among Black and White Adults in the United States

    PubMed Central

    Ruel, Erin; Robert, Stephanie A.

    2009-01-01

    We construct a dynamic racial residential history typology and examine its association with self-rated health and mortality among black and white adults. Data are from a national survey of U.S. adults, combined with census tract data from 1970–1990. Results show that racial disparities in health and mortality are explained by both neighborhood contextual and individual socioeconomic factors. Results suggest that living in an established black neighborhood or in an established interracial neighborhood may actually be protective of health, once neighborhood poverty is controlled. Examining the dynamic nature of neighborhoods contributes to an understanding of health disparities. PMID:20161138

  12. Association of Age, Systolic Blood Pressure, and Heart Rate with Adult Morbidity and Mortality after Urgent Care Visits

    PubMed Central

    Hart, James; Woodruff, Michael; Joy, Elizabeth; Dalto, Joseph; Snow, Gregory; Srivastava, Rajendu; Isaacson, Brad; Allen, Todd

    2016-01-01

    Introduction Little data exists to help urgent care (UC) clinicians predict morbidity and mortality risk. Age, systolic blood pressure (SBP), and heart rate (HR) are easily obtainable and have been used in other settings to predict short-term risk of deterioration. We hypothesized that there is a relationship between advancing age, SBP, HR, and short-term health outcomes in the UC setting. Methods We collected retrospective data from 28 UC clinics and 22 hospitals in the Intermountain Healthcare system between years 2008–2013. Adult patients (≥18 years) were included if they had a unique UC visit and HR or SBP data. Three endpoints following UC visit were assessed: emergency department (ED) visit within three days, hospitalization within three days, and death within seven days. We analyzed associations between age, SBP, HR and endpoints using local regression with a binomial likelihood. Five age groups were chosen from previously published national surveys. Vital sign (VS) distributions were determined for each age group, and the central tendency was compared against previously published norms (90–120mmHg for SBP and 60–100bpm for HR.) Results A total of 1,720,207 encounters (714,339 unique patients) met the inclusion criteria; 51,446 encounters (2.99%) had ED visit within three days; 12,397 (0.72%) experienced hospitalization within three days; 302 (0.02%) died within seven days of UC visit. Heart rate and SBP combined with advanced age predicted the probability of ED visit (p<0.0001) and hospitalization (p<0.0001) following UC visit. Significant associations between advancing age and death (p<0.0001), and VS and death (p<0.0001) were observed. Odds ratios of risk were highest for elderly patients with lower SBP or higher HR. Observed distributions of SBP were higher than published normal ranges for all age groups. Conclusion Among adults seeking care in the UC, associations between HR and SBP and likelihood of ED visits and hospitalization were more

  13. 2001 IFT Education Standards: A 5-Year Perspective

    ERIC Educational Resources Information Center

    Hartel, Richard W.

    2006-01-01

    The current IFT Education Standards used to evaluate Food Science programs for IFT approval have been in place now for 5 years. Most Food Science programs in the United States (as well as some in Mexico and Canada) have been reviewed according to these standards. The transition to instruction based on assessment of student learning outcomes, in…

  14. True or False: Do 5-Year-Olds Understand Belief?

    ERIC Educational Resources Information Center

    Fabricius, William V.; Boyer, Ty W.; Weimer, Amy A.; Carroll, Kathleen

    2010-01-01

    In 3 studies (N = 188) we tested the hypothesis that children use a perceptual access approach to reason about mental states before they understand beliefs. The perceptual access hypothesis predicts a U-shaped developmental pattern of performance in true belief tasks, in which 3-year-olds who reason about reality should succeed, 4- to 5-year-olds…

  15. Upper Body Muscular Endurance Among Children 2-5 Years.

    ERIC Educational Resources Information Center

    Gabbard, Carl P.; And Others

    The upper body muscular endurance of males and females 2-5 years of age was assessed, and relationships relative to sex, age, endurance and selected anthropometric measures were investigated. None of the relationships were found to be of practical predicative value; while upper body muscular strength increased with age, no significant differences…

  16. Stimulant Treatment over 5 Years: Effects on Growth

    ERIC Educational Resources Information Center

    Charach, Alice; Figueroa, Max; Chen, Shirley; Ickowicz, Abel; Schachar, Russell

    2006-01-01

    Objective: Long-term effects of psychostimulants on growth in height and in weight are investigated in children with attention-deficit/hyperactivity disorder. Method: Participants were 79 children, 6 to 12 years of age, with attention-deficit/hyperactivity disorder, who were followed annually for up to 5 years, between the years 1993 and 1994 and…

  17. Cognitive and Temperament Clusters in 3- to 5-Year-Old Children with Aggressive Behavior

    ERIC Educational Resources Information Center

    Sakimura, Jean N.; Dang, Michelle T.; Ballard, Kelley B.; Hansen, Robin L.

    2008-01-01

    Background: This study assessed the co-occurrence of cognitive problems and difficult temperament characteristics in children aged 3 to 5 years exhibiting aggressive behavior. Methods: Thirty-one children with high ratings on the Aggressive Behavior subscale of the Achenbach Child Behavior Checklist or Teacher Report Form were recruited from a…

  18. Mortality After Nontraumatic Major Amputation Among Patients With Diabetes and Peripheral Vascular Disease: A Systematic Review.

    PubMed

    Thorud, Jakob C; Plemmons, Britton; Buckley, Clifford J; Shibuya, Naohiro; Jupiter, Daniel C

    2016-01-01

    High mortality rates have been reported after major amputations of a lower limb secondary to diabetes and peripheral vascular disease. However, the mortality rates have varied across studies. A systematic review of the 5-year mortality after nontraumatic major amputations of the lower extremity was conducted. A data search was performed of Medline using OVID, CINHAL, and Cochrane, 365 abstracts were screened, and 79 full text articles were assessed for eligibility. After review, 31 studies met the inclusion and exclusion criteria. Overall, the 5-year mortality rate was very high among patients with any amputation (major and minor combined), ranging from 53% to 100%, and in patients with major amputations, ranging from 52% to 80%. Mortality after below-the-knee amputation ranged from 40% to 82% and after above-the-knee amputation from 40% to 90%. The risk factors for increased mortality included age, renal disease, proximal amputation, and peripheral vascular disease. Although our previous systematic review of the 5-year mortality after ulceration had much lower rates of death, additional studies are warranted to determine whether amputation hastens death or is a marker for underlying disease severity. PMID:26898398

  19. Prehospital heart rate and blood pressure increase the positive predictive value of the Glasgow Coma Scale for high-mortality traumatic brain injury.

    PubMed

    Reisner, Andrew; Chen, Xiaoxiao; Kumar, Kamal; Reifman, Jaques

    2014-05-15

    We hypothesized that vital signs could be used to improve the association between a trauma patient's prehospital Glasgow Coma Scale (GCS) score and his or her clinical condition. Previously, abnormally low and high blood pressures have both been associated with higher mortality for patients with traumatic brain injury (TBI). We undertook a retrospective analysis of 1384 adult prehospital trauma patients. Vital-sign data were electronically archived and analyzed. We examined the relative risk of severe head Abbreviated Injury Scale (AIS) 5-6 as a function of the GCS, systolic blood pressure (SBP), heart rate (HR), and respiratory rate (RR). We created multi-variate logistic regression models and, using DeLong's test, compared their area under receiver operating characteristic curves (ROC AUCs) for three outcomes: head AIS 5-6, all-cause mortality, and either head AIS 5-6 or neurosurgical procedure. We found significant bimodal relationships between head AIS 5-6 versus SBP and HR, but not RR. When the GCS was <15, ROC AUCs were significantly higher for a multi-variate regression model (GCS, SBP, and HR) versus GCS alone. In particular, patients with abnormalities in all parameters (GCS, SBP, and HR) were significantly more likely to have high-mortality TBI versus those with abnormalities in GCS alone. This could be useful for mobilizing resources (e.g., neurosurgeons and operating rooms at the receiving hospital) and might enable new prehospital management protocols where therapies are selected based on TBI mortality risk. PMID:24372334

  20. Sources and rates of mortality of the San Joaquin kit fox, Naval Petroleum Reserve No. 1, Kern County, California, 1980-1986. [Vulpes macrotis mutica

    SciTech Connect

    Berry, W.H.; Scrivner, J.H.; O'Farrell, T.P.; Harris, C.E.; Kato, T.T.; McCue, P.M.

    1987-03-01

    Sources and rates of mortality of the San Joaquin kit fox (Vulpes macrotis mutica) were studied from 1980 to 1986. Of 270 foxes radiocollared, 225 were recovered dead. Of the 225 recovered dead 53.8% (121) were killed by predators, 10.7% (24) were killed by vehicles, 4.4% (10) died from causes other than predation, and 31.1% (70) died from unknown causes. Contingency-table analysis was used to assess the relationship between cause of death and sex, age class (juvenile and adult), habitat type (undeveloped and developed), and year of death (1980-1986). More adults in undeveloped habitat were killed by vehicles than were juveniles; more female juveniles in developed habitat were killed by vehicles than female adults; more juveniles were killed by vehicles in developed habitat than in undeveloped habitat; and more adults in developed habitat were killed by predators in later years of the study than in early years. Over 90% of the foxes collared as juveniles were recovered in their first or second year. Fourteen mortality rates based on age class and year of death were estimated using maximum-likelihood estimation. Mortality rates were higher for juvenile foxes (x-bar = 0.74) than for adult foxes (x-bar = 0.52). For foxes collared as juveniles, there was no significant difference in survival between the two habitat types or between the sexes. Mortality of adults increased between 1980 and 1986. Because coyote predation was a major cause of kit fox mortality the coyote control program implemented in 1985 should be continued and its effectiveness should be evaluated by continued monitoring of kit fox, coyote, and prey populations.

  1. Contribution of exposure, risk of crash and fatality to explain age- and sex-related differences in traffic-related cyclist mortality rates.

    PubMed

    Martínez-Ruiz, Virginia; Jiménez-Mejías, Eladio; Amezcua-Prieto, Carmen; Olmedo-Requena, Rocío; Luna-del-Castillo, Juan de Dios; Lardelli-Claret, Pablo

    2015-03-01

    This study was designed to quantify the percent contribution of exposure, risk of collision and fatality rate to the association of age and sex with the mortality rates among cyclists in Spain, and to track the changes in these contributions with time. Data were analyzed for 50,042 cyclists involved in road crashes in Spain from 1993 to 2011, and also for a subset of 13,119 non-infractor cyclists involved in collisions with a vehicle whose driver committed an infraction (used as a proxy sample of all cyclists on the road). We used decomposition and quasi-induced exposure methods to obtain the percent contributions of these three components to the mortality rate ratios for each age and sex group compared to males aged 25-34 years. Death rates increased with age, and the main component of this increase was fatality (around 70%). Among younger cyclists, however, the main component of increased death rates was risk of a collision. Males had higher death rates than females in every age group: this rate increased from 6.4 in the 5-14 year old group to 18.8 in the 65-79 year old group. Exposure, the main component of this increase, ranged between 70% and 90% in all age categories, although the fatality component also contributed to this increase. The contributions of exposure, risk of crash and fatality to cyclist death rates were strongly associated with age and sex. Young male cyclists were a high-risk group because all three components tended to increase their mortality rate. PMID:25658669

  2. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality: a collaborative meta-analysis of general population cohorts

    PubMed Central

    Matsushita, Kunihiro; van der Velde, Marije; Astor, Brad C; Woodward, Mark; Levey, Andrew S; de Jong, Paul E; Coresh, Josef; Gansevoort, Ron T

    2014-01-01

    Background A comprehensive evaluation of the independent and combined associations of estimated glomerular filtration rate (eGFR) and albuminuria with mortality is required for assessment of the impact of kidney function on risk in the general population, with implications for improving the definition and staging of chronic kidney disease (CKD). Methods A collaborative meta-analysis of general population cohorts was undertaken to pool standardized data for all-cause and cardiovascular mortality. The two kidney measures and potential confounders from 14 studies (105,872 participants; 730,577 person-years) with urine albumin-to-creatinine ratio (ACR) measurements and seven studies (1,128,310 participants; 4,732,110 person-years) with urine protein dipstick measurements were modeled. Findings In ACR studies, mortality risk was unrelated to eGFR between 75-105 ml/min/1·73 m2 and increased at lower eGFR. Adjusted hazard ratios (HRs) for all-cause mortality at eGFR 60, 45, and 15 (versus 95) ml/min/1·73 m2 were 1·18 (95% CI: 1·05-1·32), 1·57 (1·39-1·78), and 3·14 (2·39-4·13), respectively. ACR was associated with mortality risk linearly on the log-log scale without threshold effects. Adjusted HRs for all-cause mortality at ACR 10, 30, and 300 (versus 5) mg/g were 1·20 (1·15-1·26), 1·63 (1·50-1·77), and 2·22 (1·97-2·51). eGFR and ACR were multiplicatively associated with mortality without evidence of interaction. Similar findings were observed for cardiovascular mortality and in dipstick studies. Interpretation Lower eGFR (<60 ml/min/1·73 m2) and higher albuminuria (ACR ≥10 mg/g) were independent predictors of mortality risk in the general population. This study provides quantitative data for using both kidney measures for risk evaluation and CKD definition and staging. PMID:20483451

  3. Efficiency of Intergeneric Recombinants Between Bacillus Thuringiensis and Bacillus Subtilis for Increasing Mortality Rate in Cotten Leaf Worm

    NASA Astrophysics Data System (ADS)

    AlOtaibi, Saad Aied

    2012-12-01

    In this study , two strains of Bacillus belonging to two serotypes and four of their transconjugants were screened with respect to their toxicity against lepidopterous cotton pest. . Bacterial transconjugants isolated from conjugation between both strains were evaluated for their transconjugant efficiency caused mortality in Spodoptera littoralis larvae . Two groups of bioinsecticides ; crystals , crystals and spores have been isolated from Bacillusstrains and their transconjugants . Insecticidal crystal protein ( ICP ) was specific for lepidopteran insects because of the toxin sufficient both for insect specificity and toxicity . The toxicities of these two groups against larvae of Spodoptera littoralis was expressed as transconjugant efficiency , which related to the mean number of larvae died expressed as mortality percentage . The results showed transconjugant efficiency in reducing the mean number of Spodoptera littoralis larvae feeding on leaves of Ricinus communis sprayed with bioinsecticides of Bt transconjugants. Most values of positive transconjugant efficiency related to increasing mortality percentage are due to toxicological effects appeared in response to the treatments with crystals + endospores than that of crystals alone .This indicated that crystals + endospores was more effective for increasing mortality percentage than that resulted by crystals . Higher positive transconjugant efficiency in relation to the mid parents and better parent was appeared at 168 h of treatment . The results indicated that recombinant Bacillus thuringiensis are important control agents for lepidopteran pests , as well as , susceptibility decreased with larval development . The results also suggested a potential for the deployment of these recominant entomopathogens in the management of Spodoptera. littoralis larvae .

  4. Mortality Rates in the General Irish Population Compared to Those with an Intellectual Disability from 2003 to 2012

    ERIC Educational Resources Information Center

    McCarron, Mary; Carroll, Rachael; Kelly, Caraiosa; McCallion, Philip

    2015-01-01

    Background:Historically, there has been higher and earlier mortality among people with intellectual disability as compared to the general population, but there have also been methodological problems and differences in the available studies. Method: Data were drawn from the 2012 National Intellectual Disability Database and the Census in Ireland. A…

  5. Determination of florfenicol dose rate in feed for control of mortality in nile tilapia Oreochromis nilotica infected with streptococcus iniae

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A dose titration study was conducted to determine the dosage of florfenicol (FFC) in feed to control Streptococcus iniae-associated mortality in Nile tilapia Oreochromis niloticus. Six tanks were assigned to each of five treatments: (1) not challenged with S. iniae and fed unmedicated feed; (2) chal...

  6. Average County-Level IQ Predicts County-Level Disadvantage and Several County-Level Mortality Risk Rates

    ERIC Educational Resources Information Center

    Barnes, J. C.; Beaver, Kevin M.; Boutwell, Brian B.

    2013-01-01

    Research utilizing individual-level data has reported a link between intelligence (IQ) scores and health problems, including early mortality risk. A growing body of evidence has found similar associations at higher levels of aggregation such as the state- and national-level. At the same time, individual-level research has suggested the…

  7. Lung cancer mortality between 1950 and 1987 after exposure to fractionated moderate-dose-rate ionizing radiation in the Canadian fluoroscopy cohort study and a comparison with lung cancer mortality in the atomic bomb survivors study

    SciTech Connect

    Howe, G.R.

    1995-06-01

    Current lung cancer risk estimates after exposure to low-linear energy transfer radiation such as X rays are based on studies of people exposed to such radiation at high dose rates, for example the atomic bomb survivors. Radiobiology and animal experiments suggest that risks from exposure at low to moderate dose rates, for example medical diagnostic procedures, may be overestimated by such risk models, but data for humans to examine this issue are limited. In this paper we report on lung cancer mortality between 1950 and 1987 in a cohort of 64,172 Canadian tuberculosis patients, of whom 39% were exposed to highly fractionated multiple chest fluoroscopies leading to a mean lung radiation dose of 1.02 Sv received at moderate dose rates. These data have been used to estimate the excess relative risk per sievert of lung cancer mortality, and this is compared directly to estimates derived from 75,991 atomic bomb survivors. Based on 1,178 lung cancer deaths in the fluoroscopy study, there was no evidence of any positive association between risk and dose, with the relative risk at 1 Sv being 1.00 (95% confidence interval 0.94, 1.07), which contrasts with that based on the atomic bomb survivors, 1.60 (1.27, 1.99). The difference in effect between the two studies almost certainly did not arise by chance (P = 0.0001). This study provides strong support from data for humans for a substantial fractionation/dose-rate effect for low-linear energy transfer radiation and lung cancer risk. This implies that lung cancer risk from exposures to such radiation at present-day dose rates is likely to be lower than would be predicted by current radiation risk models based on studies of high-dose-rate exposures. 25 refs., 8 tabs.

  8. Failure to immunize children under 5 years: a literature review.

    PubMed

    Lochhead, Y J

    1991-02-01

    This paper aims to provide a critical review of the current literature related to immunization default in children under 5 years of age. The author has used a health belief model as the framework for analysis, examining each area in detail. The principle recommendations for practice are addressed and critically evaluated with a concluding summary of the main points raised and the author's recommendation for practice. PMID:2013653

  9. Modified Mandibulotomy Technique to Reduce Postoperative Complications: 5-Year Results

    PubMed Central

    Na, Hye-Young; Choi, Eun-Joo; Kim, Hyung Jun; Cha, In-Ho

    2013-01-01

    Purpose To review the 5-year outcomes of our modified mandibulotomy technique. Retrospective review of a tertiary level oral cancer center. Materials and Methods During a 5-year period, 30 patients who had a uniform surgical technique consisting of a lower lip-splitting, modified stair-step osteotomy with thin saw blade and osteotome after plate-precontouring and combination fixation with monocortical osteosynthesis (miniplate) and bicortical osteosynthesis (maxiplate and bicortical screws), with at least 14 months postoperative follow-up, were selected and reviewed retrospectively. Results There were 8 women and 22 men with an average age of 56.5 years. All the patients involved malignancies were squamous cell carcinoma. The main primary sites of the those who underwent a mandibulotomy were the tonsil, the base of tongue, the oral tongue, the retromolar pad area, and others. Others included buccal cheek, floor of mouth, and soft palate. 23 patients received postoperative radiation therapy, and among whom 8 patients also received chemotherapy. Total four (13%) mandibulotomy-related complications occurred, only two (6.7%) requiring additional operation under general anesthesia. Conclusion Our modified mandibulotomy meets the criteria for an ideal mandibulotomy technique relatively well because it requires no intermaxillary fixation, can precise preserve the occlusion in a precise way, allows early function, requires no secondary procedures, and has few complications. PMID:23918577

  10. All-Cause, Cardiovascular, and Cancer Mortality Rates in Postmenopausal White, Black, Hispanic, and Asian Women With and Without Diabetes in the United States

    PubMed Central

    Ma, Yunsheng; Hébert, James R.; Balasubramanian, Raji; Wedick, Nicole M.; Howard, Barbara V.; Rosal, Milagros C.; Liu, Simin; Bird, Chloe E.; Olendzki, Barbara C.; Ockene, Judith K.; Wactawski-Wende, Jean; Phillips, Lawrence S.; LaMonte, Michael J.; Schneider, Kristin L.; Garcia, Lorena; Ockene, Ira S.; Merriam, Philip A.; Sepavich, Deidre M.; Mackey, Rachel H.; Johnson, Karen C.; Manson, JoAnn E.

    2013-01-01

    Using data from the Women's Health Initiative (1993–2009; n = 158,833 participants, of whom 84.1% were white, 9.2% were black, 4.1% were Hispanic, and 2.6% were Asian), we compared all-cause, cardiovascular, and cancer mortality rates in white, black, Hispanic, and Asian postmenopausal women with and without diabetes. Cox proportional hazard models were used for the comparison from which hazard ratios and 95% confidence intervals were computed. Within each racial/ethnic subgroup, women with diabetes had an approximately 2–3 times higher risk of all-cause, cardiovascular, and cancer mortality than did those without diabetes. However, the hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups. Population attributable risk percentages (PARPs) take into account both the prevalence of diabetes and hazard ratios. For all-cause mortality, whites had the lowest PARP (11.1, 95% confidence interval (CI): 10.1, 12.1), followed by Asians (12.9, 95% CI: 4.7, 20.9), blacks (19.4, 95% CI: 15.0, 23.7), and Hispanics (23.2, 95% CI: 14.8, 31.2). To our knowledge, the present study is the first to show that hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups when stratified by diabetes status. Because of the “amplifying” effect of diabetes prevalence, efforts to reduce racial/ethnic disparities in the rate of death from diabetes should focus on prevention of diabetes. PMID:24045960

  11. Relationship between Estimated Glomerular Filtration Rate and Cardiovascular Mortality in a Japanese Cohort with Long-Term Follow-Up

    PubMed Central

    Nagai, Kei; Sairenchi, Toshimi; Irie, Fujiko; Watanabe, Hiroshi; Ota, Hitoshi; Yamagata, Kunihiro

    2016-01-01

    Background Patients with renal impairment are at risk of not only end-stage kidney disease but also cardiovascular disease (CVD). The current definition of CKD stage G3a is eGFR 45–59 ml/min/1.73 m2 and of G3b is 30–44 ml/min/1.73 m2, and subjects in the CKD 3a category are considered to be at lower risk of mortality than are those in CKD 3b. Methods We evaluated the outcome of 97,043 people (33,131 men and 63,912 women) living in Ibaraki Prefecture who underwent annual community-based health checkups beginning in 1993 at age 40–80 years and who were followed for a mean of 17.1 years. Results The number of all-causes deaths was 20,534 (10,375 men and 10,159 women), of which 5,995 (2,695 men and 3,300 women) were deaths due to CVD. Multivariable-adjusted hazard ratio for CVD death in the eGFR 45–49 ml/min/1.73 m2 category was significantly increased (1.82; 95% confidential interval, 1.23–2.69) in non-elderly men, whereas all-cause mortality and CVD mortality in elderly men with eGFR 45–49 ml/min/1.73m2 were non significant. In contrast, both in non-elderly women and in elderly women with eGFR 45–49 ml/min/1.73 m2 showed small, but significant, increases in the risks of all-cause mortality and CVD. Conclusions We demonstrated proportionate increases in mortality with decreasing eGFR in a Japanese CKD population. Like patients in the CKD G3b subgroup, non-elderly men and women with an eGFR of 45–49 ml/min/1.73 m2 (i.e. a part of CKD G3a) are at considerable risk of CVD mortality. Age dependent and eGFR dependent finer risk recognition were required for CVD prevention in clinical practice with regard to CKD patients. PMID:27272675

  12. Infant Mortality and Asians and Pacific Islanders

    MedlinePlus

    ... Infant Heath & Mortality Infant Mortality and Asians and Pacific Islanders Among Asian/Pacific Islanders, Sudden Infant Death Syndrome (SIDS) is the fourth leading cause of infant mortality. Asian/Pacific Islanders women generally have lower infant mortality rates ...

  13. The suicide mortality rates between 1997-1998 and 2000-2001 in Nantou County of Taiwan following the earthquake of September 21 in 1999.

    PubMed

    Liaw, Yung-Po; Wang, Po-Wen; Huang, Chiu-Chin; Chang, Chia-Ming; Lee, Wen-Chung

    2008-01-01

    The paper aims to show the different suicide mortality rate between 1997-1998 and 2000-2001 in Nantou County of Taiwan with earthquake on September 21 (often referred to as the "9-21 earthquake") in 1999. In additional, it also identifies the preventive strategies for the high-risk suicide population. The age-standardized mortality rates for suicide in Nantou County were calculated for the years 1997-1998 and 2000-2001. The suicide standardized mortality ratio (SMR for townships in Nantou were calculated by "type of township" as the standard rate). There is a statistically significant difference in male suicide rates for the years prior to the earthquake (1997-1998) when pooled and compared to the suicide rates for the years after the earthquake (2000-2001). The rate for four age groups (under 25, 25-44, 45-64, 65 and above) all increased, yet all but one (the group of age 45-64) was not statistically significant. The male SMR has slightly increased after the 9-21 earthquake. Yet there are no statistical significances in most townships, except in Kaohsiung and Puli after the 9-21 earthquake. The Kaohsiung SMRs were 1.36 (95% CI: 0.54-2.80) before the earthquake (1997-1998) and 2.01 (95% CI: 1.04-3.52) after the earthquake (2000-2001). The SMRs before and after the earthquake in the Puli Township were 1.51 (95% CI: 0.95-2.29) to 1.56 (95% CI: 1.03-2.27). This study suggests that monitoring high-risk population, especially males or 45-64 years of age who experienced the highest statistically significant suicide rate in this study. The study provides support for providing both the psychological restoration program and, to the extent feasible, financial support for the unemployed as useful public health strategies for suicide prevention in Taiwan. PMID:18005008

  14. The current status of community-acquired pneumonia management and prevention in children under 5 years of age in India: a review

    PubMed Central

    Yadav, Krishna Kumar; Awasthi, Shally

    2016-01-01

    India has the highest number of global deaths of children under 5 years of age. In the year 2015, it was reported that there were 5.9 million deaths of children under 5 years of age globally, of which 1.2 million (20%) occurred in India alone. Currently, India has an under 5 mortality rate of 48 per 1000 live births. Community-acquired pneumonia contributes to about one sixth of this mortality. Fast breathing is the key symptom of community-acquired pneumonia. The World Health Organization recently categorized community-acquired pneumonia in children under 5 years of age into two, pneumonia, and severe pneumonia. Fast breathing with or without chest in-drawing is categorized as pneumonia and fast breathing with any of danger signs as severe pneumonia. Because effective vaccines against two of the common organisms causing community-acquired pneumonia, namely Streptococcus pneumoniae and Haemophilus influenzae type b, are available, there should be urgent and phased introduction into the Indian Universal Immunization Programme. Several preventable risk factors of community-acquired pneumonia such as lack of exclusive breast feeding for first 6 months of life, inappropriate complimentary feeding, iron deficiency anemia, malnutrition, and indoor air pollution should be adequately addressed. The community should be aware about the signs and symptoms of community-acquired pneumonia and its danger signs so that delay in qualified care seeking can be avoided. To achieve the sustainable development goal of ⩽25 under five deaths per 1000 live births by 2030, a multipronged approach is the need of the hour. PMID:27536353

  15. The current status of community-acquired pneumonia management and prevention in children under 5 years of age in India: a review.

    PubMed

    Yadav, Krishna Kumar; Awasthi, Shally

    2016-06-01

    India has the highest number of global deaths of children under 5 years of age. In the year 2015, it was reported that there were 5.9 million deaths of children under 5 years of age globally, of which 1.2 million (20%) occurred in India alone. Currently, India has an under 5 mortality rate of 48 per 1000 live births. Community-acquired pneumonia contributes to about one sixth of this mortality. Fast breathing is the key symptom of community-acquired pneumonia. The World Health Organization recently categorized community-acquired pneumonia in children under 5 years of age into two, pneumonia, and severe pneumonia. Fast breathing with or without chest in-drawing is categorized as pneumonia and fast breathing with any of danger signs as severe pneumonia. Because effective vaccines against two of the common organisms causing community-acquired pneumonia, namely Streptococcus pneumoniae and Haemophilus influenzae type b, are available, there should be urgent and phased introduction into the Indian Universal Immunization Programme. Several preventable risk factors of community-acquired pneumonia such as lack of exclusive breast feeding for first 6 months of life, inappropriate complimentary feeding, iron deficiency anemia, malnutrition, and indoor air pollution should be adequately addressed. The community should be aware about the signs and symptoms of community-acquired pneumonia and its danger signs so that delay in qualified care seeking can be avoided. To achieve the sustainable development goal of ⩽25 under five deaths per 1000 live births by 2030, a multipronged approach is the need of the hour. PMID:27536353

  16. Ten-years of bariatric surgery in Brazil: in-hospital mortality rates for patients assisted by universal health system or a health maintenance organization

    PubMed Central

    KELLES, Silvana Márcia Bruschi; MACHADO, Carla Jorge; BARRETO, Sandhi Maria

    2014-01-01

    Background Bariatric surgery is an option for sustained weight loss for the morbidly obese patient. In Brazil coexists the Unified Health System (SUS) with universal coverage and from which depend 150 million Brazilians and supplemental health security, predominantly private, with 50 million beneficiaries. Aim To compare access, in-hospital mortality, length of stay and costs for patients undergoing bariatric surgery, assisted in one or another system. Methods Data from DATASUS and IBGE were used for SUS patients' and database from one health plan of southeastern Brazil for the health insurance patients. Results Between 2001 and 2010 there were 24,342 and 4,356 surgeries performed in SUS and in the health insurance company, respectively. The coverage rates for surgeries performed in 2010 were 5.3 and 91/100.000 individuals in SUS and health insurance respectively. The rate of in-hospital mortality in SUS, considering the entire country, was 0.55 %, 0.44 % considering SUS Southeast, and 0.30 % for the health insurance. The costs of surgery in the SUS and in the health insurance trend to equalization over the years. Conclusion Despite differences in access and characteristics that may compromise the outcome of bariatric surgery, patients treated at the Southeast SUS had similar rate of in-hospital mortality compared to the health insurance patients. PMID:25626935

  17. Impact of Janani Suraksha Yojana on institutional delivery rate and maternal morbidity and mortality: an observational study in India.

    PubMed

    Gupta, Sanjeev K; Pal, Dinesh K; Tiwari, Rajesh; Garg, Rajesh; Shrivastava, Ashish K; Sarawagi, Radha; Patil, Rajkumar; Agarwal, Lokesh; Gupta, Prashant; Lahariya, Chandrakant

    2012-12-01

    The Government of India initiated a cash incentive scheme--Janani Suraksha Yojana (JSY)--to promote institutional deliveries with an aim to reduce maternal mortality ratio (MMR). An observational study was conducted in a tertiary-care hospital of Madhya Pradesh, India, before and after implementation of JSY, with a sample of women presenting for institutional delivery. The objectives of this study were to: (i) determine the total number of institutional deliveries before and after implementation of JSY, (ii) determine the MMR, and (iii) compare factors associated with maternal mortality and morbidity. The data were analyzed for two years before implementation of JSY (2003-2005) and compared with two years following implementation of JSY (2005-2007). Overall, institutional deliveries increased by 42.6% after implementation, including those among rural, illiterate and primary-literate persons of lower socioeconomic strata. The main causes of maternal mortality were eclampsia, pre-eclampsia and severe anaemia both before and after implementation of JSY. Anaemia was the most common morbidity factor observed in this study. Among those who had institutional deliveries, there were significant increases in cases of eclampsia, pre-eclampsia, polyhydramnios, oligohydramnios, antepartum haemorrhage (APH), postpartum haemorrhage (PPH), and malaria after implementation of JSY. The scheme appeared to increase institutional delivery by at-risk mothers, which has the potential to reduce maternal morbidity and mortality, improve child survival, and ensure equity in maternal healthcare in India. The lessons from this study and other available sources should be utilized to improve the performance and implementation of JSY scheme in India. PMID:23304913

  18. In Hospital and 3-Month Mortality and Functional Recovery Rate in Patients Treated for Hip Fracture by a Multidisciplinary Team

    PubMed Central

    Rostagno, Carlo; Buzzi, Roberto; Campanacci, Domenico; Boccacini, Alberto; Cartei, Alessandro; Virgili, Gianni; Belardinelli, Andrea; Matarrese, Daniela; Ungar, Andrea; Rafanelli, Martina; Gusinu, Roberto; Marchionni, Niccolò

    2016-01-01

    Objectives Medical comorbidities affect outcome in elderly patients with hip fracture. This study was designed to preliminarily evaluate the usefulness of a hip-fracture unit led by an internal medicine specialist. Methods In-hospital and 3-month outcomes in patients with hip fracture were prospectively evaluated in 121 consecutive patients assessed before and followed after surgery by a multidisciplinary team led by internal medicine specialist; 337 consecutive patients were recalled from ICD-9 discharge records and considered for comparison regarding in-hospital mortality. Results In the intervention period, patients treated within 48 hours were 54% vs. 26% in the historical cohort (P<0.0001). In-hospital mortality remained stable at about 2.3 per 1000 person-days. At 3 months, 10.3% of discharged patients had died, though less than 8% of patients developed postoperative complications (mainly pneumonia and respiratory failure). The presence of more than 2 major comorbidities and the loss of 3 or more BADL were independent predictors of death. 50/105 patients recovered previous functional capacity, but no independent predictor of functional recovery could be identified. Mean length of hospital stay significantly decreased in comparison to the historical cohort (13.6± 4.7 vs 17 ± 5 days, p = 0.0001). Combined end-point of mortality and length of hospitalization < 12 days was significantly lower in study period (27 vs 34%, p <0.0132). Conclusions Identification and stabilization of concomitant clinical problems by internal medicine specialists may safely decrease time to surgery in frail subjects with hip fracture. Moreover, integrated perioperative clinical management may shorten hospital stay with no apparent increase in in-hospital mortality and ultimately improve the outcome. These results are to be confirmed by a larger study presently ongoing at our institution. PMID:27389193

  19. Comparing UK and 20 Western countries' efficiency in reducing adult (55–74) cancer and total mortality rates 1989–2010: Cause for cautious celebration? A population-based study

    PubMed Central

    Hickish, Tamas; Rosenorn-Lanng, Emily; Wallace, Mark

    2016-01-01

    Objective Every Western nation expends vast sums on health, especially for cancer; thus, the question is how efficient is the UK in reducing adult (55–74) cancer mortality rates and total mortality rates (TMR) compared to the other Western nations in the context of economic-input to health, the percentage of Gross-Domestic-Product-expenditure-on-Health. Design WHO mortality rates for baseline 3 years 1989–1991 and 2008–2010 were analysed, and confidence intervals determine any significant differences between the UK and other countries in reducing the mortalities. Efficiency ratios are calculated by dividing reduced mortality over the period by the average % of national income. Setting Twenty-one similar socio-economic Western countries. Participants The 21 countries’ general population. Main outcome measures Cancer mortality rates, total mortality rates Gross Domestic Product and Efficiency Ratios. Results Economic Input: In 1980, UK national income was 5.6% and the European average was 7.1%. By 2010, UK national income was 9.4% being equal 17th of 21 averaging 7.1% over the period. Europe’s 1980–2010 average of 8.4% yields a UK to Europe ratio of 1:1.18. Clinical output 1989–2010: UK Cancer Mortality Rates was the sixth highest, but equal sixth biggest fall, significantly greater than 14 other countries. UK Total Mortality Rates was the fifth highest but third biggest decline, significantly greater than 17 countries. UK’s cancer Efficiency Ratios is largest at 1:301 and second biggest for Total Mortality Rates at 1.1341; the USA ratios were 1:152 and 1:525, respectively. Conclusions UK reduced mortalities indicate that the NHS achieves proportionally more with relatively less, but UK needs to match European average Gross-Domestic-Product-expenditure-on-Health to meet future challenges. PMID:27293774

  20. Mortality rate and gross pathology due to tuberculosis in wild brushtail possums (Trichosurus vulpecula) following low dose subcutaneous injection of Mycobacterium bovis.

    PubMed

    Nugent, Graham; Yockney, Ivor; Whitford, Jackie; Cross, Martin L

    2013-04-01

    Gross pathology due to tuberculosis can be established experimentally in brushtail possums (Trichosurus vulpecula) within 7 weeks of injection of virulent Mycobacterium bovis into subcutaneous connective tissues of the peripheral limbs. This pathology involves lymphadenomegaly and development of gross lesions in peripheral lymph nodes, with subsequent gross lesions in the lungs and reticuloendothelial organs. Using this artificial infection model, we here assessed the mortality rate for possums in the wild, to provide new information on the likely survival period for New Zealand's major wildlife host. Possums were trapped and inoculated with <50 CFU of M. bovis, then fitted with mortality signal emitting radio tracking collars, released and re-tracked for 6 months. Possum survival probability was 89% up to 12 weeks post-injection (p.i.), but cumulative mortality was rapid from then on. The median survival period, based on study of 38 possums, was 18 weeks p.i.; this corresponds with a predicted time interval of 11 weeks between first presentation of TB as palpable lymphadenomegaly and death for an average possum, shorter than period values currently used in possum TB epidemiological modelling. We also examined gross pathology in 11 possums by post mortem necropsy, and confirmed lymphadenomegaly and tuberculous lesions at 7 and 12 weeks p.i. Extra-peripheral gross lesions were more frequent among possums at 12 weeks p.i. than at 7 weeks, while the occurrence of lung lesions (the most likely cause of disease-induced mortality) was apparent in animals at 12 weeks but not at 7 weeks p.i. Our results suggest that the time course of TB from development of gross lesions to mortality may be shorter than previously estimated from field studies of naturally tuberculous possums. PMID:23063260

  1. ASSESSMENT OF THE RATES OF INJURY AND MORTALITY IN WATERFOWL CAPTURED WITH FIVE METHODS OF CAPTURE AND TECHNIQUES FOR MINIMIZING RISKS.

    PubMed

    O'Brien, Michelle F; Lee, Rebecca; Cromie, Ruth; Brown, Martin J

    2016-04-01

    Swan pipes, duck decoys, cage traps, cannon netting, and roundups are widely used to capture waterfowl in order to monitor populations. These methods are often regulated in countries with national ringing or banding programs and are considered to be safe, and thus justifiable given the benefits to conservation. However, few published studies have addressed how frequently injuries and mortalities occur, or the nature of any injuries. In the present study, rates of mortality and injury during captures with the use of these methods carried out by the Wildfowl & Wetlands Trust as part of conservation programs were assessed. The total rate of injury (including mild dermal abrasions) was 0.42% across all species groups, whereas total mortality was 0.1% across all capture methods. Incidence of injury varied among species groups (ducks, geese, swans, and rails), with some, for example, dabbling ducks, at greater risk than others. We also describe techniques used before, during, and after a capture to reduce stress and injury in captured waterfowl. Projects using these or other capture methods should monitor and publish their performance to allow sharing of experience and to reduce risks further. PMID:26845303

  2. Infant Stool Color Card Screening Helps Reduce the Hospitalization Rate and Mortality of Biliary Atresia: A 14-Year Nationwide Cohort Study in Taiwan.

    PubMed

    Lee, Min; Chen, Solomon Chih-Cheng; Yang, Hsin-Yi; Huang, Jui-Hua; Yeung, Chun-Yan; Lee, Hung-Chang

    2016-03-01

    Biliary atresia (BA) is a significant liver disease in children. Since 2004, Taiwan has implemented a national screening program that uses an infant stool color card (SCC) for the early detection of BA. The purpose of this study was to examine the outcomes of BA cases before and after the launch of this screening program. The objectives of this study were to evaluate the rates of hospitalization, liver transplantation (LT), and mortality of BA cases before and after the program, and to examine the association between the hospitalization rate and survival outcomes.This was a population-based cohort study. BA cases born during 1997 to 2010 were identified from the Taiwan National Health Insurance Research Database. Sex, birth date, hospitalization date, LT, and death data were collected and analyzed. The hospitalization rate by 2 years of age (Hosp/2yr) was calculated to evaluate its association with the outcomes of LT or death.Among 513 total BA cases, 457 (89%) underwent the Kasai procedure. Of these, the Hosp/2yr was significantly reduced from 6.0 to 6.9/case in the earlier cohort (1997-2004) to 4.9 to 5.3/case in the later cohort (2005-2010). This hospitalization rate reduction was followed by a reduction in mortality from 26.2% to 15.9% after 2006. The Cox proportional hazards model showed a significant increase in the risk for both LT (hazard ratio [HR] = 1.14, 95% confidence interval [CI] = 1.10-1.18) and death (HR = 1.05, 95% CI = 1.01-1.08) for each additional hospitalization. A multivariate logistic regression model found that cases with a Hosp/2yr >6 times had a significantly higher risk for both LT (adjusted odds ratio [aOR] = 4.35, 95% CI = 2.82-6.73) and death (aOR = 1.75, 95% CI = 1.17-2.62).The hospitalization and mortality rates of BA cases in Taiwan were significantly and coincidentally reduced after the launch of the SCC screening program. There was a significant association between the hospitalization rate and final

  3. Predictive 5-Year Survivorship Model of Cystic Fibrosis

    PubMed Central

    Liou, Theodore G.; Adler, Frederick R.; FitzSimmons, Stacey C.; Cahill, Barbara C.; Hibbs, Jonathan R.; Marshall, Bruce C.

    2007-01-01

    The objective of this study was to create a 5-year survivorship model to identify key clinical features of cystic fibrosis. Such a model could help researchers and clinicians to evaluate therapies, improve the design of prospective studies, monitor practice patterns, counsel individual patients, and determine the best candidates for lung transplantation. The authors used information from the Cystic Fibrosis Foundation Patient Registry (CFFPR), which has collected longitudinal data on approximately 90% of cystic fibrosis patients diagnosed in the United States since 1986. They developed multivariate logistic regression models by using data on 5,820 patients randomly selected from 11,630 in the CFFPR in 1993. Models were tested for goodness of fit and were validated for the remaining 5,810 patients for 1993. The validated 5-year survivorship model included age, forced expiratory volume in 1 second as a percentage of predicted normal, gender, weight-for-age z score, pancreatic sufficiency, diabetes mellitus, Staphylococcus aureus infection, Burkerholderia cepacia infection, and annual number of acute pulmonary exacerbations. The model provides insights into the complex nature of cystic fibrosis and supplies a rigorous tool for clinical practice and research. PMID:11207152

  4. Low birth weight, very low birth weight and extremely low birth weight in African children aged between 0 and 5 years old: a systematic review.

    PubMed

    Tchamo, M E; Prista, A; Leandro, C G

    2016-08-01

    Low birth weight (LBW<2500), very low birth weight (VLBW<1500), extremely low birth weight (ELBW<1500) infants are at high risk for growth failure that result in delayed development. Africa is a continent that presents high rates of children born with LBW, VLBW and ELBW particularly sub-Saharan Africa. To review the existing literature that explores the repercussions of LBW, VLBW and ELBW on growth, neurodevelopmental outcome and mortality in African children aged 0-5 years old. A systematic review of peer-reviewed articles using Academic Search Complete in the following databases: PubMed, Scopus and Scholar Google. Quantitatives studies that investigated the association between LBW, VLBW, ELBW with growth, neurodevelopmental outcome and mortality, published between 2008 and 2015 were included. African studies with humans were eligible for inclusion. From the total of 2205 articles, 12 articles were identified as relevant and were subsequently reviewed in full version. Significant associations were found between LBW, VLBW and ELBW with growth, neurodevelopmental outcome and mortality. Surviving VLBW and ELBW showed increased risk of death, growth retardation and delayed neurodevelopment. Post-neonatal interventions need to be carried out in order to minimize the short-term effects of VLBW and ELBW. PMID:27072315

  5. Hydrogen sulfide poisoning: review of 5 years' experience.

    PubMed Central

    Burnett, W. W.; King, E. G.; Grace, M.; Hall, W. F.

    1977-01-01

    The workforce of Alberta, a province rich in fossil fuel, faces an increasing risk of exposure to hydrogen sulfide (H2S). Basic knowledge of the population exposed during the years 1969 to 1973 inclusive was accumulated to identify the immediate medical and management problems. Data were recorded from three sources of records: the Workers' Compensation Board of Alberta, the Alberta Hospital Services Commission and the provincial coroner's office. There were 221 cases of exposure to H2S. The overall mortality was 6%; 5% of victims were dead on arrival at hospital. Admission to hospital was required for 65% of the victims arriving at a hospital emergency room (78% of the 221). Acute problems were coma, dysequilibrium and respiratory insufficiency with pulmonary edema. Increased attention to cardiopulmonary resuscitation at the exposure site and during transportation to hospital is necessary to reduce the mortality from H2S exposure. No long-term adverse effects were apparent in the survivors. PMID:144553

  6. Candidate Gene Analysis of Mortality in Dialysis Patients

    PubMed Central

    Verschuren, Jeffrey J. W.; Dekker, Friedo W.; Rabelink, Ton J.; Jukema, J. Wouter; Rotmans, Joris I.

    2015-01-01

    Background Dialysis patients have high cardiovascular mortality risk. This study aimed to investigate the association between SNPs of genes involved in vascular processes and mortality in dialysis patients. Methods Forty two SNPs in 25 genes involved in endothelial function, vascular remodeling, cell proliferation, inflammation, coagulation and calcium/phosphate metabolism were genotyped in 1330 incident dialysis patients. The effect of SNPs on 5-years cardiovascular and non-cardiovascular mortality was investigated. Results The mortality rate was 114/1000 person-years and 49.4% of total mortality was cardiovascular. After correction for multiple testing, VEGF rs699947 was associated with all-cause mortality (HR1.48, 95% CI 1.14–1.92). The other SNPs were not associated with mortality. Conclusions This study provides further evidence that a SNP in the VEGF gene may contribute to the comorbid conditions of dialysis patients. Future studies should unravel the underlying mechanisms responsible for the increase in mortality in these patients. PMID:26587841

  7. A comparison of trends in melanoma mortality in New Zealand and Australia: the two countries with the highest melanoma incidence and mortality in the world

    PubMed Central

    2013-01-01

    Background New Zealand and Australia have the highest incidence and mortality rates from cutaneous melanoma in the world. The predominantly fair-skinned New Zealanders and Australians both enjoy sun, tanned skin and the outdoors, and differences in these activities among generations have been important determinants of trends in melanoma mortality. We examined whether New Zealand trends in melanoma mortality mirror those in Australia, through detailed comparison of the trends in both countries from 1968 to 2007. Methods Five-year age-specific and age-standardised mortality rates were calculated for each country for 5-year time periods. Tests for trends in age-specific rates were performed using the Mantel-Haenszel extension chi-square test. The age-adjusted mortality rate ratios for New Zealand/Australia were plotted against period of death to show relative changes in mortality over time. Age-specific mortality rates were plotted against period and the median year of birth to illustrate age-group and birth cohort effects. To compare the mortality of birth cohorts, age-adjusted melanoma mortality rate ratios were calculated for the birth cohorts in the quin-quennial tables of mortality rates. Results The age-standardised mortality rate for melanoma increased in both sexes in New Zealand and Australia from 1968 to 2007, but the increase was greater in New Zealanders and women in particular. There was evidence of recent significant decreases in mortality in younger Australians and less so in New Zealand women aged under 45 years. Mortality from melanoma increased in successive generations born from about 1893 to 1918. In Australia, a decline in mortality started for generations born from about 1958 but in New Zealand there is possibly a decrease only in generations born since 1968. Conclusions Mortality trends in New Zealand and Australia are discrepant. It is too early to know if the pattern in mortality rates in New Zealand is simply a delayed response to melanoma

  8. Changes in Exercise Capacity of Cardiac Asymptomatic Hereditary Hemochromatosis Subjects over 5-Year Follow up

    PubMed Central

    Shizukuda, Yukitaka; Smith, Kevin P.; Tripodi, Dorothy J.; Arena, Ross; Yau, Yu-Ying; Bolan, Charles D.; Waclawiw, Myron A.; Leitman, Susan F.; Rosing, Douglas R.

    2012-01-01

    Objective A long-term effect of hereditary hemochromatosis (HH) on aerobic exercise capacity (AEC) has not been well described. Design Forty-three HH and 21 volunteer control (VC) subjects who were asymptomatic underwent cardiopulmonary exercise testing using the Bruce protocol. AEC was assessed with minute ventilation (VE), oxygen uptake (VO2), and carbon dioxide production (VCO2) at baseline (BL) at a 5-year follow up (5Y) assessment. A paired t-test was used for analyses of normality data; otherwise, a Wilcoxon singed rank sum test was used. Results Thirty-three HH subjects and 18 VC subjects returned for a repeat CPX at 5Y (80% overall return rate). At 5Y, AEC was not different between the two groups. As compared with BL measurements, exercise time, peak VO2, and the VE/VCO2 slope did not differ statistically at 5Y between both groups. Iron depletion by phlebotomy for 5 years did not significantly affect AEC in newly diagnosed HH subjects at baseline (n=14) and cardiac arrhythmias during exercise tended to decrease after 5 years of therapy in this group. Conclusions The AEC of asymptomatic HH subjects treated with conventional therapy is not statistically affected by the disease over a 5-year period. PMID:22311055

  9. Long-term benefits and risks of frontline nilotinib vs imatinib for chronic myeloid leukemia in chronic phase: 5-year update of the randomized ENESTnd trial.

    PubMed

    Hochhaus, A; Saglio, G; Hughes, T P; Larson, R A; Kim, D-W; Issaragrisil, S; le Coutre, P D; Etienne, G; Dorlhiac-Llacer, P E; Clark, R E; Flinn, I W; Nakamae, H; Donohue, B; Deng, W; Dalal, D; Menssen, H D; Kantarjian, H M

    2016-05-01

    In the phase 3 Evaluating Nilotinib Efficacy and Safety in Clinical Trials-Newly Diagnosed Patients (ENESTnd) study, nilotinib resulted in earlier and higher response rates and a lower risk of progression to accelerated phase/blast crisis (AP/BC) than imatinib in patients with newly diagnosed chronic myeloid leukemia in chronic phase (CML-CP). Here, patients' long-term outcomes in ENESTnd are evaluated after a minimum follow-up of 5 years. By 5 years, more than half of all patients in each nilotinib arm (300 mg twice daily, 54%; 400 mg twice daily, 52%) achieved a molecular response 4.5 (MR(4.5); BCR-ABL⩽0.0032% on the International Scale) compared with 31% of patients in the imatinib arm. A benefit of nilotinib was observed across all Sokal risk groups. Overall, safety results remained consistent with those from previous reports. Numerically more cardiovascular events (CVEs) occurred in patients receiving nilotinib vs imatinib, and elevations in blood cholesterol and glucose levels were also more frequent with nilotinib. In contrast to the high mortality rate associated with CML progression, few deaths in any arm were associated with CVEs, infections or pulmonary diseases. These long-term results support the positive benefit-risk profile of frontline nilotinib 300 mg twice daily in patients with CML-CP. PMID:26837842

  10. Long-term benefits and risks of frontline nilotinib vs imatinib for chronic myeloid leukemia in chronic phase: 5-year update of the randomized ENESTnd trial

    PubMed Central

    Hochhaus, A; Saglio, G; Hughes, T P; Larson, R A; Kim, D-W; Issaragrisil, S; le Coutre, P D; Etienne, G; Dorlhiac-Llacer, P E; Clark, R E; Flinn, I W; Nakamae, H; Donohue, B; Deng, W; Dalal, D; Menssen, H D; Kantarjian, H M

    2016-01-01

    In the phase 3 Evaluating Nilotinib Efficacy and Safety in Clinical Trials–Newly Diagnosed Patients (ENESTnd) study, nilotinib resulted in earlier and higher response rates and a lower risk of progression to accelerated phase/blast crisis (AP/BC) than imatinib in patients with newly diagnosed chronic myeloid leukemia in chronic phase (CML-CP). Here, patients' long-term outcomes in ENESTnd are evaluated after a minimum follow-up of 5 years. By 5 years, more than half of all patients in each nilotinib arm (300 mg twice daily, 54% 400 mg twice daily, 52%) achieved a molecular response 4.5 (MR4.5; BCR-ABL⩽0.0032% on the International Scale) compared with 31% of patients in the imatinib arm. A benefit of nilotinib was observed across all Sokal risk groups. Overall, safety results remained consistent with those from previous reports. Numerically more cardiovascular events (CVEs) occurred in patients receiving nilotinib vs imatinib, and elevations in blood cholesterol and glucose levels were also more frequent with nilotinib. In contrast to the high mortality rate associated with CML progression, few deaths in any arm were associated with CVEs, infections or pulmonary diseases. These long-term results support the positive benefit-risk profile of frontline nilotinib 300 mg twice daily in patients with CML-CP. PMID:26837842

  11. Understanding persistence in bulimia nervosa: a 5-year naturalistic study.

    PubMed

    Fairburn, Christopher G; Stice, Eric; Cooper, Zafra; Doll, Helen A; Norman, Patricia A; O'Connor, Marianne E

    2003-02-01

    Bulimia nervosa shows a marked tendency to persist, suggesting that powerful maintaining mechanisms operate. Using data from a prospective, 5-year, study of the natural course of 102 people with bulimia nervosa, the authors sought to identify predictors of persistence and to test specific hypotheses derived from the cognitive-behavioral theory of the persistence of bulimia nervosa. The results of both sets of analyses were consistent with the theory, with the degree of overevaluation of shape and weight and a history of childhood obesity predicting a persistent course. There was also support for the central prediction of the cognitive-behavioral theory. These findings suggest that the mechanisms specified by the theory influence its longer term natural course. PMID:12602430

  12. Pyomyositis in a 5-year-old child.

    PubMed

    Romeo, S; Sunshine, S

    2000-07-01

    We present a case of pyomyositis in an otherwise healthy 5-year-old child that underscores the potential for serious, life-threatening complications. Pyomyositis of the gluteal, psoas, and iliacus muscles was associated with osteomyelitis, septic arthritis, a large inferior vena cava thrombus, septic pulmonary emboli, and eventual pneumonia. Primary pyomyositis is a purulent infection of striated muscle thought to be caused by seeding from a transient bacteremia. The focal infection typically forms an abscess that generally responds to intravenous antibiotics and occasionally requires adjunctive computed tomography-guided aspiration and drainage. This localized infectious process rarely produces further sequelae unless treatment is delayed. Pyomyositis is rare in healthy individuals and requires a high clinical suspicion in patients who present with fever, leukocytosis, and localized pain. PMID:10910315

  13. Modifiable diarrhoea risk factors in Egyptian children aged <5 years.

    PubMed

    Mansour, A M; Mohammady, H El; Shabrawi, M El; Shabaan, S Y; Zekri, M Abou; Nassar, M; Salem, M E; Mostafa, M; Riddle, M S; Klena, J D; Messih, I A Abdel; Levin, S; Young, S Y N

    2013-12-01

    By conducting a case-control study in two university hospitals, we explored the association between modifiable risk behaviours and diarrhoea. Children aged <5 years attending outpatient clinics for diarrhoea were matched by age and sex with controls. Data were collected on family demographics, socioeconomic indicators, and risk behaviour practices. Two rectal swabs and a stool specimen were collected from cases and controls. Samples were cultured for bacterial pathogens using standard techniques and tested by ELISA to detect rotavirus and Cryptosporidium spp. Four hundred cases and controls were enrolled between 2007 and 2009. The strongest independent risk factors for diarrhoea were: presence of another household member with diarrhoea [matched odds ratio (mOR) 4.9, 95% CI 2.8-8.4] in the week preceding the survey, introduction to a new kind of food (mOR 3, 95% CI 1.7-5.4), and the child being cared for outside home (mOR 2.6, 95% CI 1.3-5.2). While these risk factors are not identifiable, in some age groups more easily modifiable risk factors were identified including: having no soap for handwashing (mOR 6.3, 95% CI 1.2-33.9) for children aged 7-12 months, and pacifier use (mOR 1.9, 95% CI 1.0-3.5) in children aged 0-6 months. In total, the findings of this study suggest that community-based interventions to improve practices related to sanitation and hygiene, handwashing and food could be utilized to reduce the burden of diarrhoea in Egyptian children aged <5 years. PMID:23433452

  14. Total wrist arthroplasty: a systematic review of the evidence from the last 5 years.

    PubMed

    Yeoh, D; Tourret, L

    2015-06-01

    We reviewed evidence on total wrist replacement from the last 5 years. Eight articles met a minimum set standard. The results of 405 prostheses were available, including seven different manufacturers. The mean follow up was 2.3-7.3 years with an average age of 52-63. Rheumatoid arthritis was the indication in 42% of patients. Motec demonstrated the best post-operative DASH scores. Only Maestro achieved a defined functional range of motion post-operatively. Universal 2 displayed the highest survival rates (100% at 3-5 years), while Elos had the lowest (57% at 5 years). Biaxial had the highest complication rates (68.7%), while Remotion had the lowest (11%). Wrist arthroplasty preserves some range of motion. Functional scores improved and were maintained over the mid- to long-term. Complication rates were higher than wrist fusion, with reports of radiological loosening and osteolysis. The evidence does not support the widespread use of arthroplasty over arthrodesis, and careful patient selection is essential. PMID:24963082

  15. Association of estimated glomerular filtration rate with all‐cause and cardiovascular mortality: the role of malnutrition–inflammation–cachexia syndrome

    PubMed Central

    Ou, Shuo‐Ming; Chen, Yung‐Tai; Hung, Szu‐Chun; Shih, Chia‐Jen; Lin, Chi‐Hung; Chiang, Chih‐Kang

    2016-01-01

    Abstract Background Previous studies have demonstrated that high estimated glomerular filtration rate (eGFR) is paradoxically associated with an increased risk of mortality, and the association becomes more predominant in older people. However, the role of malnutrition–inflammation–cachexia syndrome (MICS) in the association between eGFR and mortality has never been explored. Methods We conducted a community‐based cohort study using data from the Taipei City Elderly Health Examination Database, collected during the period 2001–10. All participants aged ≥65 years were included and stratified by the absence or presence of MICS, which is defined as the presence of at least one of the following markers: body mass index <22 kg/m2, serum albumin <3.0 mg/dL, or Geriatric Nutritional Risk Index (GNRI) <98. The study endpoints were all‐cause and cardiovascular mortality. Results A total of 131 354 participants were identified and categorized according to the chronic kidney disease stage based on eGFR. Compared with the reference eGFR of 60–89 mL/min/1.73 m2, the overall and cardiovascular mortality risks were markedly high in the groups with eGFR of <30 mL/min/1.73 m2 [overall: adjusted hazard ratio (aHR), 1.86; 95% confidence interval (CI), 1.72–2.00; cardiovascular: aHR, 1.87; 95% CI, 1.60–2.19] and ≥90 mL/min/1.73 m2 (overall: aHR, 1.23; 95% CI, 1.13–1.34; cardiovascular: aHR, 1.28; 95% CI, 1.06–1.54). In the absence of MICS, high eGFR was associated with lower mortality risk (aHR, 0.71; 95% CI, 0.62–0.80), and the U‐shaped relationship disappeared. Subgroup analyses produced consistent results. Conclusions MICS could influence the association observed between high eGFR and mortality in older people, particularly in those with low body mass index, albumin level, GNRI, and very low serum creatinine level. PMID:27493868

  16. Urinary Albumin-Creatinine Ratio, Estimated Glomerular Filtration Rate, and All-Cause Mortality Among US Adults With Obstructive Lung Function

    PubMed Central

    Ford, Earl S.

    2015-01-01

    BACKGROUND Elevated urinary albumin-creatinine ratio (UACR) and decreased estimated glomerular filtration rate (eGFR) predict all-cause mortality, but whether these markers of kidney damage and function do so in adults with obstructive lung function (OLF) is unclear. The objective of this study was to examine the associations between UACR and eGFR and all-cause mortality in adults with OLF. METHODS Data of 5,711 US adults aged 40 to 79 years, including 1,390 adults with any OLF who participated in the National Health and Nutrition Examination Survey III (1988–1994), were analyzed. Mortality follow-up was conducted through 2006. RESULTS During the median follow-up of 13.7 years, 650 adults with OLF died. After maximal adjustment, mean levels of UACR were higher in adults with moderate-severe OLF (7.5 mg/g; 95% CI, 6.7–8.5) than in adults with normal pulmonary function (6.2 mg/g; 95% CI, 5.8–6.6) (P = .003) and mild OLF (6.2 mg/g; 95% CI, 5.5–6.9) (P = .014). Adjusted mean levels of eGFR were lower in adults with moderate-severe OLF (87.6 mL/min/1.73 m2; < 95% CI, 86.0–89.1) than in adults with normal lung function (89.6 mL/min/1.73 m2; < 95% CI, 88.9–90.3) (P = .015). Among adults with OLF, hazard ratios for all-cause mortality increased as levels of UACR, modeled as categorical or continuous variables, increased (maximally adjusted hazard ratio for quintile 5 vs 1: 2.23; 95% CI, 1.56–3.18). eGFR, modeled as a continuous variable but not as quintiles, was significantly associated with mortality. CONCLUSIONS UACR and eGFR, in continuous form, were associated with all-cause mortality among US adults with OLF. PMID:25079336

  17. Trends in child mortality in India.

    PubMed

    Behl, A S

    2013-01-01

    To assess Indias recent trends in child mortality rates and disparities and identify ways to reduce child mortality and wealth-related health disparities, we analyzed three years of data from Indias National Family Health Survey related to child mortality. Nationally, declines in average child mortality were statistically significant, but declines in inequality were not. Urban areas had lower child mortality rates than rural areas but higher inequalities. Interstate differences in child mortality rates were significant, with rates in the highest-mortality states four to six times higher than in the lowest-mortality states. However, child mortality in most states declined. PMID:23396786

  18. Modal analysis of the deep-water solitary scleractinian, Desmophyllum dianthus, on SW Pacific seamounts: inferred recruitment periodicity, growth, and mortality rates

    NASA Astrophysics Data System (ADS)

    Thresher, R. E.; Adkins, J.; Thiagarajan, N.

    2011-12-01

    Little is known about the demography of corals inhabiting deep-sea features due to the logistical difficulties of working at the extreme depths they inhabit. To obtain basic information about growth, mortality, and recruitment dynamics for such a coral, we applied modal analysis to the size frequency distributions of live-caught and sub-fossil specimens of the widely distributed solitary cup coral, Desmophyllum dianthus, collected on SW Pacific seamounts. Comparison of live-caught material collected in 1997 and 2007-2009 indicated modal progression over time and an implied maximum age of approximately 190 years, which is similar to ages determined previously for D. dianthus using radiometric techniques. A log-linear decline in the number of individuals with increasing size further implies a constant adult mortality rate, of 15.1% per annum in 1997 and 9.2% per annum in 2007-2009. The spacing of size modes in the 2007-2009 samples suggests regularly episodic recruitment events, at 22- to 32-year intervals, which may relate to periodic variability in large-scale Southern Ocean circulation. Preliminary analyses of size frequency distributions of the sub-fossil material suggest that the trophodynamics, growth, and adult mortality schedules of D. dianthus in the SW Pacific have remained basically similar throughout the Holocene.

  19. Time trends in lung cancer mortality among nonsmokers and a note on passive smoking

    SciTech Connect

    Garfinkel, L.

    1981-06-01

    Lung cancer mortality rates were computed for nonsmokers in the American Cancer Society's prospective study for three 4-year periods from 1960 to 1972 and in the Dorn study of veterans for three 5-year periods from 1954 to 1969. There was no evidence of any trend in these rates by 5-year age groups or for the total groups. No time trend was observed in nonsmokers for cancers of other selected sites except for a decrease in cancer of the uterus. Compared to nonsmoking women married to nonsmoking husbands, nonsmokers married to smoking husbands showed very little, if any, increased risk of lung cancer.

  20. Mortality rates at 10 years after metal-on-metal hip resurfacing compared with total hip replacement in England: retrospective cohort analysis of hospital episode statistics

    PubMed Central

    Kendal, Adrian R; Prieto-Alhambra, Daniel; Arden, Nigel K; Judge, Andrew

    2013-01-01

    Objectives To compare 10 year mortality rates among patients undergoing metal-on-metal hip resurfacing and total hip replacement in England. Design Retrospective cohort study. Setting English hospital episode statistics database linked to mortality records from the Office for National Statistics. Population All adults who underwent primary elective hip replacement for osteoarthritis from April 1999 to March 2012. The exposure of interest was prosthesis type: cemented total hip replacement, uncemented total hip replacement, and metal-on-metal hip resurfacing. Confounding variables included age, sex, Charlson comorbidity index, rurality, area deprivation, surgical volume, and year of operation. Main outcome measures All cause mortality. Propensity score matching was used to minimise confounding by indication. Kaplan-Meier plots estimated the probability of survival up to 10 years after surgery. Multilevel Cox regression modelling, stratified on matched sets, described the association between prosthesis type and time to death, accounting for variation across hospital trusts. Results 7437 patients undergoing metal-on-metal hip resurfacing were matched to 22 311 undergoing cemented total hip replacement; 8101 patients undergoing metal-on-metal hip resurfacing were matched to 24 303 undergoing uncemented total hip replacement. 10 year rates of cumulative mortality were 271 (3.6%) for metal-on-metal hip resurfacing versus 1363 (6.1%) for cemented total hip replacement, and 239 (3.0%) for metal-on-metal hip resurfacing versus 999 (4.1%) for uncemented total hip replacement. Patients undergoing metal-on-metal hip resurfacing had an increased survival probability (hazard ratio 0.51 (95% confidence interval 0.45 to 0.59) for cemented hip replacement; 0.55 (0.47 to 0.65) for uncemented hip replacement). There was no evidence for an interaction with age or sex. Conclusions Patients with hip osteoarthritis undergoing metal-on-metal hip resurfacing have reduced mortality in

  1. Fractal analysis of heart rate dynamics as a predictor of mortality in patients with depressed left ventricular function after acute myocardial infarction. TRACE Investigators. TRAndolapril Cardiac Evaluation

    NASA Technical Reports Server (NTRS)

    Makikallio, T. H.; Hoiber, S.; Kober, L.; Torp-Pedersen, C.; Peng, C. K.; Goldberger, A. L.; Huikuri, H. V.

    1999-01-01

    A number of new methods have been recently developed to quantify complex heart rate (HR) dynamics based on nonlinear and fractal analysis, but their value in risk stratification has not been evaluated. This study was designed to determine whether selected new dynamic analysis methods of HR variability predict mortality in patients with depressed left ventricular (LV) function after acute myocardial infarction (AMI). Traditional time- and frequency-domain HR variability indexes along with short-term fractal-like correlation properties of RR intervals (exponent alpha) and power-law scaling (exponent beta) were studied in 159 patients with depressed LV function (ejection fraction <35%) after an AMI. By the end of 4-year follow-up, 72 patients (45%) had died and 87 (55%) were still alive. Short-term scaling exponent alpha (1.07 +/- 0.26 vs 0.90 +/- 0.26, p <0.001) and power-law slope beta (-1.35 +/- 0.23 vs -1.44 +/- 0.25, p <0.05) differed between survivors and those who died, but none of the traditional HR variability measures differed between these groups. Among all analyzed variables, reduced scaling exponent alpha (<0.85) was the best univariable predictor of mortality (relative risk 3.17, 95% confidence interval 1.96 to 5.15, p <0.0001), with positive and negative predictive accuracies of 65% and 86%, respectively. In the multivariable Cox proportional hazards analysis, mortality was independently predicted by the reduced exponent alpha (p <0.001) after adjustment for several clinical variables and LV function. A short-term fractal-like scaling exponent was the most powerful HR variability index in predicting mortality in patients with depressed LV function. Reduction in fractal correlation properties implies more random short-term HR dynamics in patients with increased risk of death after AMI.

  2. Incidence and Etiology of Acute Lower Respiratory Tract Infections in Hospitalized Children Younger Than 5 Years in Rural Thailand

    PubMed Central

    Hasan, Reem; Rhodes, Julia; Thamthitiwat, Somsak; Olsen, Sonja J.; Prapasiri, Prabda; Naorat, Sathapana; Chittaganpitch, Malinee; Henchaichon, Sununta; Dejsirilert, Surang; Srisaengchai, Prasong; Sawatwong, Pongpun; Jorakate, Possawat; Kaewpan, Anek; Fry, Alicia M.; Erdman, Dean; Chuananon, Somchai; Amornintapichet, Tussanee; Maloney, Susan A.; Baggett, Henry C.

    2015-01-01

    Background Pneumonia remains a leading cause of under-five morbidity and mortality globally. Comprehensive incidence, epidemiologic and etiologic data are needed to update prevention and control strategies. Methods We conducted active, population-based surveillance for hospitalized cases of acute lower respiratory tract infections (ALRI) among children <5 years of age in rural thailand. ALRI cases were systematically sampled for an etiology study that tested nasopharyngeal specimens by polymerase chain reaction; children without ALRI were enrolled as controls from outpatient clinics. Results We identified 28,543 hospitalized ALRI cases from 2005 to 2010. Among the 49% with chest radiographs, 63% had findings consistent with pneumonia as identified by 2 study radiologists. The hospitalized ALRI incidence rate was 5772 per 100,000 child-years (95% confidence interval: 5707, 5837) and was higher in boys versus girls (incidence rate ratio 1.38, 95% confidence interval: 1.35–1.41) and in children 6–23 months of age versus other age groups (incidence rate ratio 1.76, 95% confidence interval: 1.69–1.84). Viruses most commonly detected in ALRI cases were respiratory syncytial virus (19.5%), rhinoviruses (18.7%), bocavirus (12.8%) and influenza viruses (8%). Compared with controls, ALRI cases were more likely to test positive for respiratory syncytial virus, influenza, adenovirus, human metapneumovirus and parainfluenza viruses 1 and 3 (P ≤ 0.01 for all). Bloodstream infections, most commonly Streptococcus pneumoniae and nontyphoidal Salmonella, accounted for 1.8% of cases. Conclusions Our findings underscore the high burden of hospitalization for ALRI and the importance of viral pathogens among children in Thailand. Interventions targeting viral pathogens coupled with improved diagnostic approaches, especially for bacteria, are critical for better understanding of ALRI etiology, prevention and control. PMID:24030346

  3. Development and verification of child observation sheet for 5-year-old children.

    PubMed

    Fujimoto, Keiko; Nagai, Toshisaburo; Okazaki, Shin; Kawajiri, Mie; Tomiwa, Kiyotaka

    2014-02-01

    The aim of the study was to develop a newly devised child observation sheet (COS-5) as a scoring sheet, based on the Childhood Autism Rating Scale (CARS), for use in the developmental evaluation of 5-year-old children, especially focusing on children with autistic features, and to verify its validity. Seventy-six children were studied. The children were recruited among participants of the Japan Children's Cohort Study, a research program implemented by the Research Institute of Science and Technology for Society (RISTEX) from 2004 to 2009. The developmental evaluation procedure was performed by doctors, clinical psychologists, and public health nurses. The COS-5 was also partly based on the Kyoto Scale of Psychological Development 2001 (Kyoto Scale 2001). Further, the Developmental Disorders Screening Questionnaire for 5-Years-Olds, PDD-Autism Society Japan Rating Scale (PARS), doctor interview questions and neurological examination for 5-year-old children, and the Draw-a-Man Test (DAM) were used as evaluation scales. Eighteen (25.4%) children were rated as Suspected, including Suspected PDD, Suspected ADHD and Suspected MR. The COS-5 was suggested to be valid with favorable reliability (α=0.89) and correlation with other evaluation scales. The COS-5 may be useful, with the following advantages: it can be performed within a shorter time frame; it facilitates the maintenance of observation quality; it facilitates sharing information with other professions; and it is reliable to identify the autistic features of 5-year-old children. In order to verify its wider applications including the screening of infants (18months to 3years old) by adjusting the items of younger age, additional study is needed. PMID:23415454

  4. [Mortality. The behavior of mortality through 1987].

    PubMed

    Jimenez, R

    1988-01-01

    Mexico's crude death rate has declined from 33/1000 in the early 20th century to about 6/1000 in 1985-87. Mortality declined sharply from 1640-60. more slowly from 1960-77, and rapidly again beginning around 1980. The explanation for the mortality decline lies both in advances in medical and health care and in economic growth of the country. The mortality declines in the late 1970s and early 1980s probably resulted primarily from extension of primary health care programs in rural areas. The infant mortality rate has declined from 288.6/1000 live births in 1900 to 73.8 in 1960 and 42 in 1986-87. At present 30% of deaths in Mexico are to children under 5, but little is known of the impact of the country's economic crisis on mortality in this age group. The strong mortality decline between 1950-70 was in the economically active age group of 15-64 years. Excess male mortality in this group reached a maximum in 1980: for each death of woman there were 150 male deaths. Between 1960-80 the rate of deaths due to infection, parasfitism, and respiratory disease declined by 5%, the rate of death from cancer remained almost unchanged, and the rate of death from cardiovascular diseases increased by 9%. Deaths from accidents, homicide, suicide, and other violence increased by 38%. Male general mortality rates were 25% higher than female in 1980. Mexican life expectancy increased from 49.6 years in 195 to 67 in 1987. Life expectancy was 65.6 for males and 71.7 for females. Average life expectancy was 69 for the more privileged social sectors and 56.7 for agricultural workers in 1965-79. The life expectancy of urban women was 3 years longer than that of rural women and 10.4 years longer than that of rural men. PMID:12158030

  5. Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2013

    PubMed Central

    Oh, Chang-Mo; Won, Young-Joo; Jung, Kyu-Won; Kong, Hyun-Joo; Cho, Hyunsoon; Lee, Jong-Keun; Lee, Duk Hyoung; Lee, Kang Hyun

    2016-01-01

    Purpose: This study described the 2013 nationwide cancer statistics in Korea, including cancer incidence, survival, prevalence, and mortality. Materials and Methods: Cancer incidence data from 1999-2013 were obtained from Korea National Cancer Incidence Database and followed until December 31, 2014. Mortality data from 1983-2013 were obtained from Statistics Korea. The prevalence was defined as the number of cancer patients alive on January 1, 2014 among all cancer patients diagnosed since 1999. Crude, and age-standardized and 5-year relative survival rates were also calculated. Results: In 2013, a total of 225,343 and 75,334 Koreans were newly diagnosed and died from cancer, respectively. The age-standardized rates for cancer incidence and mortality in 2013 were 290.5 and 87.9 per 100,000, respectively. The age-standardized cancer incidence rate increased 3.1% annually between 1999 and 2013. However, the overall cancer incidence rates have decreased slightly in recent years (2011 to 2013). The age-standardized rate for all-cancer mortality has decreased 2.7% annually since 2002. Overall, the 5-year relative survival rate for people diagnosed with cancer between 2009 and 2013 was 69.4%, which represents an improved survival rate as compared with 41.2% for people diagnosed between 1993 and 1995. Conclusion: Age-standardized cancer incidence rates have decreased between 2011 and 2013; mortality rates have also declined since 2002, while 5-year survival rates have improved remarkably from 1993-1995 to 2009-2013 in Korea. PMID:26987395

  6. Evidence From Chile That Arsenic in Drinking Water May Increase Mortality From Pulmonary Tuberculosis

    PubMed Central

    Smith, Allan H.; Marshall, Guillermo; Yuan, Yan; Liaw, Jane; Ferreccio, Catterina; Steinmaus, Craig

    2011-01-01

    Arsenic in drinking water causes increased mortality from several cancers, ischemic heart disease, bronchiectasis, and other diseases. This paper presents the first evidence relating arsenic exposure to pulmonary tuberculosis, by estimating mortality rate ratios for Region II of Chile compared with Region V for the years 1958–2000. The authors compared mortality rate ratios with time patterns of arsenic exposure, which increased abruptly in 1958 in Region II and then declined starting in 1971. Tuberculosis mortality rate ratios in men started increasing in 1968, 10 years after high arsenic exposure commenced. The peak male 5-year mortality rate ratio occurred during 1982–1986 (rate ratio = 2.1, 95% confidence interval: 1.7, 2.6; P < 0.001) and subsequently declined. Mortality rates in women were also elevated but with fewer excess pulmonary tuberculosis deaths (359 among men and 95 among women). The clear rise and fall of tuberculosis mortality rate ratios in men following high arsenic exposure are consistent with a causal relation. The findings are biologically plausible in view of evidence that arsenic is an immunosuppressant and also a cause of chronic lung disease. Finding weaker associations in women is unsurprising, because this is true of most arsenic-caused health effects. Confirmatory evidence is needed from other arsenic-exposed populations. PMID:21190988

  7. A short-term sublethal toxicity assay with zebra fish based on preying rate and its integration with mortality.

    PubMed

    Abdel-moneim, Ahmed; Moreira-Santos, Matilde; Ribeiro, Rui

    2015-02-01

    Contaminant-induced feeding inhibition has direct and immediate consequences at higher levels of biological organization, by depressing the population consumption and thus hampering ecosystem functioning (e.g. grazing, organic matter decomposition). Thus, similarly to lethality and avoidance, feeding is mechanistically linked to ecosystem processes and is therefore an unequivocal ecologically meaningful response. The objective of the present study was to develop a short-term assay with the small freshwater fish Danio rerio, based on feeding. For this, a methodology to easily and precisely quantify feeding was first optimized: each fish was allowed to prey on ten live Daphnia magna juveniles, for 1h, just before the end of a 48-h exposure test period. Secondly, copper sensitivity of feeding relatively to survival and growth was evaluated. At the growth EC20 (40 μg L(-1)), feeding was inhibited by 53%, and at the feeding EC50 (36 μg L(-1)), mortality was negligible (1.3%). Integrating feeding and survival revealed a 97% depression in the population consumption at the LC50 (61 μg L(-1)). Thirdly, the influence of pH, conductivity and hardness on the feeding background variability was assessed by assaying waters collected at eight reference sites and was found to be negligible, within tested ranges. Fourthly, feeding assays with natural waters contaminated with acid mine drainage confirmed the integration of lethality and feeding to be pertinent at estimating contaminant effects at higher levels of biological organization. PMID:25462299

  8. Mortality from Cardiovascular Diseases in the Elderly: Comparative Analysis of Two Five-year Periods

    PubMed Central

    Piuvezam, Grasiela; Medeiros, Wilton Rodrigues; Costa, Andressa Vellasco; Emerenciano, Felipe Fonseca; Santos, Renata Cristina; Seabra, Danilo Silveira

    2015-01-01

    Background Cardiovascular diseases are the leading cause of death in Brazil. The better understanding of the spatial and temporal distribution of mortality from cardiovascular diseases in the Brazilian elderly population is essential to support more appropriate health actions for each region of the country. Objective To describe and to compare geospatially the rates of mortality from cardiovascular disease in elderly individuals living in Brazil by gender in two 5-year periods: 1996 to 2000 and 2006 to 2010. Methods This is an ecological study, for which rates of mortality were obtained from DATASUS and the population rates from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística). An average mortality rate for cardiovascular disease in elderly by gender was calculated for each period. The spatial autocorrelation was evaluated by TerraView 4.2.0 through global Moran index and the formation of clusters by the index of local Moran-LISA. Results There was an increase, in the second 5-year period, in the mortality rates in the Northeast and North regions, parallel to a decrease in the South, South-East and Midwest regions. Moreover, there was the formation of clusters with high mortality rates in the second period in Roraima among females, and in Ceará, Pernambuco and Roraima among males. Conclusion The increase in mortality rates in the North and Northeast regions is probably related to the changing profile of mortality and improvement in the quality of information, a result of the increase in surveillance and health care measures in these regions. PMID:26559984

  9. Cancer mortality in Brazil

    PubMed Central

    Barbosa, Isabelle R.; de Souza, Dyego L.B.; Bernal, María M.; Costa, Íris do C.C.

    2015-01-01

    Abstract Cancer is currently in the spotlight due to their heavy responsibility as main cause of death in both developed and developing countries. Analysis of the epidemiological situation is required as a support tool for the planning of public health measures for the most vulnerable groups. We analyzed cancer mortality trends in Brazil and geographic regions in the period 1996 to 2010 and calculate mortality predictions for the period 2011 to 2030. This is an epidemiological, demographic-based study that utilized information from the Mortality Information System on all deaths due to cancer in Brazil. Mortality trends were analyzed by the Joinpoint regression, and Nordpred was utilized for the calculation of predictions. Stability was verified for the female (annual percentage change [APC] = 0.4%) and male (APC = 0.5%) sexes. The North and Northeast regions present significant increasing trends for mortality in both sexes. Until 2030, female mortality trends will not present considerable variations, but there will be a decrease in mortality trends for the male sex. There will be increases in mortality rates until 2030 for the North and Northeast regions, whereas reductions will be verified for the remaining geographic regions. This variation will be explained by the demographic structure of regions until 2030. There are pronounced regional and sex differences in cancer mortality in Brazil, and these discrepancies will continue to increase until the year 2030, when the Northeast region will present the highest cancer mortality rates in Brazil. PMID:25906105

  10. NASA Infrared Telescope Facility- The Next 5 Years

    NASA Astrophysics Data System (ADS)

    Tokunaga, A. T.; Bus, S. J.; Tollestrup, E. V.; Rayner, J. T.

    2005-08-01

    The NASA Infrared Telescope Facility (IRTF) is a 3-meter optical/IR telescope dedicated to NASA-related programs of mission support and basic solar system research. All of the funding for IRTF operations comes from the Planetary Astronomy Program. We are preparing the Cooperative Agreement with NASA for the next 5 years (Feb. 2006 -- Jan. 2011). We will strive to refurbish the telescope in order to provide mission support and to allow the IRTF to provide fundamental data for future missions to Mars, comets, satellites, Near-Earth Objects, and asteroids. A major component of our activities will be to improve the image quality of the telescope and to provide high dynamic imaging on the IRTF. Details of our plans can be obtained at: http://irtfweb.ifa.hawaii.edu/Documents/pdf/1_plan_mar04C.pdf We acknowledge the support of NASA Cooperative Agreement no. NCC 5-538 with the National Aeronautics and Space Administration, Planetary Astronomy Program.

  11. Prediction of 5-Year Survival with Data Mining Algorithms.

    PubMed

    Sailer, Fabian; Pobiruchin, Monika; Bochum, Sylvia; Martens, Uwe M; Schramm, Wendelin

    2015-01-01

    Survival time prediction at the time of diagnosis is of great importance to make decisions about treatment and long-term follow-up care. However, predicting the outcome of cancer on the basis of clinical information is a challenging task. We now examined the ability of ten different data mining algorithms (Perceptron, Rule Induction, Support Vector Machine, Linear Regression, Naïve Bayes, Decision Tree, k-nearest Neighbor, Logistic Regression, Neural Network, Random Forest) to predict the dichotomous attribute "5-year-survival" based on seven attributes (sex, UICC-stage, etc.) which are available at the time of diagnosis. For this study we made use of the nationwide German research data set on colon cancer provided by the Robert Koch Institute. To assess the results a comparison between data mining algorithms and physicians' opinions was performed. Therefore, physicians guessed the survival time by leveraging the same seven attributes. The average accuracy of the physicians' opinion was 59%, the average accuracy of the machine learning algorithms was 67.7%. PMID:26152957

  12. Regulation of emotion and behavior among 3- and 5-year-olds.

    PubMed

    Kalpidou, Maria D; Power, Thomas G; Cherry, Katie E; Gottfried, Nathan W

    2004-04-01

    In this cross-sectional study, the authors examined the relationship between emotion and behavior regulation in 3- and 5-year olds. Eighty-seven children performed a compliance sorting task. The authors manipulated the demand for emotion regulation by presenting and then hiding toys (low) or making toys visible (high). Mothers and teachers rated children's coping responses. Five-year-olds sorted less in the high condition than in the low condition, and 3-year-olds spent equal time sorting in both conditions. Compliance was positively correlated with problem-focused coping and negatively correlated with emotion-focused coping. Correlations between emotion and behavior regulation were stronger for the 5-year-olds. Age groups were differently affected by the higher demands of emotion regulation, indicating that the child's resources for regulation interact with the task demands to determine behavioral outcome. PMID:15088868

  13. Working with Workflows: Highlights from 5 years Building Scientific Workflows

    SciTech Connect

    Critchlow, Terence J.; Altintas, Ilkay; Chin, George; Crawl, Daniel; Iyer, H.; Khan, Ayla; Klasky, S.; Koehler, Sven; Ludaescher, Bertram T.; Mouallem, Pierre; Nagappan, Mie; Podhorszki, Norbert; Shoshani, Arie; Silva, C.; Tchoua, Roselynne; Vouk, M.

    2011-07-30

    In 2006, the SciDAC Scientific Data Management (SDM) Center proposed to continue its work deploying leading edge data management and analysis capabilities to scientific applications. One of three thrust areas within the proposed center was focused on Scientific Process Automation (SPA) using workflow technology. As a founding member of the Kepler consortium [LAB+09], the SDM Center team was well positioned to begin deploying workflows immediately. We were also keenly aware of some of the deficiencies in Kepler when applied to high performance computing workflows, which allowed us to focus our research and development efforts on critical new capabilities which were ultimately integrated into the Kepler open source distribution, benefiting the entire community. Significant work was required to ensure Kepler was capable of supporting large-scale production runs for SciDAC applications. Our work on generic actors and templates have improved the portability of workflows across machines and provided a higher level of abstraction for workflow developers. Fault tolerance and provenance tracking were obvious areas for improvement within Kepler given the longevity and complexity of our target workflows. To monitor workflow execution, we developed and deployed a web-based dashboard. We then generalized this interface and released it so it could be deployed at other locations. Outreach has always been a primary focus of our work and we had many successful deployments across a number of scientific domains while continually publishing and presenting our work. This short paper describes our most significant accomplishments over the past 5 years. Additional information about the SDM Center can be found in the companion paper: The Scientific Data Management Center: Available Technologies and Highlights.

  14. Infant Mortality

    MedlinePlus

    ... Infant Mortality Infant Mortality: What is CDC Doing? Sudden Infant Death Syndrome Teen Pregnancy Contraception CDC Contraceptive Guidance for ... and low birth weight Maternal complications of pregnancy Sudden Infant Death Syndrome (SIDS) Injuries (e.g., suffocation). The top ...

  15. War and Children's Mortality.

    ERIC Educational Resources Information Center

    Carlton-Ford, Steve; Houston, Paula; Hamill, Ann

    2000-01-01

    Examines impact of war on young children's mortality in 137 countries. Finds that years recently at war (1990-5) interact with years previously at war (1946-89) to elevate mortality rates. Religious composition interacts with years recently at war to reduce effect. Controlling for women's literacy and access to safe water eliminates effect for…

  16. Tackling Health Inequities in Chile: Maternal, Newborn, Infant, and Child Mortality Between 1990 and 2004

    PubMed Central

    Requejo, Jennifer Harris; Nien, Jyh Kae; Merialdi, Mario; Bustreo, Flavia; Betran, Ana Pilar

    2009-01-01

    Objectives. We analyzed trends in maternal, newborn, and child mortality in Chile between 1990 and 2004, after the introduction of national interventions and reforms, and examined associations between trends and interventions. Methods. Data were provided by the Chilean Ministry of Health on all pregnancies between 1990 and 2004 (approximately 4 000 000). We calculated yearly maternal mortality ratios, stillbirth rates, and mortality rates for neonates, infants (aged > 28 days and < 1 year), and children aged 1 to 4 years. We also calculated these statistics by 5-year intervals for Chile's poorest to richest district quintiles. Results. During the study period, the maternal mortality ratio decreased from 42.1 to 18.5 per 100 000 live births. The mortality rate for neonates decreased from 9.0 to 5.7 per 1000 births, for infants from 7.8 to 3.1 per 1000 births, and for young children from 3.1 to 1.7 per 1000 live births. The stillbirth rate declined from 6.0 to 5.0 per 1000 births. Disparities in these mortality statistics between the poorest and richest district quintiles also decreased, with the largest mortality reductions in the poorest quintile. Conclusions. During a period of socioeconomic development and health sector reforms, Chile experienced significant mortality and inequity reductions. PMID:19443831

  17. Abdominal computed tomography during pregnancy for suspected appendicitis: a 5-year experience at a maternity hospital.

    PubMed

    Shetty, Mahesh K; Garrett, Nan M; Carpenter, Wendy S; Shah, Yogesh P; Roberts, Candace

    2010-02-01

    The objective of this article is to evaluate the role of computed tomography (CT) in a pregnant patient with right lower quadrant pain in whom there was a clinical suspicion of acute appendicitis. During a 5-year period the clinical records of all pregnant women who underwent imaging examination for clinically suspected appendicitis were reviewed. The imaging findings were correlated with patient management and final outcome. Thirty-nine pregnant patients were referred for imaging, of which 35 underwent initial evaluation with sonography, 23 of these women underwent a computed tomographic examination, and an additional 4 patients were directly imaged with CT without earlier sonographic assessment. Surgery confirmed appendicitis in all 5 patients who were operated on on the basis of findings of appendicitis on a CT scan. Two patients underwent surgery based on an alternate diagnosis suggested preoperatively (tubal torsion = 1, ovarian torsion = 1). All patients with negative findings at CT had an uneventful clinical course. In those patients who were evaluated only with ultrasound, a diagnosis of appendicitis was missed in 5 patients. The sensitivity of CT in the diagnosis of appendicitis in our study group was 100%, compared with a sensitivity of 46.1% for ultrasound. CT provides an accurate diagnosis in patients suspected to have acute appendicitis and is of value in avoiding false negative exploratory laparatomy with its consequent risk of maternal and fetal mortality and morbidity. Although sonography is the preferred initial imaging modality as its lack of ionizing radiation, CT is more accurate in providing a timely diagnosis and its use is justified to reduce maternal mortality and mortality in patients with appendicitis. PMID:20102691

  18. Effect of supplemental heat on mortality rate, growth performance, and blood biochemical profiles of Ghungroo piglets in Indian sub-tropical climate

    PubMed Central

    Nath, Hemanta; Hazorika, Mousumi; Rajkhowa, Dipjyoti; Datta, Mrinmoy; Haldar, Avijit

    2016-01-01

    Aim: The present study was conducted to explore the effect of supplemental heat on mortality rate, growth performance, and blood biochemical profiles of indigenous Ghungroo piglets in sub-tropical cold and humid climatic conditions of Tripura, a state of the north eastern hill (NEH) region of India. Materials and Methods: The experiment was conducted on 38 indigenous Ghungroo piglets from birth up to 60 days of age. Among the 38 piglets, 19 piglets were provided with supplemental heat ranging between 17.0°C and 21.1°C for the period of the first 30 days and thereafter between 24.1°C and 29.9°C for the next 30 days. The other 19 piglets were exposed to natural environmental minimum temperatures ranging between 7.2°C and 15.0°C during the first 30 days and then between 18.5°C and 25.5°C for the next 30 days. Results: The supplemental heat resulted in 10.6% reduction of piglet mortality from the 2nd till the 7th day of age. These beneficial effects could be related with the lower (p<0.05) plasma glutamate pyruvate transaminase (GPT) and cortisol levels and higher (p<0.05) plasma alkaline phosphatase (AP) concentrations in heat supplemented group compared to control group. Plasma AP, GPT, glucose, triiodothyronine, and luteinizing hormone concentrations decreased (p<0.05) gradually with the advancement of age in both control and supplemental heat treated piglets. Conclusion: Supplemental heat could be beneficial since it is related to a reduction of piglet mortality during the first week of life under farm management system in the sub-tropical climate of NEH region of India. PMID:27182136

  19. Cryobanking of human ovarian tissue: Do women still want their tissue stored beyond 5 years?

    PubMed

    Macklon, Kirsten Tryde; Ernst, Erik; Andersen, Anders Nyboe; Andersen, Claus Yding

    2014-10-01

    Cryopreservation of ovarian tissue is one way of preserving fertility in young women with a malignant disease or other disorders that require gonadotoxic treatment. The purpose of the study was to explore how many women remained interested in continued cryostorage of their ovarian tissue beyond an initial 5-year period. Between 1999 and 2006, a total of 201 girls and young women had one ovary cryopreserved for fertility preservation in Denmark. One hundred of these met our inclusion criteria, which included a follow-up period of at least 5 years, and were mailed a questionnaire. The response rate was 95%. Sixteen of the patients (17%) stated that they wanted disposal of their tissue; the main reason was completion of family (63%). The mean age of those requesting disposal was 36.6 years, whereas those still wanting their tissue stored were significantly younger, with a mean age of 33.0 years (P < 0.008). In conclusion, most women with ovarian tissue cryobanked requested continued cryostorage after an initial period of at least 5 years. The main reason for requesting disposal was successful completion of a family. PMID:25129692

  20. Endocrine dysfunction following traumatic brain injury: a 5-year follow-up nationwide-based study

    PubMed Central

    Yang, Wei-Hsun; Chen, Pau-Chung; Wang, Ting-Chung; Kuo, Ting-Yu; Cheng, Chun-Yu; Yang, Yao-Hsu

    2016-01-01

    Post-traumatic endocrine dysfunction is a complication of traumatic brain injury (TBI). However, there is lack of long-term follow-up and large sample size studies. This study included patients suffering from TBI registered in the Health Insurance Database. Endocrine disorders were identified using the ICD codes: 244 (acquired hypothyroidism), 253 (pituitary dysfunction), 255 (disorders of the adrenal glands), 258 (polyglandular dysfunction), and 259 (other endocrine disorders) with at least three outpatient visits within 1 year or one admission diagnosis. Overall, 156,945 insured subjects were included in the final analysis. The 1- and 5-year incidence rates of post-traumatic endocrinopathies were 0.4% and 2%, respectively. The risks of developing a common endocrinopathy (p < 0.001) or pituitary dysfunction (P < 0.001) were significantly higher in patients with a TBI history. Patients with a skull bone fracture had a higher risk of developing pituitary dysfunction at the 1-year follow up (p value < 0.001). At the 5-year follow up, the association between intracranial hemorrhage and pituitary dysfunction (p value: 0.002) was significant. The risk of developing endocrine dysfunction after TBI increased during the entire 5-year follow-up period. Skull bone fracture and intracranial hemorrhage may be associated with short and long-term post-traumatic pituitary dysfunction, respectively. PMID:27608606

  1. Outcomes 5 years after response to rituximab therapy in children and adults with immune thrombocytopenia

    PubMed Central

    Mahévas, Matthieu; Lee, Soo Y.; Stasi, Roberto; Cunningham-Rundles, Susanna; Godeau, Bertrand; Kanter, Julie; Neufeld, Ellis; Taube, Tillmann; Ramenghi, Ugo; Shenoy, Shalini; Ward, Mary J.; Mihatov, Nino; Patel, Vinay L.; Bierling, Philippe; Lesser, Martin; Cooper, Nichola; Bussel, James B.

    2012-01-01

    Treatments for immune thrombocytopenic purpura (ITP) providing durable platelet responses without continued dosing are limited. Whereas complete responses (CRs) to B-cell depletion in ITP usually last for 1 year in adults, partial responses (PRs) are less durable. Comparable data do not exist for children and 5-year outcomes are unavailable. Patients with ITP treated with rituximab who achieved CRs and PRs (platelets > 150 × 109/L or 50-150 × 109/L, respectively) were selected to be assessed for duration of their response; 72 adults whose response lasted at least 1 year and 66 children with response of any duration were included. Patients had baseline platelet counts < 30 × 109/L; 95% had ITP of > 6 months in duration. Adults and children each had initial overall response rates of 57% and similar 5-year estimates of persisting response (21% and 26%, respectively). Children did not relapse after 2 years from initial treatment whereas adults did. Initial CR and prolonged B-cell depletion predicted sustained responses whereas prior splenectomy, age, sex, and duration of ITP did not. No novel or substantial long-term clinical toxicity was observed. In summary, 21% to 26% of adults and children with chronic ITP treated with standard-dose rituximab maintained a treatment-free response for at least 5 years without major toxicity. These results can inform clinical decision-making. PMID:22566601

  2. Endocrine dysfunction following traumatic brain injury: a 5-year follow-up nationwide-based study.

    PubMed

    Yang, Wei-Hsun; Chen, Pau-Chung; Wang, Ting-Chung; Kuo, Ting-Yu; Cheng, Chun-Yu; Yang, Yao-Hsu

    2016-01-01

    Post-traumatic endocrine dysfunction is a complication of traumatic brain injury (TBI). However, there is lack of long-term follow-up and large sample size studies. This study included patients suffering from TBI registered in the Health Insurance Database. Endocrine disorders were identified using the ICD codes: 244 (acquired hypothyroidism), 253 (pituitary dysfunction), 255 (disorders of the adrenal glands), 258 (polyglandular dysfunction), and 259 (other endocrine disorders) with at least three outpatient visits within 1 year or one admission diagnosis. Overall, 156,945 insured subjects were included in the final analysis. The 1- and 5-year incidence rates of post-traumatic endocrinopathies were 0.4% and 2%, respectively. The risks of developing a common endocrinopathy (p < 0.001) or pituitary dysfunction (P < 0.001) were significantly higher in patients with a TBI history. Patients with a skull bone fracture had a higher risk of developing pituitary dysfunction at the 1-year follow up (p value < 0.001). At the 5-year follow up, the association between intracranial hemorrhage and pituitary dysfunction (p value: 0.002) was significant. The risk of developing endocrine dysfunction after TBI increased during the entire 5-year follow-up period. Skull bone fracture and intracranial hemorrhage may be associated with short and long-term post-traumatic pituitary dysfunction, respectively. PMID:27608606

  3. Prediction of glucuronidated drug clearance in pediatrics (≤5 years): An allometric approach.

    PubMed

    Mahmood, Iftekhar

    2015-03-01

    Children are not small adults. The differences between children of different age groups and adults are not merely due to body weight, but also due to physiological and biochemical differences resulting in different rates of drug metabolism or renal clearance. Glucuronidation is an important pathway of drug metabolism. Therefore, the objective of this study is to evaluate the predictive performance of several allometric exponents in children of ≤5 years for the total clearance of drugs which are mainly metabolized by glucuronidation. Four exponents (0.75, 1.0, 1.2, or 1.4) on the body weights and an allometric model developed from adults were evaluated. The four exponents and the allometric model were examined to determine the suitability of the method(s) to predict the clearances of drugs which are glucuronidated in children ≤5 years of age. Based on the analysis of ten drugs, it was noted that the combination of two allometric exponents 1.2 (for children ≤3 months) and 1.0 (for children ≥3 months ≤5 years) can be used to predict mean clearances of drugs which are mainly metabolized by glucuronidation. The suggested approach may be used to estimate a first-in-pediatric dose to initiate a pediatric clinical trial. PMID:24519316

  4. A hypothetical study of populations under constant mortality and fertility.

    PubMed

    Gupta, R B

    1976-03-01

    28 countries with different characteristics have been selected in order to observe the amount of time it takes for these different countries to reach stable age distributions. The individual populations by sex and age were projected for 150 years in 5-year intervals with the present constant mortality and fertility schedules by component method. Observations have been made by considering the following characteristics of population when it has acquired stability: age distribution; the rate of growth, birthrate, and mortality rate; the population change; the intrinsic rate of growth, birthrate and mortality rate; and approximate time taken to stabilize the population. The initial age distribution has a significant part in the amount of time it takes for a population to acquire stability, and its intrinsic rate of growth is mostly dependent upon the existing age distribution of that population. The time taken for a country's population to become stable depends upon the age distribution, fertility and mortality schedules at the beginning. It has been observed that countries having a higher intrinsic rate of growth take comparatively less time in acquiring stability than the countries having a lower intrinsic rate of growth. The mortality and fertility schedules of a country is another important phenomenon. The populations of the different countries at the point of stability were growing according to their rates of growth. No specific trend of population growth could be found among the groups of countries. Time taken for stabilizing the population is completely based upon age distributions, fertility and mortality schedules a particular country was having at the beginning. The range of time taken for different countries to acquire stability generally ranged from 100 to 135 years. Among the different countries the relationship for the time it takes to acquire stability has not been established. This is a hypothetical approach in order to obtain some idea as to how a

  5. A 5-Year Analysis of Peer-Reviewed Journal Article Publications of Pharmacy Practice Faculty Members

    PubMed Central

    Spivey, Christina; Martin, Jennifer R.; Wyles, Christina; Ehrman, Clara; Schlesselman, Lauren S.

    2012-01-01

    Objectives. To evaluate scholarship, as represented by peer-reviewed journal articles, among US pharmacy practice faculty members; contribute evidence that may better inform benchmarking by academic pharmacy practice departments; and examine factors that may be related to publication rates. Methods. Journal articles published by all pharmacy practice faculty members between January 1, 2006, and December 31, 2010, were identified. College and school publication rates were compared based on public vs. private status, being part of a health science campus, having a graduate program, and having doctor of pharmacy (PharmD) faculty members funded by the National Institutes of Health (NIH). Results. Pharmacy practice faculty members published 6,101 articles during the 5-year study period, and a pharmacy practice faculty member was the primary author on 2,698 of the articles. Pharmacy practice faculty members published an average of 0.51 articles per year. Pharmacy colleges and schools affiliated with health science campuses, at public institutions, with NIH-funded PharmD faculty members, and with graduate programs had significantly higher total publication rates compared with those that did not have these characteristics (p<0.006). Conclusion. Pharmacy practice faculty members contributed nearly 6,000 unique publications over the 5-year period studied. However, this reflects a rate of less than 1 publication per faculty member per year, suggesting that a limited number of faculty members produced the majority of publications. PMID:23049099

  6. A 5-year experience with an elective scholarly concentrations program

    PubMed Central

    George, Paul; Green, Emily P.; Park, Yoon S.; Gruppuso, Philip A.

    2015-01-01

    Problem Programs that encourage scholarly activities beyond the core curriculum and traditional biomedical research are now commonplace among US medical schools. Few studies have generated outcome data for these programs. The goal of the present study was to address this gap. Intervention The Scholarly Concentration (SC) Program, established in 2006 at the Warren Alpert Medical School of Brown University, is a 4-year elective program that not only encourages students to pursue scholarly work that may include traditional biomedical research but also seeks to broaden students’ focus to include less traditional areas. We compared characteristics and academic performance of SC students and non-SC students for the graduating classes of 2010–2014. Context Approximately one-third of our students opt to complete an SC during their 4-year undergraduate medical education. Because this program is additional to the regular MD curriculum, we sought to investigate whether SC students sustained the academic achievement of non-SC students while at the same time producing scholarly work as part of the program. Outcome Over 5 years, 35% of students elected to enter the program and approximately 81% of these students completed the program. The parameters that were similar for both SC and non-SC students were age at matriculation, admission route, proportion of undergraduate science majors, and number of undergraduate science courses. Most academic indicators, including United States Medical Licensing Examinations scores, were similar for the two groups; however, SC students achieved more honors in the six core clerkships and were more likely to be inducted into the medical school's two honor societies. Residency specialties selected by graduates in the two groups were similar. SC students published an average of 1.3 peer-reviewed manuscripts per student, higher than the 0.8 manuscripts per non-SC student (p=0.013). Conclusions An elective, interdisciplinary scholarly program with

  7. Projection of burden of cancer mortality for India, 2011-2026.

    PubMed

    D'Souza, Neevan Divya Rani; Murthy, Nandagudi Srinivasa; Aras, Radha Yeshwant

    2013-01-01

    Projection of load of cancer mortality helps in quantifying the burden of cancer and is essential for planning cancer control activities. As per our knowledge, there have not been many attempts to project the cancer mortality burden at the country level in India mainly due to lack of data on cancer mortality at the national and state level. This is an attempt to understand the magnitude of cancer mortality problem for the various calendar years from 2011 to 2026 at 5-yearly intervals. Age, sex and site-wise specific cancer mortality data along with populations covered by the registries were obtained from the report of National Cancer Registry Programme published by Indian Council of Medical Research for the period 2001-2004. Pooled age sex specific cancer mortality rates were obtained by taking weighted average of these six registries with respective registry populations as weights. The pooled mortality rates were assumed to represent the country's mortality rates. Populations of the country according to age and sex exposed to the risk of cancer mortality in different calendar years were obtained from the report of Registrar General of India providing population projections for the country for the years from 2011 to 2026. Population forecasts were combined with the pooled mortality rates to estimate the projected number of cancer mortality cases by age, sex and site of cancer at various 5-yearly periods Viz. 2011, 2016, 2021 and 2026. The projections were carried out for the various cancer-leading sites as well as for 'all sites' of cancer. The results revealed that an estimated 0.44 million died due to cancer during the year 2011, while 0.51 million and 0.60 million persons are likely to die from cancer in 2016 and 2021. In the year 2011 male mortality was estimated to be 0.23 million and female mortality to be 0.20 million. The estimated cancer mortality would increase to 0.70 million by the year 2026 as a result of change in size and composition of population

  8. Factors Affecting Access to Healthcare: An Observational Study of Children under 5 Years of Age Presenting to a Rural Gambian Primary Healthcare Centre

    PubMed Central

    Hawkesworth, Sophie; Moore, Sophie E.; Dondeh, Bai L.; Unger, Stefan A.

    2016-01-01

    Main Objective Prompt access to primary healthcare before onset of severe illness is vital to improve morbidity and mortality rates. The Gambia has high rates of child mortality and research is needed to investigate contributing factors further. This study aimed to identify factors affecting access to primary healthcare for children <5 years (y) in rural Gambia focusing on delayed presentation and severe illness at presentation as indicators in a setting where primary healthcare is delivered free of charge. Methods Data were extracted from an electronic medical records system at a rural primary healthcare clinic in The Gambia for children (0–5y) between 2009 and 2012. First clinic attendances with malaria, lower respiratory tract infections (LRTI) and diarrhoeal disease, the main contributors to mortality in this setting, were identified and categorized as delayed/non-delayed and severe/non-severe representing our two main outcome measures. Potential explanatory variables, identified through a comprehensive literature review were obtained from an ongoing demographic surveillance system for this population. Variables associated with either delayed/non-delayed and/or with severe/non-severe presentations identified by univariate analysis (p<0.1) were assessed in multivariate models using logistic regression (p<0.05). Results Out of 6554 clinic attendances, 571 relevant attendances were identified. Delayed presentation was common (45% of all presentations) and there was a significantly reduced risk associated with being from villages with free regular access to transport (OR 0.502, 95%CI[0.310, 0.814], p = 0.005). Children from villages with free regular transport were also less likely to present with severe illness (OR 0.557, 95%CI[0.325, 0.954], p = 0.033). Conclusions Transport availability rather than distance to health clinic is an important barrier to accessing healthcare for children in The Gambia, and public health interventions should aim to reduce this

  9. Incidence, mortality and survival patterns of prostate cancer among residents in Singapore from 1968 to 2002

    PubMed Central

    Chia, Sin Eng; Tan, Chuen Seng; Lim, Gek Hsiang; Sim, Xueling; Pawitan, Yudi; Reilly, Marie; Mohamed Ali, Safiyya; Lau, Weber; Chia, Kee Seng

    2008-01-01

    Background From 1968 to 2002, Singapore experienced an almost four-fold increase in prostate cancer incidence. This paper examines the incidence, mortality and survival patterns for prostate cancer among all residents in Singapore from 1968 to 2002. Methods This is a retrospective population-based cohort study including all prostate cancer cases aged over 20 (n = 3613) reported to the Singapore Cancer Registry from 1968 to 2002. Age-standardized incidence, mortality rates and 5-year Relative Survival Ratios (RSRs) were obtained for each 5-year period. Follow-up was ascertained by matching with the National Death Register until 2002. A weighted linear regression was performed on the log-transformed age-standardized incidence and mortality rates over period. Results The percentage increase in the age-standardized incidence rate per year was 5.0%, 5.6%, 4.0% and 1.9% for all residents, Chinese, Malays and Indians respectively. The percentage increase in age-standardized mortality rate per year was 5.7%, 6.0%, 6.6% and 2.5% for all residents, Chinese, Malays and Indians respectively. When all Singapore residents were considered, the RSRs for prostate cancer were fairly constant across the study period with slight improvement from 1995 onwards among the Chinese. Conclusion Ethnic differences in prostate cancer incidence, mortality and survival patterns were observed. There has been a substantial improvement in RSRs since the 1990s for the Chinese. PMID:19087276

  10. 24 CFR 903.6 - What information must a PHA provide in the 5-Year Plan?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... in the 5-Year Plan? 903.6 Section 903.6 Housing and Urban Development REGULATIONS RELATING TO HOUSING... must a PHA provide in the 5-Year Plan? (a) A PHA must include in its 5-Year Plan a statement of: (1... domestic violence, dating violence, sexual assault, or stalking. (b) After submitting its first 5-Year...

  11. 24 CFR 903.6 - What information must a PHA provide in the 5-Year Plan?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... in the 5-Year Plan? 903.6 Section 903.6 Housing and Urban Development REGULATIONS RELATING TO HOUSING... must a PHA provide in the 5-Year Plan? (a) A PHA must include in its 5-Year Plan a statement of: (1... domestic violence, dating violence, sexual assault, or stalking. (b) After submitting its first 5-Year...

  12. 24 CFR 903.6 - What information must a PHA provide in the 5-Year Plan?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... in the 5-Year Plan? 903.6 Section 903.6 Housing and Urban Development REGULATIONS RELATING TO HOUSING... must a PHA provide in the 5-Year Plan? (a) A PHA must include in its 5-Year Plan a statement of: (1... domestic violence, dating violence, sexual assault, or stalking. (b) After submitting its first 5-Year...

  13. Effects of low doses and low dose rates of external ionizing radiation: Cancer mortality among nuclear industry workers in three countries

    SciTech Connect

    Cardis, E.; Kato, I.; Lave, C.; Gilbert, E.S.; Fix., J.; Carpenter, L.; Howe, D.; Armstrong, B.K.; Bereal, V.

    1995-05-01

    Studies of the mortality among nuclear industry workforces have been carried out, and nationally combined analyses performed, in the U.S., the UK and Canada. This paper presents the results of internationally combined analyses of mortality data on 95,673 workers (85.4% men) monitored for external exposure to ionizing radiation and employed for 6 months or longer in the nuclear industry of one of the three countries. These analyses were undertaken to obtain a more precise direct assessment of the carcinogenic effects of protracted low-level exposure to external, predominantly {gamma}, radiation. The combination of the data from the various studies increases the power to study associations between radiation dose and mortality from all causes or from all cancers. Mortality from leukemia, excluding chronic lymphocytic leukemia (CLL)-the cause of death most strongly and consistently related to radiation dose in studies of atomic bomb survivors and other populations exposed at high dose rates-was significantly associated with cumulative external radiation dose (one-sided P value = 0.046; 119 deaths). Among the 31 other specific types of cancer studied, a significant association was observed only for multiple myeloma (one-sided P value = 0.037; 44 deaths), and this was attributable primarily to the associations reported previously between this disease and radiation dose in the Hanford (U.S.) and Sellafield (UK) cohorts. The excess relative risk (ERR) estimates for all cancers excluding leukemia, and leukemia excluding CLL, the two main groupings of causes of death for which risk estimates have been derived from studies of atomic bomb survivors, were -0.07 per Sv [90% confidence interval (CI):-0.4,0.3] and 2.18 per Sv (90% CI:0.1,5.7), respectively. These values correspond to a relative risk of 0.99 for all cancers excluding leukemia and 1.22 for leukemia excluding CLL for a cumulative protracted dose of 100 mSv compared to O mSv. 53 refs., 1 fig., 8 tabs.

  14. Body mass index and mortality in nonsmoking older adults: the Cardiovascular Health Study.

    PubMed Central

    Diehr, P; Bild, D E; Harris, T B; Duxbury, A; Siscovick, D; Rossi, M

    1998-01-01

    OBJECTIVES: This study assesses the relationship of body mass index to 5-year mortality in a cohort of 4317 nonsmoking men and women aged 65 to 100 years. METHODS: Logistic regression analyses were conducted to predict mortality as a function of baseline body mass index, adjusting for demographic, clinical, and laboratory covariates. RESULTS: There was an inverse relationship between body mass index and mortality; death rates were higher for those who weighed the least. Inclusion of covariates had trivial effects on these results. People who had lost 10% or more of their body weight since age 50 had a relatively high death rate. When that group was excluded, there was no remaining relationship between body mass index and mortality. CONCLUSIONS: The association between higher body mass index and mortality often found in middle-aged populations was not observed in this large cohort of older adults. Over-weight does not seem to be a risk factor for 5-year mortality in this age group. Rather, the risks associated with significant weight loss should be the primary concern. PMID:9551005

  15. Community Characteristics and Mortality: The Relative Strength of Association of Different Community Characteristics

    PubMed Central

    Roberts, Eric; McCleary, Rachael; Buttorff, Christine; Gaskin, Darrell J.

    2014-01-01

    Objectives. We compared the strength of association between average 5-year county-level mortality rates and area-level measures, including air quality, sociodemographic characteristics, violence, and economic distress. Methods. We obtained mortality data from the National Vital Statistics System and linked it to socioeconomic and demographic data from the Census Bureau, air quality data, violent crime statistics, and loan delinquency data. We modeled 5-year average mortality rates (1998–2002) for all-cause, cancer, heart disease, stroke, and respiratory diseases as a function of county-level characteristics using ordinary least squares regression models. We limited analyses to counties with population of 100 000 or greater (n = 458). Results. Demographic and socioeconomic characteristics, particularly the percentage older than 65 years and near poor, were top predictors of all-cause and condition-specific mortality, as were a high concentration of construction and service workers. We found weaker associations for air quality, mortgage delinquencies, and violent crimes. Protective characteristics included the percentage of Hispanics, Asians, and married residents. Conclusions. Multiple factors influence county-level mortality. Although county demographic and socioeconomic characteristics are important, there are independent, although weaker, associations of other environmental characteristics. Future studies should investigate these factors to better understand community mortality risk. PMID:25033152

  16. Fasting Plasma Insulin at 5 Years of Age Predicted Subsequent Weight Increase in Early Childhood over a 5-Year Period—The Da Qing Children Cohort Study

    PubMed Central

    Chen, Yan Yan; Wang, Jin Ping; Jiang, Ya Yun; Li, Hui; Hu, Ying Hua; Lee, Kok Onn; Li, Guang Wei

    2015-01-01

    Background The association between hyperinsulinemia and obesity is well known. However, it is uncertain especially in childhood obesity, if initial fasting hyperinsulinemia predicts obesity, or obesity leads to hyperinsulinemia through insulin resistance. Objective To investigate the predictive effect of fasting plasma insulin on subsequent weight change after a 5-year interval in childhood. Methods 424 Children from Da Qing city, China, were recruited at 5 years of age and followed up for 5 years. Blood pressure, anthropometric measurements, fasting plasma insulin, glucose and triglycerides were measured at baseline and 5 years later. Results Fasting plasma insulin at 5 years of age was significantly correlated with change of weight from 5 to 10 years (ΔWeight). Children in the lowest insulin quartile had ΔWeight of 13.08±0.73 kg compare to 18.39±0.86 in the highest insulin quartile (P<0.0001) in boys, and similarly 12.03±0.71 vs 15.80±0.60 kg (P<0.0001) in girls. Multivariate analysis showed that the predictive effect of insulin at 5 years of age on subsequent weight gain over 5 years remained statistically significant even after the adjustment for age, sex, birth weight, TV-viewing time and weight (or body mass index) at baseline. By contrast, the initial weight at 5 years of age did not predict subsequent changes in insulin level 5 years later. Children who had both higher fasting insulin and weight at 5 years of age showed much higher levels of systolic blood pressures, fasting plasma glucose, the homeostasis model assessment for insulin resistance (HOMA-IR) and triglycerides at 10 years of age. Conclusions Fasting plasma insulin at 5 years of age predicts weight gain and cardiovascular risk factors 5 year later in Chinese children of early childhood, but the absolute weight at 5 years of age did not predict subsequent change in fasting insulin. PMID:26047327

  17. Has the Rate of Reduction in Infant Mortality Increased in India Since the Launch of National Rural Health Mission? Analysis of Time Trends 2000-2009 with Projection to 2015

    PubMed Central

    Narwal, Rajesh; Gram, Lu

    2013-01-01

    Objectives: National Rural Health Mission (NRHM) - India was launched in 2005 to tackle urban-rural health inequalities, especially in maternal and child health. We examined national and state level trends in Infant Mortality Rates (IMR) from 2000 through 2009 to: 1) assess whether the NRHM had increased the average annual reduction rate (AARR) of IMR 2) evaluate state-wise progress towards Millennium Development Goals (MDG4) and estimate required AARRs for ‘off track’ states. Methods: Log-linear regression models were applied to national and state IMR data collated from the Sample Registration System (SRS)-India to estimate average annual reduction rates and compare AAARs before and after introduction of NRHM. The log-linear trend of infant mortality rates was also projected forward to 2015. Results: The infant mortality rate in rural India declined from 74 to 55/1000 live births between 2000 and 2009, with AARR of 3.0% (95% CI=2.6%-3.4%) and the urban-rural gap in infant mortality narrowed (p =0.036). However there was no evidence (p=0.49) that AARR in rural India increased post NRHM (3.4%, 95% CI 2.0-4.7%) compared to pre NRHM (2.8%, 95% CI 2.1%-3.5%). States varied widely in rates of infant mortality reduction. Projections of infant mortality rates suggested that only eight states might be on track to help India achieve MDG4 by 2015. Conclusions and Public Health Implications: Despite a narrowing urban-rural gap and high AARRs in some states, there was no evidence that the rate of reduction in infant mortality has increased in rural India post NRHM introduction. India appears unlikely to achieve child survival-related NRHM and millennium development goals. Government should revisit the child survival related NRHM strategies and ensure equitable access to health services. More robust monitoring and evaluation mechanisms must be inbuilt for following years.

  18. Malnutrition Among Children Younger Than 5 Years-Old in Conflict Zones of Chiapas, Mexico

    PubMed Central

    Sánchez-Pérez, Héctor Javier; Hernán, Miguel A.; Ríos-González, Adriana; Arana-Cedeño, Marcos; Navarro, Albert; Ford, Douglas; Micek, Mark A.; Brentlinger, Paula

    2007-01-01

    We performed a cross-sectional, community-based survey, supplemented by interviews with community leaders in Chiapas, Mexico, to examine the prevalence and predictors of child malnutrition in regions affected by the Zapatista conflict. The prevalence rates of stunting, wasting, and underweight were 54.1%, 2.9%, and 20.3%, respectively, in 2666 children aged younger than 5 years. Stunting was associated with indigenous ethnicity, poverty, region of residence, and intracommunity division. The results indicate that malnutrition is a serious public health problem in the studied regions. PMID:17194868

  19. Effect of a constant rate infusion of cytosine arabinoside on mortality in dogs with meningoencephalitis of unknown origin.

    PubMed

    Lowrie, M; Thomson, S; Smith, P; Garosi, L

    2016-07-01

    Administration of cytosine arabinoside (CA) by continuous rate infusion (CRI) has pharmacokinetic and pharmacodynamic advantages over traditional intermittent dosing. Whether these advantages translate into clinical efficacy remains unknown. The aim of this study was to assess the efficacy and safety of CRI of CA in dogs with meningoencephalitis of unknown origin (MUO) and to compare outcomes with a group of historical control dogs treated with conventional intermittent subcutaneous (SC) administration of CA; both groups received adjunctive prednisolone. It was hypothesised that a CRI of CA for 24 h at 100 mg/m(2) would improve survival and lesion resolution compared with conventional SC delivery of 50 mg/m(2) every 12 h for 48 h. Eighty dogs with suspected MUO were recruited from consecutive dogs presenting with suspected MUO from 2006 to 2015. All dogs underwent routine clinical evaluation, magnetic resonance imaging of the brain and cerebrospinal fluid analysis. There were 39 dogs in the SC group and 41 dogs in the CRI group; baseline characteristics were similar in both groups. Survival at 3 months was 22/39 (44%) with SC delivery versus 37/41 (90%) with CRI. No dose-limiting toxicities were noted for either group. The resolution rate of magnetic resonance imaging and cerebrospinal fluid abnormalities at the 3 month re-examination were substantially improved in the CRI group versus the SC group. The CRI regimen produced a survival advantage over the SC route of administration without clinically significant toxicity. These data supports the routine use of CRI at first presentation for the treatment of MUO in dogs. PMID:27240905

  20. Neonatal mortality in Meerut district.

    PubMed

    Garg, S K; Mishra, V N; Singh, J V; Bhatnagar, M; Chopra, H; Singh, R B

    1993-09-01

    A study of neonatal mortality in Meerut district revealed an infant mortality rate of 50.1 per 1000 live births. Neonatal mortality accounted for 37.8% of infant mortality with a neonatal mortality rate of 19.0 per 1000 live births. 90.5% of these neonates were delivered at home largely by untrained personnel (57.2%). Only 28.6% of these neonates were treated by qualified doctors and only 30.9% of their mothers were fully immunized against tetanus. At least 2/3rd of neonatal mortality was due to exogenous factors with tetanus neonatorum and septicaemia being the principal causes of mortality each accounting for a mortality rate of 4.7 per 1000 live births. PMID:8112786

  1. SVI implantation for carcinoma of the prostate: 5-year survival free of disease and incidence of local failure

    SciTech Connect

    Schellhammer, P.F.; el-Mahdi, A.E.; Ladaga, L.E.; Schultheiss, T.

    1985-12-01

    Interstitial implantation with the iodine isotope, SVI has been used as definitive treatment in 115 patients with localized carcinoma of the prostate. The disease was staged surgically by bilateral pelvic lymphadenectomy in all of the patients. Followup has been for a minimum of 1 year and 64 patients have been followed for a minimum of 5 years. There has been no operative mortality in this series. Mean patient age at implantation was 63 years. Potency has been maintained in 31 of 46 patients (78 per cent) followed for a minimum of 5 years and 15 of 26 (58 per cent) followed for a minimum of 7 years. At 5 years the actuarial survival free of disease by surgical stage was 100, 81, 49 and 41 per cent for patients with stages A2, B, C and D1 disease, respectively. Local failure was defined as palpable evidence of prostatic enlargement or irregularity with biopsy confirmation of neoplasm. The actuarial probability of local failure at 5 years was 0, 13, 27 and 44 per cent for patients with surgical stages A2, B, C and D1 disease, respectively, and 5, 23 and 43 per cent for those with well, moderately and poorly differentiated tumors, respectively. Based on our experience, interstitial implantation with SVI is reserved for patients with well or moderately differentiated stage B lesions. The ultimate success of this treatment modality awaits 10 and 15 years of followup.

  2. Total versus subtotal gastrectomy: surgical morbidity and mortality rates in a multicenter Italian randomized trial. The Italian Gastrointestinal Tumor Study Group.

    PubMed Central

    Bozzetti, F; Marubini, E; Bonfanti, G; Miceli, R; Piano, C; Crose, N; Gennari, L

    1997-01-01

    OBJECTIVE: The purpose of this study was to analyze postoperative morbidity and mortality of patients included in a randomized trial comparing total versus subtotal gastrectomy for gastric cancer. SUMMARY BACKGROUND DATA: There is controversy as to whether the optimal surgery for gastric cancer in the distal half of the stomach is subtotal or total gastrectomy. Although only a randomized trial can resolve this oncologic dilemma, the first step is to demonstrate whether the two procedures are penalized by different postoperative morbidity and mortality rates. METHODS: A total of 624 patients with cancer in the distal half of the stomach were randomized to subtotal gastrectomy (320) or total gastrectomy (304), both associated with a second-level lymphadenectomy, in a multicenter trial aimed at assessing the oncologic outcome after the two procedures. The end points considered were the occurrence of a postoperative event, complication, or death and length of postoperative stay. RESULTS: Nonfatal complications and death occurred in 9% and 1% of subtotal gastrectomy patients and in 13% and 2% of total gastrectomy patients, respectively. Multivariate analysis of postoperative events showed that splenectomy or resection of adjacent organs was associated with a twofold risk of postoperative complications. Random surgery and extension of surgery influenced the length of stay. The mean length of stay, adjusted for extension of surgery, was 13.8 days for subtotal gastrectomy and 15.4 days for total gastrectomy. CONCLUSIONS: Our data show that subtotal and total gastrectomies, with second-level lymphadenectomy, performed as an elective procedure have a similar postoperative complication rate and surgical outcome. A conclusive long-term evaluation of the two operations and an accurate estimate of the oncologic impact of surgery on long-term survival, not penalized by excess surgical risk of one of the two operations, are consequently feasible. PMID:9389395

  3. Comparative study of two anesthesia methods according to postoperative complications and one month mortality rate in the candidates of hip surgery

    PubMed Central

    Heidari, Saied Morteza; Soltani, Hasanali; Hashemi, Saied Jalal; Talakoub, Reihanak; Soleimani, Bahram

    2011-01-01

    BACKGROUND: Surgery for hip fractures can be done under general or neuraxial anesthesia. This study aimed to compare these two methods concerning their postoperative complications, duration of operation, hospitalization and the mortality rate within a period of one month after surgery. METHODS: 400 patients aged more than 30 years old and scheduled for elective operative fixation of fractured hip, randomly enrolled in two equal groups of general (GA) and neuraxial (NA) anesthesia. Hemoglobin level was measured before and 6 hours, 2, 3 and 5 days after the surgery. The intra and postoperative blood loss, duration of surgery, the severity of pain at the time of discharge from recovery and at the 2nd, 3rd and 5th postoperative days were recorded. Statistical analysis was performed using SPSS version 12.0 by Mann-Whitney, chi-square, and t tests. P < 0.05 was considered significant. RESULTS: Both groups were similar regarding age, weight, and gender ratio. There was no significant difference in baseline hemoglobin, duration of surgery, length of hospitalization before surgery and the type of surgery. The mean of intraoperative blood loss and visual analogue score (VAS) in recovery and at the 3rd postoperative day, and also the length of hospitalization after surgery were significantly less in neuraxial anesthesia group. Both groups showed a significant decrease in hemoglobin values on the 2nd and 3rd postoperative days comparing to the baseline (p < 0.001). CONCLUSIONS: The morbidity and mortality rates of patients undergoing hip surgery were similar in both methods of anesthesia, but postoperative pain, blood loss, and duration of hospitalization were more in patients undergoing general anesthesia. PMID:22091252

  4. Mortality rates above emergency threshold in population affected by conflict in North Kivu, Democratic Republic of Congo, July 2012-April 2013.

    PubMed

    Carrión Martín, Antonio Isidro; Bil, Karla; Salumu, Papy; Baabo, Dominique; Singh, Jatinder; Kik, Corry; Lenglet, Annick

    2014-09-01

    The area of Walikale in North Kivu, Democratic Republic of Congo, is intensely affected by conflict and population displacement. Médecins-Sans-Frontières (MSF) returned to provide primary healthcare in July 2012. To better understand the impact of the ongoing conflict and displacement on the population, a retrospective mortality survey was conducted in April 2013. A two-stage randomized cluster survey using 31 clusters of 21 households was conducted. Heads of households provided information on their household make-up, ownership of non-food items (NFIs), access to healthcare and information on deaths and occurrence of self-reported disease in the household during the recall period. The recall period was of 325 days (July 2012-April 2013). In total, 173 deaths were reported during the recall period. The crude mortality rate (CMR) was of 1.4/10,000 persons/day (CI95%: 1.2-1.7) and the under-five- mortality rate (U5MR) of 1.9/10,000 persons per day (CI95%: 1.3-2.5). The most frequently reported cause of death was fever/malaria 34.1% (CI95%: 25.4-42.9). Thirteen deaths were due to intentional violence. Over 70% of all households had been displaced at some time during the recall period. Out of households with someone sick in the last two weeks, 63.8% sought health care; the main reason not to seek health care was the lack of money (n = 134, 63.8%, CI95%: 52.2-75.4). Non Food Items (NFI) ownership was low: 69.0% (CI95%: 53.1-79.7) at least one 10 liter jerry can, 30.1% (CI95%: 24.3-36.5) of households with visible soap available and 1.6 bednets per household. The results from this survey in Walikale clearly illustrate the impact that ongoing conflict and displacement are having on the population in this part of DRC. The gravity of their health status was highlighted by a CMR that was well above the emergency threshold of 1 person/10,000/day and an U5MR that approaches the 2 children/10,000/day threshold for the recall period. PMID:25233090

  5. Modelling the impact of improving screening and treatment of chronic hepatitis C virus infection on future hepatocellular carcinoma rates and liver-related mortality

    PubMed Central

    2014-01-01

    Background The societal, clinical and economic burden imposed by the complications of chronic hepatitis C virus (HCV) infection - including cirrhosis and hepatocellular carcinoma (HCC) - is expected to increase over the coming decades. However, new therapies may improve sustained virological response (SVR) rates and shorten treatment duration. This study aimed to estimate the future burden of HCV-related disease in England if current management strategies remain the same and the impact of increasing diagnosis and treatment of HCV as new therapies become available. Methods A previously published model was adapted for England using published literature and government reports, and validated through an iterative process of three meetings of HCV experts. The impact of increasing diagnosis and treatment of HCV as new therapies become available was modelled and compared to the base-case scenario of continuing current management strategies. To assess the ‘best case’ clinical benefit of new therapies, the number of patients treated was increased by a total of 115% by 2018. Results In the base-case scenario, total viraemic (HCV RNA-positive) cases of HCV in England will decrease from 144,000 in 2013 to 76,300 in 2030. However, due to the slow progression of chronic HCV, the number of individuals with cirrhosis, decompensated cirrhosis and HCC will continue to increase over this period. The model suggests that the ‘best case’ substantially reduces HCV-related hepatic disease and HCV-related liver mortality by 2020 compared to the base-case scenario. The number of HCV-related HCC cases would decrease 50% by 2020 and the number progressing from infection to decompensated cirrhosis would decline by 65%. Therefore, compared to projections of current practices, increasing treatment numbers by 115% by 2018 would reduce HCV-related mortality by 50% by 2020. Conclusions This analysis suggests that with current treatment practices the number of patients developing HCV

  6. Mortality Rates above Emergency Threshold in Population Affected by Conflict in North Kivu, Democratic Republic of Congo, July 2012–April 2013

    PubMed Central

    Carrión Martín, Antonio Isidro; Bil, Karla; Salumu, Papy; Baabo, Dominique; Singh, Jatinder; Kik, Corry; Lenglet, Annick

    2014-01-01

    The area of Walikale in North Kivu, Democratic Republic of Congo, is intensely affected by conflict and population displacement. Médecins-Sans-Frontières (MSF) returned to provide primary healthcare in July 2012. To better understand the impact of the ongoing conflict and displacement on the population, a retrospective mortality survey was conducted in April 2013. A two-stage randomized cluster survey using 31 clusters of 21 households was conducted. Heads of households provided information on their household make-up, ownership of non-food items (NFIs), access to healthcare and information on deaths and occurrence of self-reported disease in the household during the recall period. The recall period was of 325 days (July 2012–April 2013). In total, 173 deaths were reported during the recall period. The crude mortality rate (CMR) was of 1.4/10,000 persons/day (CI95%: 1.2–1.7) and the under-five- mortality rate (U5MR) of 1.9/10,000 persons per day (CI95%: 1.3–2.5). The most frequently reported cause of death was fever/malaria 34.1% (CI95%: 25.4–42.9). Thirteen deaths were due to intentional violence. Over 70% of all households had been displaced at some time during the recall period. Out of households with someone sick in the last two weeks, 63.8% sought health care; the main reason not to seek health care was the lack of money (n = 134, 63.8%, CI95%: 52.2–75.4). Non Food Items (NFI) ownership was low: 69.0% (CI95%: 53.1–79.7) at least one 10 liter jerry can, 30.1% (CI95%: 24.3–36.5) of households with visible soap available and 1.6 bednets per household. The results from this survey in Walikale clearly illustrate the impact that ongoing conflict and displacement are having on the population in this part of DRC. The gravity of their health status was highlighted by a CMR that was well above the emergency threshold of 1 person/10,000/day and an U5MR that approaches the 2 children/10,000/day threshold for the recall period. PMID:25233090

  7. Relationship between Kidney Dysfunction and Ischemic Stroke Outcomes: Albuminuria, but Not Estimated Glomerular Filtration Rate, Is Associated with the Risk of Further Vascular Events and Mortality after Stroke

    PubMed Central

    Lee, Dong-Geun

    2016-01-01

    Background and Objective Estimated glomerular filtration rate (eGFR) and albuminuria are known to be associated with ischemic stroke outcomes. In this study, we investigated the longitudinal relationships of the two markers with mortality, vascular events and functional outcomes in a stroke cohort. Methods A total of 295 patients with acute ischemic stroke were prospectively recruited in a single center between May 2012 and February 2015. Renal dysfunction was defined as a decreased eGFR (<60 mL/min/1.73 m2) or albuminuria (urine albumin-to-creatinine ratio ≥ 30 mg/g). Good functional outcome at 6 months was defined as a modified Rankin scale score ≤ 2, and the occurrence of major vascular events (stroke, acute coronary syndrome or peripheral artery occlusion) or death was monitored. The associations between renal dysfunction and mortality, major vascular events, and 6-month functional outcome were evaluated by the Cox proportional hazards model and logistic regression analysis. Unadjusted and adjusted hazards ratios (HRs), odds ratios (ORs), and 95% confidence intervals (CIs) were obtained. A Kaplan–Meier survival curve for composite adverse events (major vascular events or death) was also computed according to the presence or absence of albuminuria. Results Albuminuria, not eGFR, was significantly associated with mortality (P = 0.028; HR 2.15; 95% CI 1.09–4.25) and major vascular events (P = 0.044; HR 2.24; 95% CI 1.02–4.94) in the multivariate Cox proportional hazards models adjusting for age, sex, diabetes, hypertension, current smoking, atrial fibrillation, previous stroke, alcohol history, initial National Institutes of Health Stroke Scale (NIHSS) score and eGFR. In addition, albuminuria was negatively associated with 6-month functional outcome in the multivariate logistic regression analysis adjusting for age, sex, diabetes, hypertension, current smoking, atrial fibrillation, previous stroke, alcohol history and eGFR (P = 0.001; OR 0.36; 95% CI 0

  8. Seasonal and spatial comparisons of phytoplankton growth and mortality rates due to microzooplankton grazing in the northern South China Sea

    NASA Astrophysics Data System (ADS)

    Chen, B.; Zheng, L.; Huang, B.; Song, S.; Liu, H.

    2013-04-01

    We conducted a comprehensive investigation on the microzooplankton herbivory effect on phytoplankton in the northern South China Sea (SCS) using the seawater dilution technique at surface and deep chlorophyll maximum (DCM) layers on two cruises (July-August of 2009 and January of 2010). We compared vertical (surface vs. DCM), spatial (onshore vs. offshore), and seasonal (summer vs. winter) differences of phytoplankton growth (μ0) and microzooplankton grazing rates (m). During summer, both μ0 and m were significantly higher at the surface than at the DCM layer, which was below the mixed layer. During winter, surface μ0 was significantly higher than at the DCM, while m was not significantly different between the two layers, both of which were within the mixed layer. Surface μ0 was, on average, significantly higher in summer than in winter, while average surface m was not different between the two seasons. There were no cross-shelf gradients of μ0 in summer or winter surface waters. In surface waters, μ0 was not correlated with ambient nitrate concentrations, and the effect of nutrient enrichment on phytoplankton growth was not pronounced. There was a decreasing trend of m from shelf to basin surface waters in summer, but not in winter. Microzooplankton grazing effect on phytoplankton (m/μ0) was relatively small in the summer basin waters, indicating a decoupling of microzooplankton grazing and phytoplankton growth at this time. On average, microzooplankton grazed 73% and 65% of the daily primary production in summer and winter, respectively.

  9. Mortality risk coefficients for radiation-induced cancer at high doses and dose-rates, and extrapolation to the low dose domain.

    PubMed

    Liniecki, J

    1989-01-01

    Risk coefficients for life-long excessive mortality due to radiation-induced cancers are presented, as derived in 1988 by the U.N. Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), principally on the basis of follow-up from A-bomb survivors in Japan, over the period from 1950 through 1985. The data are based on the new, revised dosimetry (DS 86) in the two cities, and reflect the effects of high and intermediate doses of basically low LET radiation delivered instantaneously. The author presents arguments relevant to the extrapolation of the risk to the low dose (dose rate) domain, as outlined by UNSCEAR in its 1986, and the NCRP (USA) in its 1980, (no 64), reports. The arguments are based on models and dose-response relationships for radiation action, derived from data on cellular radiobiology, animal experiments on radiation-induced cancers and life shortening, as well as the available limited human epidemiological evidence. The available information points to the lower effectiveness of sparsely ionizing radiation at low doses and low dose-rates, as compared with that observed for high, acutely delivered doses. The possible range of the reduction values (DREF) is presented. For high LET radiations, the evidence is less extensive and sometimes contradictory; however, it does not point to a reduction of the effectiveness at low doses/dose-rates, relative to the high dose domain. Practical consequences of these facts are considered. PMID:2489419

  10. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial

    PubMed Central

    Davies, Christina; Pan, Hongchao; Godwin, Jon; Gray, Richard; Arriagada, Rodrigo; Raina, Vinod; Abraham, Mirta; Alencar, Victor Hugo Medeiros; Badran, Atef; Bonfill, Xavier; Bradbury, Joan; Clarke, Michael; Collins, Rory; Davis, Susan R; Delmestri, Antonella; Forbes, John F; Haddad, Peiman; Hou, Ming-Feng; Inbar, Moshe; Khaled, Hussein; Kielanowska, Joanna; Kwan, Wing-Hong; Mathew, Beela S; Müller, Bettina; Nicolucci, Antonio; Peralta, Octavio; Pernas, Fany; Petruzelka, Lubos; Pienkowski, Tadeusz; Rajan, Balakrishnan; Rubach, Maryna T; Tort, Sera; Urrútia, Gerard; Valentini, Miriam; Wang, Yaochen; Peto, Richard

    2013-01-01

    Summary Background For women with oestrogen receptor (ER)-positive early breast cancer, treatment with tamoxifen for 5 years substantially reduces the breast cancer mortality rate throughout the first 15 years after diagnosis. We aimed to assess the further effects of continuing tamoxifen to 10 years instead of stopping at 5 years. Methods In the worldwide Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) trial, 12 894 women with early breast cancer who had completed 5 years of treatment with tamoxifen were randomly allocated to continue tamoxifen to 10 years or stop at 5 years (open control). Allocation (1:1) was by central computer, using minimisation. After entry (between 1996 and 2005), yearly follow-up forms recorded any recurrence, second cancer, hospital admission, or death. We report effects on breast cancer outcomes among the 6846 women with ER-positive disease, and side-effects among all women (with positive, negative, or unknown ER status). Long-term follow-up still continues. This study is registered, number ISRCTN19652633. Findings Among women with ER-positive disease, allocation to continue tamoxifen reduced the risk of breast cancer recurrence (617 recurrences in 3428 women allocated to continue vs 711 in 3418 controls, p=0·002), reduced breast cancer mortality (331 deaths vs 397 deaths, p=0·01), and reduced overall mortality (639 deaths vs 722 deaths, p=0·01). The reductions in adverse breast cancer outcomes appeared to be less extreme before than after year 10 (recurrence rate ratio [RR] 0·90 [95% CI 0·79–1·02] during years 5–9 and 0·75 [0·62–0·90] in later years; breast cancer mortality RR 0·97 [0·79–1·18] during years 5–9 and 0·71 [0·58–0·88] in later years). The cumulative risk of recurrence during years 5–14 was 21·4% for women allocated to continue versus 25·1% for controls; breast cancer mortality during years 5–14 was 12·2% for women allocated to continue versus 15·0% for controls (absolute mortality

  11. A 3.5 year diary study: Remembering and life story importance are predicted by different event characteristics.

    PubMed

    Thomsen, Dorthe Kirkegaard; Jensen, Thomas; Holm, Tine; Olesen, Martin Hammershøj; Schnieber, Anette; Tønnesvang, Jan

    2015-11-01

    Forty-five participants described and rated two events each week during their first term at university. After 3.5 years, we examined whether event characteristics rated in the diary predicted remembering, reliving, and life story importance at the follow-up. In addition, we examined whether ratings of life story importance were consistent across a three year interval. Approximately 60% of events were remembered, but only 20% of these were considered above medium importance to life stories. Higher unusualness, rehearsal, and planning predicted whether an event was remembered 3.5 years later. Higher goal-relevance, importance, emotional intensity, and planning predicted life story importance 3.5 years later. There was a moderate correlation between life story importance rated three months after the diary and rated at the 3.5 year follow-up. The results suggest that autobiographical memory and life stories are governed by different mechanisms and that life story memories are characterized by some degree of stability. PMID:26164104

  12. HIV rapid testing in a Veterans Affairs hospital ED setting: a 5-year sustainability evaluation.

    PubMed

    Knapp, Herschel; Hagedorn, Hildi; Anaya, Henry D

    2014-08-01

    Routine HIV testing in primary care settings is now recommended in the United States. The US Department of Veterans Affairs (VA) has increased the number of patients tested for HIV, but overall HIV testing rates in VA remain low. A proven strategy for increasing such testing involves nurse-initiated HIV rapid testing (HIV RT). The purpose of this work was to use a mixed methodology approach to evaluate the 5-year sustainability of an intervention that implemented HIV RT in a VA emergency department setting in a large, urban VA medical center to reduce missed diagnostic and treatment opportunities in this vulnerable patient population. In-person semistructured interviews were conducted with providers and stakeholders. Interview notes were qualitatively coded for emerging themes. Quarterly testing rates were evaluated for a 5-year time span starting from the launch in July 2008. Findings indicate that HIV RT was sustained by the enthusiasm of 2 clinical champions who oversaw the registered nurses responsible for conducting the testing. The departure of the clinical champions was correlated with a substantial drop-off in testing. Findings also indicate potential strategies for improving sustainability including engaging senior leadership in the project, engaging line staff in the implementation planning from the start to increase ownership over the innovation, incorporating information into initial training explaining the importance of the innovation to quality patient care, providing ongoing training to maintain skills, and providing routine progress reports to staff to demonstrate the ongoing impact of their efforts. PMID:24908442

  13. Increased Mortality in Narcolepsy

    PubMed Central

    Ohayon, Maurice M.; Black, Jed; Lai, Chinglin; Eller, Mark; Guinta, Diane; Bhattacharyya, Arun

    2014-01-01

    Objective: To evaluate the mortality rate in patients with narcolepsy. Design: Data were derived from a large database representative of the US population, which contains anonymized patient-linked longitudinal claims for 173 million individuals. Setting: Symphony Health Solutions (SHS) Source Lx, an anonymized longitudinal patient dataset. Patients/Participants: All records of patients registered in the SHS database between 2008 and 2010. Interventions: None Measurements and Results: Identification of patients with narcolepsy was based on ≥ 1 medical claim with the diagnosis of narcolepsy (ICD-9 347.xx) from 2002 to 2012. Dates of death were acquired from the Social Security Administration via a third party; the third party information was encrypted in the same manner as the claims data such that anonymity is ensured prior to receipt by SHS. Annual all-cause mortality rates for 2008, 2009, and 2010 were calculated retrospectively for patients with narcolepsy and patients without narcolepsy in the database, and standardized mortality ratios (SMR) were calculated. Mortality rates were also compared with the general US population (Centers for Disease Control data). SMRs of the narcolepsy population were consistent over the 3-year period and showed an approximate 1.5-fold excess mortality relative to those without narcolepsy. The narcolepsy population had consistently higher mortality rates relative to those without narcolepsy across all age groups, stratified by age decile, from 25-34 years to 75+ years of age. The SMR for females with narcolepsy was lower than for males with narcolepsy. Conclusions: Narcolepsy was associated with approximately 1.5-fold excess mortality relative to those without narcolepsy. While the cause of this increased mortality is unknown, these findings warrant further investigation. Citation: Ohayon MM; Black J; Lai C; Eller M; Guinta D; Bhattacharyya A. Increased mortality in narcolepsy. SLEEP 2014;37(3):439-444. PMID:24587565

  14. Heart rate variables in the Vascular Quality Initiative are not reliable predictors of adverse cardiac outcomes or mortality after major elective vascular surgery

    PubMed Central

    Scali, Salvatore; Bertges, Daniel; Neal, Daniel; Patel, Virendra; Eldrup-Jorgensen, Jens; Cronenwett, Jack; Beck, Adam

    2015-01-01

    Objective Heart rate (HR) parameters are known indicators of cardiovascular complications after cardiac surgery, but there is little evidence of their role in predicting outcome after major vascular surgery. The purpose of this study was to determine whether arrival HR (AHR) and highest intraoperative HR are associated with mortality or major adverse cardiac events (MACEs) after elective vascular surgery in the Vascular Quality Initiative (VQI). Methods Patients undergoing elective lower extremity bypass (LEB), aortofemoral bypass (AFB), and open abdominal aortic aneurysm (AAA) repair in the VQI were analyzed. MACE was defined as any postoperative myocardial infarction, dysrhythmia, or congestive heart failure. Controlled HR was defined as AHR <75 beats/min on operating room arrival. Delta HR (DHR) was defined as highest intraoperative HR – AHR Procedure-specific MACE models were derived for risk stratification, and generalized estimating equations were used to account for clustering of center effects. HR, beta-blocker exposure, cardiac risk, and their interactions were explored to determine association with MACE or 30-day mortality. A Bonferroni correction with P < .004 was used to declare significance. Results There were 13,291 patients reviewed (LEB, n = 8155 [62%]; AFB, n = 2629 [18%]; open AAA, n = 2629 [20%]). Rates of any preoperative beta-blocker exposure were as follows: LEB, 66.5% (n = 5412); AFB, 57% (n = 1342); and open AAA, 74.2% (n = 1949). AHR and DHR outcome association was variable across patients and procedures. AHR <75 beats/min was associated with increased postoperative myocardial infarction risk for LEB patients across all risk strata (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.03–1.9; P = .03), whereas AHR<75 beats/min was associated with decreased dysrhythmia risk (OR, 0.42; 95% CI, 0.28–0.63; P = .0001) and 30-day death (OR, 0.50; 95% CI, 0.33–0.77; P = .001) in patients at moderate and high cardiac risk. These HR

  15. Oral cancer incidence and mortality in China, 2011

    PubMed Central

    Zhang, Shao-Kai; Zheng, Rongshou; Chen, Qiong; Zhang, Siwei

    2015-01-01

    Objective To descript the incidence and mortality rates of oral cancer among Chinese population in 2011, and provide valuable data for oral cancer prevention and research. Methods Data from 177 population-based cancer registries distributed in 28 provinces were accepted for this study after evaluation based on quality control criteria, covering a total of 175,310,169 populations and accounting for 13.01% of the overall national population in 2011. Incidence and mortality rates were calculated by area, gender and age groups. The numbers of new cases and deaths were estimated using the 5-year age-specific cancer incidence/mortality rates and the corresponding populations. The Chinese population in 2000 and World Segi’s population were used for age-standardized rates. Results The estimate of new cases diagnosed with oral cancer was 39,450 including 26,160 males and 13,290 females. The overall crude incidence rate for oral cancer was 2.93/100,000. The age-standardized rates by China (ASRCN) population and by World population (ASRwld) were 2.22/100,000 and 2.17/100,000, respectively. Among subjects aged 0-74 years, the cumulative incidence rate was 0.25%. The estimated number of oral cancer deaths of China in 2011 was 16,933, including 11,794 males and 5,139 females. The overall crude mortality rate was 1.26/100,000, accounting for 0.80% of all cancer deaths. The ASRCN and ASRwld for mortality were 0.90/100,000 and 0.89/100,000, respectively. Among subjects aged 0-74 years, the cumulative mortality rate was 0.10%. The incidence and mortality rates of oral cancer were much higher in males and urban areas than in females and rural areas. In addition, the incidence and mortality rates were increased by the raising of ages. Conclusions Results in the study may have important roles for oral cancer prevention and research. Although oral cancer burden of China is not high, we must pay attention to this malignancy as well. In addition, further researches need to be done for

  16. Drowning Mortality and Morbidity Rates in Children and Adolescents 0-19yrs: A Population-Based Study in Queensland, Australia

    PubMed Central

    Wallis, Belinda A.; Watt, Kerrianne; Franklin, Richard C.; Nixon, James W.; Kimble, Roy M.

    2015-01-01

    Objective To redress the lack of Queensland population incidence mortality and morbidity data associated with drowning in those aged 0-19yrs, and to understand survival and patient care. Design, Setting and Participants Retrospective population-based study used data linkage to capture both fatal and non-fatal drowning cases (N = 1299) among children aged 0-19years in Queensland, from 2002-2008 inclusive. Patient data were accessed from pre-hospital, emergency department, hospital admission and death data, and linked manually to collate data across the continuum of care. Main Outcome Measures Incidence rates were calculated separately by age group and gender for events resulting in death, hospital admission, and non-admission. Trends over time were analysed. Results Drowning death to survival ratio was 1:10, and two out of three of those who survived were admitted to hospital. Incidence rates for fatal and non-fatal drowning increased over time, primarily due to an increase in non-fatal drowning. There were non-significant reductions in fatal and admission rates. Rates for non-fatal drowning that did not result in hospitalisation more than doubled over the seven years. Children aged 5-9yrs and 10-14yrs incurred the lowest incidence rates 6.38 and 4.62 (expressed as per 100,000), and the highest rates were among children aged 0-4yrs (all drowning events 43.90; fatal 4.04; non-fatal 39.85–comprising admission 26.69 and non-admission 13.16). Males were over-represented in all age groups except 10-14yrs. Total male drowning events increased 44% over the seven years (P<0.001). Conclusion This state-wide data collection has revealed previously unknown incidence and survival ratios. Increased trends in drowning survival rates may be viewed as both positive and challenging for drowning prevention and the health system. Males are over-represented, and although infants and toddlers did not have increased fatality rates, they had the greatest drowning burden demonstrating

  17. Macrophage elimination increases bacterial translocation and gut-origin septicemia but attenuates symptoms and mortality rate in a model of systemic inflammation.

    PubMed Central

    Nieuwenhuijzen, G A; Haskel, Y; Lu, Q; Berg, R D; van Rooijen, N; Goris, R J; Deitch, E A

    1993-01-01

    OBJECTIVE: The central question tested in this study was whether dichloromethylene-diphosphonate (CL2MDP) liposome-mediated elimination of hepatic and splenic macrophages would influence zymosan-induced bacterial translocation and the zymosan-induced generalized inflammatory response. SUMMARY BACKGROUND DATA: Both an uncontrolled activation of macrophages and the loss of intestinal barrier function have been implicated in the development of adult respiratory distress syndrome and multiple organ failure. METHODS: Macrophage elimination was accomplished by intravenous injection of 200 microL of CL2MDP-liposome suspension. Control mice received an intravenous injection of 200 microL of phosphate-buffered saline. Two days later, the animals were challenged intraperitoneally with zymosan suspended in paraffin to determine a dose-response curve (0.1, 0.5, or 1.0 mg/g body weight). Twenty-four hours after zymosan challenge, signs of systemic stress were determined, and bacterial translocation to the mesenteric lymph node, liver, spleen, and blood was measured. A separate mortality study was performed with a dose of 1.0 mg/g of zymosan suspension. RESULTS: The incidence of the systemic spread of bacteria was significantly increased in the macrophage-depleted mice. Although systemic bacterial translocation was promoted by macrophage elimination, the systemic toxic response was significantly decreased in all macrophage-depleted groups (p < or = 0.01). The 12-day mortality rate was 0% in the macrophage-depleted groups and 27% in the control group (p = 0.05). CONCLUSIONS: The lethal and toxic effects of zymosan appear to be related more to the excessive activation of macrophages than to the systemic spread of bacteria. Images Figure 1. Figure 2. PMID:8257230

  18. Statin Effects on Exacerbation Rates, Mortality, and Inflammatory Markers in Patients with Chronic Obstructive Pulmonary Disease: A Review of Prospective Studies.

    PubMed

    Howard, Meredith L; Vincent, Ashley H

    2016-05-01

    Chronic obstructive pulmonary disease (COPD) is a debilitating, irreversible disease with currently available therapies targeting symptom control and exacerbation reduction. A need for alternative disease-modifying therapies remains, specifically those that may have antiinflammatory and immunomodulatory properties that impact the pathophysiologic components of COPD. Statin drugs, the current gold standard for the treatment of dyslipidemia and prevention of cardiovascular disease (CVD), contain properties that affect the inflammatory disease processes seen in COPD. Several retrospective studies have demonstrated that statins may have a benefit in the reduction of morbidity and mortality in patients with COPD. This has led to prospective trials evaluating the impact of statins on various COPD-related outcomes. This article reviews the current body of prospective evidence for use of statins in patients with COPD. A search of the PubMed/Medline database of English-language articles was conducted from 1964 through November 2015; references of relevant articles were also reviewed for qualifying studies. Prospective studies of all types relating to statin use in patients with COPD were included if they had COPD- or respiratory-related outcomes; ultimately, eight studies were identified for this review. Statin effects on exacerbation rates, mortality, and inflammatory markers in patients with COPD are discussed. Strong prospective evidence does not currently exist to suggest that statins provide a clinical benefit in patients with COPD who do not have other CVD risk factors. Benefits from statins that have been illustrated are likely explained by their impact on underlying CVD risk factors rather than the COPD disease process. An opportunity exists for unanswered questions to be addressed in future studies. PMID:26990316

  19. Similar decline in mortality rate of older persons with and without type 2 diabetes between 1993 and 2004 the Icelandic population-based Reykjavik and AGES-Reykjavik cohort studies

    PubMed Central

    2013-01-01

    Background A decline in mortality rates due to cardiovascular diseases and all-cause mortality has led to increased life expectancy in the Western world in recent decades. At the same time, the prevalence of type 2 diabetes, a disease associated with a twofold excess risk of cardiovascular disease and mortality, has been increasing. The objective of this study was to estimate the secular trend of cardiovascular and all-cause mortality rates in two population-based cohorts of older persons, with and without type 2 diabetes, examined 11 years apart. Methods 1506 participants (42% men) from the population-based Reykjavik Study, examined during 1991–1996 (median 1993), mean age 75.0 years, and 4814 participants (43% men) from the AGES-Reykjavik Study, examined during 2002–2006 (median 2004), mean age 77.2 years, age range in both cohorts 70–87 years. The main outcome measures were age-specific mortality rates due to cardiovascular disease and all causes, over two consecutive 5.7- and 5.3-year follow-up periods. Results A 32% decline in cardiovascular mortality rate and a 19% decline in all-cause mortality rate were observed between 1993 and 2004. The decline was greater in those with type 2 diabetes, as illustrated by the decline in the adjusted hazard ratio of cardiovascular mortality in individuals with diabetes compared to those without diabetes, from 1.88 (95% CI 1.24-2.85) in 1993 to 1.46 (95% CI 1.11-1.91) in 2004. We also observed a concurrent decrease in major cardiovascular risk factors in both those with and without diabetes. A higher proportion of persons with diabetes received glucose-lowering, hypertensive and lipid-lowering medication in 2004. Conclusions A decline in cardiovascular and all-cause mortality rates was observed in older persons during the period 1993–2004, in both those with and without type 2 diabetes. This decline may be partly explained by improvements in cardiovascular risk factors and medical treatment over the period

  20. The association between price of regular-grade gasoline and injury and mortality rates among occupants involved in motorcycle- and automobile-related motor vehicle collisions.

    PubMed

    Hyatt, Eddie; Griffin, Russell; Rue, Loring W; McGwin, Gerald

    2009-09-01

    Motorcyclists have been reported to be more likely to die in a motor vehicle collision (MVC) than automobile occupants. With the recent increase in the pump price of gasoline, it has been reported that people are switching to motorcycles as main modes of transportation. This study evaluated the association between motor vehicle collision-related injury and mortality rates and increases in gasoline prices for occupants of automobiles and riders of motorcycles. There were an estimated 1,270,512 motorcycle MVC and 238,390,853 automobile MVC involved occupants in the U.S. from 1992 to 2007. Higher gasoline prices were associated with increased motorcycle-related injuries and deaths; however, this association no longer remained after accounting for changes in the number of registered vehicles. The current study observed that, while the number of injuries and fatalities in motorcycle-related MVCs increase with increasing gasoline price, rates remained largely unchanged. This suggests that the observed increase in motorcycle-related injuries and fatalities with increasing gasoline price is more a factor of the number of motorcycles on the road rather than operator characteristics. PMID:19664448

  1. Superselective radioembolization of hepatocellular carcinoma: 5-year results of a prospective study.

    PubMed

    Rösler, H; Triller, J; Baer, H U; Geiger, L; Beer, H F; Becker, C; Blumgart, L H

    1994-10-01

    Twenty patients with unresectable hepatocellular carcinoma (HCC) were followed up to 5 years after transarterial radiotherapy with 90Y-resin particles. Diagnostic radioembolizations of 99mTc-macroaggregates facilitated scintigraphic assessment of activity distribution, dose evaluation and final procedural verification. The overall survival rates were 56, 38 and 14% (after 1, 2 and 3 years, resp.). Patients with unifocal HCC and a single feeding artery (n = 7) even presented 83, 67 and 40% (2 alive after 2.75 and 4 years). With multiple arteries (n = 7), the longest survival was 26 months. Patients with multifocal HCC survived up to 33 months after selective radioembolization. Quality of life was improved in all. Survival was positively correlated with absorbed dose but residual/recurrent tumour occurred even after > or = 300 Gy. Post-treatment symptoms were minimal (35 applications), pulmonary shunt rates were correctly predicted and pulmonary complications avoided. PMID:7997379

  2. Results of proximal gastric vagotomy over 1-5 years in a district general hospital.

    PubMed

    Makey, D A; Tovey, F I; Heald, R J

    1979-01-01

    One hundred and seventy-three underwent proximal gastric vagotomy for duodenal ulceration over a 6-year period. One hundred and fifteen of these have been followed up for 1-5 years. The operative mortality was nil and the result was satisfactory in 91 per cent. The incidence of side effects was small, notably that of dumping being 2.4 per cent and of diarrhoea, 3.6 per cent. Incidence of postoperative heartburn was reduced from 13 per cent to 4 per cent by the introduction of hepatic interposition. The incidence of recurrent ulceration was 5.1 per cent after an average interval of 2 years and that of new gastric ulceration 2.6 per cent after an average of 4 years. There were no recurrent ulcers in those who had peroperative Burge tests, although secretory studies showed no difference between those tested and those not tested. Most recurrences occurred in the earliest cases operated on before Burge testing was introduced and when only 2 cm of the lower oesophagus were exposed. PMID:420970

  3. 5-Year Longitudinal Follow-up after Retropubic and Transobturator Midurethral Slings

    PubMed Central

    Kenton, Kimberly; Stoddard, Anne M.; Zyczynski, Halina; Albo, Michael; Rickey, Leslie; Norton, Peggy; Wai, Clifford; Kraus, Stephen R.; Sirls, Larry T.; Kusek, John W.; Litman, Heather J.; Chang, Robert P.; Richter, Holly E.

    2014-01-01

    Background Few studies have characterized longer-term outcomes after retropubic and transobturator midurethral slings. Methods Women completing 2-year participation in a randomized equivalence trial who had not received surgical retreatment for stress urinary incontinence were invited to participate in a 5-year observational cohort. The primary outcome, treatment success, was defined as no retreatment or self-reported stress incontinence symptoms. Secondary outcomes included urinary symptoms and quality of life, satisfaction, sexual function and adverse events. Results 404 of 597 (68%) women from the original trial enrolled. Five-years after surgical treatment, success was 7.9% greater in women assigned to retropubic-sling compared to transobturator-sling (51.3% vs 43.4%, 95% CI −1.4%, 17.2%) not meeting pre-specified criteria for equivalence. Satisfaction decreased over 5-years, but remained high and similar between arms (79%, retropubic-sling vs 85%, transobturator-sling groups, p=0.15). Urinary symptoms and quality of life worsened over time (p<0.001), and women with retropubic-sling reported greater urinary urgency (P=0.001), more negative quality of life impact (p=0.02), and worse sexual function (P=0.001). There was no difference in proportion of women experiencing at least 1 adverse event (p=0.17). Seven new mesh erosions were noted (retropubic-sling-3, transobturator-sling-4). Conclusion Treatment success declined over 5-years for retropubic and transobturator-slings and did not meet pre-specified criteria for equivalence with retropubic demonstrating a slight benefit. However, satisfaction remained high in both arms. Women undergoing transobturator-sling reported more sustained improvement in urinary symptoms and sexual